The disease profile which is dominated by infectious and neglected tropical diseases is not uniform across the country. Higher prevalences are found in the north and central regions. Taken together HIV/AIDS and malaria account for over half of the deaths in the general population, with 27% and 29% of the rate mortality, respectively. More specifically, in 2018 Mozambique shows a general seroprevalence of 12.6% for HIV/AIDS in the age group of 15 to 49 years old, 55.2% for malaria, 52% for diarrheal infection and respiratory infections, and 43% for chronic malnutrition. Further, Mozambique is amongst the countries with a high burden of active tuberculosis infections with 559/100,000 inhabitants active cases.
Though neglected tropical diseases such as intestinal parasites (53%), lymphatic filariasis (13%), schistosomiasis (47%) are not direct causes of mortality, they lead to physical and mental disabilities in children and are correlated with anemia and malnutrition in general.
Mozambique has very limited information on distribution and prevalence of these diseases though a number of restricted area information can be found.
This study was conducted at Lurio University (UniLurio), located in the north of Mozambique in Nampula province. It was created to serve the most populated province of Mozambique, with approximately 6.1 million inhabitants, an illiteracy rate of 62.3% with most of the population (71.4%) living in rural areas. According to the most recent demographic health survey, in 2011 the prevalence of malaria in children aged 6-55 months is of 55.2%, while in Maputo province is of 4.8%. Nampula is also amongst the provinces in the country with higher rates of intestinal parasites (95%), lymphatic filariasis (12%), cysticercosis (15-57%), schistosomiasis (c.a. 78%), and leprosy (0.006%). Nampula is one of the provinces with the highest number of active cases of tuberculosis (13,938 cases in 2019) inhabitants with the majority of cases due to co-infection with HIV/AIDS.
Furthermore, the northern and central provinces are less served by health professionals. In 2016, the country national average, was 100.2/100.000 inhabitants, in Nampula with 75.6/100,000 while in Maputo province and Maputo city, the number of healthcare workers was 92.8 and 242.7/100.000 inhabitants, respectively.
Despite Mozambican governmental investments in higher education, since independence from Portugal in 1975, by 2010 there were only three public medical schools in Mozambique. These were located at Eduardo Mondlane University (UEM) from a previous well-established University created during the colonial era, in 1963, and located in the capital Lourenco Marques, now called Maputo. Later on, two new public Universities were established, UniLurio in 2006 and Zambeze University (UniZambeze) in 2009. Both Universities included instructions in several health-related subjects including medicine.
Postgraduate training programs in health sciences only began in 1999, at UEM-FoM with introduction of three Master programs in Public Health and, later on, in Mental Health and in Field Epidemiology. The first Doctoral program was established in 2006 at UEM Faculty of Humanitarian Sciences. It was recognized a limited capacity to train both undergraduate and postgraduate students in Mozambique, due to a limited number of faculty members with didactic, research, and mentorship skills, with proven training requirements. Research teaching infrastructure and financial resources were also necessary.
For the period of 2004-2010, only 67% of Mozambican University faculty members had a University level degree, 22% a Master degree and only 11% had a PhD degree. Most of this were obtained abroad. A number of private institutions, mostly located in Maputo city, have also offered graduate and postgraduate training programs, though quality control of these programs and certification by the Ministry of Higher Education is ongoing. In 2003, a Higher Institute for Health Sciences (Instituto Superior de Ciencias de Saude (ISCISA) was created, supporting previous training of other mid-level health-related training professionals (nurses, non-physician technicians, dentists, and anesthetists) undertaken by other institutions of Health Sciences in the provinces of Mozambique.
In general, it was noted that most investments in higher education were concentrated in and around Maputo, the capital located at the extreme southern end of Mozambique (see Figure 1).
Under, the Medical Education Partnership Initiative (MEPI), a collaboration was established with UEM, and the University of California San Diego (UCSD) and supported by the US Department of State through the President's Emergency Plan for AIDS Relief (PEPFAR) and the National Institutes of Health (NIH). A number of postgraduate programs were created at UniLurio, aiming at scaling up training of physicians, improving research capacity and bioinformatics, and developing inter collaborative communities of practice in 12 sub-Saharan African countries.
The aim of this manuscript is to describe the strategies and processes adopted to design and implement three new postgraduate programs at UniLurio, located in a geographically resource-limited setting of Mozambique.