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The current capacity for training in public health nutrition in West AfricaFré Peppinga

a Graduate School of Advanced Studies in Food Technology, Agro-biotechnology, Nutrition & HealthSciences (VLAG), Wageningen University, Wageningen, The Netherlands

Online publication date: 25 November 2010

To cite this Article Pepping, Fré(2010) 'The current capacity for training in public health nutrition in West Africa', GlobalPublic Health, 5: 6, S20 — S41To link to this Article: DOI: 10.1080/17441692.2010.526127URL: http://dx.doi.org/10.1080/17441692.2010.526127

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The current capacity for training in public health nutrition in WestAfrica

Fre Pepping*

Graduate School of Advanced Studies in Food Technology, Agro-biotechnology, Nutrition &Health Sciences (VLAG), Wageningen University, Wageningen, The Netherlands

(Received 22 January 2010; final version received 9 September 2010)

This article is based on a paper prepared for the Workshop on Establishing aRegional Institute for Public Health Nutrition Research and Training in WestAfrica, convened in Dakar, Senegal, 26�28 March, 2009. Information wasgathered mainly prior to this workshop; several responses, however, came in afterthe workshop and these have been included in the current paper. In completion ofthe article use was made of the views and opinions as expressed during thisworkshop.

Objectives were to provide background information on academic programmes(undergraduate and graduate) and research institutions with a focus on humannutrition in West Africa, to describe the importance of foreign nutrition trainingprogrammes for West African students and to detail existing nutrition trainingactivities currently in the region. Data were obtained from a survey of 15UNICEF country offices in the West African region, previously publishedreports, United Nations University/International Union of Nutrition Sciencescapacity development activities 1996�2009, personal communications andwebsites of relevant African institutions. Results indicate that West Africannutrition academic programmes and research institutes do not adequately meetthe demand for nutritionists and technical services in the region. Exceptions seemto be Benin, Ghana and Nigeria. Diploma courses and other short courses havebeen an important means of attracting people from a variety of disciplines tonutrition. A well-equipped regional institute could directly and indirectly bolsternutrition capacity in the region. To meet the regional nutrition research andtraining needs in West Africa, it is not necessary to make a choice betweencreating a new regional institution vs. expanding existing national institutions.Based on solid capacity development principles, both options need action.

Keywords: public health nutrition; nutrition research; nutrition training; nutritioninstitutional capacity; West Africa

Background

The main objectives of this paper are to provide background information for West

Africa on:

- the number and ‘capacity’ of existing undergraduate and graduate (master and

doctoral) academic programmes in human nutrition;

- the number and capacity of research institutions focusing on human nutrition;

*Email: [email protected]

Global Public Health

Vol. 5, No. S1, November 2010, S20�S41

ISSN 1744-1692 print/ISSN 1744-1706 online

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- the relative importance of foreign training programmes for students from West

Africa; and

- other types of training activities currently available in nutrition.

The information presented in this paper was gathered during a 6-week period from

February to March 2009; therefore, it is by no means a comprehensive inventory of

existing nutrition training capacities or training needs of the West African region.

Nevertheless, the information provides a useful starting place for considering these

issues in greater detail.

The methods used to gather information for the current paper can be summarised

as follows:

- Consultation with the formal government representatives of the countries

present at the ECOWAS Nutrition Forum meetings in 2006 and 2008.

- Analysis of supplementary information from a survey initiated by staff

members of Helen Keller International (HKI) and the regional UNICEF

office for West Africa in Dakar to obtain relevant information from the country

offices that report to the West Africa regional UNICEF office.

- Review of previously published reports (e.g., reports of the United NationsUniversity/International Union of Nutrition Sciences (UNU/IUNS) capacity

development activities) and consultation with the key persons involved.

- Personal communications with, and assessments of curricula vitae of, former

participants of the leadership programmes in Africa (ANLP for English-

speaking participants since 2002 and PLAN for French-speaking participants

since 2007).

- Review of websites of relevant African institutions.

Countries that were considered part of West Africa for this analysis are the 15

member states of the Economic Community of West African States (ECOWAS)1 plus

Cameroon and the Central African Republic.

The approach used was comparable to, but less ambitious than, that of a previous

project that mapped Africa’s advanced educational capacity in public health

(IJsselmuiden et al. 2007). One of the opening sentences in the article states:

Many years of capacity-building have increased the number of senior staff in spite of thecontinuous brain-drain, and globalization of communication has contributed to anincreasing democratisation and accountability of education and politics. Combined withattitudinal changes in donor countries and institutions, there is a stronger awareness ofthe need to phrase answers to problems in terms of local ability rather than foreignassistance interest, although problems in ‘vertical programming’ remain.

It is worth considering whether the same observations may also be true for nutrition.

The aforementioned paper mainly refers to ‘advanced’ levels of capacity

development, whereas the current paper also reports on ‘undergraduate training

programmes’ (B.Sc. or Licence degree). Whether students leave university with a first

degree after 3 or 4 years varies from country to country, with differences between

Francophone and Anglophone areas. M.Sc. and Ph.D. training activities are grouped

together under the heading of postgraduate education. Research institutions that do

Global Public Health S21


not have a degree-granting capability, but a research mandate, do not appear in the

list of academic institutions, but they are listed separately. Effort was also made to

estimate the numbers of West Africans who obtain a M.Sc. or Ph.D. degree each year

outside the region. In a separate section, some examples are given about stand-alone

diploma/certificate courses and other capacity development activities. Often, such

courses provide the first opportunity for non-nutritionists to enter a nutrition career

path, and they play a complementary role in preparing professionals to upgrade or

broaden their skills in a specific area. It was particularly difficult to collect complete

and reliable information on such training programmes, which, in part, is due to the

fact that such training programmes are less institutionalised.

Capacity development issues in nutrition in Africa received renewed attention

after the UNU/IUNS meetings held in Manila in 1996 (United Nations University

[UNU] and International Union of Nutritional Sciences [IUNS] 1997) and Cape

Town in 1999. An important part of the meeting of the Standing Committee on

Nutrition (SCN) in Nairobi in 2001 was also devoted to the issue of capacity

development. The West Africa regional task force focused on developing an

‘advocacy’ strategy aiming at convincing policy and decision-makers on the role of

nutrition in the development process.

In the Manila document, the Working Group presented the concept of the

national training pyramid (Figure 1), which describes the different levels of job

responsibilities, for which specialised training is needed in nutrition and the range of

career paths for nutrition professionals. The purpose of the national training

pyramid is to provide a quantitative estimate of the needs and the different

categories for advanced training to meet the requirements for human resources. The

Working Group also developed estimates of the numbers of each type of nutrition

professional that are generally required per 5 million persons (Figure 2). Although

the specific estimates can be debated, the proposed numbers of each category of

personnel required provide a useful starting point for assessing the adequacy of the

current regional training capacity. Specifically, an estimate of 100�500 nutrition

professionals are needed in Category I per 5 million persons, 10�50 in Category II

Figure 1. National training pyramid for advanced training, a graphic representation of

functional categories within an integrated system that includes implementers, planners,

researchers, trainers and policy/decision-makers in a given field.

S22 F. Pepping


and 1�5 in Category III. For the purpose of the Dakar workshop, Category II was

of greatest interest because this is the professional category that includes the

researchers, planners and trainers that would be required to advance public health

nutrition programming in the region. Notably, the former Working Group

concluded that most action was needed in this segment. The concept of the national

training pyramid and the figures used for nutrition as given above have been used

quite extensively in the domain of nutrition and by the UN agencies involved.

Nearly all the observations made by the Working Group are still valid to date as

indicated by their statement that ‘the Working Group recognized that limitations in

available resources and the requirement for a critical mass of professionals make it

imperative that resources be concentrated in a few highly selected academic or

research institutions’.

Three levels of capacity development have been described in the publications of

the United Nations Development Programme (Lopes et al. 2002, Lopes and

Theisohn 2003):

- individual;

- institutional; and

- societal (country and its governance).

In the Dakar workshop, the focus was primarily on individual and institutional

capacity development, such as how to produce more trained nutritionists and bolster

institutional capacity to provide training and support. Regarding institutional

development, Lopes and Theisohn (2003) noted that the critical importance of

institutions for individual development is obvious. In several countries in West Africa

there are simply too few trained nutritionists, and a properly functioning regional

centre could provide such isolated individuals a helping hand in many ways. The

importance of the third level of capacity development was not fully appreciated until

recently. However, it is now more widely recognised that the state’s role in governance

Figure 2. Career paths for professionals and ranges of minimum numbers of professionals

per 5 million population in categories I�III for nutrition; the figures are not intended to be

precise estimates but represent consensus of the Manila Working Group.



is fundamental to expanding scientific and technical capacities, creating more

professional opportunities and sustaining growth. This is a vital issue when setting

up a regional initiative, which will need the commitment and support of the countries

in the region.Finally, reference is made to some observations made by Besrat in his

background paper for the 1999 Cape Town meeting.2 The UNU focused on a few

key government research institutions, so as to enable the build up of a critical mass of

expert human resources. However, implementation was difficult, primarily due to

uncertainties about which institutions had the potential to assume leadership roles.

Besrat concluded that concentrating activities in government ministries rather than

independent academic institutions was not very successful. He concluded that

‘regional collaboration is needed to establish centres that will serve the high-leveltraining needs of the countries in the region’. Can we still find traces of the UNU

investments in the past or of focused inputs of other donors? Does this lead us to the

best practices?

Results

Bachelor’s programmes

Table 1 lists the universities that provide B.Sc. (or Licence) degrees in nutrition or

food sciences and nutrition. Until recently, 3-year undergraduate (B.Sc.) programmes

were not very common in West Africa. However, the table shows that well-defined

undergraduate programmes are now available in Benin, Ghana and Nigeria. For

most Francophone countries the ‘initial degree’ programmes take longer. For several

countries, including Burkina Faso and the Central African Republic quantitative

data about the number of students were not provided; but it is not very likely that this

would change the overall picture with respect to the limited number of under-graduate programmes.

Master’s programmes and their equivalents

The data assembled in Table 2 suggest that well-established M.Sc. nutrition

programmes exist in Benin, Burkina Faso, Cameroon, Senegal, Ghana and Nigeria.

Quantitative information about the number of students is still pending for severalprogrammes and details about the number of faculty members are lacking.

Fortunately, we see some degree of mobility among Francophone countries and

between Francophone and Anglophone countries. However, several of the pro-

grammes are linked to food science programmes, for which the primary focus is often

not public health or community-oriented.

The annual output of the programmes in Benin, Burkina Faso and Senegal might

be sufficient to supply the minimum requirements for their own countries. However,

in the Francophone countries overall there seems to be a clear shortfall in thetraining capacity of the institutions involved (namely, low numbers and inadequately

trained staff, combined with a limited number of graduates). An important aspect

not included in this overview and perhaps worthwhile to investigate is the type and

quality of the thesis work. Often, this does not involve high-quality laboratory

analysis, sound epidemiological methods or suitable biostatistical analysis, so it

S24 F. Pepping


Table 1. Undergraduate nutrition programmes in West Africa and numbers of faculty

members and yearly graduates, by country.

Annual

output

Faculty

members Comments

Francophone countries

Benin

Universite d’Abomey-Calavi

� Licence en nutrition

humaine

20 12 Food science/Nutrition combined in

new programme; Nutrition one of

three specialisations

Burkina Faso

Universite de Ouagadougou 10�20 6

Guinea

No undergraduate programme in nutrition exists

Cameroon

Universite de Yaounde I � � No undergraduate programme

Universite de Ngaoundere � �Central African Republic

Universite de Bangui

� Maıtrise en Sciences

Alimentaires et Nutrition

? ? Specialisation in 3rd�4th year, No

additional information found

Ivory Coast

Universite Cocody;

Pharmaceutical Sciences

? ? Specialist of food quality control

Universite d’Abobo Adjame

Maitrise, DEA

12 6 Specialist in food science and

nutrition

Mali


Niger

UAM Inst. Sante Publique �20 1�2 License level (BAC�3), operating

4�5 years; difficult for graduates to

find employment. ISP also has

epidemiology, nutrition education

and public health study programmes

1�2 faculty members have a M.Sc. in

Nutrition

Senegal

Universite Cheik Anta Diop � � No undergraduate programme

Togo


Anglophone countries

Gambia

Information not available

Ghana

University of Ghana (Accra) 40 8 Nutrition

University of Development

Studies (Tamale)

100 9 Community nutrition

Liberia

As far as information was obtained no undergraduate programme exists

Nigeria

University of Ibadan �20 ? Human nutrition

Abia State University ? ? Food science and nutrition



would be important to assess the quality as well as the quantity of these training

programmes.

Doctoral degree programmes

Structured programmes leading to a Ph.D. degree are available in Senegal,

Cameroon, Ghana and Nigeria. Each of these programmes is described briefly, as

follows.

Senegal

A school of doctoral studies was recently established at the Universite Cheikh Anta

Diop (UCAD) in Dakar. A doctoral programme in Nutrition and Human Pathology

with specialisations in Food Science and Human Nutrition and in Public Health

exists. Nine Ph.D. degrees were awarded during the period of 1998�2007, at an

average of one per year.

Cameroon

The University of Yaounde offers Ph.D. degree training in Nutrition and Food

Sciences, and the university website reports that 15 persons are enrolled in Ph.D.

studies. During the past 5 years the combined programmes produced seven Ph.D.

theses. Also, the University of Ngaoundere offers a Ph.D. programme in Food

Science and Nutrition; 11 Ph.D. degrees were awarded during the last 5 years, but

details about the distribution of these in food science vs. nutrition were not available.

Apart from the National School of Agro-industrial Sciences located at the University

of Ngaoundere, no institution awards degrees specifically in Nutrition.

Table 1 (Continued )

Annual

output

Faculty

members Comments

University of Nigeria,

Nsukka

? ?/14 B.Sc. Nutrition and dietetics

University of Agriculture,

Abeokuta

50 B.Sc. Nutrition and Dietetics

8 others in various states ? ? Nutrition and dietetics

Sierra Leone

Njala University �20 ? B.Sc. with honours in nutrition and

food technology, average of 2009 and

2010 was 22.

Lusaphone countries

Cape Verde

No complete picture, incidental training takes place in Portugal

Guinea Bissau

No structure available that provides training in nutrition

S26 F. Pepping


Table 2. Countries with postgraduate programmes M.Sc./M.Phil. or equivalents.

Annual

output Staffing Comments

Francophone countries

Benin

Universite d’Abomey-Calavi/FSA

DIA (1986) 7�10 12a 2 specialisations, Nutrition/Food

Science

DEA (2004 onwards) 6�8

FSA and Ecole Polytechnique To start Beginning 2011 Master in Human

Nutrition (3 years on top of

Baccalaureat)

Regional Institute of Public

Health, Parakou

20 ? Canada (University of Montreal

and CIDA) and WHO supported,

M.Sc. Public Health Nutrition,

started 2009

Burkina Faso

Universite de Ouagadougou

CNRSBAN � DIA 5�10 ? Mainly Food Science oriented

CNRSBAN � DEA �5 ?

FAST ? ?

Cameroon

Universite de Yaounde I, Department Biochemistry

Lab. Food Science and

Metabolism

�10 35/25 M.Sc. in Biochemistry

Lab. Nutrition and Nutritional

Biochemistry

8 8 persons busy with DEA? See

http://www.Innb.yaoundel.com

Universite de Ngaoundere,

ENSAI

0 15/12 Mainly Food Science oriented

research

M.Sc. in Food Science and

Nutrition

M.Sc. in Applied Nutrition Professional

University of Douala

Lab. Biochemistry and Clinical

Nutrition

�3 ? M.Sc. in Biochemistry

Central African Republic

Universite de Bangui,

Maıtrise en Sciences

Alimentaires et Nutrition

? ? Specialisation in 3rd�4th year, no

additional information found

Guinea

No M.Sc. programme or equivalent exists

Ivory Coast

Polytechnic Institute HB of

Yamoussoukro

? ? Diplome de Technician Agricole/

Diplome d’Ingenieur Agronome

Malib

School of Medicine, Pharmacy,

Odonto-stomatology

0 0 1 M.Sc. and 1 Public Health MD

teaching nutrition, no nutrition

specialisation

Niger

No M.Sc. programme or equivalent exists, initial discussions started about establishing a

DEA in Food Science and Nutrition with Faculty of Agriculture



Ghana

The University of Ghana offers a Ph.D. programme in Food Sciences and Nutrition,

which graduates approximately one Ph.D. student every other year.

Nigeria

Four universities reportedly award Ph.D. degrees in Human Nutrition or closely

related fields. The University of Ibadan is relatively well-known and connected

internationally. There were a total of 15 Ph.D.s produced during the period from

2002 to 2007. The University of Nigeria in Nsukka, the University of Agriculture in

Abeokuta (reporting five students at Ph.D. level) and Umudike also have Ph.D.

programmes in Nutrition, but little information was available on these programmes.


Annual

output Staffing Comments

Senegal

Universite Cheik Anta Diop;

Faculty of Science and Technology

Programme exists for many years

DEA 3�4 3 29 M.Sc.-equivalent degrees

awarded from 1998 to 2007

Togo


Anglophone countries

Gambia


Ghana

University of Ghana (Accra) 4�6 11/9 Nutrition

Liberia


Nigeria

University of Ibadan (M.Sc./

M.Phil.)

12 10/5 Human nutrition (76 graduates

‘02�‘07)

Abia State University ? ? Food science and nutrition

University of Nigeria, Nsukka ? ?/14 M.Sc. in Nutrition

University of Agriculture, Abeokuta 23 20/12 M.Sc. Nutrition and dietetics

20 Postgraduate diploma in nutrition

University of Port Harcourt, Choba,

Rivers State

8 ? M.Sc. Nutritional Biochemistry

with 2/3 project work and 1/3

course work

8 others in various states ? ? Main focus on Nutrition and

Dietetics

Sierra Leone

Njala University 12�14 ? M.Sc. in Nutrition and Dietetics;

2009 and 2010 figures

aTotal staff/academic staff.bIt was estimated that at this moment there are two Ph.D. graduates in nutrition in the country and twoare working on their Ph.D., at M.Sc. level these figures are five and one. The only two Ph.D. Public Healthnutritionists are working abroad.

S28 F. Pepping


In summary, the focus of most of the Ph.D. programmes seems to be more on

food technology than on human nutrition. Even when there is greater attention to

nutrition, the emphasis tends to be more on clinical nutrition and nutritional

biochemistry than on public health nutrition. Thus, existing programmes might nothave the ideal set-up to work closely with a potential regional institute of public

health nutrition and nutrition intervention programmes.

Training abroad

With Cameroon, Nigeria and potentially Senegal as exceptions, it is clear that the

majority of the nutritionists with a Ph.D. degree in West Africa obtained their degree

abroad. In Table 3, an estimate is given of the number of West Africans who are

enrolled in an M.Sc. or Ph.D. programme in nutrition outside the region as of March

2009. Key universities/training institutions in Europe, North America and Australia

were contacted and alumni were asked to provide information. Although the work that

was completed was by no means comprehensive, it seems reasonable to conclude thatapproximately 80 West Africa students are currently enrolled in M.Sc. programmes

abroad and at least 40 in Ph.D. studies, with more participants from French-speaking

countries than from English-speaking countries. The foreign programmes might have a

larger proportion of public (health) nutrition, with much more emphasis on

epidemiology, biostatistics, than those offered in West Africa.

The idea of selecting regionally important developing country institutions as

done for the UNU-fellowship programme was adopted by Scrimshaw and Uauy for

the programme they initiated focusing on nutrition and infection financed by theEllison Medical Foundation (EMF).3 In West Africa, only Ghana benefited from this

programme (three Ph.D. students). A possible regional nutrition research institute

might be able to attract similar type of focused programmes.

Brain drain

Much has been written about the brain drain and the efforts to address it. The

International Organisation for Migration (IOM) had a Reintegration of Qualified

African Nationals Programme that ran from 1983 to 1999 and managed to relocate

2000 nationals to 11 participating countries (Mutume 2003). More recent initiatives

from the New Partnership for Africa’s Development (NEPAD) show that African

governments, UN agencies and bilateral donors are taking this issue more seriously.McCoy et al. (2008) described the potential benefits of well-planned academic

partnerships in health research between rich and poor countries. Although specific

figures about the nutrition discipline are unavailable, based on discussions with key

personnel from the training institutions involved, there appears to be a trend among

graduates of returning to Africa after graduation. However, a considerable

proportion of graduates begin working for NGOs and UN agencies rather than

academic institutions, as the opportunities of these academic institutions to employ

more staff are restricted. This ‘internal brain drain’ has been discussed duringsubsequent SCN meetings (Pepping, personal observation); however, viable solutions

have not been put forth. In addition, not all graduates are able to find an appropriate

position upon returning, which drives them to seek employment elsewhere (within or

outside the region). The so-called ‘push’ factors that contribute to this phenomenon



Table 3. Number of West African scholars enrolled in M.Sc. and Ph.D. programmes in

Nutrition at North African, European, North American and other foreign universities as of

March, 2009.

Country/institution Degree No.

Comments (for example countries

of origin of graduates)

Africa

Morocco M.Sc./

Ph.D.

a In CVs of applicants for ANLP/

PLAN we see that M.Sc./Ph.D.

degrees are obtained in these

countries

Algeria M.Sc./

Ph.D.

10

Egypt: Senghor University

Alexandria

Ph.D. 1�2 year The Ph.D. programme at Senghor

University has various sub-

programmes and is given in French

Europe

France: University Montpellier II M.Sc. 2 Benin, Togo

Ph.D. 4 Benin, Burkina Faso (2), Ivory Coast

France: Paris Ph.D. a

Other sites in France M.Sc. a

Ph.D. a

The Netherlands: Wageningen

University

M.Sc.

2 years

3 Ghana (all 3)

Ph.D. 5 Burkina 2, Benin, Mali, Ghana

Belgium: Gent Universityb M.Sc.

2 years

17 Benin 2, Burkina 2, Cameroon 5,

Congo 1, Ghana 3, Nigeria 3, Togo 1

Ph.D. 1 Benin

Portugal: University of Porto M.Sc. 1 Cape Verde (for the Clinical

Nutrition Programme), occasionally

they candidates for their B.Sc.

Nutritional Science from Cape

Verde, Guinea Bissau and Sao Tome

e Principe (around 10 persons last

have 5 years)

UK: London School of Hygiene

and Tropical Medicine (LSHTM)

M.Sc./

Ph.D.

a

UK: University of Glasgow Ph.D. 1 With LSHTM

UK: University of Greenwich M.Sc. 1 Nigeria, 5 students from English-

speaking countries were reported to

have deferred for financial reasons

Ph.D. 2 Nigeria (one via collaboration with

Ibadan)

UK: University of Chester M.Sc. 2 Ghana, Nigeria (public health

nutrition)

UK: other universities M.Sc. 5�10 Programmes with participants from

West Africa were reported within the

universities in Sheffield (M Med Sci),

Kings College London, Westminster

(public health nutrition) and Leeds

but accurate figures are lacking

Norway: Bergen Ph.D. 1 Burkina Faso

S30 F. Pepping


are: (1) low and eroding salaries; (2) under-utilisation of qualified personnel; (3)

discrimination in appointments and promotions; and (4) lack of research and other

facilities.

Diploma//certificate courses and other short courses

Diploma courses and other short courses have been an important means of

attracting individuals from a variety of disciplines to nutrition, and many of the

region’s nutritionists began their careers in fields other than nutrition. Thus, it is

important to maintain these opportunities for recruiting people into the field. A

possible role for a regional institute could be to offer these types of (short) courses,

and thereby enhance the visibility and credibility of nutrition. A few examples of

existing short courses are as follows.

Table 4. Number of applications to the ANLP from 2006 to 2009 (no course held in 2007).

Countries 2006 2008 2009

Gambia/Ghana/Nigeria 24 27 43

French-speaking countries 8 10 5

Number of applications received in total 76 60 106

Percentage of applications from West Africa (%) 42.1 61.7 45.3


Country/institution Degree No.

Comments (for example countries

of origin of graduates)

North America

USA: Cornell University Ph.D. 2 Ghana, Nigeria

USA: Tufts University Ph.D. 2 Funded through EMF, Ghana

USA: University of

Massachusetts

M.Sc./

Ph.D.

2 Ghana, Nigeria

USA: Tulane University M.Sc. a Few years ago programme for Mali

with 5 graduates

USA: University of California,

Davis

Ph.D. 1 Ghana

Canada: University of Montreal M.Sc. 3

Ph.D. 4 Benin, 2 Burkina Faso, Mali

Canada: Laval University,

Quebec

M.Sc. a

Ph.D. a

Australia

University of Queensland,

Brisbane

M.Sc. a M.Sc. Community Nutrition exists

for considerable period of time

University of Western Australia,

Perth

M.Sc. a

aActual numbers not available but information provided that people have been trained/are being trained.bNutrition and rural development (110 in total; 60% takes the nutrition stream, rest is home economicsand tropical agriculture).



Formation Internationale en Nutrition et Sciences Alimentaires (FINSA)

FINSA; International training programme in food science and nutrition; Universite

d’Abomey � Calavi, Benin: the 18th edition of this course (August 2009) covered

the topic of ‘Food and nutritional security and development: Impact of the HIV/

AIDS epidemic’. This 1-month course has provided the entree into nutrition for

many in West Africa. Regrettably, since 2001 the number of participants has

decreased from 20�30 annually to 8�10 participants. Since 2007, however, the

numbers are beginning to increase, and a fellowship programme is in place from

2009 onwards.

Nutrition Leadership Programmes

Since 2002, seven rounds of the African Nutrition Leadership Programme (ANLP)

have been held in South Africa. In 2007, a French version of this course started in

Morocco. Core elements of these programmes are team building, communication,

social responsibility, leadership styles and some nutrition case studies. The ANLP

statistics on the number of applications show an overwhelming interest for this

programme from English-speaking West Africa (1/3 or more of the total number of

applications). The number of applications for the 2010 edition in South Africa

exceeds 100, and for Morocco the number exceeded 50. The interest in this

programme indicates that sufficient Ph.D. holders see for themselves a career in

nutrition.

Food and Nutrition Security, Wageningen, the Netherlands

The former International Course in Food Science and Nutrition (ICFSN, 5 months)

was re-structured several years ago into a modular 11-week programme, leading to a

diploma at the postgraduate level. Most participants in recent years have been from

NGOs. Increased participation in recent years is due to better use of the fellowship

system.

Training possibilities linked to USAID-funded global, multi-country projects

The BASICS II Project of the USAID West Africa Regional Office (1998�2003) used

to provide technical support to the Regional Food and Nutrition Research

Organisation (ORANA), which covered nine Francophone West African countries

(Benin, Burkina Faso, Ivory Coast, Guinea, Mali, Niger, Senegal, Togo and

Mauritania). ORANA organised training workshops on various subjects including:

formative research methods, such as, Trials in Improved Practices (TIPS) for the

adaptation of feeding recommendations under the Integrated Management of

Childhood Illnesses programme; use of Nutrition Policy Analysis and Advocacy

tool, such as Profiles; and instruction in Community Nutrition Programming.

Currently, the Food and Nutrition Technical Assistance II Project (FANTA-2,

2008�2013) implemented by the Academy for Educational Development, is working

with USAID/Ghana to integrate community-based management of acute malnutrition

(CMAM) into the Ghana Health Service (GHS) and strengthen the capacity of the

S32 F. Pepping


GHS and national training institutions. FANTA-2 is also working with USAID’s Office

of Foreign Disaster Assistance/West Africa to support CMAM training workshops.

The respective USAID-funded projects, such as FANTA-2, BASICS and

PROFILES, continue to offer a wide range of training opportunities for the WestAfrican region and to provide employment for a considerable number of Ph.D.

holders in nutrition for various lengths of time.

Research institutions

Table 5 summarises research institutions that have an exclusive research mandate.

Several of the institutions listed were originally established in cooperation with

institutions in France. The initiatives in Senegal have also benefited from World

Bank support. The summary is far from complete, and the nutrition component of

the work of several of the institutions listed may be limited. In addition, staffing

patterns with regard to nutrition capacity are not always clear. More and more

centres seem to get involved in larger projects with several foreign partners; suchcentres could be the nuclei for cooperation with a regional institute. Not listed are

institutions like the National Nutrition Agency in Gambia and similar organisations

elsewhere as these organisations are not primarily focused on scientific research

albeit they might provide relevant input to national surveys.

Linking education and research and maintaining professionals

Assisting students to achieve a certain level of knowledge and awarding a

corresponding academic degree are one set of tasks. Another challenge is to keep

trained nutritionists involved in their profession, which is a difficult task in some

countries. Two issues are raised here:

- Sometimes people do not fit easily into a national system when returning from

training outside the country. This is an important consideration if a regional

institute is to be established. If the problem is not properly addressed, the

institute could build capacity that will not ultimately serve the region. Thus, it is

worth reiterating the importance of the third level of capacity development

focused at the society level and makes a firm commitment, visible in the

national nutrition plans, of the countries in the region a prerequisite.

- In some cases, students trained abroad can continue to work in collaborationwith their training institutions while based in the West Africa region. For

example, some nutritionists (and food scientists) from Benin and Ghana who

studied at Wageningen University continue to work on challenging research

questions after graduation in collaborative, inter-disciplinary projects funded

by the University4 and/or the European Commission (EC; FONIO and

INSTAPA).5 However, with competitively obtained funding there is no

guarantee that they will be continuously funded. Similar linkages exist between

researchers in the UK and Gambia and between researchers in France andseveral countries in West Africa. Such projects offer possibilities for continuing

development of former students’ expertise, including new areas beyond the

focus of the students’ research conducted during Ph.D. studies and might

neutralise some of the ‘push’ factors.



Table 5. Other research institutions in West African region not listed in Tables 1�3 because

they do not have a specific training mandate.a,b

Country/institute Characteristics

Burkina Faso

Institut de Recherche en Sciences de

la Sante (IRSS), Ouagadougou

Good international networkc (World Bank, IAEA,

IRD), work reported on vitamin A deficiency, strong

in malaria research, staffing in terms of nutrition?

Centre MURAZ, Bobo-Dioulasso No data available

CNRST No detailed information; food science oriented

Cameroon

Centre for Research in Food and

Nutrition (CRAN) at the IMPM

University students carry out nutrition research in

CRAN facilities under joint supervision; 16 research

staff (5 senior and 11 junior all busy with their

Ph.D.); 4 laboratories on:

- Food technology;

- Quality control;

- Epidemiology;

- Metabolism

Main research lines; nutritional value of infant

foods; and nutritional status of population groups.

Guinee

National Institute of Nutrition and

Child Health

No detailed data available, several nutritionists are

reported to be abroad for further training at M.Sc.

level.

Ivory Coast

Institut National de la Sante

Publique (INSP)

Research institute with nutrition laboratory and

nutrition rehabilitation centre. Scientific centre for

pilot experiments before scaling up any nutritional

strategy or intervention

Centre Suisse de Recherche

Scientifique

Partner for field research in nutrition and food

science,

Provide finance and technical support to Ph.D.

students

Mali

INRSP, Departement de

Sante Communautaire

Has 3 ‘services’ and one research programme

Nutrition:

- Epidemiology;

- Social Sciences; and

- Research programme on health systems.

Staffing details lacking, staff development seen as

lacking.

Senegal

Prime Minster’s Office;

Malnutrition control programme

Headed by Dr Dieng, supported by World Bank

loan

Faculty of Medicine; Research

programme on nutrition/

parasitic diseases

Headed by Prof. Sembene, also World Bank loan

Togo

No government nutrition research or analysis unit exists

S34 F. Pepping


A well-equipped regional institute could directly and indirectly provide incentives to

trained professionals to remain within the nutrition discipline in the region.

Refresher courses could be part of the programme of a regional initiative. However,

setting up the appropriate arrangements for this will need the ‘attitudinal changes in

donor countries and institutions’, as discussed by IJsselmuiden et al. (2007).

Conclusions and discussion

This section is split into two parts; in the first part the pros and cons of the existing

structures are discussed, and in the second part the focus is on the pros and cons of

setting up a new institution.

The existing structures

Are the observations made by IJsselmuiden et al. (2007); (‘many years of capacity-

building have increased the number of senior staff ’ and ‘there is a stronger awareness

of the need to phrase answers to problems in terms of local ability’) also true for

nutrition? Three developments seem to justify that this question is answered with a

firm ‘yes’:


Country/institute Characteristics

The Gambia

Human Nutrition research

MRC Keneba

Well-established field station operating for many

years. 6 Gambian Ph.D.s trained by UK, �12

trained up to M.Sc.

Partnering now with Gambian National Nutrition

Agency to contemplate accredited course sand train

two Ph.D.s while these remain in their job.

Ghana

Noguchi MIMR, College of Health

Sciences, University of Ghana

Focus on infectious diseases, Nutrition department

has broad focus, a.o. on community-based

research, micronutrients, 6 research fellows/

assistants with academic degrees, see

http://www.noguchimedres.org

Liberia

No government nutrition research or analysis unit exists

Nigeria

No information available

aNational Statistics Offices and similar institutions are left out of this overview.bOrganisation de la Coordination et de Cooperation pour la lutte contres les Grandes Endemies(OCCGE) attends the ECOWAS Nutrition Forum, not included in this list but OCCGE has an interest innutrition.cIRSS and Regional Institute of Public Health in Benin are involved in an EC-funded project coordinatedby ULB, Brussels and with University of Bordeaux II titled ‘Creation of a curriculum based on the qualityof health care in West Africa’.



10Defaultprinciplesforcapacitydevelopment

Don’t rushCapacity development is a long-term process.

It eludes delivery pressures, quick fixes and the

search for short-term results.

Respect the value system and foster self-esteemThe imposition of alien values can undermine

confidence. Capacity development builds upon

respect and self-esteem.

Scan locally and globally; reinvent locallyThere are no blueprints. Capacity development

draws upon voluntary learning, with genuine

commitment and interest. Knowledge cannot

be transferred; it needs to be acquired.

Challenge mindsets and power differentialsCapacity development is not power neutral,

and challenging mindsets and vested interests

is difficult. Frank dialogue and a collective cul-

ture of transparency are essential steps.

Think and act in terms of sustainable capacity outcomesCapacity is at the core of development; any

course of action needs to promote this end.

Responsible leaders will inspire their instituti-

ons and societies to work accordingly.

01

02

03

04

05

06

07

08

09

10

Establish positive incentivesMotives and incentives need to be aligned with

the objective of capacity development, inclu-

ding through governance systems that respect

fundamental rights. Public sector employment

is one particular area where distortions throw

up major obstacles.

Integrate external inputs into national priorities, processes and systemsExternal inputs need to correspond to real de-

mand and be flexible enough to respond to

national needs and agendas. Where national

systems are not strong enough, they should be

reformed and strengthened, not bypassed.

Build on existing capacities rather than creating new onesThis implies the primary use of national exper-

tise, resuscitation and strengthening of natio-

nal institutions, as well as protection of social

and cultural equity.

Stay engaged under difficult circumstancesThe weaker the capacity, the greater the need.

Low capacities are not an argument for with-

drawal or for driving external agendas. People

should not be held hostage to irresponsible go-

vernment.

Remain accountable to ultimate beneficiariesAny responsible government is answerable to

its people, and should foster transparency as

the foremost instrument of public accounta-

bility. Where governance is unsatisfactory it is

even more important to anchor development

firmly in stakeholder participation and to main-

tain pressure points for an inclusive accounta-

bility system.

Figure 3. Ten default principles for capacity development.

S36 F. Pepping


(1) In 2004/2005, the African Graduate Students’ Network (AGS-net)6 was

created with enormous enthusiasm. After a successful start, it has proven

difficult to maintain the network. Nevertheless, its continued existence

demonstrates some of the attitudinal changes that have occurred.(2) The Africa Nutrition Leadership Programme based in South Africa is alive

and well, with the completion of the eight sessions in 9 years. The alumni of

this programme stay connected as is demonstrated by their informal meetings

at international events and show commitment to collaborate across borders.

(3) In 2008, a very successful and inspiring third edition of the African

Nutritional Epidemiology Congress (ANEC) was organised by and for

Africans; in 2010 we will have the fourth edition.

These events in themselves will not change the situation with respect to ‘nutrition

capacity’ in Africa, but they provide evidence of ‘attitudinal changes’ and ‘stronger

awareness’ in the region.

Can results of the investments in nutrition training that UNU started in the mid

1970s still be identified? Yes, some of the African champions of this moment in

Ghana and Nigeria were beneficiaries from that programme.

Although it is not the main objective of this paper to draw conclusions in terms

of ‘we are short of x B.Sc. or M.Sc.-programmes in y countries’, it is clear that only in

a few exceptional cases are adequate numbers of nutritionists available in West

Africa. It can be concluded that a more thorough inventory providing more data and

more accurate data, with input from the responsible government agencies, is essential

in moving forward. Three documents/studies might provide insight into some aspects

that can be of relevance for the initial planning process of a regional initiative:

(1) It is important to take into account the 10 default principles for capacity

development as formulated by Lopes and Theisohn (Figure 3). The authors

use the term ‘default’ principles to indicate that the fundamentals of capacity

development are universal and that set of core principles can be identified and

applied. Which of these principles should get most attention during this initial

planning stage?

- There is no need to rush, but 12 years after Manila it is time to act.

- It’s obvious that African institutions need to lead this initiative.- ‘Positive’ incentives need to be selected and implemented with great care

to avoid a brain drain within Africa.

- We started listing the existing capacities and this makes clear on what we

can build.

- ‘Circumstances’ in West Africa will always pose a challenge!(2) A report of the Institute of Development Studies (Sumner et al. 2007) provides

useful insight regarding the attitudes of donors, who in some cases see

nutrition as a supporting investment rather than a foundational one. More-

over, capacity development is grouped under the category of ‘indirect nutrition

interventions’. Thus, nutrition training does not currently receive the highest

priority for these agencies’ development funding. The lack of institutional

champions is also seen as one of the reasons why nutrition does not get the

attention it deserves.



(3) In a study published by the International Food Policy Research Institute

(IFPRI) published in 2008 (Benson 2008) the author concludes that ‘The

manner in which available human capacity in nutrition is used is certainly as

important as the presence of trained nutritionists’. This statement confirmsthat it is not the first and second level of capacity development that hampers

progress here, but the third level involving the society and government. Large

numbers of nutritionists have been trained in Ghana and Nigeria (two of the

four countries investigated), as contrasted with the situation in Mozambique

and Uganda (the other two countries studied). Nigeria’s human capacity in

nutrition is represented by the Nutrition Society of Nigeria, which estimates

that there are �500 professionally trained nutritionists (masters level or

above) in the country.

Preliminary findings as presented in the Tables 1�5 can be summarised as follows:

- The French-speaking countries Benin, Burkina Faso, Cameroon and Senegal

have programmes that have existed for a considerable period of time and can be

regarded as reasonably sustainable, albeit continuously facing difficulties in

enrolling new cohorts each academic year because of lack of student funding.

Cameroon seems to have adequate programmes in place, but without muchfocus on ‘public nutrition’. With 10�50 level II nutritionists needed per 5

million population (average 30 and simplifying this to M.Sc. level) and taking

Benin (9 million inhabitants) and Senegal (12 million) as examples, this would

mean 54 and 72 M.Sc.-level nutritionists are needed in each country,

respectively. These countries might be able to provide for their own needs

(depending on the continued employment of these individuals and their

professional longevity). It is worthwhile to complete such exercises with more

accurate figures at the country level, as this will enhance awareness of theexisting gaps in nutrition capacities.

- Using similar assessments of the current training capacities in Ghana and

Nigeria, adequate numbers of nutritionists seem to be produced annually in

these countries.

- Many of the smaller countries do not seem to be able to meet their needs for

nutrition professionals. Taking into account Besrat’s remarks about countries

with small populations and small economies without B.Sc. programmes, there is

a clear need to foster people from such countries to send secondary schoolleavers to neighbouring countries/countries in the region to follow a nutrition

programme.

A new institution

What could be recommended for a regional institute to meet, in a step-by-step

approach, research and training needs?

- A firm commitment from countries in the region is essential and should be a

starting point. Some countries have long-standing cooperative linkages with

donor countries in the area of nutrition. A three-way linkage agreement

S38 F. Pepping


between countries from the north and the south and a regional nutrition

institute might seem complicated, but could solve part of the sustainability issue

and overcome donors’ propensities to focus on specific countries at particular

points in time. Such an approach could be the starting point for attractingbroad-based financial support from multiple donors. Given the fact that

nutrition is linked to many sectors, next steps in the planning process might be

best guided by organisations like the UNDP and the World Bank (for example

in the Global Action Plan).

- However, good links to existing programmes should not maintain existing

inequalities of national capacity. It is essential for a start-up phase of a

regional initiative to avoid having the strongest partners dominate the regional

initiative.- The EC included a variety of schemes in their sixth and seventh Framework

Programme to bring qualified people back to Europe. Perhaps the EC could

assist a similar regional nutrition in West Africa by supporting EC projects in

collaboration with West African institutions. Furthermore, the EC launched

mid 2009 a special Africa call including a so-called Coordination and Support

Action to design a research road map for nutrition in Africa. A regional

institute would have been an ideal partner in this project.

- Part-time secondments (and not always at the head office) should beinvestigated to avoid a brain drain within the region.

- A regional institute could embark on an accreditation programme for

nutrition programmes at M.Sc. level and assist the accredited universities

in maintaining a fellowship programme for students from the region. The

thesis/research component of M.Sc. programmes in nutrition could be an

important part of such an accreditation scheme. With relatively small

amounts of earmarked money available to heads of nutrition departments,

the quality of the fieldwork/analyses can be increased considerably. Smallamounts of money can promote big changes, and a regional institute could

be of help in this.

- The institute could play a role in bringing together/harmonising e-learning

modules that are nowadays prepared for distance-learning purposes.7 This is an

exciting and challenging new development, in which the ‘hands-on’ training

requirement is often underestimated.

- To address degree-granting issues (often one of the most challenging issues), it

might be advisable to seek assistance from the UNU. UNU is changing itsposition and now aspires to become a degree-granting organisation.

- At the Ph.D. level a regional initiative can make a difference for existing

doctoral programme by offering assistance in high-quality laboratory analysis,

data-management capacity, etc. The experiences of the Gambia show that a

medium- to long-term commitment is needed for this. During a starting-up

period a regional institute could affiliate with those institutions from the

north that execute their Ph.D. projects for international students on the basis

of a so-called sandwich programme, in which the preparatory period andwriting-up period take place in the north, and the field research is

implemented in the home country. Support for the fieldwork could create a

win�win situation, thereby convincing funding agencies to invest in such a

regional initiative.



In closing, to meet the regional nutrition research and training needs in West Africa,

it is not necessary to make a choice between creating a new regional institution vs.

expanding existing national institutions. Based on solid capacity development

principles, both options need action 12 years after Manila.

Acknowledgements

There are no conflicts of interest related to this manuscript. We thank the participants andinstitutions represented at the workshop. The advice of Grant J. Aaron, Mohammed AgAyoya, Inge Brouwer and Kenneth H. Brown and the contributions of colleagues whoprovided data regarding their respective institutions are gratefully acknowledged. Funding wasprovided by UNICEF, HarvestPlus, Wageningen University and HKI.

Notes

1. French speaking: Benin, Burkina Faso, Guinea, Ivory Coast, Mali, Niger, Senegal andTogo. English speaking: Gambia, Ghana, Liberia, Nigeria and Sierra Leone. Portuguesespeaking: Guinea Bissau and Cape Verde.

2. Abraham Besrat worked for a long time with UNU (Tokyo) and was involved (a.o. withScrimshaw) in implementing the fellowship programme of UNU. UNU has spent between1975 and 2000 nearly 45% of all its fellowships on food science and nutrition; 27% of thefood and nutrition fellowships came to Africa. The institutions that benefited most were:Federal Institute of Industrial Research, Oshodi; Department of Human Nutrition,University of Ibadan, Nigeria; and Food Research Institute, Ghana.

3. The programme has the title: ‘Targeting advanced fellowships to strengthen selectedregionally important developing country institutions for research on health issues related tonutrition and infection’, the overall budget was US$5,000,000 and many participatinginstitutions from the north waived fees to do more with the same amount of money.

4. Two examples: From natural resources to healthy people (food-based interventions toalleviate micro-nutrient malnutrition; Benin and Burkina Faso) and TELFUN (Tailoringfood sciences to endogenous patterns of local food supply for future nutrition; Ghana andBenin).

5. FONIO � improving the quality of fonio for West Africa and European markets (lead byInstitut de Recherche pour le Developpement, IRD, Montpellier); INSTAPA � improvednutrition through staple foods in Africa (with Wageningen, IRD, London School ofHygiene and Tropical Medicine and ETH-Zurch; 6 million Euro).

6. AGS-net � the Africa Graduate Students network. It was established by Cornell-basedPh.D. students.

7. Several of the large EC-funded programmes under FP6 have included this as one of theirobjectives and modules are (becoming) available on the use of food composition data, onrecommend intakes, etc. There are many more of such stand-alone modules that could beobtained at relatively low costs.

References

Benson, T., 2008. Improving nutrition as a development priority. Addressing undernutrition innational policy processes in sub-Saharan Africa. Washington, DC: International Food PolicyResearch Institute.

IJsselmuiden, C.B., Nchinda, T.C., Duale, S., Tumwesigye, N.M., and Serwadda, D., 2007.Mapping Africa’s advanced public health education capacity: the AfriHealth project.Bulletin of the World Health Organisation, 85, 914�922.

Lopes, C., Malik, K., and Fukuda-Parr, S., eds., 2002. Capacity for development. New solutionsto old problems. London: Earthscan.

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Lopes, C. and Theisohn, T., 2003. Ownership, leadership, and transformation: can we do betterfor capacity development? London: United Nations Development Programme and Earth-scan.

McCoy, D., Mwamsambo, C., Costello, A., and Khan, A., 2008. Academic partnershipsbetween rich and poor countries. Lancet, 371, 1055�1057.

Mutume, G., 2003. Reversing Africa’s ‘brain drain’. Africa Recovery, 17, 1�9.Sumner, A., Lindstrom, J., and Haddad, L., 2007. Greater DFID and EC leadership on chronic

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Burkina Faso: Universite de Ouagadougou. Available from: http://www.univ-ouaga.bf[Accessed July 2010].

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Sierra Leone: Njala University. Available from: http://www.njalauniversity.net [Accessed July2010].



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