Introduction

Healthcare workforce situation in Sub-Saharan Africa

As in many other countries in sub-Saharan Africa (SSA), strong higher education programmes on quantitative public health and epidemiology, especially infectious disease epidemiology, are lacking in Malawi. Reports on availability of medical education indicates that 444 medical schools existed in Africa as of 2023 (Rosenberg et al. 2024), while 168 were reported in 2010 (Mullan et al. 2011; Kiguli-Malwadde et al. 2015). Due to limited medical schools, many public health officials, surveillance specialists, and academics with epidemiology expertise in many other African countries acquired their education in Western countries. In the case of epidemics or pandemics, both practical and theoretical expertise in infectious diseases and quantitative epidemiology is much needed (Fefferman et al. 2023). According to the 2023–2027 Africa CDC Strategic Plan, there are approximately 1 million community health workers (CHWs) in SSA compared to an estimated need of about 2 million CHWs, 1900 field epidemiologists out of the 6000 required, and 5000 of the 25,000 needed frontline epidemiologists (Africa CDC, 2023). For effective public health surveillance and pandemic control, health systems will need enough highly skilled data scientists, public health experts, and medical doctors that are able to quickly generate epidemiological studies, understand the epidemic, and directly act based on infectious disease surveillance data. In turn, data scientists and medical doctors will also need practical assistance from public health professionals with an understanding of infectious diseases and their epidemiology (Fefferman et al. 2023). However, a critical shortage of health professionals, especially in SSA countries (Naicker et al. 2009) with an average of only 18 physicians per 100,000 people (Chen et al. 2012), makes it difficult to fulfil this ideal.

Malawi in particular is experiencing an acute shortage of adequately prepared personnel in the health sector (Chen et al. 2012). The shortage is seen across all cadres but is especially critical in quantitative public health (Muula, 2023), for example in (infectious disease) epidemiology and data-science oriented disciplines. This is similar in clinical medicine, where there are only approximately 1.9 physicians and 34.3 nurses per 100,000 people (Chimwaza et al. 2014). One contributing factor to this shortage is that graduates from medical schools have limited options for specialisations in Malawi(Sawatsky et al. 2014). For instance, until 2024, only one public university in Malawi offered a Master of Science in Epidemiology programme (NCHE, 2023). Therefore, here we describe experiences and perceived administrative feasibility of setting up a Master of Science in Public health with a focus on infectious disease epidemiology (MSPE) in northern Malawi.

Malawi situation analysis on training needs in infectious diseases epidemiology

The Kamuzu University of Health Sciences (KUHeS) is the only university in Malawi that currently offers a Master of Science in Epidemiology programme (NCHE, 2023; KUHes, 2024). In 2016, the American Centres for Diseases Control and Prevention (CDC) Malawi office, in collaboration with Public Health Institute of Malawi (PHIM), established the Field Epidemiology Training Programme (FETP) to contribute to counteracting the country’s lack of epidemiologists active in public health and disease surveillance (CDC, 2019). The programme aims at providing continuous professional development (CPD) for the health workforce in the Ministry of Health (MoH) in Malawi. However, we need further capacity building efforts to strengthen pandemic preparedness within SSA and beyond. To address this need, we are setting up an MSPE in the north of Malawi as a collaborative project between two universities: the University of Livingstonia and Mzuzu University.

The University of Livingstonia, a private University, was established in northern Malawi in 2003 (UNILIA, 2023) and has had a department of public health since 2012; Mzuzu University, a national public university, was established in 1997 (Chawinga and Zozie, 2016). By leveraging on the resources and strengths of these institutions, we may address educational needs in public health—particularly epidemiology—and contribute to boosting Malawi’s ability to respond effectively to infectious diseases outbreaks since infectious diseases remain the main cause of mortality in Malawi (Allain et al. 2017). For this reason, it is imperative to offer a strong and internationally collaborative programme on infectious diseases. This postgraduate programme will contribute to training staff already in the field and newly graduated students into experts on international standards in infectious disease epidemiology and modelling.

Infectious diseases and epidemiology in Malawi

Malawi, like other low and middle income countries (LMICs), faces an overwhelming burden of infectious diseases, including numerous neglected tropical diseases (CDC, 2019). For instance, MoH Malawi reports indicate that the top five causes of morbidity and mortality in the country are mainly infectious diseases including sexually transmitted infections, enteric infections, tropical infectious diseases and malaria, respiratory infections and tuberculosis (TB), and maternal and neonatal conditions (MoH, 2023). In 2020–2022, Malawi experienced three concurrent epidemics. These epidemics included a polio outbreak in February 2022 after wild poliovirus type 1 was detected in a sample from a child under 5 years old (Chunda et al. 2022), a Cholera outbreak in March 2022, and of course the declaration of the state of national disaster due to COVID-19 in March 2020(Bagcchi, 2022; McCarthy et al. 2022). Therefore, it is imperative to provide health professionals with the necessary epidemiological and modelling skills to enhance understanding of infection dynamics and determinants of diseases. Infectious disease epidemiology (IDE) encompasses the science of how infectious diseases are transmitted, how severe they are, and what interventions can be used to fight them(Lessler and Cummings, 2016; Johnson et al. 2023). IDE is also the applied science of fighting individual outbreaks, epidemics, and pandemics. IDE as a profession is therefore key to ensure pandemic preparedness on a high level.

Brief NOZGEKA project description

In collaboration with the University of Livingstonia, the University of Münster, the University of Freiburg, and Mzuzu University, the Helmholtz Centre for Infection Research (HZI) leads a consortium of these five partners in the implementation of the 4-year-long (2023–2026) pandemic preparedness “NOZGEKA” project funded by the DAAD. The main aim of NOZGEKA is to set up an MSPE in collaboration with the University of Livingstonia and Mzuzu University in Malawi. Both Malawian universities integrate the MSPE into the participating universities’ academic systems, and the candidates will pay fees for both master studies and the short-courses to ensure sustainability. Furthermore, all partner institutions will continue with the collaborative work even when funding ends, but of course with fewer resources, and maybe add further fields, such as research and clinical cooperation, to the current collaboration.

After successful completion of the training programme, graduates shall be qualified for research and able to perform relevant epidemiological studies and infectious diseases modelling, as well as effectively lead public health responses during epidemics or pandemics in Malawi and beyond. This programme will significantly contribute to achieving Sustainable Development Goal (SDG) 3, “Good health and wellbeing”, especially the aim to “strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks”(Carlsen and Bruggemann, 2022). Therefore, in this perspective, authors report on the assessments of training needs and experiences in a collaborative curriculum development process for an MSPE in Malawi.

Curriculum development

Curriculum development process

After conducting the first brainstorming sessions in February 2020, consortium building started at both the University of Livingstonia and Mzuzu University. Thereafter, a collaborative proposal was prepared in 2022 and submitted to the German Academic Exchange Service (DAAD) for funding. After the proposal was approval, joint project implementation began in 2023, as shown in the timeline and activities (Fig. 1). Furthermore, in Fig. 1, we outline the process and both achieved and expected deliverables in the programme implementation from 2022 to 2026. In 2025, we recruited the first cohort of 21 students, and the accreditation process for the MSPE is expected to be completed in 2026.

Fig. 1
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Project initiation, planning, and activities conducted in the collaborative curriculum development process.

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Since the initiation of the process, both international and local partner institutions, including representatives from the MoH and other public universities in Malawi, collaborated to develop a curriculum based on experience from all partners. To align with the national minimum standards and regulations for a postgraduate programme in public health, the curriculum development guidelines from the National Council of Higher Education (NCHE)(NCHE, 2015), a guidelines document we obtained from the University of Livingstonia, and guidelines from the Medical Council of Malawi were followed. Furthermore, direct participation of the partner institutions from Germany added an international perspective to the curriculum.

Experiences in collaborative curriculum development

Health professionals and academicians from Malawi and international epidemiologists and medical doctors from Germany actively participated in the module development meetings and workshops. The kick-off meeting took place in Malawi on 26 May 2023, with project partners and national stakeholders in attendance. During the kick-off meeting, stakeholders supported the idea of developing a postgraduate programme involving Mzuzu University and the University of Livingstonia.

After the project dissemination exercise, all participants started brainstorming on forming working groups, the structure of the academic programme, and the courses to include. This exercise was completed on 29 May 2023 through a workshop held at Laws Campus, University of Livingstonia. By the end of the workshop, 16 courses were listed, and 16 technical working groups had been created. The working groups ranged from four to eight members in each group, and all volunteers involved in the course outline development were working full time in their respective institutions. Working groups involved both local and international representatives from our Germany partners.

The module working groups including both Germany and Malawi partners were meeting monthly online via ZOOM; however, conveners indicated that almost half of the participants were not actively attending online group meetings for module development. After forming the working groups, it took the working groups six months to produce a first draft curriculum document. Thereafter, the document was submitted to the University Academic Planning Committees (APCs) from the University of Livingstonia and Mzuzu University for assessment.

Description of focus of course outlines

In Table 1, the 16 modules that we developed with focuses on clinical epidemiology, clinical basics of infectious diseases, modelling, climate change and health, surveillance, and biostatistics are outlined. Furthermore, we aligned the modules such that module materials are linked and build on each other. This arrangement ensures that we provide the training needed to produce highly qualified experts in IDE. Additionally, course contents were developed in alignment with the upper-level training outcomes suitable for an international level postgraduate study programme. Furthermore, universities will be offering four of the 16 modules as advanced short courses. The courses included in the training programme will enhance pandemic preparedness and facilitate the training of staff already in the field and newly graduated students to become experts following international standards in IDE and modelling. Two short-courses; clinical basics (22 participants including 12 females) and mathematical modelling (22 participants including 5 females) were piloted in 2024, and the second circle of short courses has started this year such that a short course on clinical basics of infectious diseases has been conducted in May 2025 (29 participants including 11 females).

Table 1 List of Modules included in the curriculum.
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Perceived administrative and technical feasibility of developing a collaborative academic curriculum

The consortium observed that the University of Livingstonia required constructive collaboration from a public university for joint implementation of the postgraduate project. Since 2012, the Public Health Department of the University of Livingstonia offers a Bachelor of Science Degree in Public Health, and in 2021, the University introduced a Master in Global Sanitation; meanwhile, the Faculty of Health Sciences at Mzuzu University offers academic programmes in Nursing and Midwifery, Biomedical Sciences, and Optometry. Both universities offer education science programmes that complement the health sciences and applied sciences programmes.

Regarding technical feasibility, both Malawian universities and the Germany partner institutions have expertise contributing to the courses outlined for the Master’s programme; however, the University of Livingstonia would need significant support to deliver the programme alone, especially in modelling and clinical courses. In some of the more specific modules, such as mathematical modelling, expertise was limited to one or two institutions, thus restricting the number of individuals who could collaborate on developing the corresponding course outlines in the curriculum. Thus, the collaborative approach that directly involves the five partner institutions from Malawi and Germany offers synergistic support to ensure the high-quality delivery of the programme.

Discussion

Overview of the experiences in joint curriculum development

In the first months of the NOZGEKA project, the focus was on identifying required resources and steps to develop a Master’s programme. One of the main challenges has been the cooperation and collaboration between all members of the course-outline-development groups due to, among others, the busy schedules of lecturers and researchers involved. Studies have shown that, for most employees, changing routines and approaches to the processes could be challenging (Pentland, Hærem and Hillison, 2011; Ebm et al. 2024). Furthermore, limited expertise in certain areas of the curriculum (for example, mathematical modelling) at specific institutions caused the inter-institution collaboration to be limited for the development of some modules. However, this also highlights the need for this programme in Malawi to facilitate building up a network of both local and international experts. On an international level, NOZGEKA can complement the African Field Epidemiology Network (AFENET) and FETP trainings that are offered in countries such as Kenya, Uganda, Zimbabwe, and Ghana, and other applied epidemiology training programmes in Africa(AFENET, 2023; Al Nsour et al. 2024)

Training needs and experiences in collaborative curriculum development

Until 2024, only one public university was offering an epidemiology postgraduate programme in Malawi. Currently, the project expects to contribute to addressing the need for additional epidemiology experts in Malawi through our consortium since the new curriculum will add value to the field of infectious disease epidemiology. The approach that was employed aligns with a study on collaborative curriculum development by Zeshan (2021) which concluded that such collaborative models of professional development have proved to be effective since they are experiential and capable of achieving success through a variety of expertise. Additionally, Goode et al. (2018) states that through the growing academic competency, the collaborative approach has the potential to change attitudes and beliefs regarding learning. Furthermore, Brown et al. (2013) explains that collaboration enhances the development of high-quality course outlines and curricula with better content and material coverage that could help to develop skills, and in this case, to effectively manage outbreaks of infectious diseases in developing countries and beyond. A study by Dhillon et al. (2012), which focused on South-East Asia, reports that infectious diseases that are contributing to outbreaks and high morbidity and mortality are key factors requiring capacity building of the health workforce globally. In the study, authors reported that there are efforts to increase the capabilities of the health workforce as well as research and training due to the escalation in infectious and non-communicable diseases. Furthermore, studies have shown that the burden of infectious disease increases the need for preparedness for support services through training of specialists in infection control (Zaidi et al. 2004; Blakely et al. 2011).

The outline of the curriculum was deductively developed and all consortium members adopted it. However, during the refinement processes, the curriculum was adapted to reflect mainly the University of Livingstonia and Mzuzu University. The plan is to offer a 24-month MSPE programme consisting of 1.5 years of taught course work, practical modules, and thesis proposal development, followed by half a year mainly focusing on thesis work under competent supervisors who have obtained at least a senior lectureship position and relevant doctoral degree. At this last stage, the main work will be data analysis and report writing. The two-year duration for a postgraduate degree aligns with most national and international postgraduate programmes that are offered in Malawi and within the region (Krause et al. 2009).

Perceived administrative and technical feasibility of developing a collaborative academic curriculum

According to minimum standards outlined by the NCHE in Malawi (NCHE, 2015), both the University of Livingstonia and Mzuzu University fulfil the criteria to offer higher education in Malawi. However, this perspective also seeks to explore the administrative and perceived technical feasibility of developing a collaborative academic curriculum through multidisciplinary lecturers and voluntary health experts. The consortium viewed that the Department of Public Health at the University of Livingstonia needed productive collaboration from a public university and other faculties within the University for Joint Implementation of the MSPE postgraduate programme. As supported by Tiernan, Kenny, and McCarren (2023), potential future changes within the interface of health technology, demographic transitions, and discoveries of emerging pathogens and behaviours of such pathogens encourages collaborations and networking in designing intervention and academic programmes. Creation of effective collaborations, among other factors, depends on the institutional structures and existing policies and guidelines. Since the NOZGEKA programme aims to improve epidemic preparedness and prediction, multidisciplinary teams with expertise in infectious disease epidemic prediction, prevention, designing response strategies, surveillance, data collection, and analytics are involved (Bedi et al. 2021; Yildirim et al. 2021). Indeed, collaborative curriculum development requires efficient administration, technical feasibility, and collective intelligence for effectively designing programmes that can help address current public health challenges in Malawi and beyond (Abegglen et al. 2023).

By establishing a collaborative and high-quality postgraduate programme that follows international standards, the consortium is adopting an approach that emphasises shifting from social responsibility to social accountability (Blowfield and Frynas, 2005; Al-Subait, Elzubeir 2012) since the aim is to contribute to epidemic preparedness, management, and prediction. The graduates will learn theory and gain hands-on practice that will be helpful in bringing tangible interventions to the health authorities. In this era when pandemics are becoming more frequent, academic programmes targeting clinical interventions and population health are essential (Bhadoria et al. 2021; Haileamlak, 2022).

Conclusions

Early stages of the NOZGEKA project to develop an MSPE have taught the project consortium invaluable lessons about the challenges and benefits of collaborative curriculum development. While limited time availability and differing areas of expertise by institutions presented challenges to the overall and inter-cultural collaboration, the differing expertise and backgrounds from members of the five partner institutions as well as the diverse collaboration partners from numerous Malawian institutions have enabled us to develop a Master’s curriculum with input from many perspectives. As the project progresses and the Master’s programme finally reaches students, both universities and the additional international collaborators hope to educate and train the next generation of infectious disease experts in Malawi and the region, and contribute to pandemic preparedness in Malawi and beyond.

Declarations

The report is explicitly describing the processes and experiences of developing a collaborative curriculum document by the consortium of five institutions. Additionally, administrations from all the partner institutions had formally recommended the implementation of projects at respective sites. Furthermore, this paper involves neither the use of identifiable private information nor bio-specimens of the faculty who participated in the collaborative curriculum development.

Availability of data and materials

No supplementary data are available. All the information in the analysis is included in this manuscript.