Adipala Ekwamu is Executive Director of the Research and Education Agency (RAE), a non-governmental organisation in Uganda. He was the founding Executive Secretary of the Regional Universities Forum for Capacity Building in Agriculture (RUFORUM) from 2004 to 2022. Reda Sadki is Founder of The Geneva Learning Foundation (TGLF). Adipala Ekwamu was exploring how to strengthen the training of health workers across Africa when he met Reda Sadki. TGLF has spent a decade inventing new ways to accompany health workers once they are in service, but had no space to discuss with universities how they are prepared before. Both saw the same gap. Graduates enter health systems unprepared for the work, and no forum brings universities and practitioners together to say so. This article is their invitation to start that conversation.
1. Universities and practitioners need a shared space they do not yet have
What will communities need from health professionals to survive?
Africa needs millions more health workers, and it needs them to be ready for a world that looks very different from the one in which most curricula were designed.
Artificial intelligence is changing what professionals need to know and do.
Outbreaks, armed conflict, extreme weather, and extreme poverty now arrive together and stay.
External funding for health has collapsed.
In this context, the survival of communities depends more than ever on the judgement, ethics, and adaptability of the people who serve them.
Universities train these people.
Practitioners, from district medical officers to community volunteers, know what the work actually demands.
Yet the two rarely sit together to ask what this means for pre-service education.
We propose to open that conversation.
RAE, RUFORUM and TGLF propose to convene university leaders and faculty engaged in pre-service education in public health, medicine, nursing, midwifery, and the allied health professions, together with practitioners and other disciplines, for an open dialogue.
The first session will be held online, hosted by TGLF, chaired by RAE. Its outputs, including next steps in the dialogue, recommendations, and resource mobilisation strategy, shall be distilled into an insights report.
2. The world university graduates enter has changed faster than the education preparing them
The workforce gap is large and concentrated where needs are greatest
The World Health Organization (WHO) projects a global shortfall of 11.1 million health workers by 2030, mostly in low- and lower-middle-income countries.
According to the WHO, African Region expanded its health workforce from 1.6 million in 2013 to 5.1 million in 2022, but still faces a projected shortage of 6.1 million by 2030.
The WHO attributes part of the problem to a mismatch between education strategies and the needs of health systems and populations.
Producing more graduates is necessary.
It is not sufficient if those graduates are not prepared for the work.
Graduates are motivated but often unprepared for what the job requires
Over the past decade, TGLF has observed young professionals leave school highly motivated, join a ministry of health, and be assigned to run vaccination services for which their pre-service education did not prepare them.
We believe this is the case for many life-saving public health functions.
They learn on the job, because they are capable.
But time is lost, lives are at stake, and the public investment in their education is only partly realized.
The Ebola outbreak caused by Bundibugyo virus makes needed rethinking of approaches urgent.
Declared on 15 May 2026 in the Democratic Republic of the Congo (DRC) and Uganda, and determined as a public health emergency of international concern days later, it has become the largest Ebola outbreak ever reported in the DRC.
By early October 2026, Ituri province alone had reported 6,370 cases, including 2,933 deaths.
Uganda contained its 20 confirmed cases and declared its outbreak over on 27 August, but the risk of reintroduction remains.
The speed, complexity, and community dynamics of such an outbreak demand capabilities that a conventional master’s in public health may be insufficient to fully develop.
Polycrisis is now the operating environment, not the exception
In the eastern DRC, where TGLF works with a network of around 9,000 health and humanitarian workers, extreme poverty, armed conflict, and increasingly frequent extreme weather events overlap with the outbreak.
For many families, Ebola is not the most pressing threat they face.
Health professionals must work across these interacting crises, with communities, and often with few resources.
Most pre-service programmes still treat such conditions as context rather than as core content.
The funding collapse forces a question of sovereignty
Global health has lost a very large share of its external funding since 2025, with cuts from multiple governments, not only the United States.
The consequences are already measured in lives lost.
Many African leaders argue that long-term dependency on donor funding was itself harmful.
Whatever one concludes, it is clear that African institutions, including universities, will have to define their own agenda for the health workforce and find new ways to resource it.
Artificial intelligence changes what a professional needs to be
There is a global debate about whether universities will adapt to the Age of Artificial Intelligence (AI), and about what AI will do to the human workforce.
When knowledge recall becomes cheap and abundant, the scarce capabilities shift: judgement in uncertain situations, working with communities, ethical conduct, collaboration across disciplines, and the ability to learn continuously from practice.
These capabilities are difficult to teach through lectures and examinations alone.
Disciplinary and institutional boundaries slow the response
A highly skilled clinician may know little about managing an epidemic, which sits under public health.
Schools of medicine and schools of public health in the same country do not necessarily work together.
Nursing and midwifery schools, which train the largest share of the frontline workforce, may not always be included from inter-disciplinary collaboration.
Many strong African schools have long-standing partnerships with institutions in the global North, but some of these partnerships are premised on needs and assumptions defined decades ago.
Ethics is a survival skill, not an elective
Large sums are mobilized for emergency response, and there are persistent concerns that not enough reaches the operations and communities it is intended for.
One role of education is to help professionals understand why ethical behaviour that serves communities is also in their own interest and in the interest of their profession.
This is an uncomfortable subject.
It belongs in the dialogue.
3. Practitioners are already showing what fit-for-purpose education can look like
TGLF works mainly with health workers already in service.
Participants tackle a real local challenge, analyse its root causes, design corrective actions, and implement them.
TGLF certifies the work produced and the evidence of results, not attendance or examinations.
Three examples illustrate what this can achieve and why universities matter:
- A young Ghanaian doctor, Dr Obed Nuobe, improved tetanus vaccination coverage in his district within two months of joining a TGLF programme, then worked with the national immunization team so that his approach could be adopted more widely.
- The head of a leading nursing school in Ghana found that female genital schistosomiasis (FGS), which affects an estimated 56 million women and girls, was not being taught to nurses. She brought TGLF course content into the national nursing curriculum.
- In Fort Portal, Uganda, the leader of a large volunteer network met Ministry of Health leaders for the first time at a TGLF alumni gathering, which changed how his volunteers are recognized and engaged.
These are examples of the change that matters.
They also raise a question that TGLF has not been able to answer alone: how can national universities recognize, and award credit for, the thinking, planning, and action that save lives?
An international certificate is one credential of value, but career progression in most countries depends on credentials from national institutions.
TGLF has long assumed that pre-service education was outside its scope and that graduates would learn what they actually need on the job.
That assumption is incomplete.
Universities hold authority, legitimacy, and continuity in their societies that no other actor can replace.
Any credible agenda for the future health workforce must include them.
4. A dialogue is needed to ask what the university is for when community survival is at stake
The central question is: what is the role of the university in preparing health professionals who can help communities survive and thrive amid artificial intelligence and compounding crises?
Guiding questions include:
- What do practitioners on the ground need graduates to know and be able to do on their first day of work that they cannot do today?
- Which capabilities become more valuable, and which become less valuable, as artificial intelligence becomes part of everyday health work?
- How can pre-service education prepare graduates for outbreaks, conflict, climate shocks, and poverty occurring at the same time?
- How can schools of public health, medicine, nursing, midwifery, and the allied professions learn and work together, and with other disciplines such as agriculture, engineering, and the social sciences?
- How can universities recognize learning and impact achieved in practice, including by health workers already in service?
- What does ethical practice require in a resource-constrained and politically complex environment, and how can it be taught?
- What would an African-led agenda for health workforce education look like, and what would it take to resource it?
We believe education, in this century as in previous ones, remains a philosophy for leading change.
Its tools must be adapted to the times, so that every person, whoever they are, can realize their potential and contribute it to their community.
Many universities will recognize themselves in this mission.
We need a dialogue to ask how they can act on it amid layers of tradition and bureaucracy, some of which matter for identity and reputation, and some of which may no longer serve the public good.