Creative Education
2012. Vol.3, Special Issue, 749-754
Published Online October 2012 in SciRes (http://www.SciRP.org/journal/ce) http://dx.doi.org/10.4236/ce.2012.326112
Delivering Creative Education for Health Promoters in
Africa—Towards Critical Mass by “Going Global and
Staying Local”
Rachael Dixey
Institute of Health and Wellbeing, Leeds Metropolitan University, Leeds, UK
Received August 1st, 2012; revised September 5th, 2012; accepted September 16th, 2012
Postgraduate opportunities for health promotion and other courses allied to health are limited in sub-Sa-
haran Africa (apart from South Africa). There are major constraints on the development of health promo-
tion in sub-Saharan Africa, and the lack of training capacity is one of them. Although potential students
can access courses in parts of the global North where health promotion is strong—Europe, North America,
Australia—this option is expensive. It also takes workers away from their posts for considerable periods
and can be gender-biased. This paper describes a creative educational approach where postgraduate study
is taken to Africa, from the UK, in the attempt to create communities of learning and to develop a critical
mass of health promotion workers, such that they can make real change to the infrastructure for health
promotion and thus to the health of the populations of their countries. In studying at home however, there
is a debate to be had about whether this fulfills one goal of higher study, which is to develop cross-cul-
tural awareness and the mindset of the “global citizen”. The paper thus questions whether it is “better” to
stay local or go global. The postgraduate course we teach in Zambia and The Gambia does seem to pro-
vide this global awareness as well as enabling health promotion workers to develop their practice, and
moreover it has the capacity to develop the critical mass of workers needed to create the momentum for
change.
Keywords: Africa; Health Promotion; Global Citizenship; Public Health Training
Introduction: Health Promotion and Capacity
in Sub-Saharan Africa
As providers of postgraduate education, we have seen the
trend of increasingly expensive courses in developed countries
such as the UK, and the decrease of scholarships, together with
the difficulties of individual international students returning to
their countries, enthused with new ideas, but unable to make an
impact on the structures within which they work. The Leeds
Metropolitan University course in health promotion has an
international reputation, and apart from its home students, at-
tracts students predominantly from Africa, plus a few from Asia
and the Middle East. The establishment of scholarships from
the Commonwealth Scholarships Commission for distance
courses led to us submitting a bid to run the course in Lusaka,
Zambia, in partnership with Chainama College of Health Sci-
ences there. In short, the initial bid and subsequent bids have
been successful, and we have run the course (MSc Public
Health—Health Promotion and Environmental Health), since
2004 in Lusaka, for six cohorts of public health workers. Later,
we also set up the same provision in The Gambia, where we
have run three cohorts. The purpose of this paper is to reflect on
the advantages and disadvantages of running a postgraduate
course in another host country, and whether by staying in-
country, students miss out on a more global experience; the
paper also asks whether the advantage of creating a critical mass
of learners outweighs other considerations. By “critical mass” is
meant a number of learners sufficient to create change. The
paper also asks whether our approach really represents creative
education, or is simply a pragmatic solution to the lack of ca-
pacity in Africa .
Health promotion is sometimes regarded as the radical wing
of public health; it is not to be confused with, or used inter-
changeably with, health education. Although health education
(intended to provide information and education to the public
about how to protect their health), is part of health promotion,
health promotion is concerned with tackling the social deter-
minants of health and health inequalities. It works “upstream”,
usually at a policy level. To take a concrete example, a health
promotion officer tackling an issue such as obesity would work
with transport planners to persuade them to prioritise healthier
means of getting around such as walking and cycling, with
schools to develop healthier school food, with the food industry
to do likewise, and so on. The Ottawa Charter (WHO, 1986)
provides the central document upon which modern health pro-
motion rests; it lists five areas for action, namely building
healthy public policy, providing supportive environments,
building strong communities, developing personal skills and
reorienting health services. A major task is to wrest “health”
from health care services (which are really sickness services)
and move the agenda into health and wellbeing, or into a “salu-
togenic” mindset. Whereas pathogenesis is concerned with
what causes illness and disease, salutogenesis is concerned with
what causes wellness and health. Those educated within a tradi-
tional health care model find this mind-shift difficult, and it is
one of the aims of the course to achieve this . The place to create

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health mainly lies outside the health care sector, and ‘upstream’.
Health promoters are thus expected to be able to plan, imple-
ment and evaluate actions that promote health, and to develop
skills in partnership working, empowering communities, strate-
gic thinking, project management, and to apply theory to their
practice.
Sub-Saharan Africa generally, South Africa excepted, (Van
den Brouke et al., 2010) has a dearth of training capacity for
health promotion (Onye, 2009). It does have diploma courses in
health education, but does not have good quality postgraduate
health promotion courses reflecting the Ottawa Charter phi-
losophy. Capacity for higher education is limited in general,
and not just in relation to health courses. Whereas African uni-
versities are acknowledged to have performed well in produc-
ing human resources (Ajayi et al., 1996), they have done this
against a background where before 1960, only 18 of 48 sub-
Saharan countries had a university (Sawyerr, 2004). The ne-
glect of secondary schooling during the colonial period left
many countries without potential university candidates (Dixey,
1997) and even today, it is noticeable that the education sys-
tems of some sub-Saharan countries are more developed than
others. Despite the development of African Universities, they
run the risk of becoming marginalized in the interconnected
global knowledge economy of the 21st century, where Univer-
sities in the global North have been on a marketization trajec-
tory for many years. Obamba (2010: p. 350), studying the
higher education sector in Kenya, suggests that the sector needs
to be bold, and “urgently institute effective policy measures that
can ensure increased liberalization”, together with dismantling
the rigid boundaries between the private and public universities.
Better conditions are required in order to keep academics in
public Universities (Afful-Broni & Nanyele, 2012), as many
leave for Universities in “developed” parts of the world. The
move of academics is mirrored by the movement of graduates,
and the trend for “brain gain” to become “brain drain” was
noted by Carrington and Detragiache (1999) who asked the
question back in the1990s as to whether the universities and
training institutions of Africa were servicing the demands of
developed countries, due to the migration of health profession-
als trained in Africa.
Towards Larger Numbers of Learners and
Communities of Learning
Shifting countries with a high disease burden into a more
“social” model of health and away from the medical dominance
of public health has been identified by African colleagues as a
central task in order for health promotion to develop in Africa
(Nyamwaya, 2003, 2005; Amunyunzu-Nyamongo & Nyam-
waya, 2009). As one of our Zambian students commented,
“In Zambia we have along way to go to start appreciating
the importance of health promotion. Our services are pre-
dominantly centred on treatment, prevention and control of
diseases. The main objective of the health services is to improve
affordability and accessibility of health services and not to
create a healthy community. A lot of money goes to the pro-
curement of drugs, medical supplies and building of health
centres while health promotion programmes do not receive the
necessary support they deserve from the government. There is
need for high level advocacy on the need for directly funded,
centrally co-ordinated health promotion programmes with an
intersectoral approach with offices in all the districts.” (Zambia
cohort 4, 2009)
This is a tall order anyway, but is even more so when coun-
tries can only afford to send small numbers of students annually
to be trained in this way of thinking; individual students return
to their often inert bureaucracies and slot back into the organi-
zation’s way of doing things. Frustrated by the slow pace of
change in ministries, they often leave to work in the NGO sec-
tor. Moreover, sending students to developed countries is ex-
pensive and a range of other issues might arise: students may
not return to their home country, the selection process might
not be fair within the home country, selection can be gender-
biased, workers are absent for considerable periods of time, and
the course they attend might not have direct applicability. That
said, many students gain enormously from the experience, and
do indeed return to make real differences in their home nations.
It is a costly process however, and in today’s more straitened
financial times, it can be questioned.
The development of a distance learning strand by the Com-
monwealth Scholarships Commission (CSC) provided an op-
portunity to bid for funding to run the course in Zambia, taking
the course to the students rather than expecting them to come to
Leeds. An in-country course delivery model became feasible
due to funding from the CSC, the willingness of Leeds Met to
enable off-site delivery, and the partnership already existing
with Chainama College, Lusaka. Preliminary visits from the
core staff enabled a partnership approach to curriculum devel-
opment and the recruitment and selection strategy, ensuring it
fitted with Ministry of Health human resource needs. It was
agreed that face-to-face delivery was the only viable option at
the time given the level of IT resources. A model emerged of
teaching modules in blocks of two weeks, with eight blocks
over two years followed by a period collecting data and writing
a dissertation.
The course was initially designed to give Chainama College
teaching staff the opportunity to gain a Masters qualification;
some of these staff member s are tutors working in re mote rural
areas. All are essential to the training of the health workforce in
Zambia, as they teach the frontline workers—clinical officers,
nurses, environmental health officers. There was therefore, a
clear need for capacity building at the College, which wanted to
pursue being granted University status. Numerous spin-offs
occurred including gaining funding for staff travel in both di-
rections for research projects, opportunities for Zambian staff to
learn about the administration and financial arrangements at
Leeds Met, and the attraction of additional projects to enable
health workers from Leeds to provide support at Chainama
Hospital.
Subsequent cohorts widened to include those working in
other health sectors in Zambia and from other higher education
colleges. This widening has continued into the sixth cohort
though Chainama is still the central location for the course. 150
students have enrolled in the programme, with approximately
half supported by CSC scholarships. The course is entirely
“owned” by Leeds Met and conforms to its quality assurance
processes. Tutors from Leeds Met travel to Lusaka for the
teaching blocks, providing an intensive workshop style student
experience. Local experts are also included as guest lecturers
and more recently, local tutors have teamed up with Leeds Met
staff so that they can ultimately run postgraduate courses them-
selves. A well thought through process of local support was
established, employing local staff to support students both per-
sonally and academically in the interim months. This provides
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professional experience, a small income and kudos as well as
meeting the needs of students. Senior staff at Chainama provide
administrative support and advice.
Paying Chainama College for use of facilities enables a flow
of income to a relatively resource-poor college, which has in
turn been able to upgrade its premises. Increased confidence
and morale, plus more tangible benefits such as being able to
attract other development funds and additional partnerships, are
apparent alongside the staff capacity building. This brief over-
view of the delivery may make the project look simple, but
cannot detail the large amount of work that has gone into plan-
ning, logistics, or relationship building. Some of this detail has
been recorded elsewhere (Dixey & Green, 2009).
The course developed in The Gambia in the same way, fol-
lowing requests from our Leeds graduates to deliver the course
there. So far, three cohorts have enrolled, totaling 94 students,
partly funded by the CSC, the National AIDS Secretariat and
additional self-funders. The Gambian provision was also adver-
tised in Sierra Leone and has included 20 students from there,
who travel to The Gambia for each module. As in Zambia, the
course has advantages of local delivery, enabling it to be made
relevant to the local situation, enabling health workers to re-
main in situ and being able to apply their learning immediately
after a teaching block.
The drop out rate for the course is lower than that found for
courses run in the UK, and the completion rate is also high.
We did underestimate the speed at which students would be
able to complete their final dissertations, mainly due to the need
to remedy the lack of research experience. However, in terms of
creating a critical mass, the courses have achieved that.
Whether this critical mass will then go on to produce the kinds
of organizational changes and challenge the status quo remains
to be seen. The fact that the course has created a community of
learners (Lave & Wenger, 1998), improved networking and
broken down some of the inter-professional barriers does bode
well.
So far, there is a suggestion that local is “better”, that the
mode of delivery restricts the need for travel, resonating with
Naidu’s (2006: p. 1), comment that “learning and cognition are
most potent when situated within a meaningful context, and
within the culture and community within which learners live”.
There are substantial benefits of postgraduate study overseas
however, as expressed by our students studying in Leeds
(Dixey, 2001). The “local or global” debate is discussed further
in the next section.
Studying Locally, Thinking Globally?
British universities have stressed in recent years not only
employability but also the development of graduates as indi-
viduals who can contribute to a globalising world, leading to
the emergence of the idea of “global citizenship”. In being able
to respond to the perceived challenges of globalisation, “it is
essential that our institutions of higher education graduate glob-
ally competent students” (Brustein, 2007: p. 3). There is also
emphasis on ‘cross-cultural capability’; at Leeds Metropolitan
University for example, we have to show in all our course vali-
dation documents, how students are being educated in terms of
cross-cultural capability, enabling them to develop intercultural
competence and by extension, intercultural citizenship (Alred et
al., 2006). Students study in Leeds in very internationally mixed
groups and are exposed to various political, religious and cul-
tural differences. It was challenging therefore, to demonstrate
how our Masters course would deliver “cross-cultural capabil-
ity” when taught in the students’ home country. Inevitably, the
cohorts within country are more homogenous and although we
as staff challenge students hard in terms of diversity, equality
and human rights, they are not exposed in the same way to a
broad range of students from different backgrounds.
The quality of learning implied in cross-cultural capability is
of “deep learning”—students are not only expected to take in
“knowledge” but are expected to learn “to be”, to somehow
develop their identity as well as learning “to do”. As such, this
learning challenges what Bordieu refers to as “doxa”, which
Charlesworth describes as the way in which people accept their
culture and environment as “natural” and as given, as this is
what they know and have been brought up with. Doxa “refers to
that which we think from rather than that which we think
about” (Charlesworth, 2000: p. 30). Deep learning implies that
people will move the horizons of their life world, from their
self-world, socio-cultural world, into the extended world. Post-
graduate education has to push the boundaries.
In moving countries, moving into the extended world, stu-
dents are confronted with cultures that are strikingly or subtly
different from those they have grown up in, and to which they
are accustomed. It is assumed that studying abroad will develop
cultural awareness and better equip students for a globalising
world, that the international student will benefit in tangible
ways by being removed from the supposed mono-culture of
their home life and that it will lead to “extra-ordinary” learning.
There is a tacit value judgement that studying abroad will be a
richer experience that “staying at home”. It is assumed that
becoming cosmopolitan (where the intellectual self is situated
outside the local) is somehow superior (Friedman, 1994). There
are also claims made for international education experiences,
such as that they “help improve social justice around the world”
(Bremer, 2006: p. 44) or that such an experience “provokes
learning about one’s own view of the world and, in the process,
changes the ‘self’” (Fantini, 2003: p. 16). As far back as Aris-
totle, there was the notion that travel will lead one to appreciate
the commonality of all humanity: “One may also observe in
one’s travels to distant countries the feelings of recognition and
affiliation that link every human being to every other human
being” (Aristotle, cited in Nussbaum, 1993). On a more prosaic
level, international students may develop an independence,
broadened outlook, greater cultural awareness and in many
cases, where students are from poorer countries, access to
higher standards of living and the chance to remit money home.
However, a number of studies are critical of the claims made
for studying overseas, more particularly of students travelling
from richer countries, and that such sojourns are over-rated in
both academic learning terms and in becoming a “global citi-
zen” with enhanced cultural awareness (Gillespie, 2002; Brock-
ington & Wiedenhoeft, 2009).
Is it possible to fulfil the “global citizen” ambition through
postgraduate education where students do not leave their home
environments? We believe it is for a number of reasons: firstly
students are exposed to staff from the global North with very
different backgrounds who deliberately challenge students to
think in new, critical ways, and who use material from a range
of cultures; some students themselves have already travelled
overseas and bring those experiences with them; students do
access the course from a few other countries (viz. from Sierra
Leone in The Gambia and in one Zambian cohort four Tanza-

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nians were present, and more recently one student from the
DRC (Democratic Republic of the Congo) has enrolled), and so
there is some element of cultures meeting. Finally, there is con-
siderable input on globalisation, global health and global gov-
ernance.
One small example of students being challenged occurred
recently in the first module of the latest cohort in Zambia. As
health promotion involves many issues of morality, legali ty and
sensitive areas in sexuality and personal behaviours, one of the
exercises we do is to ask students to consider behaviours that
are legal or illegal, moral or immoral. Invariably, they place
“homosexuality” in the “illegal and immoral” category. In-
variably, of course, staff challenge this view. What really made
a difference to their views was one student who had worked in
the USA talking about how she had friends who were gay, and
secondly, my own statements about how “gay rights are human
rights” and to me, being gay or straight was equally “moral”.
What really made the difference however, was my saying how
shocked I was that in Zambia, the main risk factor for women
acquiring HIV was being married, with the key issue being
multiple concurrent partners. In Zambia, HIV prevalence is
14%; I asserted that in the UK, the rates are so low that we do
not give them as a percentage, but as a rate per 10,000. Multiple
concurrent partners is seen as a norm, albeit a regrettable one,
in Zambia, and realising that this was shocking to an outsider
was in turn a shock to the students. This relatively small inci-
dent palpably demonstrated to them that their culture was not
‘normal’ in someone else’s eyes. It was cheering to hear at the
end of the module that a number of students, all of who are
mature adults with careers, to say that they had moved in their
views, and had at least realised that they needed to respect other
cultures even if they didn’t always agree with them.
A second example of challenging the students is to take them
on fieldwork in rural areas. Zambia has one of the highest rates
of urbanisation in Africa, and unlike other countries, where
people still have links to the villages in which they were often
born, in Zambia, there are third or fourth generation urban
dwellers. Filed work in rural villages is described as a major
culture shock by many of the students experiencing it; the
Communities and Community Health module requires several
days talking to local people about their lives. Thomas (1999)
describes the transformation that can take place even in brief
encounters with others; in this case, such transformation oc-
curred through hearing the stories of local people and thus
connecting with the life worlds of “the other”. As staff we have
been taken by surprise at this impact on the Zambian students,
whereas in The Gambia and Sierra Leone, students seem more
in tune with their rural origins. Even for the latter, it is hoped
that that studying one’s own community can lead to becoming
more globally competent. “Becoming global” requires an
awareness of one’s own peculiar socio-cultural context; Hunter
et al. (2006) say that actually this is the most critical part of
becoming globally competent. A further step is where people
become aware more generally of how cultures “work”, i.e. not
only being aware of one’s own culture but also comprehending
the workings of any culture. To appreciate the workings of
‘culture’ generally, one still has to step outside one’s own cul-
ture and this understanding can lead to an appreciation of dif-
ference, that other cultures have distinct belief systems, and that
the life worlds of others have been shaped in very different
ways (Bhawuk, 1998). The sociological imagination requires
one to ‘make strange’ common sense knowledge; further, the
aim of critical thinking is to be open-minded, ask challenging
questions and to interrogate assumptions. It should lead stu-
dents to ask uncomfortable questions about their own culture(s)
and moreover, to understand their own prejudices and how their
culture affects their perspective on the world. This kind of
critical thinking inevitably challenges the tendency to only see
the world through one’s own culture’s lens. As such, students
cross a “threshold”. In educational terms, “threshold concepts”
(Meyer & Land, 2005) suggest that these can transform one’s
worldview and/or cause a “shift in perspective (that) may lead
to a transformation of personal identity, a reconstruction of
subjectivity” (Meyer & Land, 2005: p. 4). Meaningful reflec-
tion, as part of critical thinking (Schon, 1987) can consolidate
the significance of the experiential learning and enhance the
transformation. This kind of reflection is essential at postgradu-
ate level and is a new way of learning for many students.
Another example of “making strange” common sense know-
ledge is when we ask a particular Zambian academic to give a
talk about gender. This male colleague seriously challenges the
men in the group, in a culture where students treat it as normal
to discuss how to make sure their wife carries out the husband’s
wishes and perform their “wifely duties” properly. The fact that
a Zambian male is teaching about gender is extremely potent; it
enables the students to realise that gender equality cannot be
dismissed as a Western intrusion.
A further example, applying in both countries, is that as we
challenge the practices of the students as health practitioners,
asking them to think more critically about what they are doing
and why, we “stop them in their tracks”. Asking them to con-
sider the evidence base for practice from a variety of other
countries, and suggesting alternative ways of doing things,
including applying a theory base to practice, results in a period
of discomfort and puzzlement as students question their accus-
tomed ways of doing things. Shifting from a “medical model”
of health to a “social model” is particularly challenging and
trans- formative. From the point of view of an educational ex-
perience, this raises a paradox: moving beyond the familiar into
a more extended world will challenge students’ identity and
sense of self. The ability to act (agency), flows from identity,
but if deep learning challenges identity, loosening identity an-
chor points, then the capacity to act, to exercise agency, can be
compromised in some way by that deep learning. The task of
the educator of course, is to facilitate the transition through this
period of confusion and to make it an exciting journey rather
than a crippling one.
The question of whether it is more advantageous to study at
home or to travel overseas cannot be fully answered. The bene-
fits of each are clear, but it can also be argued that “staying at
home” doesn’t preclude becoming more cross-culturally aware
or stop people developing a “global citizen” outlook. It’s well
known that travel per se doesn’t open minds—some people can
return home with their minds just as closed! One of the aspira-
tions of our postgraduate education is to enable students to be
“a global citizen in my village in a village that is globally con-
nected”.
Moreover, the option of travelling overseas is simply not al-
ways available, as one female student remarked, “When offered
a place and a Commonwealth Distant Learning Scholarship I
was overjoyed, seeing this as an opportunity to advance my
education at home. I have been trying for years to get a schol-
arship to pursue my studies. This programme has made it pos-
sible for more people to be given the chance to pursue their
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studies than if they had to go abroad for their degrees.”
Another explicit aim is to address the retention of health
workers and arguably, creating graduates capable of operating
globally is likely to fuel the exodus rather than stem it. How-
ever, it does seem to be the case that running a postgraduate
course in-country does help retention.
Impact on Students
The impact on students of studying at postgraduate level and
gaining a Masters is clear from our evaluations and student
feedback. These are a few of the types of comments made by
various cohorts, showing their appreciation for being able to
study at home, to increase their skills, confidence and opportu-
nities for promotion, and to develop a community of practice.
“There are multiplier effects from this course, especially be-
cause so many graduates are teachers and are passing their
new knowledge onto their students. Also, in the past many stu-
dents would apply for study abroad and due to strains on hu-
man resources not everyone would be allowed to go. This
course allows more people to study overall, as well as study in
their home country whilst continuing to work and link their
learning to their situations.” (Zambia cohort 2, 2007).
“There are different types of people from different walks of
life in the group and it helps to work together in class because
it prepares students for collaborative working in their profes-
sional lives with communities and colleagues.” (Zambia cohort
2, 2007).
“The organisation of the entire program has proven to be
highly cost-effective for me. This is not only because of the
awarded scholarship which you ably facilitated but also that I
have been to work and earn an income for myself and family
without any disruptions arising from my studies. In fact, my
admittance to the program has obviously widened my suitabil-
ity for job opportunities. You may wish to know that during
2005, I had 2 job offers on merit based on my curriculum vitae
which also bears MPH-Health Promotion as my current study
programme as well as the ability to articulate ideas during the
interviews. The latter part is what excites me the most because I
believe that, in part, it emanates from my self-confidence which
was enhanced during the study period through group work
presentations in which every one of us had to actively partici-
pate—no dodging as the class was relatively small to notice
those who had not presented or contributed to the group dis-
cussions. Your emphasis on ‘critical thinking’ before respond-
ing has re-oriented my thought-process such that I now en-
deavour to always analyse and comprehend issues that deserve
my attention before providing my feedback. It is probably for
this reason that during the past seven or so months, my per-
formance at work has been highly rated.” (Zambia cohort 1,
2005).
“The Master of Science in Public Health (Health Promotion
and Environmental Health) was a real challenge in my life.
However, before graduation I was promoted to a higher rank
as Manager Planning and Development for Chama District.”
(Zambia cohort 1, 2005).
Another student remarked that she is now being used as a
resource in her workplace and is consulted for feedback on
assignments (by colleagues who are students on other courses)
and on funding proposals. She has developed an advisory role,
and she is seen as such a valuable person within her organiza-
tion that one bid for funding was postponed because she was
unavailable to comment on the proposal.
Word of mouth has marketed the course: “I heard about the
course from a workmate of mine who has really improved in the
way she articulates issues and her high quality skills in writing.
I have always wanted to study health promotion and contribute
to the society I live in, but seeing how my workmate is contrib-
uting to our livelihood and the organisation in general just
gave me the final kick I needed. Mostly the critical analysis and
the reading. Looking forward to developing those skills.”
(Zambia cohort 6, 2011).
Finally, one student gave this testimony:
“The Course has changed my life around. I would simply say
that it has widened my horizon in terms of education and my
employment. By this I mean to say that I have been promoted
three times in the civil service which is not usually the case and
it’s not usually easy to achieve... The time I was starting the
programme I was working for ministry of commerce and trade.
The course enabled me to be transferred to the ministry of
health on a promotional basis from just being an economist to
being a senior Planner.
1) My new job involves resource mobilization;
2) donor coordination through the SWAp mechanism (this
was my research/dissertation topic);
3) publications of health related books—I was coordinating
the review and production of our National Health Strategic Plan
2011-2015; participated in the institutionalisation of the Na-
tional Health Accounts, participated in the designing of Social
health Insurance and the new resource allocation formula;
This is to mention but a few of my success stories in the Min-
istry of Health. I feel after the masters’ degree I am functioning
at a national level, and I am learning a lot of thing in line with
my degree. I think the degree just made me look at health from
a bigger picture and with a more analytical approach. For me
to be at the Head quarters for the Health Sector the require-
ment was a Masters degree which I acquired from Leeds Met.
My vision from here is to 1) get a multinational job with the
UN system so that I could contribute at a global picture; 2) to
do my Ph.D. with University of Leeds metropolitan.
It is my sincere wish that the commonwealth scholarships
should continue in Zambia especially that the Course at M-
level is expensive and not easily available to a common man
like me. And my thanks go to all my lecturers at Leeds Met for
equipping me with educational/academic life skills.” (Zambia
cohort 3, 2008)
What is needed now however, is an independent evaluation
of the course and its impact, and we have budgeted for this in
the near future.
North South Partnerships
North-South partnerships are essential to the kind of creative
solutions for the lack of educational opportunities in Africa that
this provision has tried to address. Achieving equity within
such partnerships is not easily achieved (Academy of Medical
Sciences and Royal College of Physicians, 2012). We are aware
that they rely on mutual trust and respect, recognition of each
others’ strengths, and that partnerships require constant main-
tenance and nurturing, based on secure personal relationships
and strong institutional bonds. Leeds Met staff require excellent
interpersonal and cross-cultural skills, a political commitment
to working with partners in the global south, and imagination
and creativity to overcome the inevitable challenges. Leeds Met

R. DIXEY
754
staff, a mix of those with considerable experience in Africa and
those with none, have all gained immensely in personal and
professional terms from the opportunity to teach overseas. The
richness of experience influences teaching back in the UK, and
enables the e nrichment of teaching mat erial. The work in Zam-
bia and The Gambia could not take place without supportive
colleagues on the ground who can see the benefit of what we
are doing. How such partnerships operate would be the subject
of another paper. However, the Leeds Met-Chainama partner-
ship was mentioned in a guide to good practice produced by the
Association of Commonwealth Universities (Wanni et al., 2010),
and features a picture of our students on its front cover.
Conclusion
Delivering our postgraduate health promotion course in Af-
rica is seen as a creative solution to the lack of educational
capacity in sub-Saharan Africa, and to the need for greater
health promotion capacity; further, it addresses the increasing
costs of students accessing courses in the global North. Devel-
oping the provision in partnership with the health worker
community in Zambia and The Gambia has ensured that the
course remains relevant to local needs. The loss of overseas
experience and of developing “global competencies” are argua-
bly outweighed by the possibility of developing a critical mass
of Masters graduates which can effectively drive changes in
public health in their respective countries. Arguably too, these
global competences can be “home-grown” and studying locally
doesn’t necessarily preclude thei r development.
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