Training the future’s health workforce within rural, poor, or vulnerable settings is a sustainable means of addressing global health inequities. Students acquire an understanding and ability to analyse the unique bio-social health challenges faced by marginalized groups, and are therefore better positioned to provide tailored, contextualized care for those most vulnerable. Yet while this need evidently exists, too few future health professionals stay within low-resourced settings where the need is greatest, swept up instead in the significant migrational trend of students to train in cities where they will likely be better compensated, and have greater access to resources. The problem of ‘brain drain’ hangs on two issues: there are too few quality institutions within rural settings, and those that do exist, lack sufficient infrastructure and facilities to compete with the education offered in urban institutions. Lack of funding (both upfront and long-term investment) coupled with a lack of properly trained project managers in these areas has resulted in widespread issues of weak physical infrastructure in rural health institutions, which severely caps the learning opportunities these institutions can provide. Without funding, many rural institutions will be unable to procure even the most basic equipment, laboratory and classroom space, and online learning capacity systems, the latter which has been critical to the survival of these organisations during Covid-19. Beyond procurement, without qualified project managers you cannot implement them in a structured and phased way to ensure future sustainability. Whilst Covid-19 has resulted in large-scale investment towards healthcare and education infrastructure in urban areas such as Nightingale Hospital in central London and Brigham and Womens Hospital in Boston Massachusetts, many rural healthcare and health education facilities including hospitals, health centres, health posts, and medical schools have been left behind. This lack of funding stems from low tax or revenue base for raising domestic funds, low prioritisation of health in public sector resource allocation, spending inefficiencies, and the widespread misconception that quality medical and learning facilities can only exist and be properly implemented within urban settings. Public and private institutions, governments and funding organizations need to recognize that by bolstering the institutional infrastructure in rural areas, they create robust foundations to contribute to better health outcomes for all. The University of Global Health Equity (UGHE), a global health sciences university in the rural north of Rwanda, is proof of this. It’s students benefit from unparalleled learning opportunities within a state-of-the-art campus, whilst also in close proximity to the communities they will go on to serve. UGHE’s well-equipped science laboratories facilitate anatomy dissection and basic and clinical sciences education, and a sophisticated campus simulation center offers students extensive practice with realistic patient care scenarios. Classrooms are equipped with modern teleconferencing capabilities to facilitate remote instruction, such as the ability to host virtual anatomy lessons between two continents. Infrastructure considerations should not stop at practical facilities, though of course these are critical. At UGHE, the strategic planning process extends to making its campus green and environmentally sound, in the knowledge that a conducive learning environment is an important part of student study. The students and those that serve them - faculty, staff, and campus contractors - study and operate in a deliberately green space, surrounded by trees, butterfly gardens, fish ponds, and the 13.5ft Muhabura volcano in Rwanda’s Volcanoes National park. This same principle applies to health facilities such as hospitals and health centers: a green and dignified ‘space’ is conducive to the provision of high quality medical care and better patient and health worker mental wellbeing. Across the valley from UGHE’s Campus, Butaro District Hospital was designed and built to provide high quality medical care and a patient-centered experience. Green energy and infection control features are also among the major guiding forces to its expansion plans that will see it accredited as a teaching hospital for Rwandas public and private medical schools. With Covid-19 putting intense pressure on health care and education institutional systems, health sectors and health education institutions should embrace agility and adaptations to maintain vital services amidst a crisis and efficiently respond to the changing institutional requirements. Adaptations include transitioning to virtual teaching, and revised campus operational policies and protocols to meet hygiene and social distancing measures. Agility is key to rapid response, supported by the collaboration, task shifting and clear communications between institutional staff who themselves can serve as agents of institutional change. Health care and health educational institutional leaders will also need to determine the facilities maintenance approaches and systems that are pertinent to their institutional architecture, engineering and location to accommodate future growth. UGHE’s Butaro Campus was uniquely built using locally sourced materials for building and a 90% local construction workforce, making maintenance easy, and simultaneously driving socio-economic impact in the surrounding communities. A mobile-first facility management system BIM 360 Ops was also acquired to manage the University wide infrastructure. The system allows quick interaction among and between the campus maintenance team and all campus occupants irrespective of where they are. The campus was also already designed to accommodate crises like Covid-19; private student and staff housing supports social distancing, and pre-existing learning management platforms facilitates virtual teaching. The ever-evolving Covid-19 measures warrant agile, adaptable systems and strong facilities management teams to maintain quality health and education services for all. The location of health care and health education facilities should not determine the quality of healthcare and health education facilities located in rural areas. High quality medical care and education can be, and should be delivered in state-of-the-art facilities in rural areas, to ensure that the health professionals trained are qualified, responsive, and equitable in their approach to delivering care to the communities that need it most. Emmanuel Kamanzi is the Director of Infrastructure at the University of Global Health Equity (UGHE).
