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Nutrition training at centres in developing countries
S.J. Ismail, A.A. Jackson, and J.P. Landman-Bogues
Tropical Metabolism Research Unit, University of the West Indies, Jamaica
In the past the training of senior-level nutritionists destined to work in developing countries had to be provided by institutions in the developed world. More recently we have seen the emergence of institutions and programmes in the developing countries that provide training for their own nationals, often within a regional context. However, to carry out training of quality at this level in such an environment presents difficulties. The World Hunger Programme within the United Nations University and the creation of a network of associated institutions located predominantly in the developing world represented an important step in attempting to address these difficulties. With the experience accumulated it is now useful to examine the relative advantages of training programmes in the developing world, the problems they face, and possible approaches towards solving these problems.
In general terms, it is desirable, wherever possible, that education take place within the context of first-hand experience. Given the extent and breadth of nutritional problems in developing countries, they offer experiences and opportunities that cannot be duplicated in the developed world.
The advantages of nutrition training within developing countries can be divided into four categories: the advantage to trainees, to the training institutions, to the countries or regions in which the institutions are located, and to the developed world.
Advantages to trainees
The training provided can be of immediate relevance to the students. While an overview should be provided of problems and experiences of nutrition in general, the programme can emphasize the socioeconomic structures and agricultural and nutritional problems as well as nutrition activities that are appropriate to that region. The student is able to learn from readily available field and clinical experience. He can be involved in the management of malnourished children; he can observe for himself the aetiology of malnutrition that is peculiar to his region
In addition, students in programmes in developing countries establish early links with future colleagues, both in government ministries and in the training institute itself. Our own experience at TMRU has been that such links are invaluable, particularly for nutritionists who are required to function in relative geographic isolation.
Advantages to training centres
The presence of a training programme within an institution or centre encourages both staff development and the development of the institution's infrastructure. The institution itself is brought into the mainstream of the immediate practical problems that the trainee will have to face and resolve. Staff development itself improves both the ability of institutions to attract and retain staff and the development of research capabilities. The institution should also seek to establish links with similar centres in other developing countries to facilitate exchange of ideas and experiences.
Advantages to developing countries
The major advantage to developing countries of programmes based in regional or national centres is the provision of nutritionists with the experience and understanding of local needs and problems. In addition, the presence of locally trained nutritionists and of a training centre improves the ability of the country of meet its national needs with a greater measure of independence. The training centre itself is available as a resource centre, to provide research and training expertise. Research carried out by the students themselves, in the field or in the laboratory, provides much valuable information.
Many students trained abroad fail to return to their countries upon completion of the training programme. The provision of good local training reduces this loss of skilled personnel, a loss that developing countries can ill afford. In addition, the development of a national research and training institution encourages professionals to remain in their own countries. Such institutions contribute to national development by increasing the pool of skilled, experienced, and professional cadres and by encouraging problem-solving and traditions of self-reliance.
Advantages to the developed world
Many of the centres that now provide senior-level nutrition training and research facilities were created and funded by countries of the developed world. Nutritionists from these countries have contributed substantially to the development of these centres and have, in turn, obtained much of their research experience and training in them. Such collaboration continues today, despite the fact that a proportion of the centres' support now comes from local governments. The continued development and maintenance of centres offering good research and training facilities is of value to all nutritionists.
It is generally assumed that one of the advantages of local training is reduced cost. This is not necessarily so. To provide a high quality of training that is on a par with training provided in developed countries, an institution requires good laboratory and library facilities and qualified staff. The cost of laboratory materials and equipment as well as that of books and journals is always higher in developing countries because of transportation costs. In addition, most developing countries face severe foreign exchange shortages. Research in developing countries is fraught with many problems, such as the maintenance of laboratory equipment, vehicles for field work, and the availability of support facilities. The cost of maintenance is high, frequently involving the cost of flying out skilled personnel to undertake equipment repair or servicing.
In order to retain qualified staff, the institution needs to offer salaries that are competitive with those offered in developed countries. Academic staff, as well as the training centres themselves, require long-term guarantees and security of existence. Short-term funding discourages the proper planning of programmes and institutional development as well as the long-term commitment of staff members that is so vital to such planning. In addition, staff members frequently experience isolation from the academic world unless frequent travel is possible. It is essential for them to attend international conferences and workshops, as well as to spend short periods at centres in both developing and developed countries in order to familiarize themselves with the latest techniques and concepts, and to exchange ideas with colleagues. Both funding and time for such travel is generally limited. Highly trained professionals are a scarce commodity in developing countries; those that are available are overburdened with a variety of tasks that may range from advising governments on national policy to supervising health aides in field projects. However, national or regional training programmes themselves can help to alleviate the shortage of professionals.
The continued existence and development of nutrition training programmes and centres in developing countries requires the long-term commitment of both governments and international agencies. The commitment of most of the staff at such centres has already been well demonstrated: some function on salaries from short-term funding with a complete absence of job security, others continue on inadequate salaries in countries with high inflation rates.
The ability to train and retain its own professionals is vital to the development of a country, and the support of training programmes and research of training centres must therefore command the attention of international and other funding agencies. Long-term guarantees are needed to provide security of tenure.
International agencies can assist specifically by offering assistance in the following areas:
Considerable assistance has already been provided in some of the areas listed above. Assistance in these areas, and in those that have received scant attention in the past, should perhaps be re-examined to establish priorities, to assess the nature and extent of support, and to discern the contribution such support makes towards helping developing countries meet their own needs.
Fellowships are crucial to the continued existence of all training programmes. Most developing countries face serious economic difficulties and are unable to provide the level of support to trainees and centres necessary for continued development. In addition, many potential candidates for training programmes are mature individuals in positions of seniority within their own countries. Fellowships should be such that they are able to attract these individuals who, upon completion of the training programmes, would be in positions that permit them to influence national food and nutrition policies and activities.
In the face of rising costs, many developing countries are unable by themselves to maintain and support the development of their training and research centres. Given the importance of the continued existence of such centres to nutritionists the world over, and to the continued development of nations, international and other funding agencies should seriously consider adequate, long-term commitments.
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