Thirty-one interviews were conducted with stakeholders, facilitators/supervisors and students involved in the programme from all the partner institutions. Of these interviews, 12 were with students in KSPH (9 master’s students, 3 PhD students), 11 with facilitators or supervisors from all three partner institutions, and eight interviews from stakeholders at UNIKIN, KSPH, rural research site, and Bergen (Table 1). One PhD student had also graduated on the master’s programme.
Four selected participants were unavailable to participate in an interview during the study period. These were one master’s student, one facilitator from KSPH and one from UKZN, and a stakeholder from Bergen. The master’s student was replaced by another student from the same cohort. One KSPH facilitator was replaced by another staff member from KSPH who had participated in teaching one module. One UKZN facilitator had left the university and could not be reached and was excluded. Overall, 13 interviews were conducted in French and 18 in English.
Characteristics of participants are shown in Table 1. Many of the facilitators and stakeholders were in management positions in the different institutions, and there was overlap between the two roles with five facilitators also having a management role in the project.
The findings are presented below under the main themes: perceptions of the partnership, experiences of joint teaching and supervision, and perceived benefits of the GROWNUT programme.
Table 1: Demographic details of participants
Supervisors/facilitators (n=19)/stakeholders n= 19
|
Age (median)
|
54 (IQR 12)
|
Gender
|
Male
|
9
|
Female
|
10
|
Role
|
Managers at KSPH
|
4
|
Manager at UNIKIN
|
1
|
Norad representative
|
1
|
Rural site respresentative
|
1
|
Facilitator/supervisor on the GROWNUT programme
|
11
|
Current position
|
Professor/academic staff
|
15
|
Project manager/advisor
|
2
|
Director of nutrition (PRONANUT)
|
1
|
Community leader rural research site
|
1
|
Institution in which based
|
University of Kinshasa
|
12
|
University of KwaZulu-Natal
|
3
|
University of Bergen
|
4
|
Students (n= 12)
|
|
Age (median)
|
39 (IQR=11.5)
|
Gender
|
Male
|
8
|
Female
|
4
|
Occupation
|
Medical doctor
|
9
|
Academic assistants
|
3
|
Level of academic of study
|
PhD / Doctoral degree
|
3
|
Master’s Degree
|
9
|
Partner university who co-supervised the degree
|
UKZN
|
5
|
University of Bergen
|
6
|
Did not have a co-supervisor from a partner university
|
1
|
Attended training at partner universities
|
Attended training at UKZN
|
9
|
Attended training at UiB
|
3
|
Perceptions of the GROWNUT partnership
Several stakeholders and facilitators/supervisors mentioned that a guiding principle of the GROWNUT partnership was that from its inception all partners had the health and nutrition needs of the DRC in mind. According to these participants, the main aim of the project was to produce a cadre of health professionals to work and conduct research in the field of nutrition in the DRC to address nutritional diseases and improve health in the country.
The partnership between the three institutions facilitated the establishment of the nutritional epidemiology master’s and PhD programme at KSPH, providing an opportunity for the training of a new cadre of researchers in DRC. Teams from the three institutions collaborated in bringing different skills and resources to capacity building at KSPH through curriculum development, support of KSPH staff, and joint teaching and supervision of students. Project activities were set to be shared among the three institutions, allowing for the exchange of knowledge and skills.
The main aim of GROWNUT is, I think it is clearly written here, is fostering capacity, capacity building, because before GROWNUT, we did not have staff and also people out of the staff with a known background in nutritional epidemiology … So, the idea was to place specialised persons with a known background in nutrition, especially in nutritional epidemiology, in the most affected health zones [health areas] and to do so you need staff with training or well trained in nutritional epidemiology. (Stakeholder 3, KSPH).
All participants perceived the partnership positively, feeling that the contributions of all three partner institutions added value to programme activities. A facilitator at KSPH summarised the overall benefits of the partnership as follows:
It was a very good experience, an experience of exchange, an experience of sharing between the three institutions. It did allow us [to] improve the level of our university, of our school of public health because the facilitators came from everywhere; Bergen, KwaZulu-Natal … sharing experiences between three universities of quality, the schools of public health of quality; it was a very good experience … I can say that it was very good to exchange and share knowledge. (Facilitator 5, KSPH).
The nutritional epidemiology programme was the first of its kind in KSPH and in DRC. The educational programme mixed theory with clinical practice at the rural site, and included facilitators from partner institutions in all aspects of the programme. The KSPH mission was structured around three distinct pillars, teaching, research, and community service, and the GROWNUT partnership provided opportunities to address all three pillars.
And you know a particular programme for GROWNUT was very good for us because they give us the means or the occasion to mix theory and practice. You know the University has three missions, the first one is to teach, the second one is to research and the third one is the service to community. GROWNUT gives us an opportunity to link all of them, you know the training of our students in Popokabaka [rural research site] were very important so there they were doing the research but serving the population too (Stakeholder 2, KSPH).
However, the nutritional epidemiology programme was dependent on external funding, which paid for bursaries, maintaining the rural site, travel to the rural site and travel to partner universities and to conferences. Many students were able to enrol in the programme through the funding opportunities provided. Several participants mentioned that it may be difficult to continue running the programme without external funding, posing challenges of sustainability after the partnership is over.
I am not sure actually that this programme will continue as it is if there is no external interest and funding (Facilitator 9, Bergen).
The importance of a common vision
The partnership was funded by the Norwegian government in response to a funding call. As a result, it was planned at the outset to comply with the requirements of the funders. However, it was important for partners to identify a common vision in running the project, so that it would benefit all partners. Some stakeholders and facilitators mentioned that bringing together partners with different cultures, expectations and requirements was very challenging at times, and emphasised the importance of developing and keeping a common vision throughout the project period.
… the experiences with bringing three different universities with three different cultures, three different kind of backgrounds together and run a long programme together has been in one way a challenge but also very much something that we have learnt from … (Facilitator 2, Bergen).
Project leaders and facilitators had meetings specifically aimed at establishing and maintaining a common vision to guide teaching and co-supervision between the partners. This was helpful for co-supervisors in capacitating them to provide supervision in partnerships.
I participated in the [supervisors] Workshop in Durban. The workshop was a good experience because it improved my skills on how to supervise students’ research project (Facilitator 4, KSPH).
Regular meetings and communication between the three institutions were highlighted as being important, and communication between participating partners continued throughout the project with regular Skype meetings that facilitators described as being useful for maintaining common goals.
I think the team, although we are in three different cities, we talk regularly, we have regular Skype meetings and our Bergen colleagues are very good at writing down the action points, following up on the action points, making sure things get done, we have not really been in any conflict around the plans (Facilitator 7, UKZN).
One challenge mentioned by the participants, that impacted on the development of a common purpose, was a concern about how the hierarchy and power dynamics played out between the partners. Some participants suggested that the partnership was viewed as a one-way partnership with the two partnering universities capacitating UNIKIN instead of a three-way partnership benefiting all three institutions. In some cases, the collaborating partners were perceived as experts and took on the leadership role in running the activities of the program.
I think the leaders are very much from Norway and the UKZN and my observations are that they are the stronger partners and the bigger voice and they drive the kind of agenda (Facilitator 11, UKZN).
Experiences of joint teaching and supervision
Teaching
Teaching was shared between the three partners, and during the first two years of the project, facilitators from collaborating partner facilitators travelled to KSPH to provide teaching jointly with local facilitators, with English as the medium of instruction. However, in many cases local facilitators failed to work in partnership with facilitators from partner universities, leaving them to teach alone. In addition, the use of English limited participation of some academic staff from KSPH because they did not feel confident to teach in English or to interact with international facilitators.
In the first year it was kind of very much divided so that when the Norwegian was teaching, there were only Norwegian teachers in the classroom. When the South Africans were teaching, there were only South African teachers in the classroom but then after the first year we decided we need to do this kind of, as a process where the Congolese teachers, there should always be a Congolese teacher in the classroom to follow so, that they can take over (Facilitator 2, Bergen).
Facilitators from collaborating universities were very much appreciated by the students who perceived their participation as an opportunity to gain additional insights into their studies and research topics. However, in some cases the language barrier made it difficult for students to understand English-speaking facilitators and hindered the learning experience for students.
For me the problem was the English language. To be honest, I did not finish the module because the English was very strong. Moreover, I did not want to appear stupid because I am passionate about school (Student 9, PhD).
Due to political unrest in DRC, international facilitators were unable to travel from the third year of the project and from the enrolment of the third cohort of master’s students the responsibility for providing classroom teaching fell on local facilitators. However, students in cohorts three and four travelled to South Africa for a two-week course on proposal development, giving facilitators from collaborating universities the opportunity to provide teaching and interact with the students as part of the common vision for the programme.
I think it was a big advantage in a way that we moved the proposal writing to Durban. Uh, not least because we then got the chance to have all the three universities together and all the three, kind of three mindsets present in the same room and doing really collective teaching. It was not one teacher observing the others but we were kind of doing this together (Facilitator 2, Bergen).
As a result of the travel ban not all KSPH based facilitators benefited from joint teaching. Many of the Kinshasa based facilitators regretted that the face-to-face teaching was largely discontinued after the second year. Local facilitators continued with teaching inspired by lessons learnt in the first and second cohort of the project.
It is true that when the programme started it was understood that the external professors will come to provide some form of coaching, bring their international expertise to Kinshasa and ensure that when he goes back Kinshasa will carry on with teaching and learning using the new methodology. I would say that it is what was done because during the first year of the programme each course facilitated had two professors, one from here and one from outside … It was the local facilitators, inspired by the experience of the first year, which had to replicate the teaching and learning approach of the first cohort (Facilitator 4, KSPH).
Supervision
Supervision was done in partnership between local and international supervisors; each student had a local supervisor and a co-supervisor from a partner university for their research. Communication between supervisors was often a problem, and supervisors reported that a lack of effective communication between supervisors in relation to comments on students’ written work caused tension between supervisors. Co-supervisors mentioned that their views and recommendations on students’ work were often disregarded, with students failing to address comments. In particular, co- supervisors’ recommendations about whether the work had reached acceptable quality for submission were sometimes ignored. KSPH had the final say on students’ graduation, causing some disagreement among partners about the quality of theses submitted.
Based on our agreement the main supervisor was from the school [KSPH], the school should be in the driving seat, so the main supervisor was from our school and others were coming in from other places. So, for instance, when a student was drafting his thesis he or she would submit first to us and then share the feedback with other colleagues from UKZN or Bergen, so but most of the time the main decision was coming from our side, that we accept or do not accept … Sometimes a supervisor from our side will go ahead and not take into account or not wait for the feedback from colleagues from elsewhere, that was frustrating for our colleagues but we were trying to address that (Facilitator 8, KSPH).
Some students also questioned whether the roles of the two supervisors were clear and mentioned that a lack of communication and co-ordination between supervisors meant that feedback was sometimes contradictory, making it difficult to know which advice to follow.
The negative side that I noted was that the co-supervisors were not collaborating between themselves and I was the bridge between them. However, I do not think they were discussing my work among themselves (Student 7, Master’s student).
Students and supervisors from all partner institutions expressed frustration with the communication between supervisors and students, the distance and lack of travel opportunities made it difficult for co-supervisors and students to develop strong relationships, thus making communication and resolutions of disagreement about students’ theses difficult.
I think that [supervision] was the biggest challenge, there were a number of challenges in the supervision. I think timelines were very difficult, people did not keep to timelines, they seemed to be quite flexible in Kinshasa, you thought you knew when people were going to Popokabaka [rural research site] and submitting their theses and so on and so on. Those timelines seemed to shift and move around and be fairly flexible, it was difficult to predict what needed to be done by when, you tended to have a lot of students wanting feedback all at the same time (Facilitator 7, UKZN).
Co-supervisors from partner institutions were perceived by students to be experts in their field but students felt that local supervisors had a better understanding of the context in which they were working. Students mentioned that it was much easier to receive feedback face-to face. The long-distance nature of the interactions was described as difficult at times, particularly given that co-supervisors communicated in English.
That [co-supervision] is a very important thing because it allows the student to have more knowledge as he has comments from all the supervisors. This helps the student to get perfection in the job done. I always say that having feedback from different supervisors is very beneficial for me, although some supervisors would have different preferences on the method of research. I take all the comments and feedback into consideration and apply all the suggestions because I believe that they have all read the document, and found mistakes that they want me to correct, after both supervisors have reached common ground. This makes for good quality and it is in my favour (Student 10, Master’s student).
Perceived benefits of the GROWNUT programme
KSPH
Facilitators/supervisors at KSPH felt that the contributions of collaborating partners enriched and strengthened their learning experiences and enhanced their academic growth by providing a variety of skills and insights from researchers at partner institutions. Some stakeholders also mentioned that the partnership was beneficial not only for KSPH but also for DRC by providing resources to address nutritional problems in the country. The interactions arising from the partnership were particularly valuable in capacity building for KSPH academic staff, including junior staff, and participants expressed appreciation for the opportunity to learn and advance their academic skills through the relationship with the partners.
I was not trained in advanced epidemiology but I had to teach it. As such, I had to learn the subject to be able to facilitate it. This contributed to improve my knowledge and skills in the subject of epidemiology. As such, GROWNUT helped me to build my own capacity (Facilitator 4, KSPH).
One of the benefits of the programme was the establishment of a rural research site in Popokabaka, and participants mentioned that the project provided an opportunity to disseminate findings from student research at the rural training site. One of the stakeholders from the rural site mentioned that the conference organised by the project in Popokabaka was helpful in getting the community to understand some of the nutritional issues they were facing.
It was done in two stages where some members of the community were selected, due to scientific nature of the project, to participate. Secondly, we used the local radio and the local language to allow the entire community to understand what the students were doing (Stakeholder 8, Popokabaka).
Some stakeholders from KSPH mentioned that through the partnership they were now moving towards a new system of learning within the university, an online system similar to what is done by international universities.
Now we are building e-learning system ... We can teach from here to KwaZulu[-Natal] and we can also receive courses, training from KwaZulu[-Natal] to here. We have just to build a very good platform for that. We have now equipment and the School of Public Health will be accompanied in these programmes by Bergen (Stakeholder 1, UNIKIN).
The programme included support and resources for KSPH staff and students to present research findings at international conferences, which was highly valued by participants. Attending conferences gave participants exposure to the broader scientific community, providing opportunities for networking with other nutrition researchers, and for engagement with a range of academics with different experience of health research across Africa and elsewhere. In addition, the contribution of the partners added to the quality of the research outputs, thereby adding credibility to the research produced by the GROWNUT students.
In terms of the quality of the research projects that I supervised, the quality was higher than those of the other [master’s] programmes. Perhaps the advantage of GROWNUT was that supervision was not conducted only locally but internationally. This brought about a level of rigour from both local and international pushing student to be more committed and less lazy than those in the other programmes (Facilitator 4, KSPH).
Collaborating partners
Facilitators and stakeholders from partner universities mentioned various positive benefits of the partnership including personal development and career development, and some international facilitators mentioned they gained skills and knowledge in nutrition, training and career growth opportunities for staff.
… it has given myself and my team a different perspective in lots of areas, … I have learnt a lot about nutrition (Facilitator 7, UKZN).
Some of the facilitators/supervisors mentioned that the partnership opened opportunities for advancing their careers, including publication of research papers and employment opportunities.
I have learned a lot and I even benefitted from it with papers from University of Bergen, because as part of being now employed at the University of Bergen because of this programme, they forced me to take this university pedagogy and I have used kind of the experiences from GROWNUT in writing up papers for those courses (Facilitator 2, Bergen).
Students
Although some of the students mentioned they were unaware of the GROWNUT partnership prior to enrolling for the Master in Nutritional Epidemiology, after enrolling the students felt that the partnership added value in their training and learning experiences.
For me, the partnership is good because it allows the programme to have high value, you see. The University of KwaZulu-Natal and the Bergen University are well known universities and take the higher rank worldwide. Having Professors coming all the way from there to our university here is huge. This triangulation, partnership shows that what we are learning is of high level and all these are for our interest (Student 10, master’s student).
For the students, the partnership offered opportunity for career pathing and opened the door to seek opportunities outside of DRC. Some of the students were employed by KSPH as assistants to provide teaching, being involved in the project improved their skills in teaching.
I am like a GROWNUT teacher, I feel like this program helped me to have more skills in my institution. To be a good teacher (Student 03, master’s student).
Some PhD students were able to publish papers during the project period. However, none of the master’s students have published any papers thus far. One of the PhD students mentioned that the partnership of institutions helped him in improving the quality of work published.
… the main objective to me is to become competitive, you know, before the programme, before starting this programme I used to publish local journals and some low quality reviews but working with the two other universities it was an important to me to aim high, you know … my paper needs to be relevant for the scientific community so I need to work hard and the skill I got from the project I think maybe I can say that the project, the two universities, Bergen and KwaZulu-Natal helped me to increase my view on scientific evidence of some array, especially for nutritional aspect in the DRC (Student 12, PhD student).