British Medical Journal, 2003
"Serious challenges remain in sustaining the future of medical schools in sub-Saharn Africa. The reasons for failure of most medical schools in sub-Saharan Africa must now be studied. The failings of institutions in resource rich countries must also be assessed while appreciating ongoing success. Case by case analysis of medical schools in sub-Saharan Africa would show an excellent first 10 years followed by a general downward spiral. History over the past 45 years clearly shows this pattern throughout Africa. The current international reputations of the schools are not similar to those during their first 10 years, although esteem for South African institutions remains much higher. The reasons are complex. Few are inherent to the medical school, most resulting from external forces beyond their control. These include civil wars, civil strife, political instability, lack of appreciation of local talent and advice, diminishing health budgets in real terms, and economic misdirection."