Background and rationale

In an article in this journal entitled ‘Positioning Africa’s public health doctoral students to lead societal transformation and development’, Ndejjo and colleagues1 argued that public health PhD programmes on the continent need to prepare candidates for a variety of roles and career trajectories in the ‘knowledge economy’ other than academia, whether in the civil service, civil society or the private sector. These careers require a skill set, including managerial, communication, networking and entrepreneurial skills, beyond formal research and teaching, and thus need to be supported by relevant curricula and work-based learning opportunities.

Calls for a differentiated approach to doctoral training on the continent are not new2 and part of global trends towards both ‘massification’3 and widening of doctoral training to serve a variety of scholarly, market and personal development purposes.4 Many people applying to PhD programmes are based, or envisage futures, outside of higher education institutions (HEIs). They are the knowledge workers who require ‘broad, transferable and generic and problem-solving skills … able to continually adjust their repertoire of knowledge and skills to changing environments’.5 These preoccupations intersect with calls for strengthening the workforce for a ‘New Public Health Order’ by the African Union,6 debates on decolonial and African epistemologies, and to the ongoing project of postapartheid transformation of the higher education sector in South Africa.7 8 Doctoral education targets are part of South Africa’s National Development Plan 2030, intended to create the ‘national capacity to appropriately and innovatively respond, through research, to the various demands of globalisation, localisation and transformation’.9 There are national funding streams for doctoral education and qualification standards monitored by the national regulatory authority, the Council for Higher Education.9

Against this back drop, we reflect on the evolution and strategies of the PhD programme of the University of the Western Cape’s School of Public Health (hereafter UWC SOPH), and how it has been shaped by and has sought to respond to these wider trends. Drawing on Moll’s10 ‘stratified model of curriculum responsiveness’ we explore further the meanings of responsive public health doctoral education and the implications for the future development of programmes in a context such as ours.

UWC SOPH is one of a dozen postgraduate Schools of Public Health that emerged across South Africa from the mid-1990s onwards, with their flagship programmes the course-work Masters in Public Health (MPH).11 With time, however, doctoral programmes have grown and become a central part of the everyday life of these schools, reflecting growing appreciation of the relevance of public health training to improving population health outcomes and strengthening health systems.12 While there is an established body of research on the MPH, including on models, key graduate attributes and even impacts,13–17 there has been relatively little consideration of public health doctoral programmes in South Africa and the continent, the imperatives shaping these programmes and the institutional capacity required to adequately respond to changing demand and needs. A key exception is the thinking contributed by the innovative Consortium for Advanced Research Training in Africa (CARTA), established in 2008 to strengthen institutional capacity through doctoral training in population and health sciences in Africa.18–21

Frame of reflection: curriculum responsiveness

The PhD is the terminal or apex qualification of a university and often characterised as an ‘independent and original contribution to knowledge’. While conceived of as an individual journey, the PhD is bound by organisational and institutional rules and norms that span the discipline, university/higher education and societal fields. A responsive curriculum in higher education, according to Moll,10 recognises and simultaneously engages imperatives at macro-social, institutional/cultural and individual learning levels, while staying true to the knowledge and ‘systematised forms of enquiry’ characteristic of the discipline and the academy. This is represented as a series of interacting levels of responsiveness (figure 1).

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Figure 1

Multi-faceted, stratified model of curriculum responsiveness. Source: Moll.10

Taking an economic/policy perspective on public health doctoral programmes, would, for example, acknowledge their growing role in training the leadership cadres of country health systems and new public health organisations on the African continent.22 In South Africa, a National Health Research Committee conducts regular national health research prioritisation exercises.23 Institutional/cultural responsiveness, on the other hand, is a more bottom-up orientation to the knowledge needs and ‘lived socio-cultural realities’10 of PhD candidates, enabling them to embark on projects that critically interrogate these realities as ‘engaged scholars’.24 It is akin to the idea of ‘epistemic justice’.7 25 Disciplinary responsiveness refers to the ways in which the established and emerging conceptual and methodological repertoires of public health (as an applied, interdisciplinary field) create ‘bridges of meaningfulness’10 with chosen research problems. Finally, pedagogical/learning responsiveness requires engaging the theoretical underpinnings of teaching and learning that promote critical and analytic thinking and autonomy; it considers the needs of students with diverse abilities, backgrounds and learning preferences in South Africa or Africa, and the strategies that enable student progress through the stages of the PhD journey, often considered an arduous experience associated with high dropout rates and mental distress.26 This is the idea of ‘epistemic access’, which refers to ‘the process of learning how to become a successful participant in the academic practice of a tertiary institution’, enabling ‘understanding of how the university operates or ‘thinks’’, in this case, with respect to the PhD degree.27

Institutional responsiveness

The University of the Western Cape was established just over 60 years ago and became widely known as a node of anti-apartheid resistance and critical scholarship in the 1970s and 1980s. In the postapartheid period, more especially over the last decade and a half, UWC has positioned itself as research-led, growing its research outputs and doctoral graduations, while seeking to remain true to its origins and ethos as an engaged university.28 As explained in its Institutional Operating Plan, this does ‘not imply a binary opposition between engaged and ivory tower. Rather, UWC [sees] the excellence of intellectual work as promoted by the challenge to make sense of a complex and changing world’. This is also reflected in UWC’s Charter of Graduate Attributes for the Twenty First Century, that commits to nurturing critical scholarship and critical citizenship alongside the ‘independence, self-learning, problem-solving … and entrepreneurship’ appropriate to ‘the changing labour market’.29

Following this tradition, the SOPH at UWC was established in the early 1990s with explicit values of equity and social justice, on the one hand, and a pan-African orientation, with respect to both faculty and students, on the other.15 From the early 2000s it introduced flexible modalities that enabled part-time and distance learning, which, with relatively low fees, facilitated access to diploma and masters programmes to students from across the African continent.15 The SOPH enrolled its first PhD students in 2000, focused initially on developing its own staff as part of university wide research capacity development. Numbers then gradually increased to 35 by 2011 and reached a ceiling of 52 enrolments by 2018, when doctoral candidates constituted a fifth of all postgraduate students. Since 2018, an additional 10–15 candidates are also enrolled in a predoctoral programme at any point in time. The majority (+80%) are studying part-time, and one-third are based outside South Africa, almost all in the rest of the African continent. As an applied field, doctoral candidates seek (and are encouraged) to evaluate real-world programmes or address policy challenges as embedded researchers30 in their settings. To date, the programme has graduated close to 80 students.

Reflecting global trends, demand for doctoral places at the SOPH has vastly outstripped the capacity to supervise. Over a 4-year period (2018–2021), the school screened more than 400 expressions of interest in the programme, nearly two-thirds from other African countries. Only one-third were based in academia, and the remainder worked in various positions in the health system, in international agencies and non-governmental organisations (figure 2).

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Figure 2

Current employment of applicants to School of Public Health PhD programme, 2018–2021 (n=427). *Health and social care providers, managers, policy makers; public and private; **unemployed/self employed.

The model of the PhD at UWC is a thesis by monograph or papers, reporting on an in-depth research project accomplished over 2–5 years. The PhD by publication, increasingly the model of choice (In 2021, PhD students were the lead authors on 30% of the SOPH’s publication outputs.) supports an incremental process of building a series of substudies into an overall dissertation. The university has a common approach to approval of doctoral research proposals, ethics reviews and examination processes across faculties. A Division of Post Graduate Studies (recently amalgamated with a Research Development Office) offers non-mandatory training courses in research methodology, statistical and qualitative analysis software, library support and writing coaches. The university has also signed ‘read and publish’ agreements with selected publishing houses and supports applications to national funding bodies (such as the National Research Foundation) for doctoral scholarships. UWC does not provide training or structured support for supervisors.

Beyond the dissertation, there is no mandatory course work, and no scope in current regulatory frameworks for accrediting such course work. The national qualifications framework does make provision for a professional doctorate, combining work-based learning and course work (40% credits) and research (60% credits). (According to the CHE,9 ‘The defining characteristic of this qualification is that in addition to the demonstration of high-level research capability it requires the ability to integrate theory with practice through the application of theoretical knowledge to highly complex problems in a wide range of professional contexts’.) However, there are limited institutional precedents for professional doctorates and the doctorate in public health (DrPH) is not offered at any South African HEIs.9 While widely regarded as necessary, the substantive formative work and approval processes to establish such a degree have yet to be undertaken.31 A few years ago, the UWC SOPH participated in a multi-country assessment of needs and competencies for a pan-African DrPH with a focus on strategic leadership,22 and SOPH is currently in the process of revisiting this model.

Disciplinary responsiveness

Over the last decade, as demand for doctoral training increased and the university targets on enrolment and throughput became more explicit, the SOPH introduced a number of doctoral programme systems and processes. These included streamlined application, screening and selection processes, a predoctoral period, 6-monthly cohort monitoring and a range of pedagogical and support strategies for candidates and supervisors.

These strategies were formalised in a programme aim and objectives in 2018 (box 1), and are steered by a departmental PhD team including two professors, a senior researcher as part-time coordinator and a senior teaching administrator, supported by a wider collective of faculty and administrative staff.

Over the last decade, the doctoral programme has shifted from a largely passive orientation, reliant on a one-on-one relationship of apprenticeship between a student and their supervisor/s (previously limited to a handful of senior players) to a more proactive, distributed and collective approach (involving a growing pool of junior and mid-career researchers).32 A supervisors’ forum meets three times a year to share challenges, exchange approaches and discuss key themes (eg, nurturing autonomy and critical thinking, managing the supervisor relationship and the role of artificial intelligence in PhD research). We are currently experimenting with a group supervision approach bringing together experienced and novice supervisors with candidates in specific thematic areas, referred to by some as a cohort model.32

The shift towards a collective programme approach has been enabled by an increasing number of PhDs among the core staff and the bolstering of the SOPH research infrastructure by the appointment of two nationally funded research chairs. Over 8 years (2014–2021) the SOPH benefited from donor funding through an international partnership that supported part-time and full-time doctoral bursaries and other doctoral programme activities. Over the last few years, however, both national and international funding has become more constrained, placing limits on future programme growth.

Pedagogical responsiveness

A key challenge of a growing doctoral programme is retention and satisfactory throughput. We identified a number of barriers to progress of candidates in our context. First, the substantive (eg, what constitutes an original contribution to knowledge) and procedural (eg, protocol approval, reporting, examination) rules of the game are often opaque to new entrants. As a result, they may underestimate the scope and complexity of the PhD, compounded by the fact that a large proportion of candidates are doing the degree part-time, often balancing work, studies and life. Finally, the PhD for the most part is a solo journey, and many experience isolation and moments of self-doubt.

Table 1 describes the pedagogical and support strategies we introduced in response to these challenges, following engagement with both students and supervisors. Drawing on notions of ‘epistemic access and success’ these strategies have sought to simultaneously demystify the learning journey from novice to expert, make explicit institutional expectations, legitimate varied (positive and negative) doctoral experiences, promote individual and UWC SOPH doctoral identities and build a doctoral community of practice. We have emphasised establishing favourable starting conditions,33 34 through a combination of a predoctoral phase and an induction programme, followed by mechanisms to promote ongoing peer interaction in retreats and monthly webinars; access to information; and writing and material support. Overall, these measures have strived for a ‘networked and supportive environment, [in which] the doctorate can involve both enjoyment and work-life balance’.33

While none of the measures are mandatory, participation has been high. In a survey of alumni and students (n=51) conducted in 2022, respondents rated most favourably the writing workshops/retreats and material support among the support strategies provided. Apart from the concentrated time away from home and work and the social writing spaces they offer, retreats provide the occasion for the emergence of informal information exchange, support and accountability networks, considered key to resilience in the PhD journey.35 36

The impact of these strategies has been better retention in and completion of the programme. Since 2018, when proactive programme strategies were introduced, only 2 of 41 (5%) new enrolees dropped out of the programme, compared with 15 of 52 (29%) enrolees between 2011 and 2017. The predoctoral programme has been key to this, allowing short engagement with a wider net of potential candidates, roughly half of whom progress to full registration. Graduation numbers have gone up (figure 3) and the mean duration on the programme has also gone down, from 6 years in 2018 (range 4–10 years) to 4.7 years (range 2–7 years) in 2022.

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Figure 3

Trends in graduation (n=77).

These quantitative achievements, however, say little about programme experiences. The reflections and inputs in monthly webinars, quarterly supervisor forums and periodic surveys and evaluations are important sources of feedback on the functioning of the doctoral programme. Through these, we have become aware that break downs in the supervisory relationship are not uncommon. We are also mindful that the intensified ‘temporal regimes’ of the ‘neoliberal university’37 may establish unrealistic timelines for part-time doctoral students, especially those in senior positions. We have been advised by administrators, for example, to forgo the predoctoral programme to meet enrolment targets for full registration, even if this leads to wasted effort and higher dropout rates. In a target driven, competitive and cash-strapped higher education environment, quantitative achievements can be a double-edged sword, and often lead to a ratcheting up of expectations of faculty. Moreover, a dominant focus on efficiency can undermine interest and investment in the non-quantifiable but critical dimensions of the doctoral programme, such as positive experiences and alternative modalities.

Elements of responsive public health doctoral education

Experiences at UWC SOPH highlight the institutional capacity and multi-level doctoral ‘infrastructures’ required for responsive public health doctoral education, able to engage continental realities, and meet evolving demands and needs in South Africa and beyond, outlined in table 2.

At departmental level, there need to be systems and support strategies that go beyond the candidate-supervisor dyad. However, sound programme practices at this level will only survive if there is wider university/institutional responsiveness. Universities need to consider the nature of demand for doctoral training and be willing to diversify and formalise curricula offerings that develop a wider set of graduate attributes; introduce programmes for training and support of new supervisors; and invest in the development of professional doctoral programmes (such as a DrPH); national accrediting bodies need to align their regulatory frameworks accordingly. We echo the views of others on the need for developing doctoral programmes responsive to African realities2 and to rethink training curricula that build critical skills for diverse career pathways in public health1 on the continent.

Second, doctoral candidates need to have the freedom and opportunity to define research questions that emerge from the policy, practice and social challenges of their context and professional networks, and to be supported with appropriate methodologies and funding. In doing so, Schools of Public Health can gain immensely from the meanings and practices that have emerged with the decoloniality movement, as well as the thinking and curricular approaches developed in programmes such as the CARTA (https://cartafrica.org/).

Finally, programmes need to take seriously doctoral pedagogies, centring epistemic access through communities of practice.21 These pedagogies need to be attuned to, surface and legitimate lived realities of doctoral candidates, and consider their well-being as equally important to numbers and throughput.