Agenda • Project Background • Project Methodology • Pre-Medicine program • Science major: Biology • Masters in Public Health program • Medical school • Summary
State of Public Health in Ghana • Ghana produces skilled clinical health workers but lacks critical thinkers • Life expectancy: 57 years (Ghana) vs. 77 years (US) • 7,700 people contract malaria and 105 people die from it each day. • 28,000 people died from AIDS in 2001.
Ashesi’s Vision • Train next generation of research oriented health professionals • Set the standard for medical and public health education in Ghana
Project Objectives • Assess the cost to add an undergrad pre med curriculum • Determine whether biology, chemistry, or physics is the most cost effective science major for Ashesi. • Assess cost to add this major given an existing pre-med curriculum • Assess cost to add an MPH program • Ballpark cost estimate for a medical school affiliated with a 100-bed hospital
Additional Findings • Medical school matriculation requirements: • The US • Ghana • South Africa • UK • Recommendations on improving student matriculation • Recommendations on reducing costs for all programs
Methodology • Over 65 interviews in US and Ghana • Professors • Educational administrators • M.D.s • Laboratory Technicians • Government officials • Suppliers • Online Research • Financial Modeling
Overview • The goal of Ashesi’s pre-med program is to have its students matriculate into medical school. • Performed an analysis of the feasibility of pre-med students from Ashesi matriculating into medical schools in various countries. • United States • Ghana • United Kingdom • South Africa
Matriculation into Medical Schools in the United States • Association of American of Medical Colleges (AAMC) specifies the medical school application requirements: • Completion of the pre-med curriculum at an accredited university (see next slide) • Medical Colleges Admission Test (MCAT) • Verbal Reasoning • Physical Sciences • Biological Sciences • Writing Sample • Community service or work experience
The Pre-Med Curriculum • Required and recommended courses by the AAMC
Challenges for International Pre-Med Students • Low acceptance and matriculation rates into US medical schools • Higher admissions standards (e.g. GPA, MCAT) than US candidates, on average (Note: “International” represents foreign students educated at universities both in the US and in foreign countries. Rates are lower for foreign students just educated outside the US.) Source: AAMC
Challenges for International Pre-Med Students (cont.) • Many medical schools require evidence of financial support before acceptance. • Most students cannot afford to pay the tuition bill without outside assistance • Lack of financial support • Attending medical school can cost over $200,000 • International students are not eligible for a Federal loan • Other loans require a co-signature from a US citizen
Recommendations to increase matriculation • Provide a dedicated pre-med support staff for students • Encourage students to apply for MD/PhD programs • Most PhD students receive a stipend, so this will reduce the financial burden on the students • Offer scholarships • Start an medical school scholarship fund • Partner with international organizations to provide scholarships • Require scholarship recipients to return to Ghana to practice medicine for a certain number of years
Matriculation into Medical Schools in Ghana • Undergraduate pre-med curriculum • In the past, Ghana followed the British education system • Now, Ghanaian universities follow a “pre-med” undergraduate curriculum more similar to the US. • Degrees • BSc in Medical Science or Biological Science (undergraduate, 3-4 years) • MB.ChB in Medicine (post-clinical stage)
University of Ghana Medical School (Korle-Bu) • Two tracks to gain admission to the clinical stage of medicine: • Apply directly to the medical school • BSc in Medical Sciences • Direct admission into the medical school upon completion of requirements • BSc in Biological Sciences from the undergrad program at the University of Ghana, Legon or an outside university • Consideration for admission is based on the recommendation of a Special Committee appointed by the Dean • Final admission decision is made by the Education Committee and the Board of Education • KNUST Medical School in Kumasi has a similar process.
Challenges for Ashesi Students • Few spaces available for non-University of Ghana undergraduates • 100 students admitted into the clinical stage out of 120-150 applicants • 80 spaces are reserved for undergrads • 20 spaces are reserved for students from outside universities, including foreign universities • Available spaces are mainly reserved for foreign students • Albert Akongo: “There is a small national cake in Ghana. And if someone already has a piece of the cake, then they will not try to take a piece away from someone else.”
Recommendations to increase acceptance • Offer a biology major • Unlike the US where you can major in any subject, Ghanaian medical schools require a strong background in biological sciences • Work with the University of Ghana and KNUST Medical School • Obtain commitment to approve the Ashesi pre-med curriculum and accept Ashesi student applicants
Matriculation into Medical Schools in the United Kingdom • Non-European students applying to medical school in Europe will encounter similar issues as in the US • Must provide evidence of financial support • Limited places for international students • Higher academic standards non-EU students • Plus, the British educational system requires students to apply into the 6-year medical school immediately after high school.
Matriculation into Medical Schools in South Africa • Limited number of medical schools and spaces available for South African medical students • Only consider applications from citizens of South Africa or the Southern African Development Community (SADC) countries that do not have medical schools • Includes Botswana, Lesotho, Namibia, and Swaziland • Only Ashesi students who are permanent residents of the African nations can qualify for admission
Assumptions • Accreditation • Ashesi will have to undergo a accreditation re-assessment for the pre-med and biology curriculum • Leveraged requirements to guide the faculty and staff allocation
Assumptions (cont.) • Pre-med curriculum is based on the requirements and recommendations of the AAMC • Ashesi already offers courses in math and English, so the cost analysis will only include biology, chemistry, and physics courses • Most US universities operate on a semester system, so 2 Ashesi quarters = 1 US semester
Assumptions (cont.) • Pre-med support staff • Essential to prepare students for the rigorous application process and exams • Hire one headcount in the pre-med support office to advise up to fifty students applying to medical school • Faculty and staff • 4 science professors to teach biology, general chemistry, organic chemistry, and physics • 3 lab technicians to maintain the 3 labs • Salaries • Ashesi Faculty Salary = 3*(University of Ghana College of Health Sciences Salary)
Assumptions (cont.) • Equipment, maintenance, and consumables • Lab equipment purchases 1 year prior • Benchmarked cost and inventory equipment from US and Ghanaian sources • $5000 for equipment purchases over time for each lab • Maintenance is approximately 8% of total equipment costs • Consumable quantities represent supplies for one year for a 24-student lab
Assumptions (cont.) • Laboratories and facilities • Class size of 24 for safety reasons • Construction of labs requires a 2-year lead time • Suppliers • Order direct from the US and UK • Furniture and storage purchased and installed by local contractors • Dissection specimens purchased from local suppliers
Assumptions (cont.) • Non pre-med program costs not included: • Dormitory • Core course instruction • Computing facility • Based on using new campus and not leasing facilities
Pre-Med Capital Investment • For class of 24, total capital investment = $347,406 • Incremental cost for equipment upgrade = $60,000
Pre-Med Operating Expenses • Start-up expenses: $523,780 • On-going expenses: • 4-year recurring: $329,079 • per student per year: ~$3,000 (without inflation)
Rationale for recommending Biology as a Ashesi’s first science major
3 Options to Evaluate • Potential Science Majors: • Chemistry • Biology • Physics
Key Assumptions • Demand side evaluated only if supply side costs are comparable • Cost estimates based on new equipment purchases • Only costs incremental to pre-med were evaluated • Curriculums modeled after UC Berkeley • Variable lab costs aren’t passed on to students via lab fees
Cost Analysis Framework • Key Cost Drivers: • # of incremental classes offered • # of incremental lab hours required Which drive usage of: • Fixed costs • Lab Equipment • Furniture • Facilities • Variable Costs • Dissection Specimen • Chemicals • HR • Overhead • Etc.
Pre-med classes • All pre-med classes count toward the bio major • Pre-med chemistry and physics courses are not advanced enough to count toward their respective majors
Resulting class and lab requirements • As a result adding Biology would require fewer additional class offerings and required lab hours.
Equipment Costs • Chemistry and Biology majors can make due with pre-med equipment • Physics majors need expensive, specialized equipment – but these are one time costs SOS Laboratory
Variable Lab Costs • Variable Lab Costs include: • Chemicals • Dissection Specimen, etc. • Biology and Chemistry have higher variable costs relative to physics
Results • Chemistry is the least cost-effective major for Ashesi to offer
Biology and Physics are Comparable • Physics has higher fixed equipment costs, but lower variable lab costs • If Ashesi were not offering pre-med, physics would be cheaper • But the costs incremental to pre-med are comparable
Demand Side Analysis • Interviewed physics and biology administrators • All agree that Biology is more relevant to health care professionals • Biology is most popular major of those who take the MCAT (62.9%) • Difficult to attract physics majors • Rigorous • Limited job options if can’t matriculate to med school • Biology students who don’t matriculate to med school can work in biotech • Ghanaian med schools prefer biology majors
Final Result • Given that • Adding Biology and Physics are comparable in cost • The demand for Biology is higher with students • The demand for Biology majors is higher with Ghanaian medical schools • We recommend that Ashesi add Biology as a first science major.
Assumptions • Assumptions made in addition to those made for pre-med costing • Based on a basic US Biology curriculum • One specialization option only: Cell Biology • Most US schools offer many options • Assumed the average # of lecture and lab hours • Demand side analysis recommended to confirm cell biology is the right specialization to offer • One teacher can teach all pre-med bio courses
Assumptions (Cont.) • Media and computer expenditures are one time • Old computers suffice for the purposes of biology labs • Build a basic lab first, and budget yearly additions of $10K for 4 years
Results • Incremental cost of adding biology with pre-med in place: $781,816 • Per student per year operating cost: ~$3,500 • Based on 48 students (24 in pre-med and 24 bio majors)
Opportunities for Cost Reduction • Purchase used equipment or solicit equipment donations • Gov’t budget cuts in US are causing some labs to shut down • Gov’t labs are selling equipment for cheap to US universities • So US universities are donating old equipment • Hire creative professors • Good profs can conduct lab exercises with lower cost goods without compromising education
Opportunities for Cost Reduction (cont.) • Hire qualified, professional lab managers • Better managers = savings in maintenance, breakage and safety costs • Partner with other Universities • Buy different equipment than what is available at other schools and share • Leverage Technology • For some applications you can get remote access to equipment
Opportunities for Cost Reduction (cont.) • Don’t offer specialized study • General Biology only • Buy in Bulk • Can reduce costs if storage space is cheap. • Charge lab fees to cover variable lab costs