I am particularly pleased to introduce this sponsored special issue, Universities in transition to improve population health: A Tanzanian case study, and Guest Editors Sarah Macfarlane (a Professor and Founding Member of Global Health Sciences at the University of California San Francisco) and Ephata Kaaya (a Professor at Muhimbili University of Allied Health Sciences – who has recently been named its Vice Chancellor). Universities in many parts of the world have long been criticized for exclusivity and distance from problems critical to development and well-being of societies. Tanzania's history, tying independence from colonialism with socialist ideals, is unusual. Having adapted the ‘barefoot doctor’ model from China 50 years ago, Tanzania today depends more than any other country in Africa on middle-level health workers. Trained by the health ministry, they fill most jobs in the health system. As explained elegantly and in more detail by the Guest Editors, the few health professionals, educated at universities, lead the ministry, provide specialty care, and teach; and the government expects the few teachers of health professionals to rapidly and dramatically raise enrollments – while improving the quality of education and student outcomes.

The motivation is compelling: in Tanzania devastating consequences of too few professionals are seen, for example, in maternal mortality rates. Experience elsewhere suggests deaths of mothers during pregnancy and childbirth can be dramatically curbed by available interventions – as much as by 80 per cent.1 The 2010 Tanzania Demographic and Health Survey reported maternal mortality to be 454 deaths per 100 000 live births in Tanzania.2

Because the focus here is education – one might reasonably ask why JPHP publishes this issue. We welcome its linking of education of health professionals to population health outcomes. Few countries have targeted improving higher education as a strategic element for improving population health. And few development agencies have taken up the challenge to support institutions of higher education to become strategic partners. This issue documents early stages of a process that can positively influence the health system to yield better population health. We hope the university reforms will produce good results; whatever comes, we hope this issue will fuel productive debates.