Except for South Africa, where the process was unique owing to its special historic and resources characteristics, Sawyerr (2004) argued that university development in SAA has generally gone through five broad phases. The first phase, before 1948, saw little to no development – colonial powers generally funded primary, secondary and vocational colleges, but not universities . In the second phase, post-World War Two period until 1960, the “major colonial universities” were established in Nigeria, Ghana (then the Gold Coast), Zimbabwe (then Rhodesia and Nyasaland) and Uganda by the United Kingdom, Senegal and Madagascar by France and the Democratic Republic of Congo (then Zaire) by Belgium. For example, the University of Ibadan was started in 1948 in collaboration with the University of London (Frenk, Chen et al. 2010). By 1960, there were 52 universities in 18 countries of SSA (Sawyerr 2004). These universities were linked to a university of the colonial power with the same curricula, a small number of students and a large number of European faculty (Ashby and Anderson 1966; Ajayi, Goma et al. 1996; The World Bank 2004).

Newly independent SSA states established universities at a modest, but steady, rate for approximately the first 20 years after independence, resulting in the number of universities increasing to 108 in 1980 (Sawyerr 2004). From the late 1970s to the early 2000’s, SSA universities faced declining real investment by their national governments yet the number of them continued to grow to 251 in 2002. During this period the number of students enrolled in universities grew incredibly quickly. In 1975, approximately 181,000 students were enrolled in SSA universities but by 1995 the number of students had increased by over 10 times to 1,750,000. As a result, the quality of classrooms and residences was low, class sizes were large and the motivation of faculty suffered accordingly as the new century began. Responding to the demand for tertiary education and decline in public higher education standards was the private sector. From 1990 to 2002, the number of private institutions in SSA increased from 27 to 84 and continues to grow (Ibid).

Since the initial SSA universities were established by or with the support of European universities it is not surprising the knowledge systems that developed were foreign to SSA. As Ashby (1966) argued, “The modern universities of Africa have their roots not in any indigenous system of education, but in a system brought from the west.” Over forty years later, it appears SSA’s higher education system remains largely influenced by other regions of the world. According to Teferra (2008) the African higher education system likely remains the least indigenous of the world’s higher education systems because of reliance of the discourse, paradigms and parameters of other regions of the world. This dependency on external knowledge may be particularly great in fields such as medicine and engineering that are grounded in basic science and evidence-informed.
How this dependency on external bodies influences SSA universities in the area of health needs to be examined in terms of international partnerships. For example, approaches could be brought from afar that allow SSA HPP to leap-frog outdated approaches to maximize benefits while minimizing resource use. However, they could also stifle independent thinking, impede empowerment and make dependence systemic within institutions.