Category Archives: Global Health Education

Learning From South-South Collaboration, April 2010, Cuernavaca, Mexico

Alliances for Global Health Education: Learning from South-South Collaboration, has been announced as the theme for an upcoming conference to be held April 9-11, 2010, in Cuernavaca, Mexico. The joint collaboration represents the 19th annual conference on Global Health Issues for the Global Health Education Consortium (GHEC), based in the United States and the 1st Latin American and Caribbean Conference on Global Health hosted by the Instituto Nacional de Salud Publica (INSP), based in Mexico.

A White Paper and call for abstracts can be found on the GHEC website here.

This promises to be an exciting conference addressing current issues and even leading edge ideas, research, and practice.   The Call for Abstracts is through November 1, 2009.  The website reports that all aspects of Global Health and Global Health Education are welcome for submission and there is a special request for “progressively-minded projects that take into consideration the ideals of global health that embrace: Social Justice, Ethical Practices, Community Ownership, Equity and Fairness, True Partnership, and Bilateral Exchange.”

CFHI Granted Consultative Status at the United Nations

Just prior to the opening of the United National General Assembly this year, I was fortunate enough to be at the UN to represent the small but powerful global family of Child Family Health International (CFHI).  Recently CFHI was granted Special Consultative Status with the Economic and Social Council of the United Nations (ECOSOC).  This is a great honor that speaks to our unique collection of dedicated professionals and students who truly work at the grassroots level to improve the health of the world community.

As the Executive Director of CFHI, it was indeed a high honor for me to represent our organization and I came prepared to explain our work and our efforts in Bolivia, Ecuador, India, Mexico, and South Africa. To my great surprise, I did not have to do any of that.  I found the staff at the NGO Section of ECOSOC  wonderfully welcoming and accommodating, and also found they had done their homework and already were quite aware of CFHI and our work.  They had read the documents we had sent more than a year earlier in the process of being granted consultative status and they also brushed-up by reading our website prior to my arrival.

What with the UN being such a huge organization, I expected everything to be very bureaucratic and fairly impersonal.  Sure it is a big place and with the leaders of the world, about to arrive, there was quite a bit of bustle all about, so it was a surprise to find such personalized service and attention.  My meetings with the Deputy Chief of the NGO Section and the Program Officer were cordial and productive.

I learned that there are about 3,200 NGOs around the world that have been granted consultative status.  Many are more associated with a cause while they see CFHI as a more “practical” organization.  The grassroots nature of our work is appealing to them as well as the diversity of our global family along with the close, long term relationships with CFHI partners who are at the front lines of the delivery of healthcare in so many places.  To a large extent, we have our finger on the pulse of global health at the grassroots level and so we have much to share, especially the CFHI model of empowering local communities.  Of those more than 3,000 organizations, only about 800 are really active.  Work is going on to improve the website of the NGO section and the hope is that there will be much more online functionality to allow for sharing and collaboration.

Flags of the CFHI Global Family now including the United Nations

Flags of the CFHI Global Family now including the United Nations

One official told me, “The international community has looked at your organization from top to bottom and the feeling is that it is a good organization and has a model that is important. We actually hope that it can be replicated in areas of health yes, but also in other areas.” So as we add the UN flag to the flags of nations comprising the CFHI Global Family, we do so with great honor and great pride, and with responsibility for the role that we have assumed through this honor.

Just What Global Health Needs … Geometry!

As Dr. Calvin Wilson began his plenary presentation at the Sixth Annual Family Medicine Global Health Workshop in Denver earlier this month, he said to the audience of physicians, “Now class today we’re going to learn geometry.”  As he began talking about the vertical approach, and the horizontal approach, Dr Wilson was joking but he was also making a point.  As disparities related to health continue to be significant and much more is needed to be accomplished in order to achieve the Millennium Development Goals set by the United Nations, it is clear that a different approach is needed to address global health issues.  Dr. Wilson, an associate professor of family medicine at the University of Colorado School of Medicine, and the director of the Center for Global Health of the Colorado School of Public Health, was attempting to deal with a controversial issue in global health today: the debate between vertical and horizontal funding of health initiatives.  The vertical initiatives are programs that address a single area of focus, such as a disease like HIV/AIDS, or malaria.  The horizontal initiatives are programs that attempt to improve aspects of the health care system in an area or a country.  Dr. Wilson gave a careful and balanced approach to this issue and pointed out pluses and minuses to both sides.  His presentation can be found through the website of the American Academy of Family Physicians.

Dr. Julio Frenk, the Dean of Harvard’s School of Public Health, and former Minister of Health for Mexico used examples from his home country to illustrate the importance of the diagonal approach when he was interviewed in the June issue of Global Pulse. Dr. Frenk sights, how work on HIV/AIDS in Mexico was designed to also enhance the healthcare system. “By starting with AIDS, we were able to build an entire insurance system that was then in place to start covering other diseases.”  Dr. Frenk’s interview with Global Pulse can be found here

It is unfortunate that this debate has gone on for so long and that there is still no clear resolution to it.  Perhaps two next steps are helpful in this process.

  1. Cease the Competition:  It is sad that any debate has developed regarding this issue at all.  Even more counterproductive is that at times there seems to be a competitive nature to the debate from one side or another.  From the grassroots perspective, it is often obvious that these approaches are much more in concert with each other rather than in competition.  Resources are needed for programs that implement specific treatments and for specific prevention methods but these programs are usually only as good as the infrastructure available to make things happen on the ground.  The reality is that vertical strategies will, at some point, need to hit the ground and their implementation will involve: public health education, vaccination, or training to increase the competencies of treating healthcare workers.  To utilize the existing infrastructure, no matter how lacking it might be, is preferable to starting from scratch or to creating parallel infrastructures.  Building on the existing infrastructure allows the lessons of past implementation experiences to inform the future and, if done well, allows for culturally appropriate adaptations to be made for each setting that can improve the effectiveness of any implementation, while reducing the potential for inflicting unintended harm.  In most resource-poor settings, when you bring in relatively small amounts of cash, you can make many things happen.  Unfortunately when you pull out the cash, it often has the effect of inhibiting the local input.
  2. A workable Construct: While there has been a lot of talk about the need for a more balanced approach, there has not been a lot of action.  It is hard to move forward without a method of implementation.  Since we are talking about a very broad spectrum of health initiatives, it is unrealistic, and frankly not very helpful to propose anything that is too specific.  One option has been proposed that appears very promising.  15 by 2015 is an initiative proposed by a partnership of the World Organization of Family Doctors (WONCA), Global Health through Education, Training and Service (GHETS), and the European Forum for Primary Care (EFPC).  In an article published in the British Journal of General Practice in January, 2008, they make their proposal, “We propose that by 2015, 15% of the budgets of vertical disease-oriented programmes be invested in strengthening well-coordinated, integrated local primary healthcare systems and that this percentage would increase over time.  15 By 2015 is a very helpful construct.  It raises the awareness of the need for both vertical and horizontal approaches that complement each other and creates a simple framework that allows customization as needed.  The 15% threshold is not meant to be the highest possible for the horizontal component but it is a conservative number that can surely be an agreed upon minimum.  In this way, new initiatives can build on the existing knowledge and experience, and leave the community with an incrementally improved infrastructure.

In his address to the Global Health Workshop in Denver, Dr. Wilson used some different language.  Instead of consistently using “vertical” and “horizontal,” he used the terms disease focus approach and integrated systems approach. These are terms that seem to fit more logically to the conversation.  Perhaps these terms can be seen to be more obviously collaborative than their geometric versions and help us bridge the gap by taking the shortest distance between these two points that should not be divergent at all.

A Definition of Global Health

Defining global health has been a challenge. This has been especially true in recent years with the increased interest in science, philanthropy, and politics related to global health. In the June 6, 2009 issue of The Lancet, a multidisciplinary and international panel brought together by the Consortium of Universities for Global Health (CUGH), and led by Jeffrey P. Koplan, MD, has taken a bold step in offering the world a definition.

The article entitled Towards a Common Definition of Global Health, represents an important step in bringing together the work, “and priorities for action between physicians, researchers, funders, the media, and the general public.” A thoughtful process is outlined considering the origins of global health in the areas of public health and international health.

The attempt is to be broad rather than limiting, and emphasizes multidisciplinary approaches and mutuality, as well as equity and collaboration.

We applaud CUGH for this effort and recommend this article to all CFHI students.  We greatly appreciate that an effort has been made across continents and cultures to find common ground for the advancement of the study and the work of Global Health.

In recent years, at conference after conference, speakers have noted that there is no real agreement on just what is involved in Global Health. This long-awaited work is welcome, especially in its tone –it is not forceful or proprietary but open, inviting, and humble. We hope that it serves as a good starting point for people from all aspects of Global Health to find a workable construct that will be helpful to collaboration in our work and research.

Please go the The Lancet website and find the article.

International Experiences and Medcial Education

The May-June issue of International Educator, the magazine of the Association of International Educators (NAFSA), contains an article by Karen Legget entitled: Teaching Medicine Without Borders.  Ms Legget traces the movement from “International Health” to “Global Health” and the impact this is having on medical education.

She looks at various programs from medical schools to organizations (including CFHI) and conducts interviews with students and administrators alike.  Her article can be found through the NAFSA website.

CFHI Program Spotlight: Sight for All

One of CFHI’s newest programs, Sight for All- Ophthalmology Rotation is unique in that it is based out of just one organization- a local NGO located in New Delhi, India. CFHI participants rotate through the various departments, learning how programs and treatment are implemented to reduce preventable visual handicaps. Participants are exposed to mobile eye care clinics, ophthalmic procedures in the operating theater, and take part in advanced level classes at the institute.

The Sight for All program recently had its first participant, Melanie Mamon, and she shares a report on her experiences.  To learn more about the program’s location, arrival dates, and clinical sites, click here.