Category Archives: Global Health

PIH | Engage: An Experiment

I first heard of PIH | Engage from a listserv email, sent out to alumni of the study abroad program I participated in. Not knowing quite what to think, but already in love with the global health nonprofit Partners In Health, I emailed this mysterious Jon Shaffer with a few questions. Instead of the standard written reply sent a few days later, and in what I would come to know as typical Jon fashion, he immediately responded with “wanna hop on the phone?”

And so started my plunge into community organizing. As I would soon find out, PIH | Engage was a completely new initiative of Partners In Health, looking to build communities of volunteer organizers across the United States. These teams of 10 or so people would work to 1. Raise funds for the lifesaving work of Partners In Health, 2. Advocate for policies that enable governments to build functioning health systems, and 3. Create a space for discussion of the global health issues marginalized populations face every day. Jon would sometimes refer to PIH | Engage as an “experiment,” aimed at harnessing the inspirational power of PIH’s brand and engaging dedicated supporters in the movement for global health equity. With the recent explosion of global health departments and student groups on university campuses, the biggest engagement gap seemed to be for recent graduates, who may have studied these issues in college but found it too difficult to find well-paying jobs in global health after graduating.

For me, a passionate supporter of PIH’s work and a public health student/soon-to-be young professional with limited opportunities for direct involvement in global health work, PIH | Engage seemed perfect. I applied to be a Community Coordinator.

Like all fledgling community organizing initiatives, PIH | Engage’s pilot year had its ups and downs. Movement-building is hard work, I found, and takes serious commitment. But I ended the year excited and hopeful for the initiative’s future—already, communities (including my own) had been built across the U.S., and PIH | Engage had brought together more than one hundred dedicated volunteers. After graduation, I was determined to stay involved with this experiment that I had come to truly believe in. After a summer spent volunteering at the PIH Boston office, I jumped at the opportunity to apply as the Community Organizing Assistant and work to build PIH | Engage full time.

An illustration of PIH | Engage’s growth: Year 1 Training Institute, in the conference room of PIH & Year 2 Training Institute, with more than 60 Community Coordinators, coaches, and volunteers.

fundraising

Now, a few months later, PIH | Engage has made tremendous progress. We have about 40 strong communities and more than 300 members, who together have raised close to $40,000, advocated for continued U.S. support of the Global Fund, and began the “PIH | Educate” curriculum based on Dr. Paul Farmer et. al.’s excellent new textbook, Reimagining Global Health. Each month, I’m on the phone with each Community Coordinator, sharing best practices, discussing struggles, and coaching them through the campaign.

I recently undertook a thorough assessment to more systematically calculate each community’s “strength,” based on a series of metrics such as the size of their leadership teams, participation in the campaign, and events held. The results of this report were promising:

69% of communities ranked in the “superstar,” “great,” or “good” category for strength
88% of communities have held a first monthly meeting; 79% have held several meetings
67% have held their first event
Leadership teams have an average of 6 members, and 74% participated in the personal fundraising campaign

Through this analysis, I was able to see more clearly what structural elements of a community led to it’s success and what barriers most often caused a community to struggle. Jon and I will use this report to target our coaching and support of PIH | Engage teams in the coming months, and reflect on ways we can better recruit and plan for next year, Year 3 of PIH | Engage. As the first step, we hosted a Midpoint Review video-conferencing webinar with our entire network last week, to reflect on our progress so far and re-launch into our spring campaign.

As much as PIH | Engage is an experiment in community organizing, my journey from Community Coordinator to Community Organizing Assistant has been a wonderful and rewarding career experiment. It’s been incredible to be a part of this initiative, and see our movement grow. I can’t wait to continue to share our progress, successes, and challenges. Onward!

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By Sheena Wood

Sheena works as the Community Organizing Assistant at Partners In Health. A recent graduate from Brown University, she enjoys reading about community organizing and global health, traveling, and eating dark chocolate.

Health as development?

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The Guardian has a good article which makes the critical point that the vast majority of foreign aid flowing into Haiti since the devastating earthquake in Haiti (the fourth anniversary is this Sunday) has been directed almost exclusively to private, U.S.-based corporate development contractors.

See the data and the graph:

Haiti, in particular, ranks among the lowest in the percentage of USAID funding going to locally based NGOs or the Haitian government:

USAID claims that most Haitian NGOs and the government do not have sufficient internal financial controls to receive these contracts. They also cite that these data do not accurately account for less formal support to local organizations via subcontracting and local partnership and interactions. It is, however, impossible to know since the data on those subcontracts has yet to be published.

Despite a desire to reform from USAID administrator Rajiv Shah, major lobbying and entrenched interests exist to block reform.

Partners In Health, of course, is working to do things differently. Interested primarily in how we can best invest resources to build systems that can protect the human right to health, we know how vital it is to strengthen Haitian – particularly public – institutions. This has been the approach and rationale behind the major investment in the construction and operation of the University Hospital in Mirebalais, Haiti. Co-operated by the Haitian ministry of health and PIH, the hope is that through accompaniment, we can work to strengthen the capacity of the public institutions necessary for fulfillment of the right to health for Haitian citizens.

Beyond the rights-base requirement for the primacy of local, public institutions, the strategy also makes strong economic sense. New analysis by PIH and partners show that investment in health systems and necessary infrastructure like hospitals, can have a major economic multiplier in growing the Haitian economy. Using an input-output matrix, a well documented economic analytical tool, the team determined that for every $1.00 invested in the construction and operation of the University Hospital in Mirebalais, $1.82 was generated in revenue across many economic sectors in Haiti.

These results are entirely consistent with the case laid out by the Global Health 2035 Commission regarding the economic gains to be made by sound investments in health care delivery. As the movement lines up behind UHC as a major focus for the post-2015 global development goals, perhaps more evidence like this will help us move beyond the primarily self-serving orientation of foreign aid and development assistance as reported by The Guardian.

The movement for UHC

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The Center for Strategic and International Studies has a nice primer on the “movement” for universal health coverage. The report doesn’t go into very much depth, but it does provide a solid overview on where the players are, the major gains that have been made, the historical context of UHC, and the challenges that could prevent forward motion.

They describe the current moment as the early phases of a “movement”:

And so the movement is gaining steam. Across the globe, national, regional, and international initiatives are under way to address barriers and provide models and assistance for governments seeking to expand health coverage; universal health coverage is even being discussed as a possible goal for the United Nation’s post-2015 global development agenda (see appendix 1). As a result, millions more people globally now have better access to health services and countries are prioritizing health spending (see graph below).

Major points from the report:

As national incomes rise, citizens are demanding access to more and higher quality health services.
Increasingly, low and middle income countries are paving the way with new and innovative models of UHC: Rwanda and Mexico are case examples.
Advancing UHC is a complex process and is fundamentally political: the government must invest more resources in health care delivery.
One major tension exists between food, beverage, and alcohol companies and proponents of UHC. Margaret Chan of the WHO has likened them to the tobacco industry, who see potential regulation as a significant threat to their business.
Scaling up UHC will require more efficient and robust tax collection systems and public redistribution of wealth.

The report does not go so far as the Global Health 2035 commission and does not discuss the potential economic gains to be had through strategic investments in hight quality health delivery systems. But, once again, we see a big opportunity for large scale advocacy at local levels and international levels. As the Millennium Development Goals come to a close in 2015, what type of galvanizing advocacy movement can propel us towards investing in policies and systems that can further justice in health?

Community Organizing, Reflection, and Humane Values

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In our increasingly individualistic and commodified world, from an assembly line education system to purchasable wedding speeches, there appears to be little emphasis on cultivating humane values such as cooperation and compassion. This seems to be especially true in the context of the corporate world. When I think of offices, an image of a cold and heartless gray tundra emerges. The scene usually includes robots working hunched over behind desks, typing furiously to crunch the numbers, motivated by the money. With that said, when I walked into the Partners in Health Boston office, I was happily surprised when greeted by colorful walls, vibrant photographs of PIH’s sites across the world, and humans!

The office-wide Tuesday Update meeting was illuminating as I began to get a sense of how things are done at PIH. I had expected the meeting to consist of setting timelines, doling out tasks, and reporting on progress—all characteristic of the robotic scene I had associated with corporate America. I certainly did not expect humane values to be the topic of a staff meeting in a paid work environment.

The meeting was run by PIH’s Executive Director Ophelia Dahl, who led a discussion on the organization’s core values: pragmatic solidarity, integrity, humility, commitment, and optimism. In addition, she stressed the importance of reflection—both on the work itself, but also on how they approach the work, and why they do it. Because the nature of PIH’s efforts involves life and death, time is always of the essence. I was pleasantly surprised to learn that despite this urgency, time taken for reflection was deemed worthwhile, and even necessary in order to meaningfully engage in the movement for global health equity.

By reflecting on humane values and the intentions behind them, we cultivate skills that prepare us to handle difficult situations and face complex problems (like the ones PIH staff work with every day) with focus, calm, and clarity. It is clear that people here are working for much more than a paycheck, and giving more of themselves than can be measured in an eight-hour workday.

As a Community Coordinator for Partners In Health | Engage, my community is constantly reflecting on what worked, what didn’t, and what we can do better. These moments of short-term concrete reflection are not only helpful for continued organizing, but also serve to unify my team in our larger purpose. Reflection on even broader topics, such as core values, can garner even deeper sense of shared purpose, motivation, and solidarity. While working in community organizing, reflection is critical in order to make values explicit and meaningful. This practice serves to cultivate a sense of shared humanity, bind people together, and motivate them to volunteer their time and energy for a cause they truly believe in.

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By Victoria Leonard

Victoria is a junior at Brown University studying Political Science and Religious Studies. She has traveled to Senegal and Ghana to work on food security and clean water projects. She enjoys doing yoga, cooking, and swimming in the sea.

A roundup of global health internships

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It’s that time of year again when undergraduates and recent grads look to beef up their practical professional experience through summer internships that can help them get a foothold in the expanding “field” of global health. Building off of a recent post on PIH’s website in which five global health experts reflect on finding jobs in global health, I thought it would be interesting to put together a little roundup of good internships.

Partners In Health: Work with PIH on meaningful projects and participate in summer seminar.

Last Mile Health: Interns will work on specific projects in close collaboration with Last Mile Health’s US leadership at a crucial point in the organization’s growth. Through this unique opportunity, interns will have the chance to learn about social justice and global health, work in a fast-paced start-up non profit organization, and gain hands-on experience in communications.

Weill Cornell Medical College Global Health Curriculum: Both a teaching associate and summer internship program available. A great opportunity to share global health curriculum.

Article 25: Three positions are available with Article 25, a new organization working to build a global movement to solve the global health crisis. Through digital tools and grassroots campaigns we enable anyone to advocate for their right to health.

FACE AIDS: Fellows will have the unique opportunity to work closely with the FACE AIDS Organizing Director and Communications Director to design new mechanisms aimed at multiplying the impact of FACE AIDS chapters.

Ride Against AIDS: The Ride Against AIDS is a unique and powerful cross-country bike ride dedicated to supporting the work of FACE AIDS and Partners In Health while igniting conversations in communities across the country about the HIV pandemic.

Clinton Foundation: Work with departments such as Research and Analysis, Communications, Logistics, Technology, and the Clinton Presidential Center.

Abt Associates: Paid internships that provide an opportunity to gain hands-on industry experience while being exposed to challenging projects and learning from some of the top experts in the field.

The Carter Center: Make substantial contributions to the Carter Center’s work to develop an informed and skilled work force committed to advancing peace and health worldwide.

Centers for Disease Control: A variety of hands-on training programs for undergraduate or graduate students still in school, and for health professionals who are in training. All offer a unique experience in one of the many exciting public health fields.

GlobeMed and Partner Organizations: Assorted volunteer and internship opportunities with GlobeMed partners organizations around the world.

American Medical Association Ethics Group: Work in Chicago doing research advancing medical ethics.

Doctors Without Borders: Interns gain practical work experience and support the work of our Communications, Development, Program, Human Resources (both for the field and the office), and Executive departments. Interns also gain a basic introduction to the field of international medical humanitarian aid and advocacy.

USAID supported internships: A wide variety of internships in different fields.

United Nations Foundation: Work in a variety of departments across the UN Foundation.

GBCHealth: Research companies’ engagement with HIV/AIDS.

World Health Organization: WHO’s Internship Programme offers a wide range of opportunities for students to gain insight in the technical and administrative programmes of WHO.

American Public Health Association: The intern will work with the Global Health Manager in the global health unit within APHA’s Center for Professional Development, Public Health Systems and Partnerships (CPDPHSP).

Unite for Sight: Work on Unite for Sight’s global health programming.

Family Health International: Work on social and behavioral change communication.

Support for International Change: IC’s service-learning programs offer university students and young professionals from all backgrounds a chance to limit the impact of HIV/AIDS in Tanzania by leading HIV prevention and education campaigns in rural villages.

PATH: PATH is an international nonprofit organization that transforms global health through innovation. Our approach blends the entrepreneurial spirit of business, the scientific expertise of a research institution, and the passion and on-the-ground experience of an international NGO.

GAVI Alliance: The overall purpose of the Internship programme is to provide eligible individuals with: a better understanding of GAVI’s mission, goals and objectives; a framework to enhance their education experience through practical work assignments, thereby developing skills which will be useful for their career and future employment; and the opportunity of working in a multicultural environment.

Kennedy Krieger Institute’s Public health Leadership and Learning Undergraduate Student Success (PLLUSS) Program: The PLLUSS Program provides students with mentored public health research and community health activities, mentorship, and professional development, especially in the area of promotion of health equity and the elimination of health disparities research.

Red Cross Summer Internship Program: Gain substantial professional experience and exposure to critical issues pertaining to the non-profit sector; Develop a comprehensive perspective on the Red Cross mission and service delivery at the local, national and international levels; Receive networking, personal and professional development opportunities, including opportunities to meet with Red Cross senior leadership.

TB Alliance Fellowship/Internship: The TB Alliance is a prominent member of the Stop TB Partnership Working Group on New Drugs (WGND, www.newtbdrugs.org), providing funding for WGND activities and hosting the WGND Secretariat. The Fellow will assist the WGND Secretariat by coordinating activities to help the working group achieve its annual objectives as mandated by its membership. The Fellow/Intern will work with a broad range of stakeholders from the drug R & D field as well as the global health and advocacy communities.

Good luck! If there are additional internships that I should post here, please feel free to email me at jonshaff@gmail.com.

The evolution of global health education

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Over the past few months Jon Shaffer, the Community Engagement Coordinator at PIH, and I began to toss around questions concerning the short history and current state of global health education. As a student at Middlebury College up in Vermont, I have spent most of that time engrossed (buried) in macromolecules and early American literature. However, amid frequent email exchanges, phone calls, and a bit of preliminary research, Jon and I have started to focus these ideas, and a foundation for a sort of meta-analysis of global health education has emerged.

Jon invited me to PIH’s main offices to help further develop these thoughts and I elected to forsake Middlebury’s “J-term,” and transplant myself to Cambridge for the month, exchanging one frigid winter landscape for another. As I begin to hang out around the PIH office in Boston, reading up on “theoretical frameworks in global health education,” and “the dramatic expansion of university engagement in global health,” we uncovered a small niche of literature addressing the surge in the study of global health education, and sparingly few databases cataloging global health programs at academic institutions in the US. While organizations such as the Consortium for Global Health (CUGH) have begun to compile this type of data, it seems that the most of this work largely lacks an in-depth academic analysis. Drawing on some sociology of higher education theory, perspectives from leading figures in the field, and both qualitative and quantitative data surrounding the growth of global health education, Jon and I seek to better understand how and why global health has ascended as a field of academic study since the late 90s, identify the factors that have fueled this rise, and perhaps look the future trajectory of the blossoming discipline.

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By Tyler Boyd

Tyler is a biochemistry and American studies double major at Middlebury College in Vermont. Hailing from outside Chicago, he enjoys graphic design and is interested in travel and global health. He is excited to be working on this project this month and into the future.

Global Health 2035: a new roadmap for global health advocacy?

Background

The World Development Report in 1993 focused on the economic value in focusing on a narrow set of health interventions.

On the 20th anniversary of the highly influential 1993 World Development Report, titled ‘Investing in Health’, an independent commission convened by The Lancet has developed a potentially groundbreaking report (Global Health 2035: a world converging within a generation) summarizing the current research demonstrating the potential economic value of universal health coverage, and lays out an aggressive but fairly straightforward set of policy recommendations that could help ministers of health, civil society, and advocacy organizations push forward legislation and regulation necessary to secure the right to health.

I think that this report is very significant for a few reasons:

The commission is a mix of the right players (Harvard academics and administrators, ministers of health, USAID, World Bank, IMF, etc).
It is fairly critical of the failings of the 1993 WDR. And, it offers sound analysis and recommendations about how to build off of the successes, failures, and lessons gained during the tumultuous decades in global health and development since then.
It seems to have Partners In Health’s strategy and logic all over it. From the almost explicit ‘preferential option for the poor’ language to the model of structure and function for emerging health systems, PIH has certainly influenced this important vision for the future.
The report is coming at just the right moment. Twenty years after the ‘Investing In Health’ WDR and approaching the end of the era of the Millennium Development Goals, we sorely need a progressive, ambitious, and inspiring vision to guide us. As I’ve written previously and continue to witness/study, more students than ever are passionate about advancing the right to health. Our work with PIH | Engage shows that people of many ages and demographics are eager to participate as well.

Major concepts in GH2035:

There is a major economic payoff in investing in global health.

How does investing in health effect personal and national income?

The report builds off of the work of the 1993 WDR in making the case that investing in health is not only a moral imperative – it is actually just that, an investment in the productive capacity and “full income” of a country. By solely using GDP growth (only accounts the market value of goods and services produced in one year) as the metric of development success, a lot of important value is missed and policy is built and evaluated in an incomplete way.

“On re-reading WDR 1993, admittedly with the benefit of hindsight after two decades, we believe that it had two major limitations. First, although WDR 1993 discussed the “instrumental value” of better health (eg, better health improves worker productivity), it did not attempt to quantify the “intrinsic value” of health (the value of good health in and of itself). Our report summarises research that quantifies the intrinsic value of mortality reduction— the findings should, we hope, lead to a notable reassesment of the priority of health in national and international investment portfolios. In particular, benefit-to-cost assessments and a strong implementation record point to the value of increased commitment to health.

Second, financial protection failed to receive sufficient attention in WDR 1993, although very few data were available in 1993 about out-of-pocket spending and catastrophic financial expenditures. Moreover, only a few analyses pointed to financial protection as an important goal of health systems. By contrast, the role of UHC in providing financial protection is a major feature of our report.”

The analysis that they have gathered shows that fully 24% of “full income” growth in low income and middle income countries can be attributable to the “value of additional life-years” which is linked to expanded investments in health.

What’s happened in global health over the past 20 years that has led to such success? Well, they’ve kindly summarized their finding in a handy table:

A grand convergence of death rates from infectious disease, child, and maternal mortality between the high and low income countries.

With the right investments made by local governments, appropriate investment in health systems strengthening, renewed commitment to expanding development assistance for health from wealthy countries, we could see an incredible convergence of rates of infectious disease death, childhood death, and maternal mortality. The report builds the case that by 2035 we could see rich and poor countries alike experiencing very little unnecessary deaths from these completely preventable sources.

What kinds of investment are necessary? Well, the price tag over the next twenty years is not small – an aggressive investment scenario calls for at least $500 billion to be invested between 2016 and 2035 in low income countries’ health systems. Here’s the breakdown:

But what types of health outcomes could you conceivably see as a result of that type of aggressive investment in health? Perhaps as many as 7.5 million lives saved across low income countries during that time period:

Fiscal policies (taxation, regulation, etc) are a major lever in controlling non-communicable diseases.

The report advocates for aggressive use of fiscal policies as levers to combat what will be rapidly growing rates of chronic and non-communicable diseases, especially in low income countries. These polices include but aren’t limited to heavily taxing tobacco and other harmful substances as well as reducing subsidies on fossil fuels.

“Progressive universalism” is the most efficient way of achieving financial protection for health programs.

For me, the most striking focus of this report is the extraordinarily pro-poor focus on achieving universal health coverage through two potential pathways that they describe as “progressive universalism.” They conceptualize the process to move toward universal health coverage using the “universal health coverage cube – a way of understanding the trade-offs and choices policy makers must make along the way.

The cube consists of three dimensions: the percentage of the population covered, the percentage of costs pre-paid at the point of service (the rest paid for out of pocket), and the percentage of interventions that are covered by prepaid schemes.

Essentially, if a system has no one covered, none of the real costs associated with clinical interventions are pre-paid, and no interventions are covered through pre-paid schemes, that’s bad and does not approach UHC. You’re in a system that is in the bottom, right, front corner of the cube. Conversely, if people within a health system have all of their costs pre-paid at the point of service, all possible services are covered within the pre-paid scheme, and everyone within a population is covered, then you’ve got universal health coverage.

The report outlines two ways of “moving through the cube.” The first, and ideal strategy, would be to create a publicly financed health insurance system that would cover essential health interventions for entire populations. Basically, using “x, y, and z” coordinates imposed on the cube above, it would mean a large x (population covered) and a large z value (percentage of costs prepaid vs out of pocket), but a relatively small y (percent of all interventions that are covered through the system).

The second feasible strategy would be to provide a larger benefit package, financed through a mix of public and personal resources, from which the poor would be exempt. Basically, a smaller x value, similar z value, and a larger y value.

Potential implications for advocacy strategy?

I’m personally most interested in this report because I think that it provides a viable “stake in the ground” around which nonprofit organizations, civil society, advocacy networks, and ministries of health can mobilize and direct collective effort. It presents an ambitious vision for what could be. It provides the beginnings of a roadmap for how we could plausibly build upon the successes and challenges of the last 20 years in global health and actually make headway in recasting health expenditure from being considered sunk costs to be minimized, and moving towards a commitment of robust investment. And, just maybe, we can even move past the idea of investment and consider health a fundamental human right to be protected as a central component of modern citizenship.

This is, of course, where politics and advocacy come in. Some questions emerge:

What types of organizations and grassroots campaigns are necessary in high-income countries to create the political space necessary to create the necessary development assistance for health funding streams necessary to see a plan like this enacted?
What types of organizations and campaigns are necessary in low-income countries to hold their governments and elected officials accountable for adequate public sector investment in health?
What type of advocacy is necessary to bring the lessons and innovations from low income countries working to pioneer UHC to high income countries, in order to disrupt dysfunctional health systems with massive politically and economically entrenched interests?

A Critical Engagement

A dialogue on advancing justice in health