Ensuring Continuity of Health Professions Training Amid a Global Pandemic: Lessons From the Uganda Safe Schools Initiative.

ABSTRACT: Uganda experienced 2 COVID-19 waves that challenged health professional education. All health professions training institutions (HPTIs) in Uganda closed in March 2020. Cognizant of the threat to quality education and the frontline workforce, the National Council for Higher Education (NCHE) and Seed Global Health partnered to examine the risks and benefits of HPTI reopening through the Safe Schools Initiative (SSI). This article described the processes to unify stakeholders in health professions education and the outcomes from these discussions during the COVID-19 pandemic in Uganda.During the first COVID-19 wave, the SSI conducted consultative meetings with key stakeholders. The SSI developed guidelines around student welfare and issued standard operating procedures (SOPs) for HPTI reopening. The NCHE recommended in-person learning for final-year students and online learning for junior years, resulting in HPTIs being the first academic institutions to reopen in the country. During the second COVID-19 wave, schools closed again. The SSI utilized recently published literature and quantitative data to inform decision making in addition to expert consensus. The NCHE recommended immediate phased reopening for students in clinical years, blended learning for nonclinical years, and prioritizing health professions education in future lockdowns. Consequently, HPTIs reopened within a month of closure. The SSI demonstrated that national advocacy for health professions education can be effective when engaging stakeholders to build consensus around difficult decisions.Key lessons learned from the SSI include the following: (1) collaborating across sectors in health professions education can amplify change, (2) occupational health guidelines must include health professions students, (3) investing in online education and simulation has value in outbreak-prone areas, and (4) systemic inequities in health professions education will require persistence and advocacy to correct. Future pandemic preparedness must prioritize HPTIs to ensure quality education and continuity of a frontline workforce.

The impact of traumatic brain injury on economic productivity in the Caribbean.

Introduction: Traumatic brain injury (TBI) is a significant cause of morbidity and mortality in the Caribbean as well as globally. Within the Caribbean, the prevalence of TBI is approximately 706 per 100,000 persons - one of the highest rates per capita in the world. Research question: We aim to assess the economic productivity lost due to moderate to severe TBI in the Caribbean. Material and methods: The annual cost of economic productivity lost in the Caribbean from TBI was calculated from four variables: (1) the number of people with moderate to severe TBI of working age (15-64 years), (2) the employment-to-population ratio, (3) the relative reduction in employment for people with TBI, and (4) per capita Gross Domestic Product (GDP). Sensitivity analyses were performed to evaluate whether the uncertainty of the TBI prevalence data result in substantive changes in the productivity losses. Results: Globally, there was an estimated 55 million (95% UI 53, 400, 547 to 57, 626, 214) cases of TBI in 2016 of which 322,291 (95% UI 292,210 to 359,914) were in the Caribbean. Using GDP per capita, we calculated the annual cost of potential productivity losses for the Caribbean to be $1.2 billion. Discussion and conclusion: TBI has a significant impact on economic productivity in the Caribbean. With upwards of $1.2 billion lost in economic productivity from TBI, there is an urgent need for appropriate prevention and management of this disease by upscaling neurosurgical capacity. Neurosurgical and policy interventions are necessary to ensure the success of these patients in order to maximize economic productivity.

A Sierra Leone 2021 Midwifery Clinical Training Needs Assessment: A Call to Action to Augment Clinical Precepting.

Objective: Sierra Leone has one of the highest maternal mortality and infant mortality rates globally. We share findings from a Midwifery Clinical Training Needs Assessment, conducted in 2021 as a collaboration between the Government of Sierra Leone and Seed Global Health. The assessment identified existing needs and gaps in midwifery clinical training at health facilities in Sierra Leone from various stakeholders' perspectives. Methods: The descriptive needs assessment utilized mixed methods, including surveys, focus group discussions (FGDs), interviews, and reviews of maternal medical records. Results: The following showed needs and gaps in labor and delivery management; record keeping; triage processes; clinical education for students, recent graduates, and preceptors; and lack of infrastructure and resources. Conclusion: The knowledge gained from this needs assessment can further the development of midwifery clinical training programs in Sierra Leone and other low-income countries facing similar challenges. We discuss the implication of our findings.

Embracing Social Engagement in Academic Medicine: Ongoing Challenges and How to Move Forward.

Academic medical centers have historically been defined by scientific discovery for health advancement. However, the mounting challenges of modern medicine are fueled by the social, economic, and political determinants of health that predict vulnerability and accelerate poor outcomes. To surmount looming threats to health, the academic medical mindset must equally prioritize social engagement-work that directly addresses the systemic social causes of health and illness-alongside the traditional pedagogy of laboratory-based, translational, and clinical research. Considerable barriers still exist, rooted in historical priorities and significant funding structured to reward scientific achievements. Academic medicine has the agency to support elements of restructuring to help prioritize research, education, and training to more prominently include social engagement. Crucial steps to ensure the success of this process include prioritizing financial commitments to community-engaged scholarship and programmatic work and rigorous recognition of faculty who work on socially engaged scholarship within promotion schemes. The COVID pandemic presents an unprecedented opportunity for academic medicine to reflect on the breadth of the work we promote and encourage, work that reflects all the complex elements of health-those that can be documented in a lab notebook and those rooted in social systems and structures that we have neglected for too long.

Hierarchy of qualities in global health partnerships: a path towards equity and sustainability.

Despite the exponential growth of global health partnerships (GHPs) over the past 20 years, evidence for their effectiveness remains limited. Furthermore, many partnerships are dysfunctional as a result of inequitable partnership benefits, low trust and accountability and poor evaluation and quality improvement practices. In this article, we describe a theoretical model for partnerships developed by seven global health experts. Through semistructured interviews and an open-coding approach to data analysis, we identify 12 GHP pillars spanning across three interconnected partnership levels and inspired by Maslow's hierarchy of needs. The transactional pillars are governance, resources and expertise, power management, transparency and accountability, data and evidence and respect and curiosity. The collaborative pillars (which build on the transactional pillars) are shared vision, relationship building, deep understanding and trust. The transformational pillars (which build on the collaborative pillars and allow partnerships to achieve their full potential) are equity and sustainability. The theoretical model described in this article is complemented by real-life examples, which outline both the cost incurred when GHPs fail to live up to these pillars and the benefits gained when GHPs uphold them. We also provide lessons learnt and best practices that GHPs should adopt to further increase their strength and improve their effectiveness in the future. To continue improving health outcomes and reducing health inequities globally, we need GHPs that are transformational, not just rhetorically but de facto. These actualised partnerships should serve as a catalyst for the greater societal good and not simply as a platform to accrue and exchange organisational benefits.

Assessment of Point-of-Care Ultrasound Training for Clinical Educators in Malawi, Tanzania and Uganda.

Integrating point-of-care ultrasound (POCUS) to enhance diagnostic availability in resource-limited regions in Africa has become a main initiative for global health services in recent years. In this article, we present lessons learned from introducing POCUS as part of the Global Health Service Partnership (GHSP), a collaboration started in 2012 between the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), the Peace Corps and Seed Global Health to provide health care work force education and training in resource-limited countries. A cross-sectional survey of GHSP clinical educators trained to use POCUS and provided with hand-held ultrasound during their 1-y deployment during the period 2013-2017. The survey consisted of 35 questions on the adequacy of the training program and how useful POCUS was to their overall clinical and educational mission. Clinical educators engaged in a series of ultrasound educational initiatives including pre-departure training, bedside training in the host institutions, online educational modules, educational feedback on transmitted images and training of local counterparts. In this study 63 GHSP clinical educators who participated in the POCUS trainings were identified, and 49 were included at the study (78% response rate). They were assigned to academic institutions in Tanzania (n = 24), Malawi (n = 21) and Uganda (n = 18). More than 75% reported use of POCUS in clinical diagnoses and 50% in determining treatment, and 18% reported procedural application of ultrasound in their practice. The top indications for POCUS were cardiac exams, second- and third-trimester obstetric exams, lung and pleura, liver and spleen and gynecology/first-trimester obstetrics. The largest perceived barriers were lack of ultrasound knowledge by the clinical educators, lack of time, equipment security, difficulty accessing the Internet and equipment problems. We concluded that our multiphase POCUS training program has increased the utility, acceptability and usage of POCUS in resource-limited settings.

Analysis of results from the Joint External Evaluation: examining its strength and assessing for trends among participating countries.

BACKGROUND: The Joint External Evaluation (JEE) is part of the World Health Organization's (WHO) new process to help countries assess their ability to prevent, detect and respond to public health threats such as infectious disease outbreaks, as specified by the International Health Regulations (IHR). How countries are faring on these evaluations is not well known and neither is there any previous assessment of the performance characteristics of the JEE process itself. METHODS: We obtained JEE data for 48 indicators collectively across 19 technical areas of preparedness for 55 countries. The indicators are scored on a 1 to 5 scale with 4 indicating demonstrated capacity. We created a standardized JEE index score representing cumulative performance across indicators using principal components analysis. We examined the state of performance across all indicators and then examined the relationship between this index score and select demographic and health variables to better understand potential drivers of performance. RESULTS: Among our study cohort, the median performance on 43 of the 48 (89.6%) indicators was less than 4, suggesting that countries were failing to meet demonstrated capacity on these measures. The two weakest indicators were related to antimicrobial resistance (median score = 1.0, interquartile range = 1.0-2.0) and biosecurity response (median score = 2.0, interquartile range = 2.0-3.0). JEE index scores correlated with various metrics of health outcomes (life expectancy, under-five year mortality rate, disability-adjusted life years lost to communicable diseases) and with standard measures of social and economic development that enable public health system performance in the total sample, but in stratified analyses, these relationships were much weaker in the AFRO region. CONCLUSIONS: We find large variations in JEE scores among countries and WHO regions with many nations still unprepared for the next disease outbreak with pandemic potential The strong correlations between JEE performance and metrics of both health outcomes and health systems' performance suggests that the JEE is likely accurately measuring the strength of IHR-specific, public health capabilities.

Has development assistance for health facilitated the rise of more peaceful societies in sub-Saharan Africa?

Growing evidence suggests that health aid can serve humanitarian and diplomatic ends. This study utilised the Fragile States Index (FSI) for the 47 nations of the World Health Organizations' Africa region for the years 2005-2014 and data on health and non-health development aid spending from the United States (US) for those same years. Absolute amounts of health and non-health aid flows from the US were used as predictors of state fragility. We used time-lagged, fixed-effects multivariable regression modelling with change in FSI as the outcome of interest. The highest quartile of US health aid per capita spending (≥$4.00 per capita) was associated with a large and immediate decline in level of state fragility (b = -7.57; 95% CI, -14.6 to -0.51, P = 0.04). A dose-response effect was observed in the primary analysis, with increasing levels of spending associated with greater declines in fragility. Health per-capita expenditures were correlated with improved fragility scores across all lagged intervals and spending quartiles. The association of US health aid with immediate improvements in metrics of state stability across sub-Saharan Africa is a novel finding. This effect is possibly explained by our observations that relative to non-health aid, US health expenditures were larger and more targeted.

Leveraging the Global Health Service Partnership Model for Workforce Development in Global Radiation Oncology.

A major contributor to the disparity in cancer outcome across the globe is the limited health care access in low- and middle-income countries that results from the shortfall in human resources for health (HRH), fomented by the limited training and leadership capacity of low-resource countries. In 2012, Seed Global Health teamed up with the Peace Corps to create the Global Health Service Partnership, an initiative that has introduced a novel model for tackling the HRH crises in developing regions of the world. The Global Health Service Partnership has made global health impacts in leveraging partnerships for HRH development, faculty activities and output, scholarship engagement, adding value to the learning environment, health workforce empowerment, and infrastructure development.

Politics and Universal Health Coverage--The Post-2015 Global Health Agenda.

What political, social, and economic factors allow a movement toward universal health coverage to take hold in some low- and middle-income countries? Can we use that knowledge to help other such countries achieve health care for all?

Scope of global health training in U.S. obstetrics and gynecology residency programs.

OBJECTIVE: To enumerate global health training activities in U.S. obstetrics and gynecology residency programs and to examine the worldwide distribution of programmatic activity relative to the maternal and perinatal disease burden. METHODS: Using a systematic, web-based protocol, we searched for global health training opportunities at all U.S. obstetrics and gynecology residency programs. Country-level data on disability-adjusted life-years resulting from maternal and perinatal conditions were obtained from the Global Burden of Disease study. We calculated Spearman's rank correlation coefficients to estimate the cross-country association between programmatic activity and disease burden. RESULTS: Of the 243 accredited U.S. obstetrics and gynecology residency programs, we identified 41 (17%) with one of several possible predefined categories of programmatic activity. Thirty-three residency programs offered their residents opportunities to participate in one or more elective-based rotations, eight offered extended field-based training, and 18 offered research activities. A total of 128 programmatic activities were dispersed across 64 different countries. At the country level, the number of programmatic activities had a statistically significant association with the total disease burden resulting from maternal (Spearman's ρ=0.37, 95% confidence interval [CI] 0.14-0.57) and perinatal conditions (ρ=0.34, 95% CI 0.10-0.54) but not gynecologic cancers (ρ=-0.24, 95% CI -0.46 to 0.01). CONCLUSIONS: There are few global health training opportunities for U.S. obstetrics and gynecology residents. These activities are disproportionately distributed among countries with greater burdens of disease. LEVEL OF EVIDENCE: II.

Adolescents and the right to health: eliminating age-related barriers to HIV/AIDS services in Rwanda.

Under international, regional, and domestic law, adolescents are entitled to measures ensuring the highest attainable standard of health. For HIV/AIDS, this is essential as adolescents lack many social and economic protections and are disproportionately vulnerable to the effects of the disease. In many countries, legal protections do not always ensure access to health care for adolescents, including for HIV/AIDS prevention, treatment, and care. Using Rwanda as an example, this article identifies gaps, policy barriers, and inconsistencies in legal protection that can create age-related barriers to HIV/AIDS services and care. One of the most pressing challenges is defining an age of majority for access to prevention measures, such as condoms, testing and treatment, and social support. Occasionally drawing on examples of existing and proposed laws in other African countries, Rwanda and other countries may strengthen their commitment to adolescents' rights and eliminate barriers to prevention, family planning, testing and disclosure, treatment, and support. Among the improvements, Rwanda and other countries must align its age of consent with the actual behavior of adolescents and ensure privacy to adolescents regarding family planning, HIV testing, disclosure, care, and treatment.