Internationalizing Medical Education: The Special Track Curriculum 'Global Health' at Justus Liebig University Giessen.

Internationalizing higher education is considered to be a major goal for universities in Germany and many medical students aspire to include international experiences into their academic training. However, the exact meaning of "internationalizing" medical education is still poorly defined, just as is the possible pedagogic impact and effects. Against this background, this article presents the special track curriculum on global health (in German: Schwerpunktcurriculum Global Health, short: SPC) at Justus Liebig University Giessen, which was established in 2011 as a comprehensive teaching program to integrate international perspectives and activities systematically into the clinical years of the medical curriculum. The report of the structure, content, didactic principles and participants' evaluations of the SPC is embedded into a larger discussion of the pedagogic value of a broad and interdisciplinary perspective on "global health" in medical education, that explicitly includes attention for health inequities, social determinants of health and the cultural dimensions of medicine and health abroad and "at home" (e.g. in relation to migration). We conclude that if properly defined, the emerging field of "global health" represents a didactically meaningful approach for adding value to medical education through internationalizing the curriculum, especially in regard to themes that despite of their uncontested value are often rather weak within medical education. The concrete curricular structures, however, have always to be developed locally. The "SPC" at Giessen University Medical School is only one possible way of addressing these globally relevant issues in one particular local academic setting.

The global health concept of the German government: strengths, weaknesses, and opportunities.

Recognising global health as a rapidly emerging policy field, the German federal government recently released a national concept note for global health politics (July 10, 2013). As the German government could have a significant impact on health globally by making a coherent, evidence-informed, and long-term commitment in this field, we offer an initial appraisal of the strengths, weaknesses, and opportunities for development recognised in this document. We conclude that the national concept is an important first step towards the implementation of a coherent global health policy. However, important gaps were identified in the areas of intellectual property rights and access to medicines. In addition, global health determinants such as trade, economic crises, and liberalisation as well as European Union issues such as the health of migrants, refugees, and asylum seekers are not adequately addressed. Furthermore, little information is provided about the establishment of instruments to ensure an effective inter-ministerial cooperation. Finally, because implementation aspects for the national concept are critical for the success of this initiative, we call upon the newly elected 2013 German government to formulate a global health strategy, which includes a concrete plan of action, a time scale, and measurable goals.

Health financing reform in Kenya - assessing the social health insurance proposal.

Kenya has had a history of health financing policy changes since its independence in 1963. Recently, significant preparatory work was done on a new Social Health Insurance Law that, if accepted, would lead to universal health coverage in Kenya after a transition period. Questions of economic feasibility and political acceptability continue to be discussed, with stakeholders voicing concerns on design features of the new proposal submitted to the Kenyan parliament in 2004. For economic, social, political and organisational reasons a transition period will be necessary, which is likely to last more than a decade. However, important objectives such as access to health care and avoiding impoverishment due to direct health care payments should be recognised from the start so that steady progress towards effective universal coverage can be planned and achieved.

Thirteen years HIV-1 sentinel surveillance and indicators for behavioural change suggest impact of programme activities in south-west Tanzania.

OBJECTIVE: To describe the evolution of the HIV-1 epidemic among women attending antenatal clinics in four different geographic areas within two rural regions with differing intervention intensity in south-west Tanzania. DESIGN AND METHODS: Age-specific trends in HIV-1 seroprevalence among antenatal clinic attendees in four distinct geographic areas of Mbeya region between 1988 and 2000 and in one area of Rukwa region between 1991 and 1999 were analysed and compared. In Mbeya region a comprehensive AIDS control programme has been implemented since 1988. Indicators measuring behavioural change and the attendance rate of patients with sexually transmitted diseases (STDs) were monitored through the established routine system, complemented by two Knowledge, Attitude and Practise (KAP) surveys in 1995 and 1999. RESULTS: Data showed an increasing HIV-1 prevalence from 1988 up to 1994/95 for women in the age group 15-24 years across all strata. Between 1994/95 and 2000 the prevalence declined significantly in all strata for this age group in Mbeya region with diverse patterns in spread of the infection accompanied by a significant decrease in the positive syphilis serology, high rate of condom use, significant delay of age for the start of sexual activity of primary school pupils and a high treatment rate for STDs. The increasing trend of the HIV-1 prevalence in Rukwa region continued. CONCLUSION: Declining trends of HIV-1 prevalence among women aged 15-24 years may correspond to a reduced incidence partially attributable to changes in behaviour and reduction of a biological factor influencing HIV-1 transmission to which the implemented programme could contribute.