Institutional Support?

Before looking more closely at the Partners in Health (PIH) model, we analyzed the impact of NGOs. While most NGOs are able to provide temporary relief to individuals in a population, they often fail at creating sustainable infrastructure to address broader issues affecting a whole population. One example of an NGO, however, that has been rather successful in creating structural-based changes has been PIH. Although we’ve mostly been following PIH’s work in Haiti, the organization’s involvement in Rwanda has also led to promising changes in healthcare delivery there (4). PIH can’t take all of the credit though. Rather, their partnership with the Rwandan Ministry of Health (5) as well as with their well-endowed affiliated institution, Harvard University, has been crucial to their continued success. Harvard Medical School, along with its affiliated medical centers like Brigham and Women’s Hospital, has especially been able to supply much of the initial resources and expertise necessary for this endeavor (4). Corrado Cancedda uses the work of Harvard as a guide for other U.S. institutions on how to “channel the innovation, creativity, resources, and expertise of academia toward the pursuit of global health inequity” (4). Institutions no doubt can play an important role, yet with the exception of other institutions in the Ivy League and perhaps Stanford, I wonder how reliably PIH’s institutional model applies to less-endowed U.S. institutions.

Many institutions have already been aiding in the Global Health effort. Brown’s Global Health Initiative, for example, provides scholarships to students seeking to conduct relevant projects or research in other countries, just as it encourages collaboration with institutions in other countries. The Alpert Medical School even has some collaboration with St. Damien Hospital in Tabarre, Haiti (2), yet there haven’t been updates regarding this collaboration since 2010 (1). For the most part, Brown’s position in the Global Health effort mainly takes the form of research, as do other institutions. Case in point, the most recent global health related article published by Brown discussed research done on HIV incidence in Nigeria (3). Harvard University certainly pioneered a different approach to institutional involvement, one that partnered with an NGO founded by two of its alumni and the Ministry of Health of Rwanda in attempt to change the way healthcare was delivered there. With one of the highest U.S. institutional endowments, some of the brightest educators and doctors, and some of the top medical and research centers in the world, Harvard is no doubt an institution that can afford to go to these great lengths and do so well. Its financial and research position allows it to wield great power and influence over systemic changes in other countries. In the case of other institutions that have fewer resources, money, and prestige, it seems they would be less likely to get past the “NGO state” when conducting global health projects, i.e. providing temporary fixes as opposed to broad, structural-based changes. This is not to discredit the global health work other institutions do and have been doing, but this is to question how replicable the PIH partnership model is for other institutions.

Discussion Questions:

1. How can the PIH partnership model apply to other less-endowed institutions?

2.  What are some other ways these institutions can create broad, structural-based changes in other countries?

Cited

  1. Brown University (2015) Global Health Initiative: Alpert Medical School in Haiti. Retrieved from http://www.brown.edu/initiatives/global-health/haiti/alpert-medical-school-haiti
  2. Brown University (2015) Global Health Initiative: Medical Education and Leadership Development. Retrieved from http://www.brown.edu/initiatives/global-health/haiti/medical-education-and-leadership-development-project-meld
  3. Brown University (2015) News From Brown: HIV Spreads Faster as Violent Conflict Looms. Retrieved from https://news.brown.edu/articles/2015/11/hivwar
  4. Cancedda, C., Farmer, P.E., Kyamanywa, P. (2014). Enhancing Formal Education and In-Service Training Programs in Rural Rwanda: A Partnership Among the Public Sector, a Nongovernmental Organization, and Academia. Academic Medicine, 89 (8), 1117-1123.
  5. Farmer, P.E., Kim, J.Y., Kleinman, A. (2013). Reimagining Global Health: An Introduction. (172-182). Berkeley and Los Angeles: University of California Press.

11 thoughts on “Institutional Support?”

  1. Hey Jeannette,

    You raise a good point here about how the PIH model of partnership across institutions may not be feasible for less-endowed educational/research institutions. I think that, even in less-endowed institutions, they can still provide valuable resources in the form of human capital for health intervention programs. With the technical skills and medical knowledge, doctors from those institutions can partner with other institutions with more funding available to contribute to the PIH model.

    If less-endowed institutions are unable to carry out the PIH model by providing human capital, then they can provide small funding to well-known and trusted NGOs such as PIH. For example, colleges across the nation, including Brown University, have PIH chapters that fundraise for the organization, so I think that may be a way to still contribute to the cause without having to rely on the amount of endowment that an institution has.

  2. Hi Jeannette,

    Thank you for your post. You point about less endowed institutions not being able to follow the PIH model as effectively was an interesting one.

    I agree with Yuki in that these less-endowed institutions could partner with other institutions to get more funding and make it more possible to follow the PIH model. I understand that partnerships can sometimes be hard to develop especially between institutions that perhaps are “competeing” with each other. This could make these partnerships hard but in an ideal world these partnerships would be made and funding would increase for both institutions.

    These partnerships could also be created between an institution and an NGO. This partnership may be more feasible just because competition would be less of an interfering issue.

  3. Hi Jeannette, I think you brought up some really interesting points in your blog. Even in institutions like Brown that are involved in the global health sphere, there is usually a greater emphasis on research than action or interventions. Moving some of the available funding away from research grants to promoting global health work – perhaps stipends for volunteers – is one possible change. Another idea is requiring a service component to research grants. This does not address the challenges of less-endowed institutions, but at least it spurs some action in global health in institutions with available resources.

  4. Hey all,

    Thanks for your comments. I agree, perhaps institutions could partner up with other universities or NGOs. I guess I was envisioning other institutions being able to go to the extent PIH/Harvard went in partnering with the Rwandan MOH in order to improve health care delivery for the Rwandan population. So far it seems like other institutions are focusing on change at the individual level. Yet, I agree that sometimes its best to support already existing movements that are trying to address issues at the population level, rather than trying to forge a separate path.

  5. Hello Jeannette,
    I appreciated that, while acknowledging PIH’s success in Rwanda, you questioned its replicability. I think your blog really highlights the fact that contributions to the global health initiatives are tiered in their capabilities. Nevertheless, it is also important to acknowledge that global health outcomes are a sum of all efforts from a range of institutions (academia, NGOs, pharmas, individuals, etc.) and fields of knowledge (anthropology, policy, epidemiology, etc.). In this sense, PIH’s model is replicable for well-endowed institutions and is perhaps the ideal for creating sustainability in countries with a strong ministry of health. However, we can idealize other models for the particular capabilities of both the endower and the endowed. For instance, in Haiti, the best way to create sustainable health involved more attention to social violence (e.g. hunger, poverty, transportation). Essentially, the best way Brown can contribute to the global health effort may be research. We can’t readily change the tier of capabilities and force an ideal model, but we can optimize a particular approach within that tier.

    1. I agree, Nikisha. Perhaps a good way of optimizing the research approach is take into consideration some of the issues Dr.Lindsey Reynolds brought up such as exploitation and ethics in global research, especially due to poor international standards that don’t take into account “local contexts and lived experience” as Reynolds describes.

  6. Hi Jeanette, thank you for bringing up this very important point of replicability. Indeed the work PIH-Harvard did in Rwanda is impressive but few institutions and NGOs have the resources to take on such a task. I think that with regard to the need to create broad, structural-based changes, it is important to note that research is not the only way to do this. In Chapter 2 of ‘When People Come First’ I was really struck by how the focus on research and on making global health interventions more ‘scientific’ has almost made us blind to the value of tailoring global health interventions to the culture of a very specific group of people (the example given to demonstrate this was the author’s inability to launch a project that promoted safe motherhood in rural Tibet- pg. 79). Therefore, I believe that if multiple less-endowed institutions continue to engage in smaller scale interventions, the overall sum of their interventions will lead to structural based change. Also, let us not forget that PIH had to have started from somewhere and indeed started with more smaller scale projects.

  7. Jeannette, thank you for your post, I particularly liked how you applied your point with examples of how Brown and other institutions get involved. I agree with your central premise that Harvard is in a somewhat unique position in terms of resources. And while I agree with other commenters that lesser-endowed institutions still have human resources to offer, the point remains that these universities tend to focus on research.

    My response is that even research should be more involving of local entities, in a fashion similar to the PIH model. Increasing infrastructure does not need to mean building training hospitals and staffing hundreds of doctors. Collaborations with local researchers, and hosting of conferences and other information-sharing events – perhaps even doing an exchange where health care professionals go to a country and learn from local experts (say TB experts), and local providers go to the NGO University and gain unique experience, could also be very valuable. It goes without saying that the process of choosing a research topic and involving local participants should also be a highly collaborative process as well.

    One point that I find highly frustrating about this situation is that there seems to exist a strict sense of territorialism when it comes to US University’s involvement in foreign aid. The collaborations Harvard and its affiliated hospitals have with PIH in Rwanda would not be open for, say, Duke, to join in. These institutions are almost trying to “corner the market” on countries where they can establish research-fruitful relationships, and even if their aim is ultimately positive, I think this spirit really hinders the functionality of these projects. If schools with less resources had an easier time joining PIH/Harved/& co, then even more could be accomplished.

  8. Hi Jeanette! I really appreciated your post, especially in highlighting one of the overarching points — “NGOs often fail to create sustainable infrastructure to address broader issues.” I also appreciated your discussion of PIH, Rwanda, and Harvard, since I think it is a more unique situation. Many other students (and yourself) made the point that Harvard is incredibly well-endowed. I also believe that this specific partnership may not have happened if it were not Paul Farmer, a former student from Harvard, and semi-legend in the world of medical anthropology. Harvard was undeniably proud of their student, but I do believe him being a Harvard graduate had something to do with it.

    Like Yuki and a few of the other posts, I agree that smaller institutions can provide manpower abroad, or more engaged forms of learning. As stated, scientific research has come to dominate this process, and it’s being dominated by individuals who have no idea or understanding of existing cultural norms, values, and traditions. We should be funding students to work, on the ground, side-by-side with organizations and people, and not manipulating beings for our own educational purposes. It is highly unrealistic to think that, in a time span of 8-weeks, a successfully completed research project will ensue, if a student has never experienced the culture, or understood the historical and political climate of the area.

  9. Hi Jeannette,

    Your blog post brings up an interesting viewpoint on the ability for less endowed institutions to replicate the Partners In Health model. Since there are few institutions that are financially capable of bringing about such a model (and have the ability to do this successfully), it is extremely important for these few institutions to continue to expand their work. To answer your first question, I think less-endowed institutions can use the PIH model, although it may be very difficult. They can do this by proposing a similar plan as PIH did, and propose their plan to potential donors.

  10. Hello Jeannette,

    I really liked your discussion of the participation of educational institutions in global health. I think that institutions like ours can play an important role in propelling initiatives as we have both experienced, informed academics as well as enthusiastic, innovative students from a wide range of disciplines to offer. I would like to echo Jacob who put forward the idea of PIH style collaborative research. The endowments of many institutions limit their capabilities outside of the sphere of research but I think there is value in the knowledge being produced by researchers and that if the approach that research currently takes was to be tweaked a little, it could have a more telling effect. Another possibility in this realm could be to have as someone suggested previously, a service component to research grants.

    A somewhat different approach could be to collaborate with NGOs and apply to funds that are given by say the Gates Foundation and attempt to simulate what PIH has achieved in some places. Lastly, if institutions could collaborate amongst themselves and form a consortium, I’m sure they would be able to develop a program that can promote sustainable change.

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