Best Practices for Global Health Programs

Identifying interesting approaches to global health education

Strength of Infrastructure

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Identify programs that demonstrate strong in-country educational and administrative infrastructure (i.e.; in-country mentorship, administrative support, telecommunications, internet access, etc.).

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IGOT has 5 established institutional partnerships (Managua-Nicaragua, Kumasi-Ghana, Dar es Salaam-Tanzania, Blantyre-Malawi, Kantmandu-Nepal) where there are designated senior mentors, residency training programs & research coordinators. IGOT has found that fiscally sponsoring local research/volunteer coordinators has been cost effective (<$1K a year) and led to improved efficiency in communications with sites. Partnering with academic institutions that have an interest in research & training has proved to enhance these partnerships. IGOT encourages & supports bilateral exchange hosting learners in SF but travel expenses & housing is a moving target & in some sites is expensive. Centralizing the logistics of coordinating travel & housing, ideally bilaterally would be an invaluable resource for IGOT. 

The UCSF Roatan Interprofessional Program is supported by Bay Area and in-country administration/leadership.  Learners receive orientation materials in advance of travel. Non-stop air from Houston, and multiple connections to San Salvador and mainland Honduras.  Standard guest apartments house learners at one consistent site in West End, Roatan.  The apartment owner lives locally and communicates regularly with program administration.  As a small tourist town, West End provides a comfortable home for our learners, with easily accessible transit and food/supplies.  Given the tourist economy, and the importance of tourism to Roatan, there is strong local attention to safety and security.  The Program itself is based in the Public Hospital Roatan, a 20 minute shuttle ride away in Coxen Hole, the major urban center of the island.  On-site internet access and VOIP, together with a 2h time difference, simplifies communication with stateside leadership/administration.   The Program supports a local physician site director jointly with the Honduran MoH;  Dra. Karla Cerritos staffs the pediatric clinic and provides mentorship to rotating residents.   As faculty of the Public Hospital, she also serves as a key liaison between visiting learners and other faculty or staff with whom they may collaborate—whether for clinical practice, research, or education.

Thanks for your thoughts about potential useful additions.  

In reference to Amber Caldwell's IGOT comment:

Looking at the 5 sites you are currently most active, I'm wondering if efficiencies might be garnered by working with Berkeley (lots of work in Nicaragua), UCSF SON (works in Malawi), and the Bixby Ctr (in Nepal) in creating the kind of centarlized support you mention.  How did you end up at these specific sites? Was there a specific need that motivated you, or a specific resource that helped you get traction at that site?

The UCSF-Gladstone CFAR supported the infrastructure and development of the new Translational Research Lab based in Kampala, Uganda, and managed by the Infectious Diseases Institute in conjunction with Makerere University Medical School’s Department of Obstetrics and Gynecology. The in-country lab director is Steffi Sowinski, a Gladstone Instittue of Virology and Immunology staff scientist, who leads a team of 5 lab scientists. This not only serves as a major capacity building endeavor for increasing the number of Ugandan trained East African researchers, but allows for speedier lab analyses for PIs of projects taking place in East Africa and is revenue generating. The UCSF-Gladstone-IDI-Makerere relationship continues to grow with this investment and the presence of Dr. Sowinski. Partnerships have already been forged with other European and American universities based on the presence of the lab. 

Recipients of the CFAR developmental pilot awards, generally early career investigators or postdocs at UCSF, frequently subcontract projects with Makerere University. They can utilize the IDI-administered and UCSF-Gladstone CFAR supported Translational Research Lab for any needed analyses. They frequently hire in-country research staff, which is both capacity-building and supportive of existing research collaborations. Investigators based abroad also have benefitted from the CFAR Developmental Awards in the International Mentored Scientist category, in which they partner with a senior UCSF or UCSF-affiliated researcher for their study, which has frequently led to the development of more robustly funded projects that they manage on their own or with their new American based collaborators.

The lab resource is invaluable, and amazing. I think it will take some time for programs to transition protocols, so be patient!  Im wondering what kind of outreach is being undertaken so that researchers at UCSF and other universities can capture capability in their grant proposals. Is there a website describing current capabilities and capacity?

Since the Student Training Education Program (STEP) is based out of the Family AIDS Care and Education Services (FACES) program in western Kenya, participants enjoy access to the facilities employed by the project. Participants are able to work in the office spaces used by FACES – including fast internet connection – and have access to vehicles, administrative support, county-level coordinators, and many other resources afforded by the multi-million dollar HIV care project. The participants are connected to a district-level clinical officer (a level of training between a nurse and a doctor), who then coordinates connecting them to a medical professional in the facility.

GPAS – Global Partners in Anesthesia & Surgery (www.globalsurgery.org)

The GPAS collaboration has maintained a continuous presence in Uganda since formation in 2007. More than half of the GPAS leadership is from Uganda and based in-country at our project sites. In addition, our faculty from North America are in Uganda nearly each month. GPAS maintains an office at Makerere University College of Health Sciecnes and supports a full-time, research and education coordinator who is based in Kampala. Through this office we arrange logistics for our visiting trainees and collaborators. This office is also home base for our in country GPAS Senior Scholars (~akin to Chief Residents) in surgery, anesthesia, obstetrics & gynecology and orthopedics. These Senior Scholars provide additional in-country mentorship for visiting faculty and trainees. 

Great information, I was not aware that GPAS had a stff member in Kampala. What is their relationship with CFARs lab director in Kampala? 

The MU-UCSF/IDRC collaboration has strong administrative infrastructure for both primary research and training projects with established policies for local hiring, management of over 40 subcontracts totaling ~$11,000,000 in funds annually including U.S. federal funds, and local Grants Management Office qualified for U.S. SAM direct funding. A centralized regulatory department for both investigators and trainees for human subjects research studies. In-house data management center that designs and develops custom adaptable software for administering questionnaires and capturing gps and fingerprints as well as capacity for multi-country data merging and coordination with custom made web-based secured access to databases. Research laboratory infrastructure including: Molecular Research Laboratory (MOLAB) located in Kampala has routine capability (including PCR, RFLP analysis, and gel imaging and documentation) to genotype parasites for clinical outcome assessments and to characterize molecular markers of parasite drug resistance and capacity for the culturing of malaria parasites; Tororo Research Laboratory (TOLAB) located in Tororo Hospital has capacity for molecular studies, culture of malaria parasites, and the harvesting of peripheral blood mononuclear cells to support translational molecular, parasitology, and immunology studies. Additionally both laboratories have capacity for long-term banked storage of samples at -80 °C and in liquid nitrogen for future research projects.

 How many UCSF trainees are in the program each year? I know that there is a strong drive to develop local capacity, including community outreach and lab capacity. Do you have a sense of how many local trainees are involved?

Contra Costa County Family Medicine Global Health Fellowship

  The mission of the Contra Costa/UCSF Family Medicine global health fellowship is to train physicians to provide and promote high quality and culturally relevant care imbued with the principles of Family Medicine in the global health setting. The fellowship is sponsored by the Contra Costa Family Medicine Residency, a UCSF affiliate.The one year fellowship will provide the fellow with: advanced clinical training in Inpatient Medicine, Obstetrics (dependent on experience) and/or Emergency Medicine with teaching opportunities at Contra Costa Regional Medical Center, advanced global health fieldwork at a vetted site with a focus on building local capacity and Family Medicine/Primary Care medical education, point of care ultrasound training, faculty development and enrollment in UCSF sponsored global health courses such as GHS 101 and Clinical Scholar Program (see UCSF Global Health Science web page) and the UCSF Heal Initiative Global Health Boot Camp. If you have any questions about the fellowship please contact Neil.Jayasekera@hsd.cccounty.us.

Could you describe the sites where the CCC Family Medicine GH Fellowship has placed fellows a bit?  

Center for Global Surgical Studies (CGSS, global.surgery.ucsf.edu)

Long-term CGSS projects in Uganda and Cameroon demonstrate strong relationships with in-country partners. For this reason, there has consistently been strong, stable infrastructure for UCSF learners to productively impact research and program progress. Local partners have been key to appropriately introducing UCSF learners to study sites and research participants and helping with any potential language and/or cultural barriers. 

GAIA was founded in 2000 in response to the global HIV/AIDS epidemic; this response has 3 primary programs: the GAIA Villages intervention, which to date has served over 200,000 rural Malawians in 180 villages and has employed more than 720 Community Caregivers. A second program is the Nursing Scholars Program that nursing students who are deployed to work for the Ministry of Health following graduation; more than 150 graduates are now working in 24 of 28 Malawi districts. The third program is the Mobile Health Clinics program in which seven Toyota Land Cruisers loaded with medical supplies and each staffed by a clinical officer (similar to a physician’s assistant), a registered nurse, a nurse’s aide, and a driver to Malawi’s most remote villages Monday through Friday; each mobile clinic serves 100-225 patients daily with care for acute and chronic conditions, providing diagnosis and treatment for life-threatening illnesses, such as malaria and pneumonia. GAIA has more than 55 full time employees in southern Malawi and the infrastructure provided by Malawi and US staff have provided infrastructure for doctoral dissertations, 10 GHS capstone projects, numerous Clinical Scholar projects, and a NIH funded R01.