Creating a charter of collaboration for international university partnerships: the Elmina Declaration for Human Resources for Health

Leveraging Responsible, Explainable, and Local Artificial Intelligence Solutions for Clinical Public Health in the Global South

In the present paper, we will explore how artificial intelligence (AI) and big data analytics (BDA) can help address clinical public and global health needs in the Global South, leveraging and capitalizing on our experience with the "Africa-Canada Artificial Intelligence and Data Innovation Consortium" (ACADIC) Project in the Global South, and focusing on the ethical and regulatory challenges we had to face. "Clinical public health" can be defined as an interdisciplinary field, at the intersection of clinical medicine and public health, whilst "clinical global health" is the practice of clinical public health with a special focus on health issue management in resource-limited settings and contexts, including the Global South. As such, clinical public and global health represent vital approaches, instrumental in (i) applying a community/population perspective to clinical practice as well as a clinical lens to community/population health, (ii) identifying health needs both at the individual and community/population levels, (iii) systematically addressing the determinants of health, including the social and structural ones, (iv) reaching the goals of population's health and well-being, especially of socially vulnerable, underserved communities, (v) better coordinating and integrating the delivery of healthcare provisions, (vi) strengthening health promotion, health protection, and health equity, and (vii) closing gender inequality and other (ethnic and socio-economic) disparities and gaps. Clinical public and global health are called to respond to the more pressing healthcare needs and challenges of our contemporary society, for which AI and BDA can help unlock new options and perspectives. In the aftermath of the still ongoing COVID-19 pandemic, the future trend of AI and BDA in the healthcare field will be devoted to building a more healthy, resilient society, able to face several challenges arising from globally networked hyper-risks, including ageing, multimorbidity, chronic disease accumulation, and climate change.

Growth model for international academic medicine partnerships: Qualitative analysis of Ghana postgraduate Ob/Gyn training program

This study aims to detail the capacity strengthening process of the Ghana Ob/Gyn postgraduate training program in order to inform a model by which international academic medicine partnerships can form, grow, and effectively tackle development challenges. A qualitative analysis with grounded theory methodological approach was utilized. Convenience and purposive sampling were used to select certified Ob/Gyn training program graduates. Interviews were conducted face-to-face in in Accra, Kumasi, Cape Coast, and Tamale, Ghana between June 21 to August 20, 2017. An additional data analysis of 48 semi-structured interviews previously collected for another study were examined for factors pertinent to graduate career development. Coded data were grouped according to themes and subthemes. Emerging themes demonstrated that graduates further complete the maternal care team and facilitate collaboration amongst healthcare workers. Themes also included graduates' pursuit of subspecialty training and research. Graduates cited the training program as key to their professional development. Graduates assume leadership roles in hospital management and operations, teaching, mentoring, interprofessional maternal care team, and knowledge-sharing. Graduates expressed eagerness to subspecialize and to advance their research training and skills. The results suggest a growth model of international academic medicine partnerships from basic obstetric training to advanced training. The model is developed for adaptability in other SSA countries and low-resource settings so that it may effectively strengthen health workforce capacity. We hope that this program can serve as a model for other partnerships in medical specialties.

The 'community turn': Relational citizenship in the Psychoanalytic Community Collaboratory®

Drawn from five years of experience in the web-based Psychoanalytic Community Collaboratory, this paper explores implications of the 'community turn' in psychoanalysis for roles, methods, clinical theory, and training. With participants from many parts of the world, the Collaboratory has become a creative generator of projects including documentary films, community memorial initiatives, and mental health interventions in highly stressed communities. The Collaboratory's unique pedagogy offers valuable experiential learning about the complex intersubjective dynamics common to group and community life. Through reflection on the interpersonal dynamics of three critical incidents, we illustrate the interplay of intra-psychic and political aspects of identity--what we have termed 'relational citizenship', an intersubjective self-state in which the individual and the sociopolitical are psychically linked and where the challenges of identifying with and belonging to one or more collectivities are recognized and negotiated.

Embedding international medical student electives within a 30-year partnership: the Ghana-Michigan collaboration

BACKGROUND

Global health experiences are an increasingly popular component of medical student curricula. There is little research on the impact of international medical electives embedded within long-standing, sustainable partnerships. Our research explores the University of Michigan medical student elective experience in Ghana within the context of the Ghana-Michigan collaborative.

METHODS

Study participants are University of Michigan medical students who completed an international elective in Ghana between March 2006 and June 2017. Post-elective reports were completed by students, including a description of the experience, highlights, disappointments, and the impact of the experience on interest in future international work and future practice of medicine. A retrospective thematic analysis of reports was carried out using NVivo 12 (QSR International, Melbourne, Australia).

RESULTS

A total of 57 reports were analyzed. Benefits of the elective experience included building cross-cultural relationships, exposure to different healthcare environments, hands-on clinical and surgical experience, and exposure to different patient populations. Ninety-five percent of students planned to engage in additional international work in the future. Students felt that the long-standing bidirectional exchange allowed them to build cross-cultural relationships and be incorporated as a trusted part of the local clinical team. The partnership modeled collaboration, and many students found inspiration for the direction of their own careers.

CONCLUSIONS

Embedding clinical rotations within a well-established, sustained partnerships provides valuable experiences for trainees by modeling reciprocity, program management by local physicians, and cultural humility-all of which can help prepare learners to ethically engage in balanced, long-term partnerships in the future.

An International Partnership of 12 Anatomy Departments - Improving Global Health through Internationalization of Medical Education

Background

At a time of global interconnectedness, the internationalization of medical education has become important. Anatomy as an academic discipline, with its close connections to the basic sciences and to medical education, can easily be connected with global health and internationalization of medical education. Here the authors present an international program based on a partnership between twelve anatomy departments in ten countries, on four continents. Details of a proposed plan for the future direction of the program are also discussed.

Objective

The aim is to improve global healthcare by preparing future global healthcare leaders via early international networking, international collaboration and exchange, intercultural experience, and connecting two seemingly distant academic disciplines - anatomy and global health - via internationalization of medical education.

Methods

Based in the anatomy course, the program involved early international collaboration between preclinical medical and dental students. The program provided a stepwise progression for learning about healthcare and intercultural topics beyond pure anatomy education - starting with virtual small groups of international students, who subsequently presented their work to a larger international audience during group videoconferences. The above progressed to in-person visits for research internships in the basic sciences within industrialized countries.

Findings

Students appreciated the international and intercultural interaction, learned about areas outside the scope of anatomy (e.g., differences in healthcare education and delivery systems, Public and Global Health challenges, health ethics, and cultural enrichment), and valued the exchange travel for basic sciences research internships and cultural experience.

Conclusions

This unique collaboration of international anatomy departments can represent a new role for the medical anatomy course beyond pure anatomy teaching - involving areas of global health and internationalization of medical education - and could mark a new era of international collaboration among anatomists.

Usability and Feasibility of an Innovative mLearning Approach for Nurses Providing Option B+ Services in Manica and Sofala Provinces, Mozambique

The scaling of Option B+ services, whereby all pregnant women who test HIV positive are started on lifelong antiretroviral therapy upon diagnosis regardless of CD4 T-cell count, is ongoing in many high HIV burden, low-resource countries. We developed and evaluated a tablet-based mobile learning (mLearning) training approach to build Option B+ competencies in frontline nurses in central Mozambique. Its acceptability and impact on clinical skills were assessed in maternal child health nurses and managers at 20 intervention and 10 control clinics. Results show that skill and knowledge of nurses at intervention clinics improved threefold compared with control clinics (p = .04), nurse managers at intervention clinics demonstrated a 9- to 10-fold improvement, and nurses reported strong acceptance of this approach. "mLearning" is one viable modality to enhance nurses' clinical competencies in areas with limited health workforce and training budgets. This study's findings may guide future scaling and investments in commercially viable mLearning solutions.

The Best of Both Worlds: Experiences of Co-developing Innovative Undergraduate Health Care Programmes in Egypt

As medical education has become increasingly globalised, universities across the world have sought to raise standards by partnering with well-established institutions and a number of different partnership models have emerged. This article describes an academic collaboration between University College London (UCL), UK, and Newgiza University (NGU), Egypt, to establish modern and innovative undergraduate medicine, dentistry, and pharmacy programmes delivered in Egypt. Academics from UCL and NGU co-developed programmes using established materials, assessments, and processes from the equivalent programmes at UCL. Dedicated project managers, regular steering group meetings, strong working relationships between project teams, and iterative curriculum and assessment development processes were important features of the success of this work. A multidisciplinary first semester included students across all 3 health care programmes. This promoted collaboration between academics at both institutions. Although UCL resources were the basis of this project, the different sociocultural, ethical, professional, and regulatory frameworks in Egypt have meant that a number of adaptations have been necessary, in both curricula and teaching content. Perhaps the most important factor underpinning the success of this project has been the mutual respect and sensitivity of academics and clinicians from both institutions.

What Makes International Global Health University Partnerships Higher-Value? An Examination of Partnership Types and Activities Favoured at Four East African Universities

BACKGROUND

There are many interuniversity global health partnerships with African universities. Representatives of these partnerships often claim partnership success in published works, yet critical, contextualized, and comparative assessments of international, cross-border partnerships are few.

OBJECTIVE

The objectives of this paper are to describe partnerships characterized as higher-value for building the capacity of four East African universities and identify why they are considered so by these universities.

METHODS

Forty-two senior representatives of four universities in East Africa described the value of their partnerships. A rating system was developed to classify the value of the 125 international partnerships they identified, as the perceived value of some partnerships varied significantly between representatives within the same university. An additional 88 respondents from the four universities and 59 respondents from 25 of the international partner universities provided further perspectives on the partnerships identified. All interviews were transcribed and analysed in relation to the classification and emergent themes.

FINDINGS

Thirty-one (25%) of the partnerships were perceived as higher-value, 41 (33%) medium-value, and 53 (42%) lower-value for building the capacity of the four focus universities. Thirteen (42%) of the higher-value partnerships were over 20 years old, while 8 (26%) were between 3 and 5 years old. New international partners were able to leapfrog some of the development phases of partnerships by coordinating with existing international partners and/or by building on the activities of or filling gaps in older partnerships. Higher-valued partnerships supported PhD obtainment, the development of new programmes and pedagogies, international trainee learning experiences, and infrastructure development. The financial and prestige value of partnerships were important but did not supersede other factors such as fit with strategic needs, the development of enduring results, dependability and reciprocity. Support of research or service delivery were also considered valuable but, unless education components were also included, the results were deemed unlikely to last.

CONCLUSION

International partnerships prioritizing the needs of the focus university, supporting it in increasing its long-term capacity and best ensuring that capacity benefits realized favour the focus university are valued most. How best to achieve this so all partners still benefit sufficiently requires further exploration.

Ethical issues in global health engagement

With an increasing number of clinicians participating in global health work, such engagement is now more than ever in need of critical ethical scrutiny. Exemplary initiatives in research, academics and publication, and other special considerations, provide potential approaches for overcoming ethical challenges in global health work. These methods demonstrate that successful global health work includes a commitment to foundational ethical principles such as trust, honesty, open communication and transparency, sustainability, capacity building, and appreciation for multiple perspectives - principles that surpass the traditional considerations of clinical practice. From this perspective, successful interventions to reduce neonatal and perinatal mortality must be strategically focused on building in-country capacity and sustainability.

Partnership Conference

BACKGROUND

The Duke Global Health Institute (DGHI) was founded in 2006 with a goal to foster interdisciplinary global health education and research across Duke University and Duke Medical Center. Critical to achieving this goal is the need to develop and sustain strong international partnerships.

OBJECTIVE

To host a conference with multiple international partners and strengthen existing relationships.

METHODS

After a deliberate year-long planning process, DGHI convened a Partnership Conference with its international partners on the Duke University campus in conjunction with its 10th Anniversary Celebration. The Partnership Conference sought to promote an exchange of novel ideas in support of global health education and research, explore new collaborations in South-South relationships, and identify and facilitate pursuit of new educational and research opportunities.

FINDINGS

A total of 25 partners from 10 countries and 46 DGHI faculty members participated in the 3-day event in October 2016. Activities included workshops on preselected research topics, educational symposia on novel teaching methods and harnessing technological advances, introduction of the Health Humanities Laboratory to prepare students and trainees for fieldwork, and discussions of research infrastructure and training needs. Surveys from visiting partners revealed a high degree of satisfaction. Proposed action items include methods to realize improved communications, enhancement of mutual education opportunities, support and mentoring to build local research capacity, and more exchange of faculty and students between partnering institutions.

CONCLUSIONS

With careful planning from all parties, a multilateral partnership conference including both university and medical center faculty can be a productive forum for exchange on global health education and research. Sustaining such partnerships is vital to the success of global health scholarship.

Post-Ebola situational assessment of opportunities for capacity building at the national obstetrics and gynecology referral hospital in Sierra Leone

OBJECTIVE

To describe a site assessment of the Princess Christian Maternity Hospital (PCMH; Freetown, Sierra Leone), the national referral center for reproductive, maternal, newborn, child and adolescent health (RMNCAH) services and logical site for focused efforts to train and expand the RMNCAH workforce in Sierra Leone.

METHODS

In April 2016, a mixed-methods assessment approach was used involving facility observation and staff interviews using the WHO's Service Availability and Readiness Assessment (SARA) tool. Quantitative and qualitative data were obtained.

RESULTS

PCMH had 150 inpatient beds and provided care for more than 4600 deliveries in 2015. The number of maternal deaths increased at a rate of approximately 40% per month from January 2015 to June 2016 (P=0.005). Key factors requiring attention were identified in the categories of infrastructure and supplies, RMNCAH services, and human resources.

CONCLUSION

SARA provided a framework for identifying strengths and weaknesses in infrastructure and supplies, RMNCAH services, and human resources. The process described might serve as a model for evaluating obstetrics and gynecology training facilities in low- and middle-income countries. Human resources are currently insufficient for the volume and complexity of patients at PCMH. Numerous opportunities exist for strengthening healthcare services and capacity building in Sierra Leone.

Global Health Ethics: The Case of Maternal and Neonatal Survival

Through their Sustainable Development Goals the United Nations recognizes the moral significance of health, stating that the elimination of maternal and early neonatal mortality are health outcomes that should be available to all women in the world. Complete prevention requires addition of a skill set for maternal care teams that is a magnitude greater than what we have today. As universities, individuals, institutions and NGO's engage in initiatives to end preventable maternal and neonatal mortality, an expanded context of ethical imperatives becomes increasingly important. Besides the traditional principles of non-maleficence, beneficence, autonomy, and social justice, imbalances between high and low income countries and cultural relativity give rise to broader ethical imperatives: mutual respect, trust, open communication, accountability, transparency, leadership capacity building and sustainability. The elimination of disparities in other women's issues, HIV, malaria, tuberculosis, chronic non-infectious diseases, can all be more effectively addressed through a lens of ethical global health engagement.

Growing partnerships: leveraging the power of collaboration through the Medical Education Partnership Initiative

A major goal of the Medical Education Partnership Initiative (MEPI) is to improve local health systems by strengthening medical education in Sub-Saharan Africa. A new approach to collaboration was intended to overcome the one-sided nature of many partnerships that often provide more rewards to institutions from wealthy countries than to their Sub-Saharan African counterparts. The benefits of this MEPI approach are reflected in at least five positive outcomes. First, effective partnerships have been developed across a diverse group of MEPI stakeholders. Second, a "community of practice" has been established to continue strengthening medical education in Sub-Saharan Africa. Third, links have been strengthened among MEPI health science schools in Sub-Saharan Africa, their communities, and ministries of both health and education. Fourth, respect among partners in the United States for a culture of ownership and self-determinism among their African counterparts committed to improving education has been enhanced. And finally, performance metrics for strengthening of health science education in Sub-Saharan Africa have been advanced. Meanwhile, partner medical schools in the United States have witnessed the benefits of collaborating across traditional disciplinary boundaries, such as physicians working within highly functioning community-based health care teams with many of the participating schools in Sub-Saharan Africa. MEPI demonstrates that North-South as well as South-South partnerships, with an explicit focus on improving local health systems through better education, can be designed to empower partners in the South with support from collaborators in the North.