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GHF2014 – PS29 – Information and Communication to Promote and Facilitate Health

Information and Communication to Promote and Facilitate Health
Prof. L. Suzanne Suggs, PhD, MS, CHES, Senior Assistant Professor of Social Marketing and Head of BeCHANGE Research Group, Institute for Public Communication (ICP), Faculty of Communication Sciences, Università della Svizzera italiana, Switzerland
Smartphones to Improve Health Workers Performance and Rational of Drug Use for Management of Childhood Illnesses in a Low Resource Settings
Ms. Clotilde Rambaud-Althaus, MD, PhD candidate, Epidemiology and Public Health Department, Swiss Tropical and Public Health Institute, Switzerland
Prof. Don de Savigny
Head, Health Systems Interventions Research Unit, Department of Public Health and Epidemiology, Swiss Tropical and Public Health Institute, Switzerland
Dr. Allison Goldberg
Director, Global Corporate Affairs, Global Corporate Affairs Anheuser-Busch InBev, United States
Dr. Anthony Adoghe
Research PhD student in Public Health at the University of Essex and founder of Adoghes’ Online Public Health Clinic, United Kingdom
Ms. Sabina Beatrice-Matter
Manager Health Projects, Novartis Foundation for Sustainable Development Switzerland

Suggs photo_sept 2011Prof. L. Suzanne Suggs

Professor Suggs is an Assistant Professor of Social Marketing and Head of the BeCHANGE Research Group in the Institute for Public Communication, Faculty of Communication Sciences, at the Università della Svizzera italiana (USI), in Lugano Switzerland. She is also Director of the USI Sustainability Incubator (USI-SINC). She received a BBA in Marketing at University of North Texas (USA), a MSc and PhD in Health Studies at Texas Woman’s University (USA), and a Post-doctoral fellowship at McMaster University (Canada).

Suzanne’s research focuses on behavior change communication through information and communication technologies. She examines the determinants of behavior and tests innovative digital communication strategies, delivered through ICT, and the influence on health behaviors. The majority of her work focuses on eating and physical activity behaviors, but also does research on alcohol, tobacco, decision-making, vaccination uptake, hand washing, HIV testing, medication compliance, self-management of conditions and therapy, and consumption behaviors.

Prior to joining the faculty in Lugano, she was Assistant Professor of Health Communication, Department of Marketing Communication, at Emerson College and Adjunct Assistant Clinical Professor in the Department of Public Health and Family Medicine at Tufts University School of Medicine (Boston, Massachusetts, USA). She has a wealth of industry experience, working with pharmaceutical companies, health insurers, foundations, organizations, and multi-media communication companies. She is a Co-Founder and on the Executive Board of the European Social Marketing Association and is on the Editorial Board for the Journal of Health Communication: International Perspectives. She teaches graduate level courses in Social Marketing, Focus Group Methods, Research Methods, and Media Skills. And for the second year in a row, Suzanne will teach a course on ” m-Health: Mobile Communication for Public Health”, in the Swiss School of Public Health+ Summer School this August in Lugano.

Rambaud Profile PhotoMs. Clotilde Rambaud-Althaus

Married, mother of two girls and MD, specialist in General Medicine (France), with a focus on Tropical Medicine and International Health. Large field experience as clinician or research scientist with Médecins Sans Frontières and Epicentre in Democratic Republic of Congo, Lebanon, Central African Republic, Cameroun, and Swaziland. Back in Switzerland after three years of expatriation in Tanzania, from 2010 to 2012 as PhD Student with Swiss Tropical and Public Health Institute and University of Basel in the field of malaria, non-malarial fever, and management of childhood illnesses. Currently finishing a PhD thesis and working as a clinician in Travel Medicine Unit of University Hospital of Lausanne.

Don de Savigny_squareProf. Don de Savigny

Professor de Savigny is an epidemiologist and public health specialist and currently Head of the Health Systems Research Unit in the Department of Epidemiology and Public Health at the Swiss Tropical and Public Health Institute, University of Basel.  He has extensive experience in conducting and facilitating health research in developing countries and has lived and worked for many years in Africa.  He chairs or is a member of a number of WHO, RBM, Global Fund, and TDR advisory committees and networks such as COHRED, the Health Metrics Network and the INDEPTH Network.  His current research focuses on interventions to strengthen health systems in developing countries, and on the health system effects of Global Health Initiatives for scaling up access.

Goldberg_Badge_squareDr. Allison Goldberg

Allison Goldberg is a recognized public health expert who has worked with private and public sector leaders around the world on topics ranging from HIV/AIDS to maternal and child health, health innovation scale-up, and health systems strengthening. Allison has published widely and presented on these topics at national and international conferences and high-level meetings with the United States Government and United Nations. Allison spent eight years working with consumer health and pharmaceutical companies, health providers, national and local governments, and non-governmental organizations all sharing interests in developing and implementing evidence-based solutions to address global health challenges. Allison is currently the Director, Global Corporate Affairs, Anheuser-Busch InBev (ABI). In this role, Allison manages and helps develop ABI’s evidence-based research approach to advancing prudent policy related to alcohol and global health. She manages a portfolio of public health initiatives and ensures that research and best practices are embedded in these initiatives. Allison earned a B.A. in Political Science from the University of Michigan, Ann Arbor and an interdisciplinary Ph.D. in Public Health and Political Science from Columbia University.

SabinaMs. Sabina Beatrice-Matter

Sabina Beatrice-Matter is Project Manager at the Novartis Foundation for Sustainable Development for some of the foundation’s healthcare projects, namely the primary healthcare program in Mali, the Tanzanian Training Centre for International Health as well as ICATT and IMPACtt – two eLearning initiatives aimed at improving training in maternal, newborn and child health in collaboration with WHO and the Swiss Tropical and Public Health Institute. From 2008 to 2013, Sabina was also in charge of Communication’s at the Novartis Foundation. Prior to joining the foundation, Sabina worked for the communications department at Novartis and did internships with the Swiss national television in Berne and the news agency FSN in Washington DC.

Sabina is currently doing an MBA in International Health Management at the University of Basel (graduation expected in 2015). She holds a Master’s degree in International Relations from the Graduate Institute of International and Development Studies in Geneva and the University of Salamanca in Spain and studied one year of Journalism at the Shenandoah University, USA.

GHF2014 – PS18 – Improving Health Information Systems for Better Decision Making

Improving Health Information Systems for Better Decision Making
Mr. Hazim Timimi
Data Manager, Tuberculosis Monitoring and Evaluation, World Health OrganizationSwitzerland
Best Practices for Building an Integrated National Health Information System: Rwanda
Dr. Caricia Catalani
Senior Researcher, Innovative Support to Emergency, Disease, & Disaster (InSTEDD) & University of California, Berkeley, School of Public Health, United States
Prof. Don De Savigny
Head, Health Systems Interventions Research Unit, Department of Public Health and Epidemiology, Swiss Tropical and Public Health Institute, Switzerland

PS18_Catalani_squareDr. Caricia Catalani

I am a researcher, focusing on digital innovations for health.  I started working in the health field at age 16, as a physician’s assistant in our family-run urgent care clinic in the rainy Pacific Northwest of the United States. Since then, I’ve worked in an emergency room in a tough neighborhood in New York City, a sex workers’ union in the Dominican Republic, devastated neighborhoods in New Orleans after hurricane Katrina, US government health departments across the coasts, a cigar factory in Cuba, one of the world’s biggest private health insurance companies, a women’s health advocacy powerhouse in Washington, DC, a milky-eyed shamanic healer’s hut on the border of Cameroon, a teen health and empowerment center in San Francisco low-income housing, and clinics with mud floors and tin roofs throughout the African continent.  These days, I spend most of my time as a research consultant to eHealth, mHealth, and digital innovation projects at ministries of health, hospitals, and non-governmental organizations around the world (especially in Rwanda, Cambodia, Kenya, India, Canada, and the USA). I am faculty at the University of California, Berkeley, where I teach courses on digital innovations for health.  Awesome comedy improv and freestyle rap give me a lot of joy.  I spend countless hours learning from my four-month old and three-year old daughters, as we grow up together in the San Francisco Bay Area.

Don de Savigny_squareProf. Don de Savigny

Professor de Savigny is an epidemiologist and public health specialist and currently Head of the Health Systems Research Unit in the Department of Epidemiology and Public Health at the Swiss Tropical and Public Health Institute, University of Basel.  He has extensive experience in conducting and facilitating health research in developing countries and has lived and worked for many years in Africa.  He chairs or is a member of a number of WHO, RBM, Global Fund, and TDR advisory committees and networks such as COHRED, the Health Metrics Network and the INDEPTH Network.  His current research focuses on interventions to strengthen health systems in developing countries, and on the health system effects of Global Health Initiatives for scaling up access.

The ESTHER European Alliance: a decade of hospital partnerships assessed

Author(s) MEZGER Nathalie1.
Affiliation(s) 1Service de Medecine Tropicale et Humnanitaire, Hôpital Cantonal Universitaire de Genève, Genève, Switzerland.
Country - ies of focus Switzerland
Relevant to the conference tracks Health Systems
Summary To evaluate a decade of activities, better define the current environment and its future, the ESTHER European Alliance, an initiative based on hospital/institutional partnerships with low resources countries, requested an external, qualitative assessment. Results showed that added value of these partnerships and of the EEA were well perceived. EEA seems in line with the current development cooperation landscape, helping to tackle the health human resources crisis and adapted to face the new health challenges. Nevertheless to better contribute and improve, there was a need to better demonstrate EEA's contribution to the health system strengthening and review its strategy.
Background The ESTHER Alliance (Ensemble pour une Solidarité Thérapeutique Hospitalière En Réseau - EEA), a French initiative composed currently by 12 European member states (France, Italy, Luxembourg, Spain Germany, Austria, Belgium, Portugal, Greece, Norway, Switzerland, Ireland) and 1 observer (UK), was launched in 2002 to strengthen, through hospital partnerships, the capacities of low income countries to face the HIV/AIDS emergency and related diseases. Each ESTHER national entity is different from each other, but all signed a ministerial declaration of engagement to develop the initiative and are linked by a joint charter of principles.
In 2012 the Alliance members were active in 41 countries and involved in a wide range of training activities including collaboration with civil society organisations. As the last 10 years has seen a change in the worlds health needs and cooperation landscapes, ESTHER evolved and broadened its scope, scale and type of activities to include other health priorities that contribute to meet the Millennium Development Goals 4-5-6 and strengthen health systems to improve health outcomes.
In 2013, an external study was ordered by the Alliance to qualitatively assess the achievements and challenges faced by the EEA over its decade of existence.
Objectives This external qualitative evaluation of the ESTHER initiative, at European and country implementation level, aimed to capture the EEA’s achievements and challenges, draw lessons and clarify the EEA position in the current, evolving, development cooperation and health landscape in order to better define its future. This work was made on request of the EEA.
It focused on identifying the added value of the institutional partnerships for health, on identifying and analyzing the added value that the Alliance brings as a European platform for development cooperation in health, identifying commonalities and challenges for Alliance member bilateral partnership programs, evaluating contributions that partners have made to Health Systems Strengthening (HSS) and presenting future option to move forward.
Methodology Capacity Development International won the EEA international tender after each ESTHER national entity ranked the different candidate’s proposals for this qualitative evaluation.
Two investigators ran it. In all stages of the assessment they included the priority countries that have an active bilateral program (France, Germany, Spain, Italy, Norway and Ireland). Switzerland, Luxembourg, Greece and UK were involved in the first stage of this evaluation. Belgium, Portugal and Austria did not participate.
An extensive review of documents and literature provided by the EEA secretariat, the national coordinating bodies and the technical implementing partners, was performed. It was completed by an international literature review guided by key informants related to development cooperation, health partnerships, capacity development, human resources for health and health system strengthening.
The first stage of interviews focused on the ESTHER model, its achievement, its added value, the challenge and future. They reached the EEA secretariat, 10 northern governments, 13 national coordinating bodies and 2 experts working in the institutional partnerships.
Best practice demonstrating projects were selected by the interviewed national coordinating bodies to be included for the second type of interviews, which focused on the added value of hospital partnerships. Enablers, challenges, lessons learned and contribution to health system strengthening were reviewed. Nine northern implementing partners, 11 southern implementing partners and 3 southern government representatives were interviewed.
Results were analyzed at 4 different levels (added value of institutional partnerships for health, EEA level, National Secretariat level and partnership/project (case studies and lessons learned)) using the OECD/DAC framework (relevance, efficiency, effectiveness, sustainability) to draw out the main themes. Results were synthesised in the perspective of current thinking and EEA objectives and guidelines. Case studies concretely illustrated the evaluation, highlighted innovations, lessons learned and challenges in contributing to HSS.
Limitations were due to the limited time and geographical constraints. Data objective verification was beyond the scope of the study. Best practice projects were selected by the national secretariat and may be subject to bias. Descriptions were dependent on the completeness of information provided.
Results The added value of institutional partnerships (IP) for health based on capacity building and sustainable improvement was clearly perceived. Benefits were: institutional strengthening, responsiveness to needs, ownership, long term building of trust and capacity, peer to peer multidisciplinary exchanges, solidarity, innovation, ability to fund unusual interventions for development cooperation, opportunities to learn how to manage in deprived conditions and cultural sensitivity. IP was felt to go well beyond traditional assistance which is centered on short term filling of capacity gaps and was considered to be a complement to the classical development cooperation.
If hospitals, often neglected in the development, should remain central to ESTHER, inclusion of other organizations or levels was valued.
Concerns expressed the IP potential contribution to the aid fragmentation/proliferation, unintended harms, the creation of pockets of excellence and their real capacity to strengthen the health system.
Recognition, objectification, better definition of the EEA contribution to the HSS were felt to be improved, as the conceptualization of the IP added value to the gaining of knowledge, evidence and ease and the conceptualisation of costs.
The EEA added value was recognized (networking, information sharing), but much of its potential is not fully realized (joint projects, joint working, coordination).
Political mandate and release of resources not straightforward. Weight given to EEA validation and mandate varies. Political commitment was sometimes seen as a mere weight to back-up “ESTHER”, an IP quality brand. Consequently the quest for external funds becomes vital. This would be eased by a better demonstration of the EEA added value beyond members’ programs. The ESTHER diversity, a wealthy fishpond cemented by valuable charter of principles, makes knowledge generation and joint work challenging. If key, knowledge management will have to be balanced as resources are restricted.
In the changing global health agenda ESTHER seems well adapted to address issues such as the non-communicable diseases or the horizontal and integrated approaches. By building capacity, contributing to medical education and continued professional development EEA clearly addresses the human resource crisis.
There is momentum to revisit the EEA vision, strategy and objectives to better adapt to the on-going changes in economy, health and development cooperation.
Conclusion This qualitative study outlines that the EEA, which is based among others on institutional/hospital partnerships, capacity building, local ownership, is needs driven, has long term involvement, respects the Paris Declaration (enshrined in its shared charter of principles), is well aligned with the current thinking and best practices in development cooperation for health. It especially helps in tackling the health human resources crisis.
These principles and ESTHER multidisciplinary identity are clearly of value in the post MDG landscape. Initially focused on the HIV/AIDS crisis, a thematic which was already broadened to include the MDG4-5-6, the EEA has the potential to evolve and contribute to the new emergent health themes.
Added values of IP and of the EEA are well perceived by members, even if it is felt that there is still unveiled potential. The perceived addition of the work in partnerships over other forms of technical cooperation and of the EEA is nevertheless difficult to measure and demonstrate. Creation of enabling, inspiring environments by partnerships does not fully guarantee results. Approaches that address knowledge and capacity gaps through empowerment, leadership by the beneficiary and use of country systems are quite recent and lack rigorous evaluation material to assess their impact. Therefore, efforts should be made to develop material and evaluate processes and projects, but in a light and bearable manner. This could contribute to developing evidence on how to make a quality partnership that brings added value, a matter in which the Alliance could play a role.
Worldwide, little agreement exists on the effective strategy to strengthen the health system, one of the ultimate EEA goals. Operational research could help to clarify how partnership work can contribute to HSS at different levels. The EEA projects/programs diversity is a rich field to work on. This will require the Alliance members to better define and share a common understanding of the HSS.
This knowledge generation would serve EEA to better demonstrate its impact/contribution and increase donors and key stakeholders’ interest. Balance between operational research, monitoring/evaluation and service delivery will have to be found, especially when resources are scarce.
To take advantage of this momentum, clarification and re-definition of the Alliance strategy and structural improvement seem to be needed. A motivating challenge !

Best Practices for Building an Integrated National Health Information System: Rwanda.

Author(s) Caricia Catalani1, Angela Hoth2, Dawn Seymour3, Tyler Nelson 4, Felix Kayigamba 5, Richard Gakuba6
Affiliation(s) 1Innovative Support to Emergency, Disease, & Disaster (InSTEDD) & University of California, Berkeley, School of Public Health, San Francisco, United States, 2Innovative Support to Emergency, Disease, & Disaster (InSTEDD), Berkeley, United States, 3Rwanda Health Information Exchange, Regenstrief Institute, Kigali, Rwanda, 4Maternal Health & RapidSMS, The Access Project, Kigali, Rwanda, 5The Access Project, Kigali, Rwanda, 6 Rwanda Health Information Exchange , Kigali, Rwanda
Country - ies of focus Rwanda
Relevant to the conference tracks Innovation and Technologies
Summary The Rwanda Health Information Exchange (RHIE) is among the world’s first efforts to establish an integrated national health information system in a low-resource setting. Global decision-makers and implementers can benefit from both RHIE's open source tools and knowledge of leading and managing innovation for integration. This study assesses best practices in the design, development, and deployment of RHIE from the perspective of key stakeholders. Themes from the analysis of semi-structured interviews with funders, leaders, and implementers include recommendations on governance of country-owned initiatives, technological design and development, and deployment in a low-resource setting.
Background RHIE is a cloud-based system that supports quality of care and continuity of care over time, across geographies, and across different care delivery sites. RHIE’s vision is to improve health and wellbeing by ensuring that critical information follows patients when and where they need it, despite the dozens of different information systems used nationwide. In 2010, RHIE was designed and developed under the leadership of Rwanda’s Ministry of Health by the Open Health Information Exchange (OpenHIE), a global open-source technology community including partners at PEPFAR, Canadian International Research Development Center, Rockefeller Foundation, Regenstrief Institute, InSTEDD, Jembi Health Systems, IntraHealth, and others. RHIE’s national rollout began in 2012 and entailed working across sites with minimal infrastructure and among providers with little computer experience to configure hardware, install software, build local capacity, and manage technical support . Today, and as scale-up continues, RHIE facilitates the movement of health information across Rwanda with the primary aim of improving maternal and child health and the treatment and prevention of HIV/AIDS.
Objectives The Open Health Information Exchange builds free and open-source tools to enable other national leaders, policymakers, and implementers to improve the integration of health data and systems through the establishment of health information exchanges. Today, the partnership is collaborating with national leaders from six countries, providing technical support required to spearhead this effort. However, more than just tools and technical support, decision-makers need practical insights into the process of leading and managing innovation of this kind. As such, this study aims to describe the best practices in design, development, and deployment of a health information exchange, based on the RHIE experience. Researchers conducted key stakeholder interviews among RHIE funders, leaders, and implementers with a range of expertise from computer engineering to health systems management to clinical care. From their critical reflections of the RHIE initiative, its three years of history, and its pathways forward, stakeholders provide recommendations on approaches to governance of country-owned initiatives, strategies for technological design and development, and tactics for managing deployment of technological innovation in low-resource settings.
Methodology Qualitative semi-structured interviews were conducted with RHIE key stakeholders. Stakeholders included Ministry of Health leaders & implementers, project managers & strategists, technology architecture designers & developers, and funders & other institutional partners. Semi-structured interviews guided a conversational interview, providing the interviewers with key points of discussion without requiring strict adherence to a set order of questioning or phrasing of the questions. As such, interviewees provide descriptions of their experiences, ideas, and critiques in an open and guided discussion. Interview were conducted by two trained interviewers via phone, audio-recorded, and documented through detailed notes. Interview duration ranged from 45-75 minutes. Analysis was conducted using Dedoose Mixed Methods Analysis Software, a cloud-based research and analysis application. A modified grounded theory approach was used in the analysis of qualitative data. This approach facilitated the detailed and systematic examination of data regularities in the relationships between and within codes, and for variations and contrasts within codes. Major themes emerged from the codes and a descriptive framework formed.
Results Key stakeholder interviews included 14 participants from 7 organizations and 4 countries. Several key themes emerged across the major phases, spanning partnership building, design, development, deployment, and evaluation. First, eHealth is a new field without established guidelines for management and leadership and, as such, most found it challenging to partner without clearly articulated governance rules. Terms of governance, they argued, provide guidance for decision-making, roles and responsibilities, accountability, and transparency. The RHIE experience confirmed for most that country-ownership of the initiative should be established early and embedded into the partnership’s governance structures.Second, most partners commented on the difficulty of collaboration when key contributors were spread across several countries and time-zones. They explained that in a low-resource setting, it is often necessary to look for eHealth integration expertise and capacity from people based in other countries. Cross-cultural, cross-national, and cross-disciplinary communication was immensely difficult, although building an integrated system required a well-integrated team. Stakeholders found that it was critical to have a shared commitment to regular communication and ample budget for in-person meetings.Third, experts were adamant that an eHealth integration initiative should start by looking at existing, tested, and ideally open-source tools that might serve as customizable building blocks for their own solution. While identifying these tools, most argued that the team must create a shared standard of assessment so that they can transparently evaluate tools in a world where business interests may sway these decisions. Many stakeholders shared the opinion that eHealth solutions must be simple, tested, and even boring, although “the siren song is to do something new, bold, and innovative.”Finally, most partners found that the health and human development objectives of the project were obfuscated by the technological objectives of the project. RHIE contributors spent the vast majority of their efforts on designing and developing the technology, often without a shared vision of how the system would ultimately impact health services, morbidity, and mortality. One expert argued that it should have been the opposite and that “in a sociotechnical system, the technical should be 10% and the rest of the money and time should be spent focusing on implementing.”
Conclusion The health systems integration experts involved in RHIE shared a common sense of the challenges and opportunities inherent in partnering, designing, developing, and deploying a health information exchange. Several best practices emerge from these findings: establish rules of governance to guide the partnership; plan for regular and in-person communications to facilitate collaboration among diverse contributors; build on existing, tested, and open-source technologies before considering anything new; and, create a shared strategic and practical vision for how a new eHealth tool will impact health. As the OpenHIE expands beyond Rwanda and into new country implementations, these findings can be used to guide policy-makers, implementers, and other experts. Worldwide, country leaders are struggling to take advantage of the digitization of health information while managing innovation within health centers and protecting patient privacy. In an era of big data, health information exchange is one way to integrate and manage health information across disparate systems. Health information exchange tools and best practices may improve health and wellbeing by ensuring that critical information follows patients when and where they need it, despite the dozens of different health information devices, tools, and systems emerging worldwide.

Health as an indicator of sustainable development: How health can contribute to and benefit from sustainable policies.

Author(s) Natalie Mrak1, Callum Brindley2
Affiliation(s) 1Development studies, The Graduate Institute for International and Development Studies, Geneva, Switzerland, 2Development Studies , The Graduate Institute for International and Development Studies, Geneva, Switzerland.
Country - ies of focus Switzerland
Relevant to the conference tracks Environment and Sustainability
Summary This study highlights how health can be a cross-sectoral indicator for the proposed 2015 sustainable development goals. The impacts of environmental changes on human wellbeing have been clearly established but insufficient work has been done to show how sustainable policies can also benefit health. This study recommends health indicators that can be used to measure sustainable progress in the sectors of water, food, energy, housing and transportation within the urban environment. It also provides suggestions on accountability and governance mechanisms that should put be in place at local, national and global levels to ensure that everyone takes responsibility for sustainable development.
Background Growing concerns about the impact of environmental changes on health have emerged as middle-income countries have adopted the consumption and greenhouse gas emission behaviours of high-income countries. The same economic trajectory that has created a global marketplace dependent on increasing volumes of production, consumption and the long-distance transport of goods, has also led to the overexploitation of finite natural resources, energy shortages and the overburdening of the natural environment. The affects from this trajectory not only pose challenges to the sustainability of the environment but to human health as well. About 24 per cent of the global burden of disease and 23 per cent of deaths are attributable to environmental causes and around 36 per cent of the disease burden in children is caused by environmental factors. Despite this information, health has been an omitted aspect in climate policies. The collective health benefits that can be gained from a low carbon economy have been overlooked when they can actually be motivation for further cutting greenhouse emissions. Emphasizing the joint benefits could make reducing greenhouse emissions attractive since they serve as a means towards achieving both public health and climate goals.
Objectives The primary objective of this study is to demonstrate how health is a cross-sectoral theme of sustainable development that can be used to motivate behaviour change. The secondary objective is to show how human wellbeing will be impacted if sustainable approaches to development are not pursued. Since the MDGs were established in 2000, tremendous progress has been made to improve health outcomes but this progress will become compromised if measures are not taken to improve the current state of the environment. Everyone will be impacted but particularly the poorest and most vulnerable whose already scarce access to public goods could be further compromised as governments grapple with economic devastation as result of changes in the climate and environment. Urban areas will continue to grow, unable to accommodate their expanding population, which could lead to increased food insecurity as dry arable rural lands become incapable of producing crops. Prolonged drought conditions and increased occurrence of natural disasters could also lead to water insecurity. This situation, combined with poor housing conditions, unsustainable energy sources and carbon-motorized transport will negatively impact health and the environment. The tertiary objective is to show how policies across diverse sectors can improve human wellbeing and the environment. Health can be used to measure the effectiveness of policies in various sectors as well as benefit from policies that also improve the environment. In order to tackle the health risks that environmental changes pose, an integrated, cross-sectoral approach needs to be taken since human wellbeing is not only affected by such factors as health systems as but also other factors like pollutants and physical activity. The additional objective is to analyse the opportunities and challenges to promoting more sustainable behaviour. Everyone can contribute to a sustainable future from healthcare workers to businesses as well as governments and civil society. The post-2015 development agenda provides an opportunity to implement accountability mechanisms that do not currently exist. As cities become centres of human settlement, there is also a need to implement environmental-friendly policies that enhance rather than detract from economic growth.
Methodology The main question of this study is to see how health is a cross-sectoral indicator of sustainable development. The study was conducted between June and September 2013. The search strategy sourced reports and articles primarily published by the United Nations, especially the WHO, UNICEF and UNEP as well as the below leading health and development journals. We reviewed only articles published in English and concentrated on the period from 1990 to 2012. Our principal search terms were: “health” AND “sustainable development”; “environmental burden of disease”; “healthy environment”; “urban health”; “healthy cities”; “health” and “results-based management”; “health indicators.” In total, we closely reviewed over 100 reports and articles. To analyse the literature, the following questions were posed:• How can health and sustainable development be linked?
• How is health positioned in the post-2015 development agenda and the sustainable development goals debate?
• What are the strengths and limitations of indicators
• What current health indicators exist and what are their merits?
• What lessons can be drawn from the WHO’s Healthy Cities programme?
• How can inter-sectoral cooperation be promoted?The study looks at sustainable development within the context of urban areas, focusing on five key areas – food, water, energy, households and transport. Cities were selected as the geographic area of focus since their populations are expected to continue to increase over the course of this century. The five areas of focus were selected on the basis of their strong cross-sectoral communications with health and the burden of disease from their associated risk factors. The study demonstrates how the relationship between health and sustainable development can be thought of in three ways: health contributes to the achievement of sustainable goals, health can benefit from sustainable development and health is a way to measure progress across all three pillars of sustainable development policy.
Results The results of the study clearly demonstrate that health is an integral part of sustainable development whose contributions should be considered more seriously in the post-2015 development agenda discussions. First, climate change is contributing to the increased incidence of natural disasters and disease outbreaks, increasing the global burden of disease. Second, urban areas will endure great burdens as a result of climate change, which will be primarily due to the increased migration to cities. Third, there are measures that can be implemented across sectors, which can reduce greenhouse gas and pollutant emissions as well as improve human well-being. Last, this study also found that while there is an abundance of data on health as an indicator of sustainable development and the distinctiveness of each country’s context make it difficult to discern which existing indicators are most practical and useful, there are a series of assessments that can be carried out to develop a fit-for-purpose complement of indicators. The below tool outlines the method for conducting these assessments by focusing on a country’s:• Burden of disease
• Level of economic and social development, and
• Environmental condition and pressuresTables of indicators by income-level for the health-sustainable development nexus were created. It was found that each indicator has the following four strengths;

• Relates closely to both health and sustainable development
• Relies on data that is easily accessible and reliable
• Communicates clearly a development challenge
• Facilitates practical policy interventions

The primary limitation of this study was the lack of first-hand qualitative data which is due to the top-down approach of the study. A complementary bottom-up study containing ethnographic work could help confirm these findings and provide a people centered-approach to seeing how health is an integral part of sustainable development.

Conclusion Health can be a useful focal point to promote inter-sectoral cooperation at the local level but there is unfortunately no set of health indicators that are relevant to all contexts. A drawback to the work that has been done on health as an indicator of sustainable development in urban settings has been the emphasis on the quantitative aspect of indicators. This has made it difficult to single out a set of best practices and to actually see whether these interventions improve well-being. As urban populations continue to expand in the coming decades, new approaches to urban planning need to be taken which engage a variety of stakeholders and adapt to the dynamic nature of cities. Small-scale interventions in urban areas can be key to providing insights into what does and does not work. To ensure the work on health and sustainable development continues, health needs to be an integral component of the post-2015 development agenda. The sustainable development goals of the post-2015 agenda will not be achieved if a concerted effort is not made to assist low and middle-income countries in developing and implementing renewable energy techniques as their populations and economies continue to grow in the coming decades. Mechanisms should be created that not only transfer funds but knowledge and technology as well. Governance mechanisms need to be set in place, which marry policy and scientific evidence and impose accountability. Increasing public awareness of the intricate relationship between public health and the environment could help promote sustainable behaviour and raise attention to the need of holding all stakeholders accountable. Ultimately, there needs to be commitment at all levels of government and society in order for sustainable development to become a reality.

Protecting the Health of International Labor Migrants through Intersectoral Action from a Source Country Perspective: The Philippines

Author(s) Ramon Lorenzo Luis Guinto1
Affiliation(s) 1None, None, Manila, Philippines.
Country - ies of focus Philippines
Relevant to the conference tracks Social Determinants and Human Rights
Summary This source-country perspective study examines how intersectoral action can be harnessed to protect the health of international labor migrants. With nearly 10% of its citizens living overseas, the Philippines, with its decades-long history of institutionalized labor migration, has established structures and processes that ensure migrants' rights and welfare. While best practices exist, there is room for improving intersect oral action to  address migrants' health, such as strengthening the Department of Health's coordinating role, developing monitoring and evaluation mechanisms, and emphasizing health in bilateral labor agreements with destination countries.
Background With nearly 10% of its citizens living overseas, the Philippines has been a key provider of migrant labor force to over 200 countries in hundreds of occupational categories and employment arrangements, in addition to a sizeable number of immigrants. The progressive growth of international migration of Filipinos has been significantly attributed to a wide institutionalized network of government organizations with respective legal mandates and programs. The country’s international labor migrants have greatly contributed to the growth of the country’s gross domestic product especially in recent decades. While much has been documented about the social and economic dimensions of international migration in the Philippines, little is known about the health of Filipino workers overseas – and the structures and mechanisms that govern migration health. Furthermore, much of the available migration health literature analyse the situation in destination countries, so a source country perspective is of critical importance and usefulness for developing sound migration health policy in today’s increasingly mobile world.
Objectives Since both migration in general and migration health in particular are complex issues that require action across a wide range of stakeholders, this study will examine how intersectoral action can be harnessed to protect the health of migrants, particularly international labor migrants. While most studies looked at destination countries, this study will present experience and lessons in addressing migration health from a source country such as the Philippines. In this study, policies, programs, institutions, and mechanisms that support the health of "Overseas Filipino Workers" or OFWs will be mapped and described. As a result of this situational analysis, challenges and opportunities in the Philippines approach to migration health will be identified, and priorities and activities that the government and other stakeholders can undertake in order to advance the health of Filipino migrants overseas will then be proposed.
Methodology In order to guide the direction of this qualitative analysis of migration health governance in the Philippines, a conceptual framework was developed, which provided a strong emphasis on the principle of intersectoral action for health. An extensive desk review of relevant literature, including existing policies, was initially conducted. This was followed by a multi-stakeholder analysis using key informant interviews and focused group discussions as primary methods of data collection. Various organizations that represent various stakeholder groups (government, private sector, civil society, and intergovernmental organizations located in the Philippines) were pre-identified according to the findings of the literature review and served as key sources of information. During the interviews and group discussions, a discussion guide was used to ask the participants about key themes that reflect the different phases of the whole migration process (pre-departure, travel, interception, destination, and return) as well as the migration health action points articulated in the World Health Assembly resolution 61.17 on the health of migrants: monitoring migrants’ health, existence of policy-legal frameworks, building migrant-sensitive health systems, and participating in local and international partnerships and networks. Data gathered from both literature review and multi-stakeholder analysis were individually analyzed and then triangulated.
Results There exist a limited number of studies that have been conducted to assess the health needs of Filipino migrants overseas. However, much of the available grey literature indicate mental health problems as a common cause of illness among OFWs, while HIV-AIDs is becoming a growing concern, especially among returnees. Such a dearth of robust information is indicative of a weak information system that is supposed to monitor the health status and needs of migrants. In terms of policy-legal frameworks, the Philippines has instituted a number of laws that protect the rights and welfare of international labor migrants, which also cover some health-related aspects. Meanwhile, most of the existing migration health services are provided during the pre-departure phase of the migration process (i.e. pre-departure medical assessment). On the other hand, there is a limited amount of health supportive services that address the health needs of returning Filipinos. The Philippines is also a signatory to a number of international frameworks that commit to advancing migrants’ health, both at the international and regional levels. Interestingly, government institutions that craft policies, regulate actors, and provide services related to migration health lie outside of the health sector (i.e. labor), while at present, the Department of Health plays a minimal role (i.e. implementing quarantine among returnees suspected with contagious disease). While no concrete or clear mechanism exists to coordinate migration health-related efforts, there are some interactions occurring between various government agencies in order to implement certain functions.
Conclusion The existing structures and mechanisms that protect and ensure the health rights of Filipino labor can provide the template for a more concerted whole-of-government approach to migration health. While certain migration health policies and services do exist, there remain gaps in some key action areas recommended by the WHA resolution, especially in terms of monitoring migrants’ health and establishing migrant-sensitive health systems. The Department of Health should therefore assume a greater coordinating and technical role to support the migration health-related functions already performed by various non-health government agencies and other stakeholders. Furthermore, as international labor migrants interface with health systems of destination countries, source countries such as the Philippines should strengthen their diplomatic functions so they can negotiate for better provision and protection of health for their citizens residing overseas. Finally, the cause of advancing the health of international labor migrants offers an opportunity for governments, most especially countries that serve as sources of international workforce, to implement meaningful intersectoral action for health.

Integrating neuro-psychiatric disorders at the level of primary health care centres: Guinea

Author(s) Abdoulaye SOW1, Oury SY2, Amatigui DIALLO3, Abdoulaye KOULIBALY4, Mouctar DIALLO5, Binta BAH6.
Affiliation(s) 1Mangment, Medical fraternity Guinea, Conakkry, Guinea, 2Physian, Medical fraternity Guinea, Conakry, Guinea, 3Physian, Medical fraternity Guinea, Conakry, Guinea, 4Physian, Medical fraternity Guinea, Conakry,Guinea, 5Physian, Medical fraternity Guinea, Conakry, Guinea, 6research, Medical fraternity Guinea, Conakry, Guinea.
Country - ies of focus Guinea
Relevant to the conference tracks Chronic Diseases
Summary Mental, neurological, and substance use disorders make a substantial contribution to the global burden of disease. According to the World Health Report 2000 neuropsychiatric disorders (a component of mental health) are the second cause of disability-adjusted life years (DALYs), behind the infectious and parasitic diseases. Under the theme “Stop exclusion, Dare to care”, the year 2001 was dedicated by the WHO as the "Year of mental health”. Since ancient times, epilepsy has remained a controversial subject for many world populations. This is because mental illness has been perceived as socio-anthropological for many societies.
What challenges does your project address and why is it of importance? Primary health care strategy aims to make accessible to as many people as possible healthcare according to people’s needs, at an affordable cost and taking into account a country's given resources. Equity and social justice are the basic principles of this strategy.
According to the World Health Report 2002, neuropsychiatric disorders account for 13 % of the global burden of disabilities adjusted life years (DALYs). In Guinea, while significant progress has been made in primary health care programmes, little improvement has been measured in the field of mental health. The psychiatrist ratio per capita is one of the lowest in the world. A similar gap in the number of neurologists prevails throughout the country.
In order to address this gap, the Guinea Medical Fraternity (a Guinean association of doctors) opted for the integration of neuropsychiatric consultation into the daily work of the general practioners working in its health centers.
At the opening of its health centers in the 90's, one missing element was the lack of data about the number of patients who sought consultation for mental health problems. At that time, no information was available due to the lack of qualified human resources and poor access to medicines. To tackle this challenge, Guinea Medical Fraternity initiated the project SaMoa, and used 'action research.'
How have you addressed these challenges? Do you see a solution? The model of care employed is based on the three-dimensional approach used in outpatient mental health management: medical, socio-psychological and the community. These three dimensions are combined for almost all patients in our centers, without following neither a chronological nor a hierarchical order.
For the two groups of diseases described in this abstract, epilepsy and mental health disorders, a care package is offered to the patient. This includes: identification of fixed and advanced strategy for the patient, medical treatment (with antipsychotics and/or anticonvulsants), follow-up and psychosocial support (individual interview, with family members, home visits), family and community reintegration through discussion groups and reintegration workshops (graphical expression, apprenticeships) and finally social support interventions (such as supporting the recovery of a lost job or supporting patients in rebuilding a couple in crisis).
In order to ensure continuity of care, a number of materials have been developed.
These include:
• Personal health record (first visit and follow up)
• Home visit notebook
• Reintegration notebook (describing the patient personal project)
• Group workshops notebook.
• Monthly collection sheet.
• Monthly report
Regular inter-professional encounters have been established in order to promote synergies and complementarity among caregivers and has been used to foster continuous staff training. This framework is supported by:
• A joint consultation between a generalist and a specialist (neuropsychiatrist ) at the beginning of the project
• A daily joint consultation between doctors and social workers
• A weekly team meeting between doctors, social workers and community volunteers, to discuss specific cases
• A monthly coordination meeting, which brings together the heads of unit of each health center and the officials of the NGO.
How do you know whether you have made a difference? From January 2000 to June 2013, 7079 mental health problems were diagnosed among which 47 % were psychoses, 33% were epilepsy cases and the remaining 20% represented by depression, dementia, neurosis, social problems and cerebral motor deficiencies.
Among patients put under treatment, two main molecules were used for psychosis (different forms of Haloperidol and Akineton as corrector) and for epilepsy, four essential generic drugs (carbamazepine, phenobarbital, phenytoin and sodium valproate). We found a positive impact for both patients and their families, health care providers as well as for health centres.
For the patient, the impact is assessed by how much healthcare management has improved by integrating the socio-cultural context of the patient and his/her family, how much the intervention has strengthened patient-provider relationship and contributed to better adherence and how much the intervention has facilitated patients social reintegration and has strengthened their economic capacity.
At the level of health centers and providers: the impact is felt at many levels
 Improved patient-provider relationship (beyond mentally ill patients).
Indeed, GP’s trained to adopt a more holistic bio-psycho-social approach with psychiatric patients and spontaneously applied a similar approach vis-à-vis other patients, spending more time, listening and discussing with them and paying more attention to their psychosomatic problems.
 Improved relationships between health centers and the communities they serve.
Communities started to see healthcare providers and the health centres as partners and contributed to the development of the relationship.
 Improved relationships between primary health centers and referral hospitals.
Given the fact that the care package provided by the programme is not available in district hospitals, the project has reversed the usual pattern of the health pyramid that usually sees PHC centers referring their patients to a hospital. In this case, the opposite took place, hospitals sending their patients to the lower level of care.
 Implementation of several community initiatives around the health centres.
The momentum created by the project has allowed the emergence of community-led initiatives such as economic interest groups among intervention communities, involvement of young people in the village around health promotion activities and the establishment of patient support groups.
 Health centre as a training and internships for medical students in public health and community health workers. Successful health centres are coveted by academics whose students are engaged in the internships and the development of dissertations.
Have you or the project mobilized others and if so, who, why and how? The project involved several actors in different and various socio-medical fields.
In Guinea, networking is not integrated into the system. Each association operates in isolation and tries to protect its field of competencies as a private territory. Initiatives are confined to a limited territory or to a given intervention and do not benefit neither the beneficiaries nor field social workers. To break this single thought mindset, our project has created an inter-professional approach mobilizing a supportive and dynamic network of various health workers, social workers and human rights advocates in order to improve the management of heavy neuropsychiatric disorders.
Among the objectives, this initiative attempted also to demedicalize some health problems, to push healthcare providers to pay more attention to social problems and to involve other social stakeholders in medical work.
As an illustration, health centres provide care (medical consultations, nursing services and drugs) to all populations. Social centres provide services (psycho -social support, legal support, rehabilitation, social and professional reintegration) to the same populations. The interaction of these two levels of intervention can only be beneficial for patients, providers and medical-social structures.
Our methodology involves the organization of platforms for dialogue between actors, field visits, referrals of patients or target groups and the organization of joint actions.
The platforms are organized around a theme: clinical, social, results or best practice.
Field visits take place upon request in order to assess the social and/or medical situation of an identified patient, or to meet with an association that wants to share its experience and best practices or seek advice.
Social workers refer their clients to a healthcare professional for a medical condition and the healthcare professional refers their patients to social workers in order to be more effective not only in medical care but also to delegate certain activities (counseling, search of lost to follow up) in order to deal with other aspects.
Joint actions are put in place to identify, plan and agree upon a synergic mode of implementing activities that improve the quality of services offered.
When your donor funding runs out how will your idea continue to live? The project initially depended on single funding, but since its activities are integrated into health centres, it has become routine and no longer dependent on external funding. Yet, the fact that we are in the process of replicating and scaling up the programme in several other health centres, funding will be needed in order to train staff, provide a starting stock of essential generic drugs, conduct reintegration workshops and provide supportive teaching materials.

Integrating HIV Commodity Supply Chains to Prevent Mother to Child Transmission Scale Up in Nigeria.

Author(s) Chioma Nwuba1, Sunday Aguora2, Ogubuike Inmpey3, Elvis Okafor4, Okechukwu Agbo5, Vincent Ihaza6.
Affiliation(s) 1HIV/AIDS, Supply Chain Management Systems, John Snow Inc., Enugu, Nigeria, 2HIV/AIDS, Supply Chain Management Systems, John Snow Inc., Abuja, Nigeria, 3HIV/AIDS, Supply Chain Management Systems, John Snow Inc., Enugu, Nigeria, 4HIV/AIDS, Supply Chain Management Systems, John Snow Inc., Abuja,Nigeria, 5HIV/AIDS, Supply Chain Management Systems, John Snow Inc., Enugu, Nigeria, 6HIV/AIDS, Supply Chain Management Systems, John Snow Inc., Enugu, Nigeria.
Country - ies of focus Nigeria
Relevant to the conference tracks Health Systems
Summary Reduction in the rate of mother to child transmission of HIV in Nigeria depends on the availability of antiretroviral (ARV) drugs and HIV test kits in sufficient quantities at service delivery points.
The challenge of multiple storage and distribution channels for HIV commodities, late submission of reports, coupled with low commodity delivery coverage of rural clinics has led to pregnant women travelling long distances to access ARV treatment at urban hospitals.
Integrating existing supply chain management systems to prevent stockouts of essential commodities is crucial for preventing new HIV infections among children and for improving the lives of HIV positive pregnant women in Nigeria.
What challenges does your project address and why is it of importance? Globally, the gap for pregnant women receiving antiretroviral (ARV) medicines for the prevention of mother to child transmission (PMTCT) of HIV is 80% and Nigeria alone accounts for 32% of this gap. In addition, Nigeria has the largest number of children acquiring HIV infection with nearly 60,000 children infected with HIV in 2012 alone.
Thus, ensuring that all pregnant women receive access to HIV testing services and anti-retroviral treatment if tested positive is a priority for achieving PMTCT targets in Nigeria. The current system for collection and transmission of logistics management information system (LMIS) reports, from service delivery points at rural clinics to the central medical store, are complex and labor intensive. As a result, report submission is often delayed, leading to stockouts of critical HIV/AIDS commodities and a reduction in the number of pregnant women who have access to the much needed life-saving antiretroviral treatment.
In addition, multiple storage and distribution channels are often uncoordinated, and this has resulted in stockouts of commodities at some health facilities when there are excess stocks at other facilities.
How have you addressed these challenges? Do you see a solution? In order to improve access to HIV testing services and antiretroviral drugs for HIV positive pregnant women, at 471 rural clinics in five focus states, the USAID funded SCMS project of John Snow Inc. in Nigeria implemented the following data driven interventions: Integrated existing parallel HIV/AIDS commodity management system in the region to form a unified system for procurement, storage and distribution of commodities.
 Integrated collection and analysis of LMIS reports with already existing data collection systems thus facilitating timely report submission which informs resupply decisions to health facilities offering PMTCT services.
 Established an axial storage location within the region for storage & distribution of HIV/AIDS commodities to health facilities.
 Strengthened capacity and skills of community health workers on logistics management of HIV/AIDS commodities through on-site training and mentoring on the use of logistics management information system (LMIS) tools, standard operating procedures, good storage practices and quality improvement processes for efficient delivery of PMTCT services
 Introduced simplified reporting forms to aid community health workers in the collection and timely submission of accurate consumption and requisition reports.
 Initiated bi-monthly cluster review meetings which provides a forum for community health workers to have access to continuing education on the management of HIV commodities, review logistics management information reports, share best practices and address challenges.
 Increased collaboration with government agencies and implementing partners to support LMIS report collation and to address stock imbalances through timely inter facility transfer and redistribution of commodities to avert stockouts and reduce wastages due to expiration.
 Commenced monitoring and supportive visits to monitor quality of services delivered and strengthen the performance of health workers at service delivery points.
 Challenges and issues identified at service delivery points are shared with health facility management teams and the regional technical working group who proffer and implement solutions to address these challenges.
How do you know whether you have made a difference? At the end of six months, the reporting rate for ARV drugs increased from 28.7% to 60% while that of HIV test kits increased from 30.4% to 63.7%.
Due to improved availability of rapid test kits, the number tested for HIV increased from 39,044 before intervention to 79, 384 after intervention. Subsequently, the quantity of test kits ordered increased by 98.5% post intervention.
Integration of all existing HIV/AIDS commodity management systems in the region has resulted in improved commodity security of HIV test kits and ARV drugs thus ensuring continuous availability of these commodities for HIV positive pregnant women and children. Furthermore, the introduction of a simplified HIV commodity reporting form which harmonizes collection of data on ARV drugs and HIV test kits has made it easier for community health workers in rural clinics offering PMTCT services to report consumption of commodities and to make requisitions for re-supply.
The cluster review meetings have improved quality of logistics data as well as the collection and timely transmission of such data required for resupply decision making, resulting in increased availability of HIV-related commodities and improved quality of care.
Have you or the project mobilized others and if so, who, why and how? The outcome of our interventions and lessons learned were adopted during the implementation of the third phase of the HIV/AIDS Supply Chain Unification Project , which covered seven states in the South Western region of Nigeria. It integrated all existing HIV/AIDS commodity management systems in the region aimed at improving commodity security in the supply of HIV rapid test kits and ARV drugs. We commenced by convening a stakeholders meeting with the state ministry of health, implementing partners and other relevant agencies on the need to harmonize the warehousing and distribution of HIV commodities to all service delivery points. The importance of HIV testing services especially for pregnant women and the outcome of treatment interruptions due to stock-out of essential ARV drugs was discussed.
Health workers at service delivery points were trained on the logistics management of HIV/AIDS commodities, use of standard operating procedures, logistics management information system (LMIS) tools and good storage practices.Bi-monthly reports on consumption and requisition of commodities are reviewed during cluster review meetings thus ensuring that commodity requests sent to the central level more accurately reflect health facility needs and, consequently, decrease the occurrence of stock imbalances (under/over stocking) which could result in stockouts or wastage due to expiration and damage.
When your donor funding runs out how will your idea continue to live? This program was executed in collaboration with the Federal/State Ministry of Health (HIV/AIDS Division), National Agency for the Control of AIDS and relevant stakeholders of each participating state. Government ownership and leadership of the program is facilitated through the Procurement and Supply Management Technical Working Group (PSM TWG) which is government driven and has representatives of each participating state as members.
This group conducts regular on site monitoring and supportive visits to health facilities in the region where they review performance of the supply chain system at various facilities, assess program implementation, identify and addresses challenges relating to the management of health commodities and quality improvement of supply chain processes in the region.
The government driven PSM TWG also advocates for funding support from respective state governments while seeking ways to improve overall program efficiency.Furthermore, to facilitate ownership and sustainability, each state is actively involved in the collection, transmission of LMIS reports and inter facility redistribution of commodities to health facilities within their states through the state logistics management team.
Working closely with relevant key stakeholders, we hope to achieve government’s leadership and ownership of the project in three to five years from now.

South-South Cooperation for Strengthening Health Systems in Developing Countries

Author(s): S. Islam*1, H. S. Jooseery2, M. Ly1
Affiliation(s): 1Programme Officer, 2Executive Director, Partners in Population and Development, Dhaka, Bangladesh
Keywords: South-South cooperation, PPD, health systems, collaboration, health workforce, developing countries

With changes in the global political environment and the development of a new economic order ushered by the growing forces of globalization, and the recognition of substantial progress in some developing countries, it was becoming apparent that there is potential for cooperation among countries with common socioeconomic and political background. South-South Cooperation became the guiding force and was recognized as one of the key route to attain success in the Health Sector. Countries with greater commonalities reinforced their cooperation ties and worked synergistically. South-South Cooperation is an excellent example of the way developing countries can help each other to accomplish much more than they can individually achieve. Achievements and lessons from one country can eliminate the need of trial and another, thereby reducing costs and enhancing efficiency. In a scenario where resources – whether financial or technical - are really scarce, such collaborative efforts can unlock potential resources. The essence of South-South Collaboration is that developing countries are not poor, and the wealth of knowledge and expertise that they possess can marvel and sprinkle extraordinary energy that can reshape their own destiny.


South-South Cooperation in the areas of Health and other population related activities is based on two premises. One, that a number of developing countries have in the last several decades acquired considerable expertise and experience in the design and implementation of highly successful and effective health programmes. Two, that the sharing of this expertise and experience among developing countries will enrich and strengthen the entire health policies and programmes. South-South Cooperation encourages long-term bi-lateral and multi-lateral relationships which permit implementation of a mix of modalities for deriving optimal benefit from such cooperation.


South-South Cooperation is increasingly seen as an innovative, cost-effective and result oriented modality for transfer or exchange among developing countries of relevant knowledge and experience in the field of Health. Through Networking it provides a useful database of the range of expertise and resources available in the health system. South-South collaboration can strengthen through the launching of inter-country projects, training and fellowship activities and research and documentation involving member as well as non-member states in the region. Regional Health Networks are launched and exchanges of expertise carried out in the form of policy dialogue, training and joint projects in many countries. Best practices and lessons learned can be easily replicated in another country of the south following a southern model rather than from the developed countries. This allows developing a cadre of national and regional health experts dealing with their own problems and assisting countries with similar problems.

Lessons learned:

It is here that a common voice is needed to push collaboration mechanisms that are aligned with members’ needs. A review of how technical cooperation is conducted would need to be looked at, as well as the political will of stakeholders to promote Health Systems in general. The majority of health interventions planned by countries are usually implemented within their borders; South-South Cooperation has thus possibilities of complications about ownership, management, and even regarding funding. This is a challenge, especially for developing countries, as they possess no easy means of collaborating with their neighbours to create joint projects on Health. To achieve stronger results in the countries we serve, we must strengthen the link between national, regional and global levels, paying due attentions to sub-regions and work together as one team.

Promoting Population Health through Voluntary Health Professional Alliances: The Medicine and Public Health Initiative (MPHI)

Author(s): J. H. Glasser*1, R. Cranovsky2, R. Levinson3, J. Huang4
Affiliation(s): 1The Medicine and Public Health Initiative, Houston, USA, 2Consultant, Epalinges, Switzerland, 3Health Management, Howard University, Washington DC, USA, 4Epidemiology, Peking Union Medical College, Beijing, China

Integrating medicine and public health, national and global, interdisciplinary education and manpower development, translational research and capacity building


Complexity, cost, and rising expectations have created capacity, manpower needs, and resulted in gaps in healthcare system improvements. The recognition of the consequences of the gaps provides opportunities to strengthen the integrity of the system through interdisciplinary education, evidence-based delivery, and diffusion of best practices into delivery systems. Improved professional networking supports efforts to mobilize professional associations and health institutions to coordinate efforts in the cyber age.


The Medicine and Public Health Medicine Initiative (MPHI) provides practical experience in building an organization to better effect such changes by providing voluntary professional and institutional participation in action oriented programmes. MPHI is structured around the continuum of the framework of population health improvement. This paper describes:
1 – Answering the challenge to close gaps among Clinical Medicine, Public Health and the Health Professions;
2 – How MPHI evolved both nationally and internationally;
3 – Strategic targets and goals of MPHI;
4 – The organizational structure; how MPHI builds on local and regional priorities;
5 – The role of professional associations, health delivery, and educational institutions to affect sustainable changes in population health.


1 – The approach and model complements the development of integrating health networking.
2 – A continuum to counterbalance the evolution of the separate paths of Medicine and Public Health.
3 – National, state, and international network partners are collaborating.
4 – Strategic goals provide an interconnecting continuum to bridge the gaps;
5 – Interdisciplinary education and training;
6 – Applied and translational research diffusion;
7 – Capacity building and demonstration projects.
Three illustrations:
1 – Integrated Disease Intervention spectrum: The MPHI modification of the (USA) CDC National Forum on Heart Disease and Stroke Heart Prevention programme.
2 – National and State: adopting the MPHI model to specific settings: Examples, California: Policy and Advocacy, Texas: Multidisciplinary health professions education and student participation.
3 – International: Cross national MPHI collaboration: In MPHI China it includes Associations, Universities, and local health authorities in applied research in China

Lessons learned:

MPHI population health framework provides essential enablers; builds on nascent activities of collaboration; provides value added to existing efforts; world wide web and dissemination network; collaborative multi-site projects and technical assistance; linking education across the continuum from current students through continuing practitioners; expanding to new areas in care and prevention for multiethnic, multicultural/religious populations. Barriers exist: institutional inertia; need for a small core of champions: leaders, professional association, university, or health delivery settings; resources, though modest, needed from internal or external sources.