Program in Global Medical Education and Social Change
Joia S. Mukherjee, MD, MPH, Program Director
This is a very exciting time in Global Health. Just prior to the year 2000, the movement to provide HIV treatment to all and the drafting the Millennium Development Goals (MDGs) by the United Nations highlighted the need to address the social determinants of ill health (such as poverty, malnutrition and lack of education and) and to deliver both preventive and curative health care directed at the burden of disease. In the ensuing decade it has become increasingly clear that there are few trained health professionals who can administer these programs: what we are facing today in developing countries has been called the “Health Care Worker Crisis.”
In fact, the movement to address the AIDS pandemic and other infectious disease as well as the goals of achieving the MDGs has laid bare the inadequacies of the existing health workforce in resource poor settings to meet the vast health care needs. Developing countries bear 90 percent of the global burden of disease, yet only 12% of all health expenditures are going to stem this tide ($351 billion out of a global total of $3.2 trillion.) Africa is home to only 3% of the global health workforce who are paid with less than 1% of global health expenditures.
The Program in Global Medical Education and Social Change, housed within the Department of Global Health and Social Medicine at Harvard Medical School seeks to forge long-term academic partnerships to support the education of health professionals and to create a culture of teaching and training in public sector facilities in resource-limited settings that will serve as the nexus of teaching and scholarship for the emerging discipline of global health for decades to come. Thus, the program offers opportunities for students, residents, fellows, and faculty from resource-limited settings to be trained side-by-side with students, residents, fellows and faculty from Harvard University and other academic medical centers around the world. Embedded in these programs is a rigorous evaluation of quality of care, capacity of the practitioners, and the capacity of the training programs to produce health care professionals that remain committed to the areas of greatest need. We believe that the growing interest in global health among students and faculty at Harvard and other academic institutions can--and should--be channeled to achieve the highest quality of training for those shouldering the burden of global health delivery. The cornerstone of the curricula developed by the Program in Global Medical Education and Social Change is “accompaniment”--that is the art of working with local governments and partners, and of responding effectively to priorities outlined by them though a combination of direct patient care, clinical innovation, training, research, and policy work.
- Pablo Gottret & George Schieber, Health Financing Revisited: A Practitioner’s Guide (The World Bank 2006).
- World Health Report 2006, Working together for health (WHO, Geneva, 2006).
The Program in Global Medical Education and Social Change is linked to ongoing clinical, research, and advocacy efforts in the United States, Latin America and the Caribbean, and Africa and seeks to:
- Generate evidence and scholarship to elucidate the factors contributing to and perpetuating the health care worker crisis in resource poor settings and investigate strategies to mitigate them.
- Identify and pursue policies that will help to retain trained health workers in areas of greatest need.
- Leverage academic partnerships to develop programs in resource poor settings that will increase the quality and breadth of both the pre-service and service-delivery phases of health professional training.
- Develop a novel pedagogical framework that spans undergraduate, medical, nursing and post graduate medical education to address both the global burden of disease and the complexity of its social determinants.
Featured InitiativesField based curriculum in Global Health and Social Medicine for medical students (US, Haiti, Rwanda)
There is a marked demand from students in the US and abroad for pre-service (i.e. undergraduate and pre-clinical medical school level) education in global health. Specifically, students want both training in the principles of the delivery of care in resource limited settings and opportunity to experience the work first hand. Generally, experiential learning of global health has been ad hoc and based on individual projects and relationships. The Program in Global Medical Education and Social Change is working to develop a common rotation in Social Medicine and Community Health for medical students from Harvard Medical School well as the medical schools in Haiti and Rwanda. The goal of this rotation is to develop common learning objectives and experience for US and local national medical students to work and learn jointly in the field.Residency in Global Health Equity (Brigham and Women’s Hospital)
In 2004, Dr. Paul Farmer and Dr. Howard Hiatt created a global health track for Internal Medicine residents at the Brigham and Women’s Hospital. Through the Doris and Howard Hiatt Residency in Global Health Equity, residents spend approximately 11 months of their training in clinical rotations at international sites and earn a Master's degree in Clinical Effectiveness from the Harvard School of Public Health. Graduates of the four-year program are expected to develop a career as global health leaders and to accompany colleagues and leaders in low-income countries through the daunting process of strengthening their health care systems. As more medical institutions in the U.S. offer global health training, there is an urgent need to develop and evaluate the formal pedagogy for residency training. The Program in Global Medical Education and Social Change is working with the residency at the Brigham and Women’s Hospital and elsewhere to develop and evaluate this curriculum.Residency in Family and Community Medicine (Rwanda and Haiti
The majority of physicians in resource poor settings have not had the benefit of residency training. Those with residency training were often trained in areas without the medicines or other tools needed to properly care for the poorest and sickest patients. The residencies in Family and Community Medicine offered in public facilities in Haiti and Rwanda draw upon the expertise of leading academic institutions in the United States to train residents in Family and Community Medicine within public facilities that have been reinforced with adequate staff and supplies by the work of Partners In Health. The transformation of a health care facility into a teaching hospital is conceptually appealing as a way to increase staffing ratios, improve the quality of care, and increase the pipeline of medical professionals with experience in and commitment to the public health system of Haiti and Rwanda. This project will serve as a pilot for future efforts as we aim to replicate this capacity building and residency program in Mirebalais, Haiti and Butaro, Rwanda. The residency program will train and appropriately compensate residents while exposing them to the most pressing needs of the most vulnerable populations who seek care in the public sector.Fellowship in Global Health Delivery (Haiti)
To create a locally owned and operated model of care, it was necessary to train a cadre of Haitian health workers to the difficult work of implement HIV care while improving primary health care within the public sector. The Fellowship in Global Health Delivery was created to meet this need. It includes a didactic component which includes: the teaching of the principles of social medicine, human rights, the community based approach as well as approaches to common conditions—such as HIV, TB, Malaria and non-communicable diseases. In addition, clinical and programmatic work is mentored by experienced faculty from both the Brigham and Women’s Hospital and international sites.
The Program in Global Medical Education and Social Change is dedicated to developing strong ties with institutions and organizations that share its goals of developing the discipline of global health through rigorous collaborative training programs in the field. Current affiliations include the Brigham and Women’s Hospital, Children’s Hospital of Boston, Partners In Health, the University of Colorado, the University of Miami, Dartmouth University, Duke University, The Haitian National Medical University, and the Rwandan Medical School in Butare.