Program in Global Primary Care and Social Change
Andrew Ellner, MD, MSc, Program Director
Biomedical innovation has revolutionized physicians’ ability to prevent, diagnose, and treat disease. But this revolution has not created the equitable and efficient provision of health care for all. Ten percent of the US population, for example, accounts for 70 percent of total US health expenditures—the confluence of the socioeconomically vulnerable and the medically frail. Worldwide, thousands of people die every day from preventable and treatable disease. Now, more than ever, innovation in primary health care delivery is necessary to help researchers and clinicians translate innovations in biomedical science into better health outcomes for people across the globe.
The Program in Global Primary Care and Social Change takes a multidisciplinary approach to innovating new approaches to primary health care delivery and training, engaging experts from a variety of disciplines, including behavioral economics, management science, and systems engineering. We seek new models of care delivery that effectively, efficiently, and equitably serve all people, and models of training that enable students to develop skills in management, program design, and advocacy that will help them lead the health systems of the future. The Program places a particular emphasis on caring for the most vulnerable patients, who are the most costly to treat in the US system and the most underserved in resource-poor settings. Its research focuses on the organizational and behavioral aspects of the primary health care team (including providers, patients, and communities) and their interactions with disease-specific interventions, technologies, and sociopolitical contextual factors, as the key locus for creating value in global health care delivery.
In addition to systematically studying primary health care worldwide, the Program aims to develop reciprocal, multidirectional exchanges of ideas and training opportunities with institutions in Brazil, Haiti, Rwanda, the United Kingdom, and other countries in which innovation in primary health care is occurring.
Specific objectives of the Program in Global Primary Care and Social Change include:
- Developing and refining a conceptual framework for understanding primary health care delivery in a variety of contexts, and systematically studying primary care models and innovations around the world.
- Engaging scholars from a range of academic disciplines in creating, piloting, and evaluating new organizational and technological approaches to primary care delivery.
- Training and providing opportunities for scholarship to medical students, residents, and fellows interested in engaging in primary care innovation.
- Creating a mechanism to facilitate the global exchange of approaches, innovations, and training opportunities in primary health care.
Featured InitiativesUnderstanding Global Primary Care Delivery
While primary health care is a rubric frequently invoked as a care-delivery or sociopolitical ideal, little systematic, rigorous understanding exists of how this care is actually organized and delivered in different contexts around the world to create value for health systems and societies. This initiative aims to develop a conceptual framework for analyzing different approaches to primary care delivery and then refine the framework by studying representative examples of primary health care around the world. The product of this work will be a series of case studies and a summative report, as well as novel curricular materials for training medical students and residents.Developing Interdisciplinary Pilot Projects for Trainees and Faculty
This is a critical time globally for innovating new, higher-value models of care delivery, particularly models that better care for socioeconomically vulnerable and medically frail populations. This initiative creates opportunities for students of medicine and other academic disciplines to collaborate with each other and with faculty members to conduct research and scholarship aimed at developing, piloting, and evaluating innovative approaches to primary health care delivery to be implemented at “effector arms,” including Brigham and Women’s Hospital and Cambridge Health Alliance, and at partner sites in countries such as Brazil, Haiti, Rwanda, and Uganda.Creating a New Primary Health Care Curriculum for Harvard Medical School
Addressing the renewed emphasis on primary care at HMS and the burgeoning understanding that medical students must be trained in nontraditional skill sets to lead and thrive in new models of health care delivery, the Program is creating novel curricular offerings for medical students that may be chosen as electives during the preclinical and/or clinical years. These include both didactics and coordinated field experiences with faculty mentors, working in collaboration with students and faculty of other academic disciplines, including engineering, management, and public policy.
The Program in Global Primary Care and Social Change has developed relationships with the Brigham and Women’s Hospital Primary Care Division, the Cambridge Health Alliance, and Partners In Health sites in Haiti and Rwanda.