Partnerships are a key component of successful global health programs but could be strengthened by addressing inequities in relationships between high- and low-income institutions, developing additional South-South collaborations and better preparing North American students for training in low-resource settings. These and other findings were the result of a study by the Center for Strategic and International Studies (CSIS), conducted with the Consortium of Universities for Global Health (CUGH) and the Department of Global Health at the University of Washington.
Photo by Ross Marlow for CUGH
A new study examines various aspects of global
The report, titled "Global Health Programs and Partnerships: Evidence of Mutual Benefit and Equity," also presents a framework for success to guide the development of sustainable global health programs and calls for additional funding to support partnership building. The project, launched with a panel discussion at CSIS, builds on a previous analysis of the dramatic growth of interest in global health on campuses, conducted in 2009.
For the new study, researchers surveyed 101 CUGH member institutions about their partnership activities and received 82 responses. The scientists also conducted in-depth interviews with global health leaders at 15 North American academic institutions and 11 partnering international institutions. The results showed near unanimous agreement that partnerships are beneficial and that most work well. Some issues of inequities between high- and low-income partners were noted, however, in terms of decision making related to the one-sided provision of funding, lack of bi-directional student exchange and sometimes in journal article authorship.
An analysis of funding sources for global partnerships showed universities themselves are the largest supporters, with NIH ranked second. There has been a steep migration of clinical trials over the last decade, the report stated, with medical breakthroughs increasingly coming from research conducted in low-resource settings.
"The game has shifted overwhelmingly to those countries," observed Dr. J. Stephen Morrison, co-author of the report and director of the Global Health Policy Center at CSIS. "That's where the clinical trials are happening, it's where programmatic implementation is happening and it's where discovery is concentrated. So in a way, they are sitting in the driver's seat."
Although traditional South-North collaborations were cited as having been the most valuable to date, nearly 40 percent of respondents said expanding South-South partnerships will be their highest priority in the future.
While acknowledging North American students are a great resource, some respondents suggested they could be better prepared for assignments overseas with improved language and cultural awareness training, and more realistic expectations of the challenges and limitations of working in developing countries.
A framework for success in academic global health programs:
- Gauge enthusiasm, identify champions, organize core team
- Prepare strategic plan
- Secure institutional support and baseline funding
- Establish centralized presence on campus
- Develop future leaders
- Guide student enthusiasm and manage expectations
- Develop existing partnerships, identify new partners
- Establish metrics for success, monitor progress
- Develop and maintain communication
- Build interdisciplinary networks
With the study findings and a review of relevant literature, the report authors developed a framework of ten key components for starting, developing and sustaining successful global health partnerships. (see box at right)
It is critical that major investments are made to develop the next generation of global leaders, both in North America and internationally, said Dr. King Holmes, a co-author of the report and founding chair of UW's global health department. "It's amazing to see how the young people we've had coming in for Fogarty training, for example, are now out running their national ministries of health or universities," he said.
The global health community should also examine partnerships and relationships to ensure they are producing the desired results, suggested Dr. Keith Martin, co-author and CUGH director. "How can we pivot so that the impacts for our colleagues in low-income countries are really much greater," he asked, "and that in these partnerships, they are not only going to benefit us, but are also going to benefit them in the ways that they need?"