Global Health Institute

Through the Global Health Initiative student fellowship program, I’ve had the opportunity this semester to work with Dr. Indira Narayanan on a project to improve the quality of neonatal care in Ghanaian hospitals and to assess the effectiveness of distance learning methods in quality improvement. The project involves a series of webinars, each focused on a different topic of concern in the neonatal units including birth asphyxia, hypothermia/temperature maintenance, and jaundice. 

Each session involves a case presentation by a Ghanaian hospital related to the topic of focus, which asks the presenting hospital to share examples of past cases. From this, a neonatal physician from the GUMC tailors a follow-on presentation to address the relevant issues faced in Ghanaian hospitals. Our team collaborates with each participating hospital to determine their primary area of concern, identify the shortcomings within the hospital that limit their effectiveness of treating the condition, and develop quality improvement activities accordingly. 

Following preliminary surveys it was determined a common issue in Ghanaian hospitals that impedes effective neonatal was lack of sufficient education of all personnel involved in care of the newborn. This was assessed to stem from infrequent training of hospital staff accompanied by high staff turnover rate. A potential accessible solution for this issue may be found through a distance learning program. 

Previously conducted distance learning programs in LMICs show successful models in course deployment and participation, as well as in resulting knowledge gains. In Zambia, a program organized by Johns Hopkins University in collaboration with Zambian experts on HIV received good feedback from participants, with significant increase in number of participants in each subsequent session. By the third session, more than 500 students had registered for the distance learning course. Another course focused on diagnosis, treatment, and prevention of tuberculosis involving the US, South Africa, India, and Pakistan resulted in an increase in the median test score from 66% to 86%, while a program in India on biostatistics and research ethics showed similar knowledge gains between on-site and online learning platforms immediately following course completion and in knowledge retention three months afterwards. 

These programs reflect good prospects for distance education in LMICs, however, more research is needed to examine the effectiveness of distance learning programs on clinical practice as well as in comparison to more standard methods of clinical training. Distance education also has the potential to contribute to more equitable healthcare in resource-poor settings by expanding access to training to community health workers who are the main providers of healthcare in more remote communities. If distance learning programs are found to be successful with effective clinical results, they can be a more accessible and flexible training method as they limit the need for travel, are more financially sustainable, and have lower opportunity costs for learners who must balance training with active patient care.

As an intern at the Office of Global Affairs at the US Department of Health and Human Services this fall semester, I had the opportunity to help prepare HHS leadership to attend the 2019 G20 Health Ministers’ Meeting held in Okayama, Japan. The meeting was one of the eight ministerial gatherings that took place in addition to the G20 Summit. At these multilateral meetings member states work to advance ongoing collaboration and reaffirm shared commitments to address global health issues. The meetings also provide a platform for the member states to establish or further advance diplomatic relationships among themselves. The main themes of this year’s G20 Health Minister’s meeting was The Achievement of Universal Healthcare, Response to Aging Societies, and Health Risk Management and Health Security/Antimicrobial Resistance (AMR). 

At the conclusion of these meetings, member states often adopt a shared declaration. In the Okayama Declaration of the G20 Health Ministers, the member states agreed to various commitments in regards to The Achievement of Universal Healthcare such as “provide gender-responsive interventions to meet health needs of all and recognize immunizations is one of the most cost-effective health investments”. Other issues included in the declaration included promotion of health data and technologies, reform of health workforce programs, and cooperation with the private sector for financial sustainability of health systems. While there are often areas of disagreement on these issues, the high-level consensus of their importance by prominent member states an important signal that attention will be given to these issues. 

Similarly, in regards to the theme of Response to Aging Societies, the member states agreed on the importance of quality of life, utilization of health data, and addressing dementia-inclusive environments in society. The declaration also included action items such as encouraging OECD and other organizations to urge WHO to respond to its responsibility to prepare a Decade of Healthy Ageing 2020-2030 proposal and to treat aging as one of its priorities. Similarly, the declaration outlines more specific action items such as asking the member states to develop a national implementation plan in response to the WHA-endorsed Global Action Plan of the Public Health Response to Dementia 2017-2025 and focus their efforts on particular areas such as elderly labor market and early detection of dementia. The G20 consensus on the issue of aging is updated to address the evolving trends of demographic shifts and how the world’s public health system should prepare for the growing burden. 

The meeting is an important occasion where the health ministers and high-level health officials from various countries convene at one place. Health ministers and officials often hold bilateral meetings to reaffirm the importance of health cooperation, exchange each country’s health priorities, and explore future collaboration opportunities and ideas. On the sideline of the G20 Health Minister’s Meeting, for example, the HHS Deputy Secretary Eric Hargan represented the US and met with Health Minister Tawfig AlRabiah from Saudi Arabia to strengthen the two countries’ partnership on Global Health Security Agenda and the promotion of vaccines use. 

Another outcome was the signing of a Memorandum of Understanding (MoU) to establish a common line of goals and actions. Deputy Secretary Hargan also visited South Korea during this trip and signed a MoU between the U.S. Centers for Disease Control and Prevention (CDC) and the Korea CDC. The two CDCs agreed to collaborate on various public health issues including infectious disease outbreaks, anti-microbial resistance, and vaccine-preventable diseases. Specific action items such as information exchange and routine consultation are also listed to direct cooperative effort effectively.

Meetings like the G20 Health Ministers Meeting are important because they help prioritize public health issues among the member states and mobilize countries’ political leadership to address critical public health issues in the coming years. For readers who are interested in the high-level global health policy and hope to be informed, a quick and easy way is to follow the chief US health officials’ Twitter accounts to stay updated. And a reading recommendation for those who want to learn even more is a textbook titled 21st Century Global Health Diplomacy published by World Scientific. 

Angela Lu (NHS’20) is a senior in the School of Nursing and Health Studies studying in healthcare Management and Policy and Public Health. She is currently a Global Health Officer Intern at the Office of Global Affairs in the US Dept. of Health and Human Services. She is also a Student Fellow with the Global Health Institute at Georgetown University.