Global Health Institute

By Shuait Nair 

The sphere of global health has witnessed an impressive growth in progress over the past few decades. The notion of the right to health has gained familiarity across many societies, though the term itself is still shrouded in ambiguity. Today, many global health activists are working to clearly define the right to health, primarily by identifying the types of health services which fall under this broader umbrella, while ensuring that all populations have access to any essential services. Keifer Buckingham, Senior Policy Advisor for International Public Health at Open Society Foundations, is one such global health advocate who has worked on elucidating the right to health. In particular, she has devoted her career to the advocacy of a form of health which many countries either ignore or are quick to dismiss: reproductive health. Buckingham’s career began with examining the right to HIV care among populations throughout the world. In her freshmen year of college, Buckingham had the opportunity to travel to Rwanda on an exchange program. While there, she visited a PEPFAR-funded clinic– her first-hand experience with seeing international communities and the extent to which health impacted their livelihoods inspired her to create her own major in international development at a time when the now popular field was virtually non-existent. In graduate school, her health focus transitioned from global HIV care to domestic reproductive rights. 

Buckingham claimed that this shift in interest was catalyzed by her discovery of an unsettling irony rooted in the U.S. global health agenda, namely that while the US fought hard to provide HIV treatment for women abroad, the country was all too quick to limit reproductive rights at home. Buckingham began pursuing research on domestic policies that regulated reproductive health, such as the Global Gag Rule (Mexico City policy), which blocked funding to NGOs that directly supported or advocated for access to abortions. With time, Buckingham unearthed the reproductive health paradox in the U.S., noting in her article published in The Hill, how post-Roe v. Wade, U.S. policies like the Global Gag Rule and Helms Amendment restricted a woman’s fundamental right to reproductive health. 

A central part of Buckingham’s career has been to consolidate this concept of reproductive health rights. In our conversation, Buckingham mentioned how reproductive health rights had largely varying associations between countries. For example, Buckingham noted that while reproductive health rights in the U.S. mostly focused on the right to terminate an unwanted pregnancy (abortion), the term often referred to the right to access prenatal care and postnatal in refugee camps across the Middle East and Asia. However, Buckingham argued that the concept of reproductive health was its own umbrella consisting of a spectrum of rights, from the right to survive a pregnancy and have a healthy baby to more nuanced rights, such as the rights to have a child (via fertility treatment), receive sexual education, and exercise gender identity. Buckingham reminded us that even though the U.S. often debated the more complex concepts of reproductive health, it still struggled with the more fundamental rights, noting the disparity in maternal mortality rates between white women and women of color in the country. 

For the past year, Buckingham has worked as a senior policy advisor on international health at the Open Society Foundations, an organization which develops and provides grants to smaller independent groups hoping to tackle global health initiatives. Her work in the Open Society Foundations has given activists the opportunity to open up conversations on the more divisive issues within the realm of global health. It is essential that we these platforms to spread awareness of reproductive health rights despite the efforts of countries to avoid such matters. Whether they are ready or not to recognize this issue should no longer be a ground for delay; it’s about time we address the elephant in the room. 

Shuait Nair is a sophomore in the School of Foreign Service studying Science, Technology, and International Affairs. He is also a researcher on refugee and migrant health rights.

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.