Global Health Experts Research Articles

The benefits and limitations of establishing the PA profession globally: A systematic review and mixed-methods study.

Physician associates/assistants (PAs) and their equivalents offer a solution to the supply and demand crisis to alleviate global healthcare needs. This study investigated how PA and PA equivalents address global healthcare needs across different healthcare systems, revealing recommendations for their use. The study also sought to catalog the global healthcare needs that PAs and equivalents are successfully alleviating, the roles in which they function, and the barriers facing implementation. A systematic review was conducted from October 2021 to April 2022 and rerun in June 2023 following PRISMA 2020 guidelines; additionally, supporting interviews were conducted with PAs and global health experts. Primary outcomes were geographic region, economy, healthcare needs, and healthcare systems. Secondary outcomes were PA use, license recognition, and successes or barriers when implementing PAs. The literature and interviews focused on the global use of PAs and PA equivalents in six geographic regions, 63 countries, and five US territories where PAs or PA equivalents are employed, have been employed, are volunteering, or are being considered to support global healthcare needs. Most countries have a developing economy and an out-of-pocket healthcare system. PAs and PA equivalents hold 35 different practice titles, and most work in primary care. PAs alleviate healthcare shortages and economic disparities, specifically related to inequitable healthcare access. Globally, the profession is limited by a lack of legislation, regulation, and support. PAs and PA equivalents worldwide belong to an adaptable profession that has well-documented success in alleviating the global healthcare shortage and addressing healthcare needs. Countries desiring PAs or PA equivalents should identify their specific needs, train their existing workforce, employ pilot programs, and focus on seeking early legislation and regulation. Broad support for existing PA and PA equivalent international organizations is recommended for global collaboration. This study serves as a guide for those advocating for the continued or future implementation of PAs and PA equivalents in their own country and provides a comprehensive resource to aid in the globalization of this profession. We offer recommendations to address the dire healthcare needs and workforce shortage faced across the globe.

Infodemic, Ignorance, or Imagination? The Problem of Misinformation in Health Emergencies

Abstract In understanding and responding to the problem of misinformation during global health emergencies, health experts and organizations such as the WHO have relied on the concept of the “infodemic,” or the idea that there is such an overabundance of information that ascertaining trustworthy sources and reliable guidance is difficult. Is this the best way to understand the problem of misinformation, however? A large and multidisciplinary literature has argued that such an approach misses the important role of individual psychological factors and societal “mega-trends” such as hyperpolarization, structural shifts in the media, and public mistrust in elites. This article argues that such contributions are important in understanding the multifaceted problem of misinformation but may miss another, equally important component: the politics of emergency. Specifically, the prominent role of speculation during moments of emergency—the need to respond to “what ifs” rather than just “what is”—provides a conducive context for misinformation, facilitating its production and spread while also problematizing efforts to correct it. The article illuminates this relationship through a discourse analysis of prominent misinformation claims during the US responses to Ebola in 2014 and COVID-19 in 2020.

Rethinking Health Systems Responsiveness in Low- and Middle-Income Countries: Validation Study.

Health systems responsiveness (HSR) is the ability of systems to respond to legitimate non-health expectations of the population. The concept of HSR by the World Health Organization (WHO) includes respect for dignity, individual autonomy, confidentiality, prompt attention to care, availability of basic amenities, choice of provider, access to social support networks, and clarity of communication. The WHO tool is applied globally to assess HSR in low, middle, and high-income countries. We have revised the conceptual framework of HSR following a rigorous systematic review and made it specific for low- and middle-income countries (L&MICs). This study is designed to (1) run the Delphi technique to validate the upgraded conceptual framework of HSR, (2) modify and upgrade the WHO measurement tool for assessing HSR in the context of L&MICs, and (3) determine the validity of the upgraded HSR measurement tool by pilot testing it in Pakistan. The Delphi technique will be run by inviting global public health experts to provide suggestions on the domains and subdomains of HSR specific to L&MICs. Cronbach ɑ will be calculated to determine internal consistency among the participants. The upgraded HSR conceptual framework will serve as a beacon to modify the measurement tool by the research team, which will be reviewed by subject experts for refinement. The modified tool will be pilot-tested by administering it to 1128 participants from primary, secondary, and tertiary care hospitals in Rawalpindi district, Pakistan. Additionally, an "observation checklist" of HSR domains and subdomains will be completed to objectively measure the state of HSR across health care facilities. HSR assessment will be further strengthened by incorporating the perspective of hospital managers, service providers, and policy makers (ie, the supply side) as well as community leaders and representatives (ie, the demand side) through qualitative interviews. The study was started in January 2024 and will continue until February 2025. A multidimensional approach will yield significant quantifiable information on HSR from the demand and supply sides of L&MICs. This study will provide a conceptual understanding of HSR and a corresponding measurement tool specific to L&MICs. It will contribute to global public health literature and provide a snapshot of HSR in Rawalpindi district, Pakistan, with concrete action points for policy makers. DERR1-10.2196/59836.

Development and evaluation of scenario-based e-simulation for humanitarian health training: a mixed-methods action research study

ObjectivesThis study aimed to develop and evaluate a scenario-based e-simulation (SBES) to address the limited avilability of accessible and practical training for humanitarian public health responders. The objectives included SBES...

International Hackathon as a Tool to Augment Education, Collaboration, and Innovation in Global Neurosurgery.

Health care providers' exposure to global surgical disparities is limited in current nursing and/or medical school curricula. For instance, global health is often associated with infectious diseases or maternal health without acknowledging the growing need for surgical care in low- and middle-income countries (LMICs). We propose an international virtual hackathon based on neurosurgical patient cases in under-resourced settings as an educational tool to bring awareness to global surgical disparities and develop relationships among trainees in different countries. Participants were recruited through email listservs, a social media campaign, and prize offerings. A 3-day virtual hackathon event was administered, which included workshops, mentorship, keynote panels, and pitch presentations to judges. Participants were presented with real patient cases and directed to solve a barrier to their care. Surveys assessed participants' backgrounds and event experience. The hackathon was executed through Zoom at Harvard Innovation Lab in Boston, MA, on March 25 to 27, 2022. Participants included medical students, with additional participants from business, engineering, or current health care workers. Three hundred seven applications were submitted for 100 spots. Participants included medical students, physicians, nurses, engineers, entrepreneurs, and undergraduates representing 25 countries and 82 cities. Fifty-one participants previously met a neurosurgeon, while 39 previously met a global health expert, with no difference between LMIC and high-income countries' respondents. Teams spent an average of 2.75 hours working with mentors, and 88% of postevent respondents said the event was "very" or "extremely conducive" to networking. Projects fell into 4 categories: access, language barriers, education and training, and resources. The winning team, which was interdisciplinary and international, developed an application that analyzes patient anatomy while performing physical therapy to facilitate remote care and clinical decision-making. An international virtual hackathon can be an educational tool to increase innovative ideas to address surgical disparities in LMICs and establish early collaborative relationships with medical trainees from different countries.

Research priorities for water, sanitation and hygiene (WASH) in humanitarian crises: A global prioritisation exercise

Water, sanitation and hygiene (WASH) interventions should provide access to safe water and sanitation, and promote good hygiene practices with dignity, comfort and security. Multiple systematic reviews have noted evidence gaps and is a paucity of good quality evidence related to the effectiveness and implementation of WASH programmes and interventions in humanitarian crises. The aim of this study was to generate consensus-based actionable research priorities for the humanitarian WASH sector. A research prioritisation exercise was conducted by adapting the Child Health and Nutrition Research Initiative (CHNRI) method. Research questions were compiled from a rapid scoping review, key informant interviews (KIIs) and focus group discussions (FGDs). Questions were reviewed by a technical expert group. An online survey was circulated to score research questions according to five criteria. An overall prioritisation score was calculated and weighted to prioritise questions. A diverse range of 286 global WASH and health experts engaged in the CHNRI process. A list of 128 questions were generated and scored by experts. Prioritised research questions focussed on evaluating existing interventions or programmes, and making iterative changes to current programmes. Other important questions centred on describing WASH conditions and associated health risks in crises contexts. Priorities were also stratified by gender, organisation and region to understand differences globally. The WASH in Crises Research Agenda has identified key research questions of most importance to those implementing WASH in humanitarian crises and has established a list of research priorities. The identified priorities reinforce how more evidence is needed, and underlines the need for research to evaluate current practices in order to improve the quality of humanitarian response. Stakeholders, including donors, international and national organisations, governments and academic institutions, are invited to use this research agenda to encourage, inspire and enable relevant and high-quality research that will be used to inform humanitarian responses.

Changing roles in global health governance following COVID-19.

The Global Health Governance (GHG) response to the COVID-19 pandemic has been criticized, particularly regarding vaccine management, and changes in the roles of GHG actors have been recommended. To investigate the perception of experts regarding changes in the roles of different GHG actors following the COVID-19 pandemic. This study used a 3-round Delphi survey to collect data from 30 global health experts between May and December 2022. The GHG roles investigated were stewardship, production of guidelines and policies, promotion of solidarity and collaboration, and management of global health challenges. Social network analysis was performed and collected data was converted into a 1-mode network. Degree centrality and Eigenvector centrality were calculated using the UCINET 6.757 modelling programme. There were variations between the current and future roles in degree centrality and eigenvector centrality for the 19 GHG actors in each of the 4 functions investigated. For stewardship, WHO, governments and the World Bank had the highest degree centrality and eigenvector centrality during both the current and future periods. In terms of production of guidelines and policies, WHO maintained the highest current and future eigenvector centralities, while research agencies, UNICEF and Gavi upheld their current eigenvector centrality measure. For the promotion of solidarity and collaboration, WHO had the highest centrality measures, followed by UNICEF, governments and Gavi. Regarding the function "management of global health challenges", WHO lost its position to UNICEF as the most central, while UNDP, FHI 360 and research agencies were predicted to have a more central role in the future. The findings position WHO as the current and future top actor in stewardship, production of guidelines and policies, and promoting solidarity and collaboration, and UNICEF as the upcoming most central actor in managing global health challenges. Governments were major actors in all GHG functions except for managing global health challenges. Funding actors were central in all GHG functions, indicating finance as an important factor in obtaining a central role in GHG. Research organizations received a high centrality rating, indicating their importance in GHG.

Community-based mental health interventions in low- and middle-income countries: a qualitative study with international experts

BackgroundMental health services are scarce in low- and middle-income countries (LMICs), and designing and implementing effective interventions can be difficult. The aim of this international study was to explore the key lessons for developing, implementing, and evaluating community-based mental health and well-being interventions in LMICs, with an additional focus on older adults.MethodsResearch and clinical experts in developing and implementing psychosocial community-based interventions in LMICs were interviewed remotely between October 2021 and January 2022. Participants were recruited via existing global health networks and via published literature searches. Participants were asked about their experiences of developing and implementing interventions, and about key barriers and facilitators during the process. Interviews lasted up to 45 min, and data were analysed using combined inductive and deductive thematic analysis.ResultsSixteen global mental health experts participated. Five themes with different sub-themes were generated: Mechanisms and contexts; Barriers; Facilitators; Public and stakeholder involvement; Looking through an ageing lens. The development and delivery of mental health interventions in LMICs are facilitated through integration into existing health infrastructures and working with existing job roles as delivery agents. Public and stakeholder involvement are crucial at all stages of development through to implementation to focus on meeting local needs and sustaining participant motivation. Logistical barriers of transport, resources, and location need to be addressed, emphasising local sustainability.ConclusionsThis study provides important insights for how the development, implementation, and evaluation of community-based mental health and well-being interventions in LMICs can be optimised, and can complement general guidance into complex interventions developments.

AGING AND FOREIGN POLICY: EXPERIENCING THE GLOBAL TRACK OF THE HEALTH AND AGING POLICY FELLOWSHIP

Abstract The Health and Aging Policy Fellowship includes a Global Track that provides fellows with the opportunity to shape global policy or U.S. foreign policy for an aging society. The author, a global health expert and 2022-2023 fellow, sought a fellowship placement with a member of Congress with jurisdiction over U.S. global health policy. Although global health is a significant foreign policy priority for the U.S. government, U.S. global health programs do not include dedicated funding for activities designed to benefit older adults or help development partners adapt to population aging. The result is that US-funded programs on issues from infectious disease to health systems strengthening to disaster relief lack a focus on older adults, despite their many links to this growing population. To help address this policy gap, the author secured a fellowship placement with Senator Benjamin Cardin (D-MD), a senior member of the Senate Foreign Relations Committee (SFRC) and Chair of the SFRC Subcommittee overseeing the State Department, US Agency for International Development, and bilateral development assistance. With his track record of legislation and oversight on issues such as Medicare, health disparities, medical research, oral health, health systems strengthening, and retirement security, Senator Cardin is well positioned to help integrate the needs of older adults into U.S. development assistance. The author used his fellowship year to help advance the global health-related legislative priorities of Senator Cardin and his Health Team, bringing his expertise and perspective on aging to the policy table while gaining invaluable skills in the policy process.

Consensus on global health competencies for Korean medical students using a modified Delphi method

Purpose: This study aimed to reach a consensus among experts on the global health competencies for medical students in Korea.Methods: A global health competency model was developed to identify domains and competencies for medical education, and a three-round modified Delphi method was used to reach consensus among 21 experts on the essential global health competencies. The degree of convergence, degree of consensus, and content validity ratio of the model were used to reach a consensus.Results: A list of 52 competencies in 12 domains were identified according to a literature review. In the first-round Delphi survey, the global health competencies were refined to 30 competencies in eight domains. In the second round, the competencies were reduced to 24. In the final round, consensus was reached among the expert panel members, and the competencies were finalized. The global health competency domains for medical students include global burden of disease (three items), globalization of health and healthcare (five items), determinants of health (two items), healthcare in low-resource settings (two items), global health governance (three items), health as a human right (four items), cultural diversity and health (three items), and participation in global health activities (two items).Conclusion: The group of experts in global health achieved a consensus that 24 global health competencies in eight domains were essential for undergraduate medical education in Korea. The domains and competencies identified herein can be used to develop an undergraduate medical education curriculum in global health.

Group think? Questioning the individual global health expert

Group think? Questioning the individual global health expert

Global Health Expertise in the Shadow of Hegemony

What enables actors to shape norms in global health governance? Scholarship on global health has highlighted the role of experts and expertise in operationalizing norms across a variety of issues. The degree of expert consensus or dissensus and the negotiation processes between expert communities—for example, in international organizations, NGOs or academia—are commonly identified as centrally important for explaining these processes. In this article, we posit that norm-making in global health governance occurs in the shadow of hegemony; a system of status and stratification that is centered on economic and security concerns and maintained by countries at the core of the world system. These countries—notably the USA and other major economies in the Global North—project their hegemonic position in the world system across areas of global organizing, including in global health. We explore the relationship between epistemic consensus and hegemonic interests as parameters that shape the outcome of norm-making processes. To pursue this argument, we examine this relationship in the context of the development of policy norms to counter non-communicable diseases in developing countries and to pursue the securitization of global health.

Who is a global health expert?

Who is a global health expert?

Job preferences of Japanese global health personnel: results from a discrete choice experiment

Background The disintegration of the boundary between global and national health due to the emergence of global health issues, such as COVID-19, led to the increasing need to nurture global health experts so as to strengthen global and national health capacity. One approach is to engage in work at health-related United Nations (UN) and international organizations. However, the issue of member states underrepresentation exists, which poses a challenge both in nurturing global health experts and realizing the equitable geographical distribution prescribed in Article 101 of the United Nations Charter. Japan, among other member states, remains underrepresented in UN organizations. This study aimed to understand the job preferences of Japanese experts wishing to work at health-related international organizations and present policy proposals for strengthening capacity development and promoting international dispatch. Methods The discrete choice experiment (DCE) survey was conducted online to determine the job preferences of health/non-health experts and students – (i) who wished to work at health-related international organizations (Seekers), (ii) who are currently working at these organizations (Workers), and (iii) who resigned from these organizations (Resignees). The binary logit main effects model was used to examine the relative importance of various job attributes. Results DCE analysis showed the relative importance of duty station, salary, work–life balance (WLB), and job satisfaction for all groups and return post and employer’s contribution to welfare benefits for Seekers and Resignees but not for Workers. Conclusions The “uncertainty-avoidance” characteristics mainly perceived in Seekers and Resignees propose two separate approaches, which entails supporting (i) the few selected ones, and (ii) the majority who are interested but remain uncertain and indecisive to work overseas. The social structural challenge associated with the lack of national organizations and hospitals that value experiences gained at international organizations needs to be addressed by introducing systems such as sabbatical leaves or reemployment systems for returnees. Furthermore, an incentive information package combining both financial and nonfinancial incentives focusing on favorable conditions relating to duty station, salary, WLB, and job satisfaction, which could be achieved at international organizations, could be actively publicized at career development seminars.

Public-Private Partnerships and the Landscape of Neglected Tropical Disease Research: The Shifting Logic and Spaces of Knowledge Production.

Until the recent spread of public-private partnerships, pharmaceutical firms had avoided research and development into neglected tropical diseases (NTDs). Because these are diseases that affect the poorest populations in developing regions, research and development initiatives have for the most part depended on the resources and expertise drawn from academia, international organizations, and intermittent state interventions in disease-endemic countries. Over the last few decades, however, public-private product development partnerships (PDPs) have been introducing new collaborative agreements in which the existing resources and expertise combine with the those traditionally withheld by the pharmaceutical industry and global health NGOs. This paper explores recent transformations in the representation of NTDs by examining the shifting logic and spaces of knowledge production which the advent of PDPs has enabled. An analysis of two case studies focused on Chagas disease-related initiatives addresses recurring preoccupations in Science, Technology and Society studies as well as in critical analyses of PDPs: that is, the back-and-forth movement of the disease from being an object of scientific inquiry to a public health concern, and the legitimacy risks and material asymmetries entailed in global health PDPs. Both cases show that it is major global health stakeholders and experts in non-endemic countries, rather than transnational pharmaceutical firms, that exert the greatest influence upon these changing representations: PDPs attempt to expand the preexisting biomedical focus on NTDs by means of incorporating "real world" drug development preoccupations (which I term epistemic shifts), but they also combine their stated global humanitarian aim with security concerns about the diseases spreading to non-endemic, industrialized countries (which I term geographical shifts).

Unbracketing the multiplicity of trauma in North Kivu, Democratic Republic of Congo

As international health organizations have increasingly acknowledged the global burden of psychological trauma, global health experts have sought to appraise and organize the treatment of trauma through objective, neutral forms of classification and calculation. Rather than see trauma as a singular thing whose biological, social and psychological formation is bracketed by expert perspectives, this paper focuses on how psychological trauma is enacted—that is, brought into being and sustained—in particular contexts and practices. If trauma can be made and unmade in practices, rather than assumed to be a stable thing, then these practices become a matter of concern rather than fact for geographers. We take as our empirical focus the province of North Kivu in the eastern Democratic Republic of Congo, where trauma has become a matter of growing local, national and international concern. Working with and beyond the conceptual work of Annemarie Mol, we demonstrate how different ‘versions’ of trauma uneasily co‐exist in the region. Interrogating these versions, we explore the tensions that arise from attempting to explain and summate the incidence of trauma that is not singular or stable but is, instead, emergent and enacted in a variety of practices.

Longitudinal Analysis of Eye Health Disparities Due to Trachoma Using Country-Level Data from the Global Burden of Disease Study 2019

ABSTRACT Purpose To assess the change in eye health disparities due to trachoma using longitudinal country-level data (1990–2019) from the global burden of disease study 2019. Methods:Statement We obtained data on the burden of trachoma and population statistics from the Global Health Data Exchange website. We assessed the geographic distribution of trachoma at the global level and World Bank regional level from year to year using Gini coefficients and statistics of inequality that ranged from 0 (total equality) to 1 (total inequality). Result We found that 60 countries and territories had a burden of trachoma, and these were from all regions except Central Europe, Eastern Europe, and Central Asia. At the global level, the Gini coefficient had increased from 0.546 to 0.637 (p for trend: <0.001) in the last three decades, while the mean disability-adjusted life years (DALYs) per 100,000 people declined from 13.0 to 3.2 (p for trend: <0.001). The inequality statistics had significantly worsened in South Asia and Sub-Saharan Africa (p for trend: <0.001) despite the decrease in the mean DALYs per capita. Conclusion Our study revealed that the burden of trachoma dramatically decreased; however, the eye health inequality due to trachoma increased globally and in two of the most endemic regions in the last three decades. Global eye health experts need to monitor the distribution of eye diseases and ensure appropriate, effective, uniform, and high-quality eye care for all.

Expertise, translation, and pandemics

Sociologists have much to learn from recent anthropological accounts of expertise in global health. This review surveys three recent ethnographies from Fearnley (2020), Keck (2020), and Porter (2019) to examine how global pushes for biosecurity and zoonotic disease surveillance are unfolding in the global periphery. Collectively, these accounts of global health programs in Mainland China, Hong Kong, Taiwan, Singapore, and Vietnam show how global forms of expertise are translated into local contexts, running up against resistance and creating new alternate networks of expertise to overcome these barriers. While this focus on translation examines how practices of biosecurity originating from the Global North are implemented elsewhere and are transformed in the process, in preparation for future pandemics, global health experts should also consider how to collect, assemble, and translate local expertise so that it is legible to global science and policymakers faraway.

The pandemic is not the great equalizer: front-line labor and rationing in COVID-19 critical care.

Framed as "the great-equalizer," the COVID-19 pandemic has intensified pressure to adapt critical care labor and resulted in rationing by healthcare workers across the world. To critically investigate how hospital intensive care units are critical sites of care labor and examine how rationing highlights key features of healthcare labor and its inequalities. A practice-oriented ethnographic study was conducted in a United States academic ICU by a medical anthropologist and medical intensivists with global health expertise. The analysis drew on 57 in-depth interviews and 25 months of participant observation between 2020 and 2021. Embodied labor constitutes sites and practices of shortage or rationing along three domains: equipment and technology, labor, and emotions and energy. The resulting workers' practices of adaptation and resilience point to a potentially more robust global health labor politics based on seeing rationing as work. Studies of pandemic rationing practices and critical care labor can disrupt too-simple comparative narratives of Global North/South divides. Further studies and efforts must address the toll of healthcare labor.

New Masks, New Meanings: Covid Perspectives on African Art History: Part 1: Behind The Mask: African Art History in a Pandemic Era

New Masks, New Meanings: Covid Perspectives on African Art History: Part 1: Behind The Mask: African Art History in a Pandemic Era