Global Health Initiatives Research Articles

Scaling up Health Services for Type 1 Diabetes in India

This report, “Scaling up Health Services for Type 1 Diabetes in India: Towards a strategy to transition to sustainability of programmes supported by CDIC in India ”, was developed under the guidance of Professor Rifat Atun, Professor of Global Health Systems at Harvard University and Director of the Health Systems Innovation Lab, and implemented by a team consisting of Dr Che L. Reddy, Associate Director Health Systems Innovation Lab, Harvard University, Zia Shakir, Research Scholar at Health Systems Innovation Lab, Harvard University, and Meghna Raman, Research Scholar at Health Systems Innovation Lab, Harvard University, and Anne Sofie Olsen who provided valuable comments. The analytical framework used in this report is drawn from earlier research and engagement with major global health initiatives led by Professor Rifat Atun at the Health System Innovation Lab. The study was supported by Novo Nordisk financially supported this work through a research grant. The funders had no role in study design, analysis, decision to publish, or report preparation.

Global Health Policies and International Cooperation in the Middle East and North Africa (MENA)

The core belief behind global health is that “disease knows no borders” and thus, in order to eliminate health risks, we should focus on the scope of their problems and not their location. However, some countries, such as those located in the Middle East and North Africa, which are dealing with economic and political instability as well as conflict, have to face greater health challenges than others. These states tend to depend more on international cooperation and global health policies to eliminate the growing health challenges in their region. This paper seeks to examine the general health status, health risks as well as some global and regional health initiatives implemented in the MENA region, aiming to respond to the multitude of health issues affecting these countries.

Rethinking structural competency: Continuing education in mental health and practices of territorialisation in Brazil

ABSTRACT Brazilian mental health focuses on the social determination model within mental health policies and interventions to address mental and social suffering as resulting from social exclusion and structural violence. Structural concerns focused on class stratification and socioeconomic inequalities overweight cultural ones in Brazilian mental health. In this article we examine, first the role of culture and interculturality in mental health practices and mental health guidelines for health professionals continuing training in Brazil. Second, we explore interviews with health professionals around Continuing Education in Health provided by mental health collaborative care initiatives within primary health care as illustration of a local practice of structural competency in mental health. Finally, we examine the central role played by the practices of territorialisation in shaping health care training and care interventions. The focus on the territory can promote critical apprehensions of the intercultural and structural factors that shape health practices, enrich health professional education oriented towards the basic tenets of social medicine and provide global discussions around structural competency with innovative ways of thinking about health education, health care and spatiality. We believe that our results may be useful for comparing structural competency training initiatives in global health.

Veterinarians Will Save More Than Their Patients by Acting on Climate Change and Embracing Sustainability

Climate change is a worldwide health problem. Veterinarians and other health professionals have been called upon to participate in mitigation and adaptation efforts to protect animals and people. The objectives of this article are to review the ways in which climate change impacts animal health and highlight ways in which veterinarians and other animal health professionals can engage on the topic. Disease in terrestrial and aquatic species as well as domesticated and wild animals occurs through a series of shared exposure pathways (temperature, air, water, food, vector-borne disease, extreme events, and welfare). To meaningfully address this problem, the veterinary profession must recognize climate change as part of a complex and interwoven collection of sustainability challenges. Proposed actions include leading by example, building new partnerships, and promoting education, policy, and research. Veterinary professionals are key contributors to global health initiatives and trusted messengers of health information. Lending our voices and actions to address the climate crisis and related sustainability issues will go a long way to protect the health of all species.

Early childhood growth in Daasanach pastoralists of Northern Kenya: Distinct patterns of faltering in linear growth and weight gain.

Investigations of early childhood growth among small-scale populations are essential for understanding human life history variation and enhancing the ability to serve such communities through global public health initiatives. This study characterizes early childhood growth trajectories and identifies differences in growth patterns relative to international references among Daasanach semi-nomadic pastoralist children living in a hot, arid region of northern Kenya. A large sample of height and weight measures were collected from children (N=1756; total observations=4508; age=0-5 years) between 2018 and 2020. Daasanach growth was compared to international reference standards and Daasanach-specific centile growth curves and pseudo-velocity models were generated using generalized additive models for location scale and size. Compared to World Health Organization (WHO) reference, relatively few Daasanach children were stunted (14.3%), while a large proportion were underweight (38.5%) and wasted (53.6%). Additionally, Daasanach children had a distinctive pattern of growth, marked by an increase in linear growth velocity after 24 months of age and relatively high linear growth velocity throughout the rest of early childhood. These results identify a unique pattern of early childhood growth faltering among children in a small-scale population and may reflect a thermoregulatory adaptation to their hot, arid environment. As linear growth and weight gain remain important indicators of health, the results of this study provide insight into growth velocity variations. This study has important implications for global public health efforts to identify and address sources of early growth faltering and undernutrition in small-scale populations.

Our Lives as Women: An Analytical Framework of What Makes Q'eqchi' Women Sick

The global pattern of women suffering from worse health than men, based on cultural, economic, and biological factors, was found in a small group of Q’eqchi’ women in the Toledo district of Belize. This research follows the health narratives of 20 Q’eqchi’ women to determine what they believe causes their poor health. Through in-depth personal interviews Q’eqchi’ women shared that they suffer from backaches, headaches, pain in their bones, and heavy bleeding. Further, the women also reported ‘thinking too much’ as a factor in their health caused by their reproductive roles. Through thematic analysis and an extensive review of varied literature, this research found that the colonization-rooted Latin gender roles of machismo and marianismo work to sustain Q’eqchi’ women to the domestic sphere. Based on the fact that most Q’eqchi’ women are mothers and wives, these women are stripped of opportunities to obtain education and gain employment, leading to high stress levels and a dependency on their partners for socioeconomic support. Moreover, Q’eqchi’ women’s domestic responsibilities involved arduous physical labour with little rest or help from their male spouses. This labour, combined with the pressures and responsibilities associated with their sex, results in their somatic and psychosomatic expressions of sickness. The research presented in this paper underpins the significance of women’s sex and cultural systems when analyzing global health outcomes. More nuanced considerations of cultural structures, like those mentioned by Q’eqchi’ women, need to be prioritized by policymakers and global health initiatives internationally to better support women’s health.

Probing key informants’ views of health equity within the World Health Organization’s Urban HEART initiative

To date, no studies have assessed how those involved in the World Health Organization’s (WHO) work understand the concept of health equity. To fill the gap, this research poses the question, “how do Urban Health Equity Assessment and Response Tool (Urban HEART) key informants understand the concept of health equity?”, with Urban HEART being selected given the focus on health equity. To answer this question, this study undertakes synchronous electronic interviews with key informants to assess how they understand health equity within the context of Urban HEART. Key findings demonstrate that: (i) equity is seen as a core value and inequities were understood to be avoidable, systematic, unnecessary, and unfair; (ii) there was a questionable acceptance of need to act, given that political sensitivity arose around acknowledging inequities as “unnecessary”; (iii) despite this broader understanding of the key aspects of health inequity, the concept of health equity was seen as vague; (iv) the recognized vagueness inherent in the concept of health equity may be due to various factors including country differences; (v) how the terms “health inequity” and “health inequality” were used varied drastically; and (vi) when speaking about equity, a wide range of aspects emerged. Moving forward, it would be important to establish a shared understanding across key terms and seek clarification, prior to any global health initiatives, whether explicitly focused on health equity or not.

How the Global Violence Against Children and Youth Surveys Help Improve Pediatric Global Health.

How the Global Violence Against Children and Youth Surveys Help Improve Pediatric Global Health.

디지털 헬스리터러시 향상을 위한 국가 및 글로벌 수준의 제고방안

Objectives: This study examines a digital health literacy model and the global and national initiatives on digital health and provides policy implications to improve digital health literacy. Particular attention is given to the disparity in digital health literacy. Methods: A thematic literature review on eHealth and digital health literacy was conducted, along with an analysis of the following global and national health initiatives: WHO Global Strategy on Digital Health and US Healthy People. Results: The Lily model, which focuses on digital health literacy at the individual level, emphasized digital health literacy as “a form of meta-literacy.” Digital health literacy was closely related to the characteristics of vulnerable populations. The global and national health initiatives recognized and emphasized their roles in improving digital health literacy and reducing disparities. The policy implications include the need for an integrated approach to reduce the digital divide; establishment of multi-level sustainable health objectives, data, and evidence-based interventions; development of people-centered digital health tools; and promotion of the health system and the national and global collaboration to address disparities in digital health literacy. Conclusion: Continuous multi-level and multi-faceted efforts should be made to improve digital health literacy and reduce health disparity.

Historical and contemporary factors that influenced the emergence and continuity of WANEL: Lessons for sustainable HPSR network formation in LMICs.

To explore historical and contemporary factors and processes that influenced the emergence of WANEL and analyse how the formation process has influenced the network's continued existence and sustainability and lesson for sub-regional health policy and systems research (HPSR) networking in Low -and -Middle -Income Countries (LMICs). Qualitative explanatory case study which used process tracing to chart the formation and development of WANEL. Data was obtained through document reviews, semi-structured interviews, group discussions, and participant observation. Data was analysed using thematic content analysis. The emergence of WANEL was made possible by several factors, including support from a network of senior HPSR champions and institutions across West Africa; sustained funding from IDRC Canada, a reputable funder with a track record in supporting research capacity development in LMICs; learning and networking opportunities provided by CHEPSAA Emerging Leaders and the Institute of Tropical Medicine Antwerp Emerging Voices for Global Health initiative. Its formation followed a mix of emergent and engineered processes. WANEL is the first and currently the only sub-regional network for early and mid-career health policy and systems researchers and practitioners in West Africa. To ensure its long-term sustainability, the network needs to put in place mechanisms to constantly attract and develop the next generation of early and mid-career researchers, maintain links with senior researchers, strengthen its capacity for coordination and facilitation, and develop a plan for its long-term financial sustainability. The study is funded by IDRC Canada Project 108237-001: Popularly known as the Consortium for Mothers, Newborn, Children, Adolescents and Health Policy and Systems strengthening in West and Central Africa. (COM-CAHPSS).

Impact of a Single Institution Resident-Led Education Committee in Radiation Oncology

Purpose Resident-led collaborative groups provide a platform to refine ideas and support professional development and scholarship during residency. To actively engage in radiation oncology (RO) education and leadership, residents formed an Education Committee (EC). Here, we discuss the structure and impact of a resident-led EC. Methods With the support of the RO program leadership at a single academic institution, this committee was created with the goals of (1) identifying and addressing gaps in residency education, (2) implementing sustainable educational initiatives across various interprofessional groups, and (3) sharing ongoing projects within medical education to identify resources and invite collaboration. The leadership core consisted of 1-2 resident co-chairs and committee sub-leads. The committee held one-hour monthly meetings, which consisted of journal club to review medical education literature followed by pre-set discussion of topics spanning committee goals. Faculty consultants were invited to attend to provide their expertise. Results The EC included medical and physics residents and grew from 6 to 10 members within the first two years of implementation. It worked with department and institutional leadership to implement initiatives to address gaps identified in medical resident education, medical student outreach, and interprofessional RO education. Additionally, members used this platform to find collaborators and identify resources for education projects, including global health and climate health initiatives. Key outputs of the EC included an updated repository of shared residency resources with high-yield educational material, site-specific reading lists developed with faculty, and a week-long statistics module now integrated into the curriculum. To improve medical student outreach, the EC established collaboration with the affiliated medical school's Oncology Interest Group to launch mentorship programs, including a tumor board seminar series engaging students in multidisciplinary oncology care. To support interprofessional RO education, the EC leads a medical assistant RO curriculum, which now has plans for multi-institutional expansion to other RO programs. Discussion Residencies are in need of pathways to foster resident engagement in medical education and scholarship. Additionally, the apprenticeship nature of RO training often lacks leadership and teaching opportunities, which can be supplied through resident-led collaborative groups. Here, we described our experience establishing a resident-led EC in RO, which has cultivated a community of resident leaders in education at our institution. This committee has been instrumental in implementing and sustaining initiatives across various facets of medical education. Successful initiatives can then be scaled for national implementation. This committee structure can serve as a framework for other RO programs. Resident-led collaborative groups provide a platform to refine ideas and support professional development and scholarship during residency. To actively engage in radiation oncology (RO) education and leadership, residents formed an Education Committee (EC). Here, we discuss the structure and impact of a resident-led EC. With the support of the RO program leadership at a single academic institution, this committee was created with the goals of (1) identifying and addressing gaps in residency education, (2) implementing sustainable educational initiatives across various interprofessional groups, and (3) sharing ongoing projects within medical education to identify resources and invite collaboration. The leadership core consisted of 1-2 resident co-chairs and committee sub-leads. The committee held one-hour monthly meetings, which consisted of journal club to review medical education literature followed by pre-set discussion of topics spanning committee goals. Faculty consultants were invited to attend to provide their expertise. The EC included medical and physics residents and grew from 6 to 10 members within the first two years of implementation. It worked with department and institutional leadership to implement initiatives to address gaps identified in medical resident education, medical student outreach, and interprofessional RO education. Additionally, members used this platform to find collaborators and identify resources for education projects, including global health and climate health initiatives. Key outputs of the EC included an updated repository of shared residency resources with high-yield educational material, site-specific reading lists developed with faculty, and a week-long statistics module now integrated into the curriculum. To improve medical student outreach, the EC established collaboration with the affiliated medical school's Oncology Interest Group to launch mentorship programs, including a tumor board seminar series engaging students in multidisciplinary oncology care. To support interprofessional RO education, the EC leads a medical assistant RO curriculum, which now has plans for multi-institutional expansion to other RO programs. Residencies are in need of pathways to foster resident engagement in medical education and scholarship. Additionally, the apprenticeship nature of RO training often lacks leadership and teaching opportunities, which can be supplied through resident-led collaborative groups. Here, we described our experience establishing a resident-led EC in RO, which has cultivated a community of resident leaders in education at our institution. This committee has been instrumental in implementing and sustaining initiatives across various facets of medical education. Successful initiatives can then be scaled for national implementation. This committee structure can serve as a framework for other RO programs.

Embroidering as a transformative occupation

ABSTRACT The influence of arts on health has long been researched but often in general terms or related to a patient population. Specific practice within everyday life remains under investigated. In this paper I argue that embroidering is an occupation where limited knowledge exists about how engagement might influence health. This qualitative narrative inquiry-based study was situated in the United Kingdom and gathered discursive data over 6 months with five women who embroidered. The research question aimed to establish how embroidering influences meaningful change within the context of a person’s everyday life. Interpreted through narrative analysis, the findings suggest that embroidering can promote meaningful change through an intimate companionship of body, mind, and materials. This companionship is situated, reciprocal, develops over time, and is proposed as the means for health potential. Once established, this companionship provides resources that can be used to manage everyday life and thus promote health and well-being. Considered as active agents in the embroidering process, materials can incite a combination of mental and physical responses, which become meaningful experiences associated with embroidering. These experiences may explain the recent fervour of crafting in everyday western societies and supports research that shows that the arts are a crucial component of health and well-being. In line with global health initiatives, consideration of the therapeutic companionship of body, mind, and materials is needed to further explore the transformative potential of engagement in specific crafts as media for improving and sustaining health and well-being.

The comeback of "one health" and global health: let us not make the same mistakes again

RésuméLa pandémie liée à la COVID-19 a fait redécouvrir le concept d’« une seule santé » et l'idée que l'animal, l’être humain et l'environnement sont intimement liés. Ce concept n'est pourtant pas nouveau, mais il reste labile, ce qui contribue à créer une certaine confusion. Dans la pratique, les actions de terrain manquent encore cruellement et « une seule santé » ne parvient pas à intégrer les trois dimensions. Cet éditorial vise ainsi à partager six défis que devra relever la mise en oeuvre de l'approche « une seule santé » pour éviter les écueils d'autres initiatives de santé mondiale. Ainsi, les programmes dédiés à une seule santé ne pourront être pertinents et pérennes sans impliquer activement les communautés. En outre, ce déploiement implique une indispensable décolonisation de la santé, c'est-à-dire une remise en cause de la manière dont les programmes sont gouvernés, financés, formulés, mis en oeuvre et évalués, avec et pour les personnes et pays concernés. Elle ne pourra se faire sans s'attaquer aux inégalités sociales de santé et aux enjeux de pouvoir. Cette approche pousse à interroger les modèles d'exploitation des ressources tant agricoles que naturelles. Penser « une seule santé » implique de penser les problématiques et les interventions dans une perspective tant intersectorielle, inclusive et participative qu'interdisciplinaire, sinon transdisciplinaire et d'appréhender la complexité qui en résulte. Enfin, il conviendra de prendre en compte l'utilisation des résultats des recherches pour construire les actions et les politiques publiques. Prendre en compte ces différents défis et s'inscrire dans une perspective systémique et interdisciplinaire ancrée dans des contextes locaux selon une démarche participative et inclusive nous paraît ainsi essentiel pour répondre de manière appropriée, pertinente et durable aux enjeux associés à « une seule santé ».

How service delivery implementation strategies can contribute to attaining universal health coverage: lessons from polio eradication using an implementation science approach

BackgroundImproving service delivery is a key strategy for achieving service coverage, one of the two components of universal health coverage (UHC). As one of the largest global public health initiatives, individuals involved with the Global Polio Eradication Initiative (GPEI) have learned many important lessons about service delivery. We identified contributors and challenges to delivering health services at national and subnational levels using experiences from the GPEI. We described strategies used to strengthen service delivery and draw lessons that could be applicable to achieving UHC.MethodsOnline cross-sectional surveys based on the Consolidated Framework for Implementation Research (CFIR) domains and socioecological model were conducted from 2018–2019. Data were analyzed using an embedded mixed methods approach. Frequencies of the contributors and challenges to service delivery by levels of involvement were estimated. Chi-square tests of independence were used to assess unadjusted associations among categorical outcome variables. Logistic regressions were used to examine the association between respondent characteristics and contributors to successful implementation or implementation challenges. Horizontal analysis of free text responses by CFIR domain was done to contextualize the quantitative results.ResultsThree thousand nine hundred fifty-five people responded to the online survey which generated 3,659 valid responses. Among these, 887 (24.2%) reported involvement in service delivery at the global, national, or subnational level with more than 90% involved at subnational levels. The main internal contributor of strengthened service delivery was the process of conducting activities (48%); working in frontline role had higher odds of identifying the process of conducting activities as the main internal contributor (AOR: 1.22, p = 0.687). The main external contributor was the social environment (42.5%); having 10–14 years of polio program implementation was significantly associated with identifying the social environment as the main external contributor to strengthened service delivery (AOR: 1.61, p = 0.038). The most frequent implementation challenge was the external environment (56%); working in Eastern Mediterranean region was almost 4 times more likely to identify the external environment as the major challenge in service delivery strengthening (AOR:3.59, p < 0.001).ConclusionPriority actions to improve service delivery include: adopt strategies to systematically reach hard-to-reach populations, expand disease-focused programs to support broader primary healthcare priorities, maximize community outreach strategies to reach broader age groups, build community trust in health workers and develop multisectoral leadership for collaboration. Achieving UHC is contingent on strengthened subnational service delivery.

Pharmaceutical cocrystal consisting of ascorbic acid with p-aminobenzoic acid and paracetamol

Abstract As small molecule drugs become harder to develop and less cost effective for patient use, efficient strategies for their property improvement become increasingly important for global health initiatives. As a new crystal engineering strategy, cocrystals have opened a new way to modify the physicochemical properties of pharmaceutical solids. Improvements in the physical properties of Active Pharmaceutical Ingredients (APIs) without changes in the covalent chemistry have been possible through the application of binary component solids. In this work, a pharmaceutical cocrystal of ascorbic acid (A) + para-aminobenzoic acid (B) and ascorbic acid (A) + paracetamol (P) cocrystal are synthesized and characterized by PXRD, DSC, and FT-IR. FT-IR indicates the kind of interactions occurring between API and coformer. The DSC thermogram for (A–B) cocrystal showed a single endothermic peak attributed to the melting temperature at 155 °C. The thermal behavior of the cocrystal was distinct with different melting temperatures from that seen with either of the individual components; this suggests the formation of a new phase. As molecular modeling is presented as a support to the experiment, a computational study using density functional theory (DFT) at the level of the WB97XD functional and 6-311 + G (d, p) basis set was carried out using the Gaussian 09 program. This theoretical study made it possible to calculate the energetic properties, the intramolecular hydrogen bonds as well as the thermodynamic properties for the two cocrystals.

Rethinking mental wellness among adolescents: an integrative review protocol of mental health components

BackgroundAdolescents have been overlooked in global public health initiatives as this period is generally considered to be the healthiest in an individual’s life course. However, the growth of the global adolescent population and their changing health profiles have called attention to the diverse health needs of adolescents. The increased attention toward adolescent health has accentuated existing gaps as global health reports have emphasised that there is a continued need for valid and reliable health data. In this context, evidence has shown that mental health issues constitute one of the greatest burdens of disease for adolescents. This integrative review aims to unpack the meaning of mental wellness among adolescents and its associated constructs by analysing and synthesising empirical and theoretical research on adolescent mental wellness. In doing this, we will develop a working definition of adolescent mental wellness that can be used to develop an instrument aimed at measuring adolescent mental wellness.MethodsThe integrative review is guided by the five steps described by Whittemore and Knafl. A comprehensive search strategy which will include carefully selected terms that correspond to the domains of interest (positive mental health/mental wellness) will be used to search for relevant literature on electronic databases, grey literature and government or non-governmental organisations (NGO) websites. Studies will be included if they describe and/or define general mental wellness in adolescent populations aged 10–19. The screening and reporting of the review will be conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data from the integrative review will be analysed using narrative framework synthesis for qualitative and quantitative studies.DiscussionThis integrative review aims to search for and synthesise current research regarding adolescent mental wellness to identify how wellness is being described and conceptualised. We aim to identify gaps and to contribute to a more comprehensive definition of mental wellness which can aid in the development of an age- and culturally appropriate measure of adolescent mental wellness.

Representation of Global Health Initiatives in Plastic Surgery Training: A Social Media Analysis.

Over the last several years, various social media platforms have been used to increase collaboration, education, and research internationally. The purpose of this study was to evaluate how plastic surgery residency programs use social media to promote global surgery education, research, and collaboration. A full list of active integrated residency programs was obtained from the American College of Academic Plastic Surgeons website. A total of 82 programs were identified. Instagram, Facebook, and Twitter were searched for active accounts. Only accounts dedicated to plastic surgery programs or had a significant amount of residency-related content were included. Inclusion criteria included posts relating to global health, global surgery, mission trips, international plastic surgery education, and global surgery research. Caption language was analyzed and classified as either "resident education in global surgery," "an individual's interest in global surgery," "research in global surgery," "visiting international professor," or "global collaboration." Image content was then assessed for "images with patients," "images with other surgeons/residents," "images of international location," a combination thereof, "other," or "none." Instagram was by far the most used by plastic surgery residency programs with a total of 76 programs having accounts compared with only 32 programs and 33 programs having Facebook and Twitter accounts, respectively. There was no significant difference in the proportional number of posts relating to global surgery across the 3 platforms (P = 0.1911). On all 3 social media platforms, the majority of posts fell into the category of "international collaboration" with 42.5%, 50.7%, and 48.8% on Instagram, Facebook, and Twitter, respectively. None of the caption categories examined showed a significantly different proportion of posts across the 3 platforms. Image analysis showed a significant difference in the proportional representation across the 3 platforms in the categories of "images with other surgeons/residents" (P = 0.0196) "images with patients" (P = 0.0082), combination (P = 0.0225), and other (P = 0.0114). Although social media offers programs an easy way to promote global surgery research, collaboration, and education with a wider audience, it is being underused for this purpose as evident by the relatively lower number of postings on each platform relating to this content.

Global Regulatory and Public Health Initiatives to Advance Pediatric Drug Development for Rare Diseases.

The literature thoroughly describes the challenges of pediatric drug development for rare diseases. This includes (1) generating interest from sponsors, (2) small numbers of children affected by a particular disease, (3) difficulties with study design, (4) lack of definitive outcome measures and assessment tools, (5) the need for additional safeguards for children as a vulnerable population, and (6) logistical hurdles to completing trials, especially with the need for longer term follow-up to establish safety and efficacy. There has also been an increasing awareness of the need to engage patients and their families in drug development processes and to address inequities in access to pediatric clinical trials. The year 2020 ushered in yet another challenge—the COVID-19 pandemic. The pediatric drug development ecosystem continues to evolve to meet these challenges. This article will focus on several key factors including recent regulatory approaches and public health policies to facilitate pediatric rare disease drug development, emerging trends in product development (biologics, molecularly targeted therapies), innovations in trial design/endpoints and data collection, and current efforts to increase patient engagement and promote equity. Finally, lessons learned from COVID-19 about building adaptable pediatric rare disease drug development processes will be discussed.

Participatory mental health interventions in low-income and middle-income countries: a realist review protocol

IntroductionThe launch of the Movement for Global Mental Health brought long-standing calls for improved mental health interventions in low-and middle-income countries (LMICs) to centre stage. Within the movement, the participation...

Reflections on "Orchestrating for Impact": Harmonizing across Stakeholders to Accelerate Global Health Gains.

ABSTRACT.For developing countries and partners to accelerate the availability of new innovations to communities in need of intervention, it is necessary to find improved ways to work together that challenge today’s status quo in global health. By adopting new approaches and accepting shared risk and reward, diverse partners can work together to accelerate progress toward a common global health goal. A symphony orchestra—with a conductor who recruits, arranges, harmonizes, and orchestrates diverse musicians to work together to create something not possible by individual musicians on their own—provides an apt metaphor for successful global health initiatives. In such settings, stakeholders must be engaged and harmonized, workplans composed, and partnerships conducted such that all stakeholder roles progress from workplans that are sequential and independent to those that are integrated and interactive. Reflecting on the successful global health partnerships discussed here and beyond, we use this orchestral metaphor to illustrate the elements needed to make partnerships increasingly successful.