Power, potential, and pitfalls in global health academic partnerships: review and reflections on an approach in Nepal

doi:10.1080/16549716.2017.1367161

. 2017;10(1):1367161.

doi: 10.1080/16549716.2017.1367161.

Power, potential, and pitfalls in global health academic partnerships: review and reflections on an approach in Nepal

David Citrin^{1

2

3

4}, Stephen Mehanni^{1

5

6

7}, Bibhav Acharya^{1

5

6

8

9}, Lena Wong^{1

5

6

10}, Isha Nirola^{1

5}, Rekha Sherchan^{1

5}, Bikash Gauchan^{1

5}, Khem Bahadur Karki¹¹, Dipendra Raman Singh¹², Sriram Shamasunder^{5

6}, Phuoc Le^{5

6}, Dan Schwarz^{1

13

14}, Ryan Schwarz^{1

13

15

16}, Binod Dangal¹, Santosh Kumar Dhungana¹, Sheela Maru^{1

17

18

19}, Ramesh Mahar¹, Poshan Thapa¹, Anant Raut¹, Mukesh Adhikari²⁰, Indira Basnett¹, Shankar Prasad Kaluanee^{1

21}, Grace Deukmedjian^{1

5

6

22}, Scott Halliday^{1

4}, Duncan Maru^{1

13

14

16

23}

Affiliations

¹ a Possible , Kathmandu , Nepal.
² b Department of Anthropology , University of Washington , Seattle , WA , USA.
³ c Department of Global Health , University of Washington , Seattle , WA , USA.
⁴ d Henry M. Jackson School of International Studies , University of Washington , Seattle , WA , USA.
⁵ e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA.
⁶ f Division of Hospital Medicine , University of California, San Francisco , San Francisco , CA , USA.
⁷ g Gallup Indian Medical Center , Gallup , NM , USA.
⁸ h Department of Psychiatry , University of California, San Francisco , San Francisco , CA , USA.
⁹ i Shared Minds , Boston , MA , USA.
¹⁰ j Tuba City Regional Health Care , Tuba City , AZ , USA.
¹¹ k Nepal Health Research Council , Ministry of Health , Kathmandu , Nepal.
¹² l Public Health Monitoring & Evaluation Division , Ministry of Health , Kathmandu , Nepal.
¹³ m Department of Medicine, Division of Global Health Equity , Brigham and Women's Hospital , Boston , MA , USA.
¹⁴ n Department of Medicine, Division of General Pediatrics , Boston Children's Hospital , Boston , MA , USA.
¹⁵ o Department of Medicine, Division of General Internal Medicine , Massachusetts General Hospital , Boston , MA , USA.
¹⁶ p Department of Medicine , Harvard Medical School , Boston , MA , USA.
¹⁷ q Department of Obstetrics and Gynecology , Boston Medical Center , Boston , MA , USA.
¹⁸ r Department of Obstetrics and Gynecology , Boston University School of Medicine , Boston , MA , USA.
¹⁹ s Department Medicine, Division of Women's Health , Brigham and Women's Hospital , Boston , MA , USA.
²⁰ t District Health Office, Department of Health Services , Ministry of Health , Mangalsen , Achham , Nepal.
²¹ u School of Leadership and Development , Eastern University , St. Davids , PA , USA.
²² v Tséhootsooí Medical Center , Fort Defiance , AZ , USA.
²³ w Department of Global Health and Social Medicine , Harvard Medical School , Boston , MA , USA.

PMID: 28914185
PMCID: PMC5645653
DOI: 10.1080/16549716.2017.1367161

Power, potential, and pitfalls in global health academic partnerships: review and reflections on an approach in Nepal

David Citrin et al. Glob Health Action. 2017.

. 2017;10(1):1367161.

doi: 10.1080/16549716.2017.1367161.

Authors

Affiliations

¹ a Possible , Kathmandu , Nepal.
² b Department of Anthropology , University of Washington , Seattle , WA , USA.
³ c Department of Global Health , University of Washington , Seattle , WA , USA.
⁴ d Henry M. Jackson School of International Studies , University of Washington , Seattle , WA , USA.
⁵ e Health Equity Action Leadership Initiative , University of California, San Francisco , San Francisco , CA , USA.
⁶ f Division of Hospital Medicine , University of California, San Francisco , San Francisco , CA , USA.
⁷ g Gallup Indian Medical Center , Gallup , NM , USA.
⁸ h Department of Psychiatry , University of California, San Francisco , San Francisco , CA , USA.
⁹ i Shared Minds , Boston , MA , USA.
¹⁰ j Tuba City Regional Health Care , Tuba City , AZ , USA.
¹¹ k Nepal Health Research Council , Ministry of Health , Kathmandu , Nepal.
¹² l Public Health Monitoring & Evaluation Division , Ministry of Health , Kathmandu , Nepal.
¹³ m Department of Medicine, Division of Global Health Equity , Brigham and Women's Hospital , Boston , MA , USA.
¹⁴ n Department of Medicine, Division of General Pediatrics , Boston Children's Hospital , Boston , MA , USA.
¹⁵ o Department of Medicine, Division of General Internal Medicine , Massachusetts General Hospital , Boston , MA , USA.
¹⁶ p Department of Medicine , Harvard Medical School , Boston , MA , USA.
¹⁷ q Department of Obstetrics and Gynecology , Boston Medical Center , Boston , MA , USA.
¹⁸ r Department of Obstetrics and Gynecology , Boston University School of Medicine , Boston , MA , USA.
¹⁹ s Department Medicine, Division of Women's Health , Brigham and Women's Hospital , Boston , MA , USA.
²⁰ t District Health Office, Department of Health Services , Ministry of Health , Mangalsen , Achham , Nepal.
²¹ u School of Leadership and Development , Eastern University , St. Davids , PA , USA.
²² v Tséhootsooí Medical Center , Fort Defiance , AZ , USA.
²³ w Department of Global Health and Social Medicine , Harvard Medical School , Boston , MA , USA.

PMID: 28914185
PMCID: PMC5645653
DOI: 10.1080/16549716.2017.1367161

Abstract

Background: Global health academic partnerships are centered around a core tension: they often mirror or reproduce the very cross-national inequities they seek to alleviate. On the one hand, they risk worsening power dynamics that perpetuate health disparities; on the other, they form an essential response to the need for healthcare resources to reach marginalized populations across the globe.

Objectives: This study characterizes the broader landscape of global health academic partnerships, including challenges to developing ethical, equitable, and sustainable models. It then lays out guiding principles of the specific partnership approach, and considers how lessons learned might be applied in other resource-limited settings.

Methods: The experience of a partnership between the Ministry of Health in Nepal, the non-profit healthcare provider Possible, and the Health Equity Action and Leadership Initiative at the University of California, San Francisco School of Medicine was reviewed. The quality and effectiveness of the partnership was assessed using the Tropical Health and Education Trust Principles of Partnership framework.

Results: Various strategies can be taken by partnerships to better align the perspectives of patients and public sector providers with those of expatriate physicians. Actions can also be taken to bring greater equity to the wealth and power gaps inherent within global health academic partnerships.

Conclusions: This study provides recommendations gleaned from the analysis, with an aim towards both future refinement of the partnership and broader applications of its lessons and principles. It specifically highlights the importance of targeted engagements with academic medical centers and the need for efficient organizational work-flow practices. It considers how to both prioritize national and host institution goals, and meet the career development needs of global health clinicians.

Keywords: Global health; Nepal; health equity; partnership; training support.

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References

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[1] Crane J. Scrambling for Africa? Universities and global health. Lancet. 2011;377:1388–9. - PubMed

[2] Crane J. Scrambling for Africa? Universities and global health. Lancet. 2011;377:1388–9. - PubMed

[3] Kelly E, Doyle V, Weakliam D, et al. A rapid evidence review on the effectiveness of institutional health partnerships. Global Health. 2015;11:48. - PMC - PubMed

[4] Kelly E, Doyle V, Weakliam D, et al. A rapid evidence review on the effectiveness of institutional health partnerships. Global Health. 2015;11:48. - PMC - PubMed

[5] Elmusharaf K, Tahir H, O’Donovan D, et al. From local to global: a qualitative review of the multi-leveled impact of a multi-country health research capacity development partnership on maternal health in Sudan. Global Health. 2016;12:20. - PMC - PubMed

[6] Elmusharaf K, Tahir H, O’Donovan D, et al. From local to global: a qualitative review of the multi-leveled impact of a multi-country health research capacity development partnership on maternal health in Sudan. Global Health. 2016;12:20. - PMC - PubMed

[7] Networking and coalition building: lessons from a Latin American Network. COHRED learning brief. Geneva: Council on Health Research for Development (COHRED); 2000.

[8] Networking and coalition building: lessons from a Latin American Network. COHRED learning brief. Geneva: Council on Health Research for Development (COHRED); 2000.

[9] McCoy D, Mwansambo C, Costello A, et al. Academic partnerships between rich and poor countries. Lancet. 2008;371:1055–1057. - PubMed

[10] McCoy D, Mwansambo C, Costello A, et al. Academic partnerships between rich and poor countries. Lancet. 2008;371:1055–1057. - PubMed

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Power, potential, and pitfalls in global health academic partnerships: review and reflections on an approach in Nepal

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Power, potential, and pitfalls in global health academic partnerships: review and reflections on an approach in Nepal

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