Developing Health Partnerships that Transcend Boundaries
Few global initiatives have the potential to touch more lives than the World Health Organization’s Immunization Agenda 2030, which seeks to ensure that vaccines for more than 20 life-threatening diseases are distributed in equitable ways so “everyone, everywhere, at every age, fully benefits from vaccines to improve health and well-being.”
In drafting the shared goals of the agenda, the Johns Hopkins University International Vaccine Access Center (IVAC) worked with a range of nongovernmental organizations and global ministries of health to develop accountability scorecards and conduct advocacy and outreach.
“Johns Hopkins’s experience in research, learning, technical assistance, data, and so much more added incredible value to the partnership,” says Lisa M. Hilmi, MPH, RN, executive director of the CORE Group, an organization based in Washington, D.C., that focuses on community-level public health efforts and helped create the agenda.
While global health issues may be receiving more attention now than they were before the current COVID-19 era, the work of building and maintaining successful international partnerships for public health solutions is often not that different from other collaborative efforts.
“Long-lasting partnerships require trust, frequent and good communication, mutual respect, clear roles and responsibilities, flexibility, and strategic vision,” says Hilmi. At the same time, the complexity and history of global health requires senior international officers (SIOs) and other leaders to evaluate additional considerations.
“Long-lasting partnerships require trust, frequent and good communication, mutual respect, clear roles and responsibilities, flexibility, and strategic vision.” —Lisa M. Hilmi
“The nature of the work means it has to be viewed through a different lens,” says Roger Brindley, PhD, vice provost for global programs at Pennsylvania State University.
According to experts, there are several considerations and approaches required for successful partnerships.
1. Collaborate with the institution’s own health leadership.
At many institutions, colleges of medicine and health have separate leadership structures in recognition of their unique needs. It is essential for SIOs to collaborate with their peers to navigate the specific challenges that come with global health partnerships, including partner nation laws and regulations, safety issues involving infectious and transmittable diseases, and ethical considerations.
“I rely on my colleagues to navigate that process,” says Brindley. “A key part of being an SIO in the field of global health is to build those connections and that community of practice and to maintain excellent communication.”
In particular, medical colleges and their leaders are more familiar with issues such as patient privacy and ethics involving vulnerable populations, which have important implications for global health partnerships. “The health side of the house may be ahead of us,” says Kiki Caruson, PhD, interim vice president of USF World at the University of South Florida (USF).
“A key part of being an SIO in the field of global health is to build those connections and that community of practice and to maintain excellent communication.” —Roger Brindley
In a pandemic and postpandemic world, collaborations with medical college leadership also can provide advice on the feasibility of travel for in-person partnership activities involving other disciplines across the entire institution, Brindley adds.
2. Develop trust.
International efforts in other disciplines can help establish credibility for global health partnerships, according to Lynette Menezes, PhD, assistant vice president for international at USF Health and assistant dean of USF Medicine International at the Morsani College of Medicine. She notes that USF’s emphasis on global partnerships began well before it added medical programs. “It was helpful we had that experience,” she says.
Leveraging faculty who are from targeted regions also can be useful to create trust. At USF, faculty from China and Thailand helped develop relationships with partners in those countries. “When we face challenges [in their home country], we reach out to them and they help us,” Menezes says.
3. Address imbalances.
Whether you refer to high- and low-income countries, the Global North and Global South, or other nomenclature, the issue of inequity often surfaces in global health initiatives. For U.S. institutions, that means it is important to avoid repeating the past history of “extractive” relationships that benefit partners unequally, according to experts.
“It is important to be committed to an equal decision-making process, shared governance and voice, and budgets,” Hilmi says. “As we aim to decolonize global health, these are vital concepts to lay as a foundation in forming and operationalizing partnerships.”
For U.S. institutions, doing so means involving country-level colleagues in the full scope of partnership development, including planning, process, and project design, as well as ongoing discussions once the program is underway.
“It is important to be committed to an equal decision-making process, shared governance and voice, and budgets.” —Lisa M. Hilmi
Equity considerations also involve assessing gender and racial imbalances in partner organizations, according to Hilmi. “You cannot ignore these factors and must prioritize them in forming partnerships,” she says. “If these elements are not considered, there will be significant challenges as the partnerships move forward, or they may halt the partnership entirely.”
4. Consider resource allocation through an equity lens.
It is vital to conduct what Caruson calls “the unglamorous work of developing shared expectations” around deliverables and, in particular, resources.
“You have to do all that work beforehand, all these thorny things: what staff [are involved], what are the expectations, [and] what do you expect us to pay for? It can get pretty granular, and culturally these conversations are hard,” she says.
Negotiations can be particularly challenging because U.S. institutions are often the ones bringing funding and capacity in other forms to the table. But leaders must remember that global partners provide valuable assets, including access to field sites, experts, and populations essential to collaborative work.
“Everybody’s got to have a stake in the outcome.” —Kiki Caruson
The one nonnegotiable? “Everybody’s got to have a stake in the outcome,” Caruson says.
5. Identify opportunities for cross-disciplinary collaboration.
Some institutions intentionally connect researchers from different disciplines for global projects, but even those that do not take this approach should make any faculty who are involved in global health partnerships aware of peer collaborations in the same country or region to open the door for mutual support and collaboration. “There’s a lot of work to do there generally,” Brindley says. When these connections are neglected, institutions run the risk of duplicating efforts or missing out on synergies.
6. Keep in mind that not all global health initiatives are international.
“You don’t necessarily have to travel outside U.S. borders to have a global experience,” Caruson says. USF, for example, works with Florida’s migrant and diaspora communities and other populations with language, cultural, and health disparities “right in our backyard,” she says.
As institutions face enrollment and budgetary challenges coming out of the pandemic, SIOs may be able to point to global health as one of many justifications for continued investment in internationalization, emphasizing that such partnerships work to address and solve global issues through collaboration.
“We have the worst pandemic in a century, all the economic disruption, drought and wildfires, and we’re grappling with systemic institutional racism. If we’re not teaching global, what are we teaching?” Brindley asks. •
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