Expanding Global Surgery as Part of the Global Health Agenda - Program of Global Surgery and Social Change, Philippines, (Fall 2019)

Organizational Background:

The Program in Global Surgery and Social Change (PGSSC) is a collaborative effort between the Harvard teaching hospitals, Harvard Medical School/ Department of Global Health and Social Medicine, Boston Children’s Hospital (BCH) and Partners In Health (PIH). This organization emerges out of work of the Lancet Commission on Global Surgery, that was led by Dr. John Meara at Harvard Medical School (and a 1986 ND graduate). PGSSC’s objective is to advocate for Universal access to safe, affordable surgical and anesthesia care when needed. The strategy is two-fold: 1) Global Surgical Systems Strengthening through Research, Advocacy, and Implementation Science, using the Frameworks developed as part of the Lancet Commission on Global Surgery, and 2) Developing Leaders in Global Surgical and Health Systems through Research, Advocacy, and Care Delivery. PGSSC's research focuses on surgical and health systems strengthening that is measurable, transparent, and locally-driven. Click here for the Strategic Plan that focuses on implementation science, research, advocacy, and training leaders.

The Opportunity:

The World Health Organization (WHO) Western Pacific Regional Office (WPRO) has developed a strategic health plan for the region. At the recent World Health Assembly in Geneva, the Regional Director for WPRO indicated his interest to integrate surgery into the regional health plan, and specifically promote the National Surgical, Obstetric, and Anesthesia Plan (NSOAP) model for countries of the WPRO region, potentially including Philippines, Malaysia, Cambodia, Laos, Viet Nam and/or Mongolia.

Initial Steps:

One of the initial steps in the development of NSOAPs is a baseline analysis of a country’s current surgical capacity. Review the Tanzanian background research document that created a baseline for the Tanzania NSOAP as a first step to moving forward on the NSOAP process in the WPRO.

Identify with the client the most relevant countries to research.

Conduct a systematic review of academic literature and government policy documents, including form the Ministry of Health websites, to build a baseline on access to and the state of surgery in each of the selected countries.

What does success look like?

The development of research to support a set of future scenarios or pathways that PGSSC might use for potential partnerships with the WHO regional office to support the development of surgical policy, as well as the strategic use of their experience, expertise, and capacity to maximize their organization’s impact on global surgery goals.

Meet the Team:

Building a new university-based, interdisciplinary center for global health - ITESM, Mexico (Fall 2018)

Client Profile

The Tecnológico de Monterrey and its network of campuses throughout Mexico is committed to providing quality education, world-class research, and building innovative models for the benefit of society. With the leadership of ITESM’s School of Medicine and the School of Government, the University is looking to build a new interdisciplinary center for global health training and research with strong links to practice.

The DGHSM aims to be a global center of excellence that generates health through training, research, innovation and knowledge translation, addressing in a profound and interdisciplinary way the existing inequities in Mexico and the world, based on health as a human right.  The DGHSM aspires to lead in training, research, implementation and public policy development in Global Health and Social Medicine in Latin America, through the creation of integral solutions to address social factors and strengthen health systems with a preferential option for vulnerable populations.

Definition of Opportunity

ITESM’s DGHSM is currently exploring the possibility of partnerships with the Program on Global Surgery and Social Change (PGSSC) and the Partner In Health’s sister organization, Compañeros en Salud in Chiapas, Mexico.  The Program on Global Surgery and Social Change (PGSSC) is a collaborative effort between the Harvard teaching hospitals, Harvard Medical School/ Department of Global Health and Social Medicine, Boston Children’s Hospital (BCH) and Partners In Health (PIH).  This organization emerges out of work of the Lancet Commission on Global Surgery, tled by Dr. John Meara at Harvard Medical School (a 1986 ND graduate).  PGSSC’s objective is to advocate for Universal access to safe, affordable surgical and anesthesia care when needed. Compañeros en Salud is affiliated with Partners In Health and works in rural Chiapas Mexico to provide quality health care to underserved communities and hopes to serve as an inspiring model to train and accompany health professionals and community health workers, and to deliver quality health care in low resource settings in Mexico and elsewhere. Both PGSSC and PIH have deep ties to Notre Dame, and have served as clients on DAT projects over multiple semesters.

Initial Ideas

The ITESM Department of Global Health & Social Medicine is looking for models of university-based, interdisciplinary centers that work in the international context in close partnership with health service providers and policy makers.

●      ITESM is interesting in exploring different models of partnership that have been established for developing, first-rate, interdisciplinary global health centers that have strong links to practice, that highlight different institutional structures, incentives, and potential partnerships.

●      ITESM hopes to explore and expand partnerships with international development and health organizations, such as Compañeros en Salud, the Harvard Medical School and the University of Notre Dame, consistent with its strategic objectives.

●      ITESM is interested in implementing a framework to develop international partnerships.

Definition of Success

That ITESM uses the systematic examination of different examples and models for building an interdisciplinary, university based Center for Global Health with a strong link to practice in ways that it might serve as a roadmap for a path forward.

Recommendations

Expanding Global Surgery - PGSSC (Fall 2017)

Client Profile

The Program on Global Surgery and Social Change (PGSSC) is a collaborative effort between the Harvard teaching hospitals, Harvard Medical School/ Department of Global Health and Social Medicine, Boston Children’s Hospital (BCH) and Partners In Health (PIH).  This organization emerges out of work of the Lancet Commission on Global Surgery, that was led by Dr. John Meara at Harvard Medical School (and a 1986 ND graduate).  PGSSC’s objective is to advocate for Universal access to safe, affordable surgical and anesthesia care when needed. Their  strategy is two-fold:

• Global Surgical Systems Strengthening through Research, Advocacy, and Implementation Science, using the Frameworks developed as part of the Lancet Commission on Global Surgery.       

• Developing Leaders in Global Surgical and Health Systems through Research, Advocacy, and Care Delivery.  

PGSSC research focuses on surgical and health systems strengthening that is measurable, transparent, and locally-driven. 

Initial Ideas & Options

PGSSC has been opportunistic about the issues and countries where they have engaged, trying to take best use of the capacity they have to promote their strategic objectives. The PGSSC is interested, in its planning for the future, to explore and expand partnerships with international development and health organizations, such as Partners In Health and the World Health Organization, as well as universities, such as the Harvard Medical School and the University of Notre Dame, consistent with its strategic objectives.

Definition of Success

The development of a set of future scenarios or pathways that PGSSC might explore for potential partnerships, as well as the strategic use of their experience, expertise, and capacity to maximize their organization’s impact in the future.

Development Advisory Team

Recommendation

Developing a National Surgical Plan - Lancet Zambia (Fall 2016)

Client Profile

Universal access to safe, affordable surgical and anesthesia care when needed saves lives, prevents disability, and promotes economic growth. In January 2014, President of the World Bank, Dr. Jim Yong Kim, called for a “shared vision and strategy for global equity in essential surgical care,” stating “surgery is an indivisible, indispensable part of health care.” This call came at a pivotal time for global health. As focus transitions from the Millennium Development Goals (MDGS) to a set of Sustainable Development Goals (SDGs), commitments to Universal Health Coverage (UHC), and a broader focus on building resilient health systems, the global community must develop strategies to reach these new aims.

Global Surgery 2030, the landmark initial report of The Lancet Commission on Global Surgery, describes the role of surgical and anesthesia care in improving the health of individuals and the economic productivity of countries. Developed by a multidisciplinary team of 25 commissioners and collaborators from over 110 nations, the report presents findings on the state of surgical care in low-income and middle-income countries (LMICs), as well as a framework of recommendations, indicators and targets needed to achieve the Commission’s vision of universal access to safe, affordable surgical and anesthesia care when needed.

Definition of Problem

Developing surgical systems, like any global health endeavor, can present unique challenges. These challenges need not be met in isolation- learning from successes and failures in other parts of the world can strengthen the impact of individual efforts and accelerate global progress. The Lancet Commission on Global Surgery aims to create new material for mutual learning, and has been working with a series of universities, including Notre Dame, to do so.

Zambia is one of the first countries that has partnered with the Lancet Commission on Global Surgery to design and implement a contextually-tailored National Surgical and Anesthesia Plan based off the framework developed by the commission. The Ministry of Health intends to incorporate this National Surgical and Anesthesia Plan into their overarching 5-year Zambian Health Strategic Plan generated for 2017-2021.  There is a unique opportunity to develop a teaching case on the Zambian experience – that explores both the advances and challenges – as it develops its national surgical plan.

 Initial Ideas and Options

• Review existing cases in the Lancet case series. http://www.globalsurgery.info/teaching-cases/

• Explore other related cases http://www.ghdonline.org/cases/?ref=globalhealthdelivery

• Look at information on case writing  http://www.rsm.nl/fileadmin/Images_NEW/CDC/How_to_Write_a_Good_Teaching_Case.pdf

•  Reach out to client to get background on Zambia. The DAT team will have access in developing the case to the key actors related to the National Surgical Plan in Zambia as well as those from the Lancet Commission.

Definition of Success

Develop a 8-12 page teaching case with additional exhibits that document the development of Zambia’s national surgical plan in an interesting and engaging fashion, that could be used as a teaching case, exploring challenges and opportunities, especially for other countries considering such a plan.

Development Advisory Team

Final Report