An introduction to key challenges and concepts important to understanding the current status and determinants of global health.
How do Actors Implement Global Health Best Practices?
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Del curso dictado por Duke University
The Challenges of Global Health
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De la lección
Actors & Action: Finding Global Health Solutions
This module explores the main global health actors, how they work, and what strategies they use to improve global health outcomes and to solve global health problems.
Conoce a los instructores
Dr. David BoydHymowitz Family Professor of the Practice of Global Health
Duke Global Health Institute
In order to produce better health outcomes, is it sufficient
simply to do things like put up no smoking signs or to put labels on cigarettes?
Well, the answer is no.
Those things can help of course.
But, we must always use the best practices possible to
implement changes, strategies, in global health.
And what I want to do now is talk about exactly how global health actors
implement the best practices that we have already discussed,
in order to achieve their goals.
What I talked about earlier as global health challenges,
we can also describe as global health, our targets.
Our infectious diseases or non-communicable diseases, injury,
violence and disaster, and maternal, child and
reproductive health, how do we target those challenges?
What are the steps that we take to improve challenges?
That challenge might be as structural as finding ways
to improve the medical supply chain so that we can get medicines and
necessary equipment to health posts in rural areas of Guatemala,
or to such issues as how to improve flossing, whether it's among,
cadets in Scotland, or among population in general.
Whether we're talking about a structural, a structural implementation or
an individual or
an implementation that actually encourages changes in individual behavior.
There are many strategies and many considerations that we must make.
And I say that we must make because I want you to always understand that in global
health, knowledge ground work reflection should precede implementation.
One of the key mistakes that a global health actor can make is simply to jump in
and try to do something, right, without really having the knowledge,
necessarily, without doing the groundwork, without thinking about what they're doing.
And I want you not to make that kind of mistake.
I want you to understand that the implementation process comes
after a lot of other work.
So, before an actor acts, there are many things that he or she should think about.
First, research is necessary.
You need to understand what exactly are the problems.
What are the determinants underlying?
What are previous solutions that had been attempted, or
had been attempted in other parts of the world with similar problems?
And what impact have they had?
Is the problem something that can be resolved best on an individual level?
A community level?
An organizational level?
Or even a systemic level?
In terms of tackling whatever your target might be, what is the best approach?
Should it be to completely make it a complete change so that the practice or,
the disease that you're targeting is no longer an issue,
or should it be harm reductions?
Simply mitigating the impact of of the practice or
disease, or trying to reduce how much of it occurs.
Are you trying to achieve a short-term effect or a long-term impact?
Are you going to be pushing for structural changes, behavioral changes?
Do you need to first make a policy change, or what's the best target?
Is it better to start, upstream?
In other words, making larger structural changes, or
is it better to start downstream, with individuals?
Or you want to push people towards a certain type
of behavioral change, or do you want to pull them towards it?
Will you need to phase in your strategy or
is it something that can be put into play immediately?
You're going to use a horizontal approach, a diagonal approach, right?
What are the strengths, weaknesses, opportunities and difficulties?
Your threats to implementation of whatever you're trying to do.
Are there opportunity costs?
In other words, if you're spending x amount of money for
intervention to target malaria in a particular region.
Is that money being, will that money be taken away from other resources or
will health care workers then be funneled towards malaria prevention and there
won't be enough health care workers to deal with ma, with say, HIV AIDS, right?
Or with a primary prevention.
All of these things you have to think about.
What are your benefits?
What are the potential harm, right?
What resources does the community already have that can be utilized, right?
Are there going to be incentives for change?
Are there going to be performance incentives?
Are there perverse incentives?
In other words,
will the incentives that you might use have unintended consequences?
How feasible is your project?
Is it sustainable long-term?
Can it be scaled up?
Do you have buy in, or cooperation from community partners and leaders?
Have you talked with community partners and leaders?
Have you got a sense of what the population and
the leaders feel are the primary needs in the community?
Maybe they don't match what you think, right?
Maybe they are completely different as well.
Perhaps you're concerned with malaria, but in terms of the community they
are much more concerned with babies dying of diarrhea constantly or
not having good sources of drinking water.
What's the information that you have, right?
You can't just go in to try to make a change.
You must work with, collaborate with leaders on the ground.
I cannot emphasize how important this is.
The Global Help Problem-Solving Process is a participative process and
it is an iterative process.
And what I mean by this is it requires the participation and
buy-in throughout the entire process of local community leaders.
People, government, organizations,
it is an iterative process because it's not necessarily linear, right?
You may have to go back.
Something's not working.
You might have to rethink it.
Seen examples of this in some of the case studies that you have read.
All that being said, there are many factors that go into the process.
I've created sort of a pathway here that all situations are different,
so no one may follow ever completely this pathway, but I think it will give you
an idea of the way that we think about problem solving in global health, right?
Once we identify an issue, we do a needs assessment, right?
What are the, what, what, what's the extents of the problem, right?
What impact does it have, right, do we need to work on, right?
Are we going to have the ability to work on it?
And then within that issue, what exactly are we targeting?
If we're trying to work on malaria, for
example, what's our target going to be, right?
Are we going to focus on killing mosquito larva?
Are we going to focus on providing and getting people to sleep under bed nets?
What's it going to be?
So exactly what points we are going to intervene and what kinds of
strategies are we going to come up with, right, to to, to hit our targets?
Do we have enough resources to do this?
What are the resources that we're going to need?
Can we guess?
What do we prioritize?
Do we prioritize distributing bed nets?
Do we prioritize giving the people who have bed nets to sleep under them first so
that we can then use them as examples before we, distribute other bed nets.
What are our priorities?
How are we going to figure out whether our outcomes, how,
whether we've had good outcomes?
Whether we are succeeding or whether we are failing?
We need to create metrics for success.
How are we going to implement this?
What is our strategy?
What is our timeline for doing it?
How are we going to monitor and evaluate whether or not we are successful?
How are we going to make sure that we maintain sufficient resources and
maintain partner buy-in?
Then we ask ourselves, how are we going to roll out this implementation?
How are we going to implement it and
how are we constantly going to evaluate whether or not we've been successful?
Whether we've had just an effect, short-term, or
whether we're happy in the long-term impact.
All of these things are critical for success.
What this means is that a lot of information you need to think about,
apart from what I mentioned earlier, you need to understand the attitudes,
the beliefs, the models, right, of people in the community, all right?
What is their level of people, what are their behaviors, right?
To what extent will there be any ease of changing?
What impact might change have on the community, right?
Is there readiness to change?
Are there constraints whether real or perceived, right?
How do behaviors,
beliefs, interact with each other within particular environments, right?
Can we increase empowerment of populations for
change and can those changes be sustainable?
Are there people already in the community who are doing things
that are already improving health outcomes, and that are already,
working, say, to, to to help meet our, our target?
In other words, are there people who are already doing things that,
make them less prone to malaria?
Right, what are those things and can we utilize whatever they're doing and
have it spread to the community, community as a whole?
We actually call this positive deviance.
People say, who are deviating from a norm in a community, that,
that deviation in fact, is producing better health outcomes.
If we come up with an innovative strategy,
which we introduce into the community, how do we diffuse that?
Who are the people who will first adopt the strategy?
How do we get that strategy then, that innovation,
to diffuse among networks, among communities, to leaders, right?
How do we find the appropriate channels within a community to help us
frame the issues that we want to address, to set agendas, to raise awareness?
And how do we think through the impact of those constraints to change?
All of this must be considered.
If you're listening to me now and you're saying, Dr. Boyd, that seems overwhelming.
Well, you know what?
It is, a lot.
But it's better to know it now and
to realize you have to think through these issues.
It's another reason why in global health, we don't go at it alone.
We talked about cooperation, multisect, multisectorality.
Global health is not an individual endeavor.
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