Prof guides global health reform

A Yale professor is establishing a framework for health reform across the globe.

In the Dec. 21 issue of medical journal “Public Library of Science Medicine,” School of Public Health professor Elizabeth Bradley and nine other global health leaders detailed 10 principles that they think will strengthen global health systems. Bradley said she hopes the principles will serve as a type of “checklist” funding agencies will consider when choosing global health projects to support.

Ultimately, though, the guidelines were intended to create a common language and open a dialogue around the issue of global public health, Bradley said.

The 10 principles are meant to improve the implementation of global health projects aimed at “Health Systems Strengthening,” or HSS — a broad-based approach to improving health service delivery that includes hospital care, health care provider training, and general funding, among other things, Bradley said.

The global health industry has renewed its focus on HSS in recent years, Bradley and her colleagues said in the paper.

“HSS is one of these terms that’s coming to vogue,” Bradley said. “We thought it would be helpful to have language where people can say ‘this is consistent with the strengthening we’re trying,’ so it doesn’t make the word completely lose meaning.”

Adriano Cattaneo, another co-author of the paper, said now that the 10 guidelines have been published, the authors and other global health officials must wait to determine the level and quality of interest the principles strike in the field.

But Erika Linnander, contributor to the paper and associate director of Yale Global Health Leadership Institute said she believes most global health leaders would agree that the principles are necessary for any HSS project.

“If you put this list in front of people, I’d think they’d agree,” Linnander said. “I don’t think there’s debate.”

Instead, the central debate hinges on how to apply each of the principles in practice, Cattaneo and Linnander said.

Bradley said she agrees that global health leaders must do more work to determine how to apply these principles.

“The principles are not the end of the story, it’s the beginning,” Bradley said. “More work has to be done to see how to operationalize the principles.”

Still, Bradley said she is confident that the guidelines have begun a necessary discourse on HSS. Many of the 10 guidelines authors are affiliated with agencies that fund HSS projects, such as the Global Alliance for Vaccines and Immunisation, Bradley added. As a result, these agencies are aware of the principles, she said.

Holism is one of the 10 principles proposed by the paper, an idea that may be one of the “least tangible” but most important said Linnander.

“If you are better at thinking about holism, all the other aspects of the guiding principles fall into place,” Linnander said. “And you start to see the effect that your work has on the entire system.”

Linnander said previous work measuring the quality of Ethiopian hospitals has illuminated her appreciation of another one of the principles: evidence-informed action, which encourages global health professionals to gather, analyze and report data locally.

While on the Ethiopia project, Linnander said she found that her fellow global health professionals measured the hospital performance well but sent the information off to larger agencies rather than the actual facilities on the “ground level.” By providing information at the grass roots level as well, the health system can be improved more quickly, Linannder said.

Bradley was the first Yale recipient of the John D. Thompson Prize for Young Investigators, awarded annually by the Association of University Programs in Health Administration.

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