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Post by Josie on Nov 12, 2021 1:28:42 GMT
Hello everyone, Thanks for participating in fourth session. Module 4 has There are 4 discussion questions, however you do not need to respond to all questions to participate in the discussion forum. You can respond to just one of the discussion questions using the sub-boards.
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Post by danika on Nov 12, 2021 17:29:28 GMT
Discussion 1) What is the role of Government/Ministry of Health in capacity strengthening and how will you maintain partnership with them?
Local governments/Ministries of health are best suited to identify internal issues with access to and quality of healthcare, and should be able to communicate those problem areas to other organizations willing to help resolve them. Governments know the amounts and types of funding that are presently available and project what further funding is needed to institute change (whether through an intervention or reorganization), as well as how that funding should be best applied. These organizations should maintain/build infrastructure where medical services can be delivered (as well as roads/methods of transportation to get there) and provide access to adequate teaching and training to develop a work force equipped to carry out new treatments or protocols.
To maintain a partnership as an external organization working with a local government or ministry of health, it is important to have a shared, unified goal that is clear and measurable (SMART goals!) that people are passionate about working on. Setting a reasonable timeline detailed with measurements of change and outlining what resources/materials are needed for each step would be beneficial. Open lines of regular communication are essential to coordinating collaborative efforts and addressing any unforeseen issues that arise (as plans are dynamic and must be flexible to change). External organizations would have greater impact if their attitude was one of "what areas have you identified that need strengthening and how can we help address them together" with listening/observing early in the partnership, instead of an attitude of "We're here to help and here's how we think it is best to do so" (more authoritarian). It would also be mutually beneficial to conduct research to determine the effects of any implemented changes (external organizations may have more capacity to do this), and share this knowledge to inform other communities pursuing similar goals. Lastly, the local government and/or external organizations can work together to identify leaders within local communities to sustain these efforts beyond the initial intervention period.
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Post by mollybrazil on Nov 20, 2021 16:14:06 GMT
Reflect on this statement: “External assistance/provision is to increase the self-sustaining ability of people to recognize, analyze and solve their problems by more effectively controlling and using their own and external resources and not for the external provider to control projects it has resourced.”
What are the power dynamics at play in capacity strengthening partnerships? Discuss how power dynamics may positively or negatively impact capacity strengthening efforts.
The ability to empower a community to be in charge of sustainable solutions is such an important and often overlooked component of global health work. As we discussed, the current systems in place often lead to aid only being given to communities in need, which does not incentivize improvement if that means aid will be lost. On top of that, the current model often leads to entire communities feeling as if they do not have any skills, commodities or strengths, and that disheartening feeling leads to a lack of ongoing engagement. At the root of it, as always, are the financial power dynamics. It is easy to assume the partner with the money has the power, when in reality, the decisions need to be made together. For a successful partnership, the aid group needs to understand how to empower the local stakeholders to lead the efforts.
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Post by mollybrazil on Nov 20, 2021 16:21:09 GMT
The attitude change from an authoritarian approach to a true partnership is such an important factor in a successful effort. The local government is uniquely suited to identify the local stakeholders that can transform the effort into a sustainable intervention. I think the group with the money often wants to be in charge, but as we discussed, they don't have the insight into the limitations of a community.
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Post by shobanaram on Nov 27, 2021 0:26:14 GMT
Reflect on this statement: “External assistance/provision is to increase the self-sustaining ability of people to recognize, analyze and solve their problems by more effectively controlling and using their own and external resources and not for the external provider to control projects it has resourced.”
What are the power dynamics at play in capacity strengthening partnerships? Discuss how power dynamics may positively or negatively impact capacity strengthening efforts:
When considering CBPR partnerships, there are a number of power dynamics that come to the forefront particularly based in wealth and expertise. For example, in thinking of efforts towards strengthening preventative cardiovascular health measures in South Asia (i.e. increasing more healthcare workers/nurses for initial screenings in difficult to access communities), capacity building from outside country funders are likely to focus on initiatives that are based in EBM/research that has been performed and organized in communities that are not South Asian but rather based in predominantly Western countries (whether that be from a pharmacotherapy perspective, or from a "threshold creation" perspective). Capacity building that is asset-based would likely also support initiatives focused on research looking at the communities of focus by researchers within the community, thereby placing the "expertise" dynamic in the hands of the community of focus.
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Post by christyhenderson on Nov 29, 2021 23:02:57 GMT
Reflect on this statement: “External assistance/provision is to increase the self-sustaining ability of people to recognize, analyze and solve their problems by more effectively controlling and using their own and external resources and not for the external provider to control projects it has resourced.” What are the power dynamics at play in capacity strengthening partnerships? Discuss how power dynamics may positively or negatively impact capacity strengthening efforts. The ability to empower a community to be in charge of sustainable solutions is such an important and often overlooked component of global health work. As we discussed, the current systems in place often lead to aid only being given to communities in need, which does not incentivize improvement if that means aid will be lost. On top of that, the current model often leads to entire communities feeling as if they do not have any skills, commodities or strengths, and that disheartening feeling leads to a lack of ongoing engagement. At the root of it, as always, are the financial power dynamics. It is easy to assume the partner with the money has the power, when in reality, the decisions need to be made together. For a successful partnership, the aid group needs to understand how to empower the local stakeholders to lead the efforts. Totally agree. As we discussed in groups, it is so common for those who are providing resources to hold the power in a partnership. It is critical, I find, for those with the financial power to make an additional effort to engage the local community to empower them in the partnership. |
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Post by strainsk on Dec 1, 2021 2:49:08 GMT
Discussion 2
What are some of measures/indicators needed to assess the operational capacity of Haiti’s health system? Government, urban and rural.
This is by no means an all inclusive list but some common indicators from a more 10,000 ft view could be some of the indicators we have previously discussed in class such as life expectancy, under 5- mortality, measles immunization, number of healthcare providers/100,000, and number of hospitals. For more urban areas, population growth, density, crime, and poverty index could be some measures to examine. In rural areas, access to water and malaria incidences could be explored. Overall, some more detailed/specific measures that could be implemented locally are: trend of TB and cholera cases, trend of rates of immunizations, how many laboratory tests are being run, and what surveillance is being done, if any.
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Post by strainsk on Dec 1, 2021 2:54:27 GMT
Reflect on this statement: “External assistance/provision is to increase the self-sustaining ability of people to recognize, analyze and solve their problems by more effectively controlling and using their own and external resources and not for the external provider to control projects it has resourced.” What are the power dynamics at play in capacity strengthening partnerships? Discuss how power dynamics may positively or negatively impact capacity strengthening efforts. The ability to empower a community to be in charge of sustainable solutions is such an important and often overlooked component of global health work. As we discussed, the current systems in place often lead to aid only being given to communities in need, which does not incentivize improvement if that means aid will be lost. On top of that, the current model often leads to entire communities feeling as if they do not have any skills, commodities or strengths, and that disheartening feeling leads to a lack of ongoing engagement. At the root of it, as always, are the financial power dynamics. It is easy to assume the partner with the money has the power, when in reality, the decisions need to be made together. For a successful partnership, the aid group needs to understand how to empower the local stakeholders to lead the efforts. Totally agree. As we discussed in groups, it is so common for those who are providing resources to hold the power in a partnership. It is critical, I find, for those with the financial power to make an additional effort to engage the local community to empower them in the partnership. It would interesting, and maybe not at all feasible at many levels, to have a third party whose sole responsiblity is to have a neutral party to handle and distribute resources, some entity which is not the income generator of course. |
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Post by Audrey on Dec 31, 2021 2:20:15 GMT
Discussion 1) What is the role of Government/Ministry of Health in capacity strengthening and how will you maintain partnership with them?
The partnership between the government or ministry of health and external providers is key to the efficacy and sustainability of a global health intervention. Several examples of these collaborations were provided in the readings, with both positive and negative outcomes.
One role for the government in the beginning phases of a health intervention is to set an overarching vision and define a clear, measurable goal. Citizens, healthcare workers, and health partners had to ally around a shared mission of reducing the incidence of Malaria through a concerted national effort. Setting clear goals of reducing the incidence of malaria and measuring intermediate outcomes such as allocation of nets and medication utilization allowed for efficacious use of foreign aid. Setting clear goals is also important since external providers may fail to deliver what they initially promise. As described by Dr. Farmer in Reimagining Global Health, foreign aid provided to Rwanda stimulated conflict and structural violence due to inequitable distribution of aid, even as the government made claims about improvements in mortality and GDP. Their current national development plan emphasizes transparency and accountability with clear goals and progress checks for NGO’s delivering international aid. Governments can work to prevent these potential harms by setting clear, measurable health goals on a national level and by demanding transparency about progress and resource allocation. In some cases, governments should ask NGO’s to leave the country.
Governments should also facilitate equitable health access in under-resourced regions. A positive example of this was in Haiti, where the coordinating body led by Mildred Aristide worked with Zanmi Lasante to ensure that grant funding from the Global Fund to Fight AIDS, Tuberculosis, and Malaria would be distributed to resource-limited areas outside of the relatively resource-laden capital. Often the government can supply building space for NGO’s work from, as in this case where Zanmi Lasante was asked to work from an existing clinic in Lascahobas. The government is also responsible for devising a payment model and coverage scheme for the poorest citizens to receive health care. In Rwanda, Inshuti Mu Buzima worked closely with the Rwandan Ministry of Health as the nation transitioned to the mutuelle health insurance scheme. Foreign aid is administered to those whom locals deem too poor to pay for premiums. Additionally, much of the aid is distributed into the mutuelle scheme to cover the costs of malaria treatment and diagnosis, care for children less than 5 years old, and ancillary costs for mutuelle enrollment. Importantly, local citizens are primarily involved in setting priorities for the distribution of foreign aid.
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