1. Strengthening Health Systems in East Africa by Strengthening Education: The Impact of the Global Health Service Partnership Esther M Johnston, Libby Cunningham, Sadath Sayeed, Vanessa Kerry The STFM 2016 Annual Spring Conference

2. Outline Why was the Global Health Service Partnership (GHSP) formed? What is the GHSP model? What are our methods for monitoring and evaluation? Two years in, what is our impact in the countries where we operate? Looking forward, what new directions will the GHSP program take?

3. WHY?

4. 28 500

5. 11 167

6. 71

8. Brain Drain

9. People are at the heart of a health system.

10. THE GLOBAL HEALTH SERVICE PARTNERSHIP (GHSP) MODEL

12. GHSP Program Objectives Increase capacity and strengthen the quality and sustainability of medical and nursing education and clinical practices Provide clinical and didactic instruction, mentoring, and other student and faculty professional development activities to increase sustainability

13. The GHSP Model Physicians and Advanced Practice Nurses Year-long commitment Work as faculty in classrooms and clinics/wards/ORs Teach, mentor, work with faculty peers

14. The GHSP Multiplier Effect

15. Benefits of Service for the Volunteer Host Institutions – Housing – Transportation Peace Corps – Living allowance – Health benefits and malpractice coverage – Student loan deferments and partial cancellations Seed Global Health – Clinical and academic support – Professional allowance – Debt repayment awards (up to 30k)

16. METHODS OF EVALUATION

17. Methods for Monitoring & Evaluation Monthly Volunteer Reporting Tool – Robust data tracking and monitoring system reported to a central office in the US – Measures of productivity collected monthly Post-event feedback surveys – Ongoing process evaluation and improvement Stakeholder interviews – Semi-structured group and individual interviews [180 interviews with ~390 stakeholders over 2 years] – Transcribed, coded and analyzed for themes – Validation and member checking in the US and partner countries.

18. Methods for Monitoring & Evaluation (cont) The persistence of programs that GHSP volunteers initiate, from clinical simulation labs to new courses, is monitored from year to year to assess sustainability. Starting in Year 3, pre- and post-course surveys will be administered to students in courses where GHSP volunteers provide a significant amount of classroom and/or bedside instruction.

19. 2 YEARS: THE IMPACT OF VOLUNTEERS (SPECIFICALLY FAMILY MEDICINE DOCTORS) IN THE GHSP

20. Mzuzu University Kamuzu College of Nursing (KCN) University of Malawi, College of Medicine Bugando Medical Centre (BMC) BMC Sengerema Designated District Hospital University of Dodoma Hubert Kairuki Memorial University Muhimbili University of Health and Allied Sciences Gulu University Lira University College Mbarara University of Science and Technology UGANDA TANZANIA MALAWI Mvumi Clinical Officer Training Program Mirembe School of Nursing Sites: Years 1 & 2

21. Family Medicine MDs in the GHSP 8 FM MDs in Year 1 & 2 Uganda: – Gulu University Dept of Internal Medicine – Mbarara University of Science and Technology Dept of Internal Medicine Tanzania: – MVUMI Clinical Officer’s School – University of Dodoma School of Medicine Dept of Internal Medicine – Hubert Kairuki Memorial University School of Medicine Dept of Pediatrics & Child Health Malawi: – The University of Malawi College of Medicine Family Medicine MMED Program at Mangochi District Hospital

25. Student Feedback on GHSP

26. The Birth of a New Family Medicine Residency Founded by Dr. Prosper Lutala and Dr. Martha Makwero of the University of Malawi College of Medicine in conjunction with two 2014-2015 GHSP volunteers: Dr. Allana Krolikowski and Dr. Jessie Reynolds The first 3 registrars are now entering their second year

27. Short-term resident rotations US academic institution Clinical care Continuing education & mentoring Locally-relevant projects Resident overlap (orientation & project handover) Supervised by GHSP Volunteer Human resource support Patient care Trainee and staff training & mentoring Process/quality improvement outcomes Site impact Long-term, mutually beneficial partnership Post-residency global health experience and faculty pipeline for Partner institution Partner institution Partner institution Through GHSP, Seed and Peace Corps place yearlong faculty volunteers and provide academic and clinical support, facilitate logistics and infrastructure needs, and provide evaluation systems. Global Health Service Partnership Establishment of a Partnership: WWAMI-COM

28. NEW DIRECTIONS

29. Entering Year 4

30. Looking Forward: New Opportunities Expansion to New Sites Expansion to New Countries: – Swaziland: RNs only – Liberia: MDs & RNs Aiding in Developing New Family Medicine Programs Exploring New Academic & NGO Partnerships

31. Looking Forward: Challenges & Questions How does GHSP as a whole capture the long- term impact of our work? – Reduction in brain drain? – Increased interest in faculty roles? – Improved quality of teaching? – Training methods? – Improved research?

32. Questions? Esther Johnston - Director of Family Medicine Programs for Seed Global Health ejohnston@seedglobalhealth.org