Community Partnerships and Global Health: Necessary Hard Work Mark Ryan, MD Steve Crossman, MD David Aday, PhD Mike Stevens, MD

2 Activity Disclaimer ACTIVITY DISCLAIMER It is the policy of the AAFP that all individuals in a position to control content disclose any relationships with commercial interests upon nomination/invitation of participation. Disclosure documents are reviewed for potential conflicts of interest (COI), and if identified, conflicts are resolved prior to confirmation of participation. Only those participants who had no conflict of interest or who agreed to an identified resolution process prior to their participation were involved in this CME activity. Mark Ryan, David Aday, Mike Stevens, and Steve Crossman have indicated they have no relevant financial relationships to disclose.

Importance of community engagement The risk of being inward-looking. Projects can be described as community engaged in any or all of the following ways: –They recognize, take account of, and plan services that are appropriate to local context –They pursue and engage partnerships –They pursue efforts to promote sustainable improvements in health and health care (community change) It is also important to consider relevant challenges to these partnerships and projects. 3

Importance of community engagement What does this mean? –Context: Examples of relevant context variables include geographic proximity to resources; local, regional, and national culture; host to affinity and identity groups –Source of partnerships: Examples include relationships and arrangements for collaboration with local physicians and health foundations; local public health nurses –Community change: Efforts to develop and pursue strategies to promote sustainable improvements in health and health care 4

Examples Context: Health brigade in northwest Nicaragua –Plan for remote location and limited access to basic health care; persistent health issues (parasites, gripe, URI) Source of partnerships: Recurring brigade arrangements –Prepare for outreach and collaboration with local and regional health resources and professionals, build reciprocal arrangements Community Change: Partner with non-medical specialists to conduct research on community and to promote locally controlled health and health care arrangements Example: A health planning committee Example: Food safety project to reduce rat infestation in preparation for parasite control 5

Partnerships and collaborations

VCU GH 2 DP: Yoro, Honduras 7

Context: Health brigade in northern Honduras –Serve 2,000 people living in 17 villages with little to no access to care; active in area since 2005 Source of partnerships: Government, regional and community partners –Work closely with regional Ministry of Health –Have close relationship with local Catholic church –Have strong relationships with public health nurses that are active in the communities we serve –Have identified informal local community leaders with whom we partner closely 8

VCU GH 2 DP: Yoro, Honduras Community Change: Trip leaders identified key partners in the local Ministry of Health (identified by community partners) as well as local (informal) community leaders –The above relationships have led to the identification of numerous health-related issues (indoor air pollution, Chagas disease, et cetera) and have led to formal needs assessments and educational campaigns related to these issues 9

VCU GH 2 DP: Yoro, Honduras Challenges: –Competing priorities across our community partners –Turnover (we have seen 3 Health Ministers in the past 4 years) –Difficulty communicating with key leaders in all the communities in our catchment area regularly (some communities can only be reached by a 6 hour hike)

Shoulder to Shoulder and VCU: Pinares 11

Shoulder to Shoulder and VCU: Pinares Context –Department of Family Medicine embracing a relationship with the community of Pinares (service area of 7 villages in mountains of SW Honduras); year-round clinic with three planned health brigades each year. –I worked with somebody who worked with somebody who founded a group to work in rural Honduras and had met someone who lived in Pinares. Everybody liked each other and we agreed to work together. 12

Source of Partnership

Shoulder to Shoulder and VCU: Pinares Community Change –Comité –Water filters –Cookstoves –Child health initiative (CHI) –Composting Challenges –Funding –Partner relationships –Communication 14

SOMOS and DASV

Contexts: –Marginalized barrio NW of Santo Domingo with little established medical care. –Undergraduate students conducted ethnographic and mapping research to describe community, identify health resources, and characterize health and health care concerns; plan and deliver annual clinics accordingly Source of partnerships: –Undergraduate students and DASV physicians, students, and partners contacted local government, health care agencies, Physicians for Peace, EWB, and local/national foundations to encourage and enact collaborative efforts Community Change: –Undergraduate students conducted field research to understand interpersonal networks of communication and leadership; based on this research, fostered infrastructure including regional focus groups and community planning and decision-making arrangements, which resulted in a five-year plan for improving health and health care 16

SOMOS and DASV Community change, continued: –Undergraduate students, DASV physicians, HOMBRE students, and partners facilitated development of community health planning committee facilitated proposal for partnership between community, SOMOS, and EWB to construct community center to reduce impact of recurring flooding facilitated community-based research to identify obstacles to access to continuous care for NCDs facilitated connections between local Ministry of Health services and the community 17

SOMOS and DASV Challenges: –Government involvement (absence or intrusive) –Community cohesion and shared vision –Trust in existing and nascent community organizations –Discordant health priorities between partners –Acceptance as outsiders –Sense of progress/timeline 18

Summary and conclusions Sustainable community-based and short-term medical service trips require careful evaluation of local context and existing and potential partnerships Community change must develop out of these ongoing partnerships, and must include a sustainable and meaningful level of community involvement. Understanding community priorities requires careful investigation and inclusive methods. The community’s priorities must be a central consideration Sustaining community partnerships is challenging, and requires ongoing communication, re-evaluation, and adjustments as indicated to ensure the partners’ priorities are being respected 19

Contact information 20