1. Many Hands Make Light(er) Work
Developing Academic/NGO Partnerships to Enhance Global Health Projects
Many Hands Make Light(er) Work

2. 2012 AAFP Global Health Workshop
Mark Ryan, MD
President, HOMBRE Board of Directors; President Dominican Aid Society of VA
VCU School of Medicine Department of Family Medicine
Steve Crossman, MD
Director, HOMBRE Board of Directors; COO VCU-Thundermist Pinares Project
Jessica Evert, MD
Medical Director, Child Family Health International
UCSF Department of Family and Community Medicine
Michael Stevens, MD, MPH
Director, HOMBRE Board of Directors
VCU School of Medicine Department of Internal Medicine

3. Objectives At the end of this session, participants will be able to
describe the challenges faced by short-term global health engagements.
explain how NGOs can enhance the impact of short-term medical projects and global health education.
describe characteristics of successful partnerships with NGO’s.
recognize ethical tenants that underwrite successful, sustainable, partnerships.

4. Why are the interest in global health?
Student and faculty interests include:
Altruism and service
Clinical experience
Research opportunities
Student participants are:
More likely to enter primary care
More likely to work with public insurance
More likely to work with underserved communities in the USA

5. Challenges in global health
Transient participants
Intermittent presence
Insufficient preparation
Lack of cultural competency
Funding
Relationship building
Host community trust and involvement

6. Ethical framework Well-structured programs Explicit agreements
Appropriate selection of trainees
Formal training for program participants& trainees
Development & implementation of safety protocols
Comprehensive accounting of costs
Transparency and information sharing
Development & implementation of processes for formal feedback
Focus on local needs and priorities
Focus on mutual benefit
Established long-term partnership
Effective supervision and mentorship
Compliance with standard guidelines and policies
Adapted from:
Crump JA, Sugarman J et. al., Global health training: ethics and best practice guidelines for training experiences in global health. Am J Trop Med Hyg 83:
Working Group on Ethics Guidelines for Global Health Training (WEIGHT), published recommendations in 2010

7. DR DR SOMOS VCU HOMBRE Fundación Sol Naciente
Dominican Aid Society of Virginia
SOMOS
Fundación Sol Naciente
VCU HOMBRE

8. DR Name Location Description Partner 1 Partner 2 Partner 3 Partner 4
 Dominican Aid Society of Virginia
 Richmond, VA
US-based 501©3 non-profit with independent Board of Directors; emphasis on direct medical care and establishing relationships with local Ministry of Health and nonprofit healthcare providers in Dominican Republic
Partner 2
 Student Organization for Medical Outreach and Sustainability (SOMOS)
 Williamsburg, VA
University and course-based non-profit focused on participatory community development.  Based in social scientific theory and research to promote community partnerships and sustainable and long-term strategies for improving health and health care.    Emphasis on research and knowledge to promote and support social change.
Partner 3
 Fundación Sol Naciente
Santo Domingo, D.R.
Dominican non-profit founded in Partners with Physicians for Peace and provides direct free or low-cost medical services. Medical care provided at a healthcare center in eastern Santo Domingo
Partner 4
 VCU/HOMBRE
Richmond, VA
Supports the June medical/community development trip to Paraíso via HOMBRE, enhances continuity of care for the community, allows future development of academic and research partnerships.
SOMOS: embodies “an effort in engaged scholarship that combines service learning, fundamental precepts, core concepts, a basic method, and a systematic approach to partnering to pursue long-term, small-step strategies to improve health and health-care in Paraíso, Dominican Republic”.
FUNSI: Mission is to propel the harmonious development and integration of the people through the investigation and programs of Health and Education, in accordance with other related institutions, in the endeavor of creating a more just and fair society

9. DR +/- +/+ -/- +/- +/+ +/+ +/- -/- -/- Guideline DASV SOMOS FUNSI
VCU/HOMBRE
Well-structured programs
+/- 
+/+ 
Explicit agreements
-/-
+/-
Appropriate selection of trainees
+/+
 +/+
Formal training for program participants& trainees
 +/-
-/- 
Development & implementation of safety protocols
Comprehensive accounting of costs
Transparency and information sharing
Development & implementation of processes for formal feedback
Focus on local needs and priorities
Focus on mutual benefit
Established long-term partnership
Effective supervision and mentorship
Compliance with standard guidelines and policies
 -/-
DASV: ongoing collaborative relationships, but less formalized re: MOU, formal protocols, policies, etc. Focus has been on securing meds/supplies and coordinating volunteers who travel as individuals collaborating on a project. More formal relationships, agreements, protocols would be an area of focus.
SOMOS: strong student organization and student leadership; university oversight leads to a formal program and oversight. Less emphasis on MOUs.
FUNSI: role focused on in-country logistics and collaboration in clinical care. Organization may have strong internal protocols, etc. but little formal interaction with medical service teams aside from shared care.
VCU/HOMBRE has an effective, organized structure that addresses each of these areas effectively.
Adapted from:
Crump JA, Sugarman J et. al., Global health training: ethics and best practice guidelines for training experiences in global health. Am J Trop Med Hyg 83:
Code: +/+ = guideline achieved well
+/- = guideline marginally achieved
-/- = guideline not adequately achieved yet

10. Norte, Honduras
Norte
Golden Phoenix
VCU
(NPH)
HOMBRE

11. Norte Name Location Description Partner 1 Golden Phoenix Foundation
United States 
Non-profit focused on issues around international adoption. Dr. Mason, physician co-site leaders for Norte, is the physician director of Golden Phoenix. They sponsors our water filter project.
Partner 2
Nuestros Pequenos Hermanos (NPH)
Honduras and International 
Organization has contributed to our medical and public health mission in Yoro with contributions of personnel and supplies. Dr. Mason works with the NPH group and this is the origin of NPH’s support of our mission in Yoro. Due to geographic limitations, the NPH orphanage group is no longer involved in our Yoro work (as of 2012, were involved ).
Partner 3
HOMBRE
United States
Non-profit, also a VCU medical student interest club. Provides VCU medical and pharmacy students opportunities to rotate on our health brigade in Yoro. Also helps fund medication and supplies for brigades.
Partner 4
VCU
Primarily involves the Global Health & Health Disparities (GH2DP) program within the Department of Internal Medicine. Also the Department of Pediatrics at our Inova Fairfax campus.

12. Norte +/- +/+ +/+ +/- -/- +/+ +/- Guideline Golden Phoenix HOMBRE VCU
Well-structured programs
+/-
+/+ 
Explicit agreements
+/+
Appropriate selection of trainees
Formal training for program participants& trainees
+/- 
Development & implementation of safety protocols
Comprehensive accounting of costs
Transparency and information sharing
Development & implementation of processes for formal feedback
-/-
Focus on local needs and priorities
Focus on mutual benefit
 +/+
Established long-term partnership
Effective supervision and mentorship
Compliance with standard guidelines and policies
 +/-
Adapted from:
Crump JA, Sugarman J et. al., Global health training: ethics and best practice guidelines for training experiences in global health. Am J Trop Med Hyg 83:
Code: +/+ = guideline achieved well
+/- = guideline marginally achieved
-/- = guideline not adequately achieved yet

13. Shoulder to Shoulder, Inc.
Pinares, Honduras
Pinares
Hombro a Hombro
Shoulder to Shoulder, Inc.
VCU / Thundermist
Comite’

14. Pinares Name Location Description
Partner 1
Virginia Commonwealth University, Department of Family Medicine; Thundermist Health Center (VCU/T)
Richmond, VA;
Woonsocket, RI
An academic family medicine department with dynamic medical student programs as well as five affiliated family medicine residency training programs in Virginia; a large federally qualified community health center in Rhode Island
Partner 2
Shoulder to Shoulder, Inc. (S2S)
Cincinnati, Ohio
An international NGO based in the United States which works to serve the poor in multiple countries on multiple continents
Partner 3
Hombro a Hombro (HaH)
Intibuca, Honduras
The Honduran NGO affiliate of Shoulder to Shoulder which works with their affiliates whose projects are in Honduras.
Partner 4
Pinares Health Comite’ (Comite’)
A local committee of village volunteers that partners in managing the clinical and public health projects undertaken in these communities

15. Pinares +/+ +/+ +/+ +/- +/- -/- -/- -/- +/+ -/- +/- Guideline VCU/T
S2S
HaH
Comite’
Well-structured programs
+/+ 
 +/+ 
+/+  
+/- 
Explicit agreements
+/-
 -/-
  -/-
Appropriate selection of trainees
Formal training for program participants& trainees
 -/- 
Development & implementation of safety protocols
+/+
Comprehensive accounting of costs
Transparency and information sharing
-/- 
Development & implementation of processes for formal feedback
Focus on local needs and priorities
Focus on mutual benefit
Established long-term partnership
Effective supervision and mentorship
+/-  
Compliance with standard guidelines and policies
Adapted from:
Crump JA, Sugarman J et. al., Global health training: ethics and best practice guidelines for training experiences in global health. Am J Trop Med Hyg 83:
Code: +/+ = guideline achieved well
+/- = guideline marginally achieved
-/- = guideline not adequately achieved yet

16. CFHI 20 yr old US-based NGO
20 explicitly educational programs in 5+ countries
Asset-based engagement
Consistent professional structure at each site
Local Medical Director
Local Coordinator
Preceptors
600+ students/residents annually
Institutional partnerships with medical, undergraduate, health-science schools
“Out-sourcing” of sustainable partnerships, risk, contract negotiations, incident management, safety policies, eval./assessment & program management

17. CFHI’s 20+ Global Sites SOUTH AFRICA BOLIVIA INDIA ECUADOR MEXICO
HIV/AIDS & Healthcare- Durban
Healthcare Challenges- Cape Town
BOLIVIA
Chagas- Tarija
Pediatric Health- La Paz
INDIA
Sight for All- Ophthalmology Rotation- New Delhi
Rural/Urban Community medicine- Rural Himalayas
Intro to Traditional Medicine- Rural Himalayas
Communicable Disease- Mumbai
HIV & Public Health Challenges- New Delhi
Maternal and Child Health- Pune
Hospice and Palliative Care in Southern India
ECUADOR
Vector-borne Diseases- Amazon
Andean Health- Quito
Urban & Rural Comparative Health- Quito/Chone
Reproductive Health-Quito
Community Medicine-Amazon
Indigenous Health- Amazon
Sonrie Dental Program- Quito
MEXICO
Cultural Crossroads in Health- Oaxaca
Tropical Medicine & Rural Health- Puerto Escondido
Women’s Reproductive Health- Puerto Escondido

18. CFHI “Standard” programs accessible by individual students
10+ “Institutional partnerships” which customize to specific academic institutions
Avoids the wavering support of administration, unreliable funding streams, change in resources & commitment to global health
Downside of tuition-based is less accessible to students without means & ability to fundraise
Educational rather than service mission
‘Service’ & reciprocity provided through a professional development/community health grants program that is under local control

19. Perseverance through political unrest/instability
CFHI
Annual contracts negotiated with individuals and organizations / clinical sites
Programs all have ‘themes’ determined by partner’s/community’s strengths
Guideline
CFHI Partnerships
Well-structured programs
 +/+
Explicit agreements
Appropriate selection of trainees
 +/-
Formal training for program participants& trainees
+/- 
Development & implementation of safety protocols
+/+ 
Comprehensive accounting of costs
Transparency and information sharing
Development & implementation of processes for formal feedback
Focus on local needs and priorities
Focus on mutual benefit
Established long-term partnership
Effective supervision and mentorship
Compliance with standard guidelines and policies
Annual report and clear tuition costs and per capita fees paid to partners/clinics
Focus on local strengths / assets & reciprocity / professional development focuses on needs/deficits
Challenge of preceptors wanting students to ‘really like it’ and allowing them to act beyond training
Perseverance through political unrest/instability
Adapted from:
Crump JA, Sugarman J et. al., Global health training: ethics and best practice guidelines for training experiences in global health. Am J Trop Med Hyg 83:
Code: +/+ = guideline achieved well
+/- = guideline marginally achieved
-/- = guideline not adequately achieved yet

20. Benefits of NGO partnerships
Ongoing community relationships
Participant preparation
Project facilitation
Cultural brokers
Fundraising

21. Challenges to academic/NGO partnerships
Sustainability
Differing organizational cultures
Staff changes
Ethical challenges
Funding

22. Conclusions Partnerships with NGOs can: Enhance the safety
Enhance effectiveness
Improve sustainability
These partnerships face many challenges, but a robust ethical framework increases likelihood of continued success

23. Partnerships and collaborations