2007 Global Health Mini-U Highlights and Pearls

On October 5, 2007, close to 650 global health students and professionals attended the 7th annual Global Health Mini-University. (See the 2007 Mini-U photos here.) This year's event featured nearly 70 global health topics and over 100 "Mini-U faculty members," who shared the latest evidence-based knowledge from a range of technical areas, including: Cross-Cutting, Family Planning and Maternal Health Integration, Family Planning and Reproductive Health, HIV/AIDS, and Infectious Diseases. (View or download the 2007 Mini-U presentations here.) For the second year in a row, the event was held at the George Washington University School of Public Health and Health Services. And for the third year, Continuing Education Units (CEUs) from the American College of Nurse Midwives were offered for selected Mini-U sessions.

Knowledge Extravaganza

At the end of the day, participants gathered for a closing session called the Knowledge Extravaganza, during which a synthesis of the day's knowledge was shared. Jim Sherry, Director of the Global Health Department at George Washington University, and Kent Hill, Assistant Administrator for USAID's Bureau for Global Health gave opening remarks. Jim Shelton, Science Advisor, Bureau for Global Health, and "Dean" of the Mini-University, served as emcee.

In an annual competition called the N'Lightening Round, Mini-U "faculty members" lined up to present, before a panel of judges, the key concepts and take-home messages ("pearls") from their session topics. This year creativity became the norm as "pearls" were presented by means of text, drawing, song, dance, skit, anagram – and even Haiku poetry!

Judges

This year's panel of judges included:

• Shanti Conly, Senior Technical Advisor, USAID, Office of HIV/AIDS
• Jeff Spieler, Senior Science Advisor, USAID, Office of Population and Reproductive Health
• Richard Greene, Office Director, USAID, Ofice of Health, Infectious Disease, and Nutrition
• Jim Sherry, DIrector, Global Health Department, George Washington University

Pearl Criteria

• Brief
• Clear and specific
• Practical and realistic
• Useful
• Innovative
• All around impact to make the world a better place

While the judges deliberated, Jim Shelton conducted a Bureau for Global Health version of "Who Wants to Be a Millionaire?" This year's contestant was Willa Pressman, Africa Team Leader, Bureau for Global Health. With assistance from "lifelines" in the audience, she fielded a series of global health-related questions.

After much anticipation, the judges returned and the winners were announced. The first, second, and third place pearl winners received Mini-University caps, as prizes, as well as energy-conserving light bulbs of varying wattage equivalents – a truly enlightening award. Honorable Mention winners each received a copy of Family Planning: A Global Handbook for Providers.

And the Prize-Winning Pearls Are . . .

First Place

Opportunities Gained: It’s Not the Stock Market, It’s Postpartum Hemorrhage Prevention!
Harshad Sanghvi and Debbie Armbruster

Second Place

Addressing the Reproductive Health Needs of People Living with HIV: What Do Systems Have to Do with It?
Betty Farrell, Laura Subramanian

Systematize It!
1. Integration is more than training. It's all about systems.
2. Don't stress the systems – set realistic goals for integrating family planning with ART services.

Third Place

Controlling Cervical Cancer in LDCs – Is the HPV Vaccine a Silver Bullet?
Ricky Lu, Amy Kleine, Jeff Spieler
Prevent Cervical Cancer
Avoid HPV
Screen and Treat and/or Vaccinate

Honorable Mentions

Not Your Mother’s Vaccines: Using New Vaccines Against the Old Enemies of Diarrheal Disease and Pneumonia
Rebecca Fields, Angela Weaver
You thought immunization was over and done??
THINK AGAIN!
We can prevent one in four child deaths by committing to reach all children with both traditional vaccines and new vaccines against pneumonia and diarrhea that are available now.

Health Inequality: Challenges and Approaches
Suneeta Sharma, Mai Hijazi
Mind your 'Ps' and 'Qs'

Poor have limited access.
Policy decisions influence access among the poor.
Pro-poor policies, strategies, and financing mechanisms can improve access.

Quintile Analysis
Quantity of resources is limited.
Quality of life of the poor.

"Where Have All the Workers Gone?”: The Extent of the Global Health Care Worker Shortage, Why Workers Are Leaving and Some Strategies for Addressing the Crisis
Lois Schaefer, Pam McQuide

Happy, healthy people visit health care workers.

Pearls from Other Sessions

The Urban Crucible: We Cannot Ignore the Urban Health Imperative
Vic Barbiero
Urban Health Haiku
The World Cities Grow
We Are Numb to the message
Feel Them Suffer now . . .

Chronic Disease Programming – A Development Crossroad for Health
Vic Barbiero
Chronic Disease Management Haiku
Pyramids Tell All
Double Burdens Kill Millions
Are WE Blind? Action . . .

Community Case Management: A Necessity for Reducing Child Mortality and Achieving MDG4
Ciro Franco

• We have recently seen for the first time in decades an annual reduction in CU5 mortality below 10m.
• Key intentions contributing to this reduction are available at the community level.
• Community Case Management is essential to continue/improve access/utilization to these interventions to continue this trend.

Human Trafficking: Hidden in Plain Sight
Clydette Powell
Trafficking in Persons (TIP)
"TIP" #1
Like the tip of an iceberg, TIP is deceptive:
 -partly seen
 -completely destructive

"TIP" #2
The tipping point for TIP will occur when public outcry exceeds public demand.

The REALLY BIG Picture: What You Need to Know about the Changing "Aid Architecture"
Al Bartlett, Karen Cavanaugh
Proliferation of initiatives – urban sprawl
Paris Declaration principles
-Country ownership
-Harmonization
-Alignment
Global Campaign on the Health Millennium Development Goals (MDGs)
-Catalytic Initiatives
-Deliver Now for Women and Children
-International Health Partnership

Postabortion Care 101: Everything You Wanted to Know, But Didn’t Know What to Ask
Carolyn Curtis
-Three-component system
-Complete care includes the future
(FP)
-Community is key
-education, resources, service changes

Getting the Most Bang for Your Health Information Buck
Tara Sullivan, Saori Okhubo
When we produce . . . 
 -journals
 -periodicals 
 -program reports
 -technical briefs
  -counseling tools
We need to know if these initiatives work.

That is…
  -Are we getting the most bang for your health information buck?

Oddly enough, we found that audiences are the key to success . . .
Specifically, if we focus on
1) BCC Theory
2) Participation
3) Diverse Channels

All of these in turn improve
-Design
-Development
-Implementation
-Dissemination

And inform and Monitoring & Evaluation

Ensuring Contraceptive Security During Integration and Decentralization of Health Systems
Wendy Abramson, Linda Allain
1) Consumption-based contraceptive logistics systems are excellent models to use when developing integrated logistics systems.
2) Successful decentralization and integration of the health system requires thoughtful strategic planning for the logistics system.

Palliative Care in HIV/AIDS: Strengthening the Missing Links
Ana Bodipo-Memba, Karen Stewart
Palliative Care is NOT:
Supportive care without pain and symptom control.
And it is not:
Pain and symptom control without supportive care.
*With the success of ART, we must remember the complementary and critical role palliative care services play in improving comprehensive care for PLHIV

HIV and Nutrition: A Framework for Addressing Patient and Family Needs
Tim Quick

• Malnutrition in HIV+ individuals is a medical condition that should be comprehensively managed at the clinic level, including HAART (if warranted), treatment of opportunistic infections (e.g., TB, diarrhea), and nutritional assessment, counseling, and support.
  
• Clinical nutritional support for individual HIV+ patients provides an entry point to assess family needs, and if warranted, to arrange for food security and livelihood assistance support to strengthen the capacity of the family to address its long-term requirements for food and other basic needs. 
  
• Active nutritional surveillance (using mid-upper arm circumference or MUAC) linked to home-based care and other community programs provides an entry point to refer chronically ill, malnourished individuals to clinics for HIV testing and clinical care and treatment.

On the Horizon of Novel HIV Prevention: An Update on Pre-Exposure Prophylaxis and Vaccines
Margaret McCluskey, David Stanton
HIV Vaccines
1) We do not currently have a vaccine against HIV but we are working our tails off to find one!
2) T-Cell-based vaccines are a concept to pursue further.
    HIV vaccines will need to fit into the larger prevention landscape.

Pre-Exposure Prophylaxis Prep
The science is on track, but public policy is lagging way behind. We urgently need to address the issues of feasibility, cost, and access and manage the public's expectation.

Junkies, Hookers and Queers, Oh My! HIV Prevention with Most At-Risk Populations
Billy Pick
Disclaimer: "By simply discussing with you today the best practices for SW, MSM, and IDV, I am in no way advocating for the use of the term "harm reduction" nor for the needle and syringe exchange elements of the best practices mentioned nor am I advocating for or promoting the legalization of prostitution and/or homosexuality."

Clinicians or Counselors? Challenges to the Scale-Up of HIV Testing and Counseling in Health Facilities
Alison Surdo
P (Provider) I (Initiated) C (Counseling) + T (Testing)
Protecting Human Rights
Increasing Access
Controlling the Epidemic
Training Lay Counselors

Examining the Evidence for a Behavior Change Approach to HIV Prevention
David Stanton
Probably THE most important behavior to change is multiple concurrent partnerships. Any Questions?

Who Gives a @#!&? We Doo…Moving Beyond Technology to Improve Basic Sanitation
Christopher McGahey, Scott Tobias, John Borrazzo

• Problem –  Lack of access to a safe means of feces disposal remains a huge public health problem in SS. Africa and South and East Asia
  
• New programmatic solutions focus on enhancing demand and private sector supply of technologies. HEALTH PROGRAMS AS FACILIATORS, NOT IMPLEMENTERS

Business Approaches to Engaging Private RH/FP Providers
Meaghan Smith, Makaria Reynolds, Taara Chandani

• Credit is an engine of growth for private RH/FP providers.
  
• Business and financial management skills are KEY to sustainable delivery of RH/FP services.
  
• Trade fairs break the isolation of private providers and link them to essential business and health services.

FGC/M: A Gender and Development Approach
Laura Raney
Proverb from Western Sudan about progress in changing social norms (i.e., FGM):
"No matter how slowly, a caravan that walks steadily ultimately reaches its far-away destination."
Sustained community education leads to behavior change and abandonment of female genital cutting.

Can the 4 P’s Still Save Lives? How Social Marketing Programs Meet the Changing Public Health Context
Jeff Barnes, Francoise Armand

• There are no longer two distinct social marketing models.
• The time is ripe to experiment with new combinations of interventions in social marketing programs. (Rethink the bundle!)
• Sustainability can be improved in all programs including low income countries.

Surviving a Pregnancy But Only Just: Digital Stories about Fistula Clients and Services from Uganda
Katie Tell
Women with obstetric fistula are visible testimonies to the great challenges of Safe Motherhood.

Fundamentals of Clinical Trials and Human Subjects Protection at USAID: Who Does What, and Is It Done Right?
Lee Claypool
WHEN IT COMES TO CLINICAL TRIALS AND HUMAN SUBJECTS PROTECTION EVERYONE GETS A PART.

• Per Congress, USAID plays a valuable role in clinical trials of products to improve lives in developing countries.
  
• USAID and partners work together per the "common Rule" (22 CFR 225), to safeguard rights and welfare of HS.
  
• Regulations can't address every question and situation – knowledge, good sense, and ethical commitment to the Pillar Principles of Protection are key.

Making Successful Advances: Microbicides in Human Trials
Lee Claypool, Chris Mauney

• Vaginal microbicide gels – with a slip and a slide, it's still a bumpy ride.
  
• Although two advanced leads have been dropped, other candidates continue to look promising as options for HIV prevention that women can use to protect themselves.
  
• Behavioral issues –  Acceptability, role of men, and adherence will be "Pearls for Progress."

The New Infant and Young Child Feeding Practices Indicator: Measuring for Meaningful Results
Erin Boyd

• New Composite indicator on three feeding practices:
   1. Continued Breastfeeding
   2. Frequency of complementary feeding
   3. Dietary diversity
• Useful for programming, monitoring, and evaluation

Infectious Disease and an Empty Stomach: New Evidence on Malnutrition as the Neglected Disease
Frances Davidson
1. Malnutrition is the neglected disease.
2. Funds should reflect highest impact interventions.

Contraception: What’s Hot, What’s Not, and What’s in the Pipeline
Mihira Karra, Judy Manning
Unless you want to have a baby, there is no excuse for not contracepting!
There is a method for you no matter what your age, sex, stage of life, or political affiliation!

Keeping Health Systems Healthy: How Governance and Accountability Can Help
Derick Brinkerhoff, Saul Helfenbein
1. "People Power": Where there is voice, there is responsiveness and accountability.
2. The power of the triangle:
       State-Citizens-Providers
3. "It's the governance, stupid!"
Good governance – Good Programs –  Good Health

Save Lives, Alleviate Poverty, Spur Development: Invest in LAPMs
Roy Jacobstein, Fred Ndede, John Pile
1. LAPMs (implants, IUDs, and male and female sterilization) are excellent choices for all categories and almost all individuals.
2. LAPMs are efficient, cost-effective, and can reduce overall burden on the health system.

New Evidence on Pregnancy Spacing and Neonatal and Maternal Health: How Can Pregnancy Spacing Contribute to Healthy Pregnancy?
Maureen Norton
1. HTSP: An effective approach to reach adolescent/young adults
2. Long-acting methods (implants and IUDs) are an excellent choice and promote HTSP.

All We Need Is the Product, Right? Scaling up SDM in Rwanda and EC in Bangladesh
Victoria Jennings, Jim Foreit

• Government commitment is KEY, even before the pilot.
• Easier to scale up product/method or practice that is EASY, COMPATIBLE w/ current practice
• The devil is in the details –  consistent TA and follow-up are necessary for success.

Tenacity for Capacity: The Expansion of Country Capacity to Respond to Emerging and Re-emerging Infectious Disease Threats
Angela Weaver
NO Surveillance
NO Information
NO Response
NO NOTHIN'

TB 101: A Breath of Fresh Air on an Old Topic
Clydette Powell
1. You are at risk if you breathe; Prevention is more than A-B-C.
2. When men and women are not compliant, we grow a bug that's mighty defiant.

Task Shifting: Making the Most of the Workers You Have
Barbara Stilwell, Lois Schaefer
Task-sharing: A FRESH Approach to Workforce Development
F -Focused
R -Rational
E - Efficient
S- Systematic
H-Highly Competent
Approach to Workforce Development

Hustle, Hustle, Give A Little Muscle, Muscle!  Putting More Muscle Into Our Youth HIV and Pregnancy Prevention Programs
Ilene Speizer
All Programs Should: Use a logic model, collect data, ensure community involvement, and incorporate skills development to ensure program success . . .
Particularly youth programs because . . .
Youth are a diverse group
There is some resistance to youth sexual and reproductive health programs
Varying program types are needed to score multiple goals!
One Size Does NOT Fit All . . .
 Youth ages 10-24 include a diverse group with varying needs based on:
 -Age
 -Sexual Experience
 -Marital Status
Go for 3 Goals!!!
1. Create safe and supportive environments for YSRH.
2. Improve knowledge, attitudes, skills, and practices of youth.
3. Increase youth use of health services.

Saving Mothers and Newborns: Responding to Emergencies
Barbara Deller, Patricia Gomez
Emergency Obstetric and Newborn Care (EmONC)… 
. . . connecting life-saving interventions with life-threatening complications, one mother at a time.
Complication – EmONC Function
Infection  – Administer antibiotics
Eclampsia – Administer anticonvulsants
Postpartum hemorrhage – Administer uterotonics, manual removal of placenta
Obstructed labor  – Assisted vaginal delivery, c-section
Retained products of conception – MVA
Asphyxiated newborn – Newborn resuscitation

Lessons in Mixology: Family Planning and Maternal, Newborn, and Child Health
Catharine McKaig, Holly Blanchard
(FP/MNCH Hokie Pokie):
Put the Family Planning in,
Don't take the MCH out,
Put the LAM transition in, and mix it all about,
Prevent unintended pregnancies to save more lives –
That's what it's all about!

Where There Is No Doctor or Nurse: Can Newborns Survive?
Joseph de Graft-Johnson
1. Exclusive breastfeeding saves newborn lives, but exclusive and early initiation of breastfeeding within one hour saves the most lives!
2. Mothers/fathers and other family members are the best "incubators" ever made for management of low-birth-weight babies – Let us spread the news and make use of these incubators!

New Evidence on the Role of Anemia in Maternal Mortality
Phil Harvey and Tina Sanghvi
Anemia Kills but Preventable!!! "Link" with many other health problems.

• Mobilize communities.
• Identify those key "trusted" people within the communities.
• Package anemia health info with other aspects of maternal and women's health as well as community health.

Strengthening M&E Systems Through a Data Quality Approach
Karen Hardee

• M&E systems strengthening tools available from the Global Fund and Measure Evaluation
• Data quality assessment tools in development
• Good quality data essential for program planning and efficient allocation of resources

Not your Mother’s Method Mix: How Community-based Outreach Is Going Beyond Pills and Condoms
Winnie Mwebesa, John Stanback
Community-based Outreach Anagram of the Day:
Outreach! Save Women! = Reach Out! Save ‘em Now!

The Cutting Edge: Male Circumcision and HIV
Peter Johnson
ABC² 
Let’s keep the less-dressed penis warm.
Male circumcision offers an unprecedented opportunity to reach out to men.
Let us NOT underestimate them.

HIV/AIDS Treatment: Adult and Pediatric Similarities and Differences
Bob Ferris
1. We can never treat our way out of this epidemic – Prevention is Key.
2. We still must maintain our conviction to create access to high quality treatment to all in need.

Heath System Strengthening in Post-Conflict Settings: Perfectly Logical or Totally Insane?
Yogesh Rajkotia

• HSS is a critical part of the transition from relief to development .
• Focusing on policy development early on is critical to ensure reconstruction efforts are systematic, not ad hoc.
• Post-conflict approach must be a hybrid of relief and "development."

Improving Service Results Through Improved Leadership and Management
Morsy Mansour, Mark Webster
1. We can learn how to lead.
2. Leading and managing effectively accelerate health results.
3. We believe that a committed group of people can change the situation.

A Basic Operational Framework for eHealth and Telemedicine: How to Get Started
Stephen Settimi
*Right stakeholders @ the table
In the view of those at the table
-Opportunity-
Know where eHealth Telemedicine is needed

• Under-resourced
• Farthest distance
• Highest Health Care Need

Absolutely!

10 Secrets of Partnering and Collaboration
Catharine McKaig, Theresa Shaver

1. Make sure more than one person is involved from each organization.
2. Involve "unlikely" partners including multiple sectors and hard-to-reach groups.
3. Make sure partners are committed and will work to integrate partnership activities into their work.
4. Evolve at a pace that builds trust and cohesion.
5. Have realistic expectations and clear understanding of roles.
6. Establish decision-making processes that balance speed and broad participation.
7. Recruit partners and utilize partner strengths.
8. Demonstrate results! Celebrate success!
9. Look ahead . . .
10. The Secret is there is no Secret!!