Tangible Results in Egypt after Two Years of Program Development

Imagine going into the doctor’s office at 7 a.m., sitting in the waiting room with 60 other patients and their families. If you’re one of the lucky few, you’ll be among the first five patients seen by the doctor. If you happen to be a part of the majority, you could wait for more than 16 hours just to see the doctor.

This may be difficult to imagine here in the United States, but in Egypt, this is a reality. Erika Linnander, associate director for the Global Health Leadership Institute (GHLI) at Yale, sat down with me to explain the role of GHLI’s program in Egypt. Cutting waiting times in half was just one of the main accomplishments.

GHLI’s involvement with Egypt began with collaboration between Dr. Harlan Krumholz, a faculty member at GHLI, and Dr. Adel Allam, an Egyptian cardiologist with connections to Yale. Dr. Allam wanted to initiate a study to improve cardiovascular outcomes, and Dr. Krumholz saw this as an opportunity for GHLI to actively drive health care quality improvement in Egypt. Linnander explained how opportunities for potential partnering countries, like Egypt, are evaluated by matching a country’s need to GHLI’s core values.

Linnander and Elizabeth Bradley recently spent four days in Egypt working with the National Bank. She explained that the project has two main goals: to improve quality of care for patients with cardiovascular disease and to improve management systems to make sure that hospitals are working well over the long term.  Based on early successes in Egypt, the team believed that the project could be replicated on a large scale nationally. Linnander and her partners went directly to the Ministry of Health to outline their strategy. The Ministry supported GHLI’s ideas, but wanted to see  how this plan could be implemented. This is where GHLI stepped in by drafting specific details, such as staffing requirements, timelines and budgets.

Linnander explained how testing earlier pilot models for Egypt’s cardiovascular care helped develop a health care management system. The approach to building management systems in Egypt is similar to what’s used in GHLI’s other programs, such as Ethiopia, but is also tailored to Egypt’s unique needs.  

Cutting waiting times in half is only one of the results of GHLI’s program in Egypt. Creating a registry, in collaboration with the National Bank and five local hospitals, helps Linnander and her team acquire data and understand the type of care that patients with heart attacks receive.  This foundation of evidence makes results for GHLI’s program in Egypt, improving quality of care, possible.

Amanda Sorrentino, GHLI Intern

2011: Innovation

Imagine a panacea pill, the most innovative novel product to date. Dr. Ahmed Mushfiq Mobarak from the Yale School of Management studies why it may fail. He began Monday night’s Global Health Seminar series for the professional schools with: “It’s not that we don’t have the solutions, but that once they’re on the market, people aren’t buying them.”

In true economist form, his presentation was entitled “Low Demand from ‘Apparently Beneficial’ Products and Behaviors.” His field research took us to Rangpur, one of the poorest and famine-ridden regions of Mobarak’s native Bangladesh where seasonal migration rates are also the lowest in the country. Mobarak’s research piloted cash and credit migration facilitation programs and found that having a migrant worker in the family was an effective source of income and thus, an increase in the health measurement of caloric intake. So why were there not more migrant workers before? Mobarak’s explanation is a behavioral one: regardless of the slim probability, the consequences of failure are too overwhelmingly devastating. No “culturally salient educational” intervention would be effectual enough to override this behavior but further development of his intervention programs might.

In the same way, Mobarak’s second project in the presentation involved discovering why technologically improved cook stoves that reduce indoor pollution were not being “taken up,” or used. You can read the details of his positive conclusions on social network marketing here, but what I’d like to note was how freely Mobarak shared the criticisms of his own projects, which will drive his next. The act of building a cheap, resource-sensible stove is a “complex engineering problem with a lot of constraints” and acknowledged that he was going back to the drawing board with engineers on developing more powerfully efficient stoves to market.

The Global Health Seminar promises themes of innovation, implementation, and maternal and child health for the semester. Although Mobarak lectured under the banner of innovation, I might say that his focus was implementation – on the difficult and oftentimes unexpectedly perplexing movement of technologies out of the lab and academia and into the real, developing world.

Connie Cho, GHLI Intern

2011: A New Year, a New GHLI Initiative

Vibrant as her round, blue signature glasses, Dr. Jane Aronson, executive director of World Wide Orphans, may have been the perfect selection for the launch of the GHLI Exchange on Friday. I’ll try not to spend time glorifying her after she quipped in her introduction, “I’m not a humanitarian. I’m Jewish,” but you can read the depth of her work here.

In the spirit of the Exchange, Aronson forewent the presentation slides (apologies, the accompanying photo of a stiff professor is misleading). She largely advocated a “New World” attitude in international development work, wary of the “rescue mentality” and viewing the on-the-ground community as the “most important unit” of consideration. Aronson vacillated between cautionary and boldly critical on the high number of NGOs and inspired individual start-ups, which we usually find praised in the press or in the dreams of students. It seems to me that at this point, her insight is not novel, but that every NGO or development worker believes that they are not that NGO. I’d be interested to hear how those with international development work or projects touted under the “social innovation” movement take this into consideration. Maybe the next innovation to come around will help facilitate international collaboration?

             

As the Exchange advertised itself as a forum to collectively explore organizational challenges, donor education and public communications made a salient emergence in the discussion. I saw an exasperated Aronson on the fixation on short-term disaster relief as a panacea for Haiti.  “We get on a private jet with other fixers, do some fixing, leave, come back and do some more fixing, and that’s great,” but it’s “unpopular to talk about not being successful” in the big picture when, as a faculty member from the audience added, “the problem [in Haiti] took a long time to create.” The New York Times editorial board seems to agree. Aronson’s op-ed might cite more concern for mental health, the environment, food security, and transparency.

For the approximately 20 attendees - undergraduates, MPHs, international workers, and faculty – the new Exchange forum proved to be more than a free-food-on-Friday lecture series with a flashy name. I’m no seasoned global health expert (just a student in the College) but I’d encourage both those who are and those who are not to look out for the next Exchange or email ghli.exchange@yale.edu with interest.

Connie Cho, GHLI Intern