Integrating Interventions for Early Childhood Development in Brazil: GHLI Forum for Change

Bacy Fleitlich-Bilyk, PhD 

I am a child psychiatrist, and when I leave home to see my patients, my son Tiago understands that I have to go and help them feel better. But my trip to Yale University was a little more difficult to explain; the focus was much broader: “Integrating Interventions for Early Childhood Development (ECD) in Brazil.”

ECD is a global health challenge that requires multi-disciplinary collaborations. Our delegation is composed of professionals from the public sector, academia, and NGOs.  At the beginning of our visit we set two main goals: learn how to bridge policy and practice in ECD; and how to work together in public and private partnerships. After just the first day of sessions, I left with a greater understanding about these issues. And hearing about the great work done at Yale inspired me to continue my work back home!

Then we spent time with Minding the Baby Training Institute staff to learn how they help needy families to improve parenting, parent-child and family relationships, and child development. The training program presented us with new concepts such as mentalization theory and reflective functioning – tools that we can take home to help us build our own parenting program. The challenge, however, will be to adapt this tool in a city with 860,000 children under 3 years old and an average of 175,000 births per year.

Over the course of the week, invaluable bonds were formed. Maybe GHLI was the spark that we needed to spur collaboration, or maybe we all needed to benefit from learning and practicing the reflective functioning approach, but we all returned home with a renewed energy to continue to work towards improved ECD in São Paulo.

Learning Beyond the Lectures

Joan Rhee, 2014 GHLI Intern

Last week, Yale welcomed United Kingdom National Health Service visitors for the International Health and Social Care Leadership Programme (IHSCLP). The IHSCLP is a partnership between GHLI, the South Essex Partnership Trust, and Health Education East of England. Participants learn different problem solving strategies and explore public health issues in their respective home institutions for nine months, eventually presenting their final findings to Yale faculty. I had the amazing opportunity at GHLI to help organize this program and attend it as part of my internship here this summer.

The delegates’ visit was filled with lectures from Yale faculty on various issues as well as field assignment presentations from program participants. We also visited local healthcare facilities, which promoted an enriching exchange of ideas between health management experts from the UK and US. After learning details about the Affordable Care Act, delegates were visibly dazed by the scope of our problems. They asked if I thought there was hope for the American health care system, and I said I honestly wasn’t sure.

During the celebratory final dinner on Thursday night, I was asked again–do I think there is hope? I reflected on everything I learned this week through conversations, lectures, and the delegate presentations showing how each participant had managed to make a difference, ranging from better budgeting for specialized services to improving efficiency in acute hospitals. I DO have hope.

Despite my having much to learn, this internship has shown me that the American healthcare system is on an upward trend and there is a continuous desire to improve. The experience of working on IHSCLP has solidified my desire to work in global health, and I am extremely thankful for the opportunity and learning this internship has brought me.

Delivering Community-Based Mental Health Care in Ghana

Austin Jaspers, 2014 GHLI Fellow

I am thrilled to be in Ghana this summer to take part in the country’s ongoing partnership with GHLI.  Within two days of touching down in Accra, I met with the Mental Health Technical Support Team at the Ghana Health Service headquarters to discuss plans for this summer and beyond.  The GHLI Forum for Change is steadily taking shape and it will be hosted in Accra in autumn 2014.  

In addition to helping organize this upcoming event, I am collaborating with stakeholders in Ghana and psychiatrists at Yale to draft a training toolkit for community mental health workers here.  In my first few weeks, I have applied concepts and techniques I learned in GHLI Faculty Director Elizabeth Bradley’s course on Strategic Thinking in Global Health by engaging with people at every level of the mental health system.

Improving mental health care is a strategic priority for the country, where capacity and resources for treatment are lacking.  Parliament made major headway when it passed the Mental Health Bill.  One of its provisions created the Psych Corps program to deploy Ghanaians with bachelor’s degrees in psychology to clinics and hospitals across the country.  The next group of 74 Psych Corps enters service in September and they will receive a copy of the toolkit at orientation. 

This exciting work builds on the longstanding collaboration between clinicians, policymakers, researchers, professors, and NGOs in Ghana with their colleagues at Yale. I first met the Ghanaian delegation during their visit to New Haven in June 2013 while serving as a Student Ambassador at the GHLI Conference.  Since then, I have followed the progress of their accomplishments, and now I have the special opportunity to be in country to contribute to this important work that delivers impact for the Ghanaian people.  

Changing Hospital Culture to Save Lives

Zahirah McNatt, project director, Yale GHLI

Last week, GHLI and a group of representatives from hospitals across the country convened in the city of Atlanta because we believe that leadership saves lives and that organizational culture can impact clinical outcomes in the hospital setting.  

A stretch? Perhaps. 

A decade of research led by Yale highlights five strategies for reducing mortality rates for patients with heart attacks. We argue that these strategies are proxies for aspects of organizational culture and that culture may be just as significant as new drugs and devices.

During the Leadership Saves Lives (LSL) launch, we met with hospital executives, nurses, interventional cardiologists, emergency room physicians, physician assistants and quality improvement directors - all with the goal of understanding the evidence base for organizational culture and clinical outcomes and creating a learning community.

We spent two days cultivating relationships across ten U.S. hospitals, reviewing the science behind the intervention, laying out a plan for our two years of work together and exploring each hospital’s organizational culture through artistic activities. We partnered with amazing institutions--The Medicines Company and the Mayo Clinic Care Network--both at the vanguard of their industries.  

The commitment and enthusiasm expressed by each of the 10 hospital teams was inspiring. They came from across the nation, including Montana, Florida, North Dakota and Kentucky. They spoke of issues like “turf wars” between professions and a need for a greater sense of respect in the workplace. They highlighted their successes with integrating pharmacists into the AMI care continuum and challenges with better engaging emergency medical services in quality improvement efforts.

Together, we focused on creative problem solving, a technique for finding solutions to clinical and operational issues, through engaging key staff, developing strategy and being open to new ideas. And we explored how best to encourage interdisciplinary communication and coordination. 

The launch and the project are the result of both personal and professional efforts to improve care for patients with AMI. We are proud to be a part of this endeavor.

Innovation and Strong Partnerships: The Equation for Global Health Success

Mike Skonieczny, executive director, Yale Global Health Leadership Institute

Recently I attended a gathering of major influencers in the world of global health  – ministers of health, U.S. government officials, and representatives from NGOs, philanthropic organizations and the private sector. “Acting on the Call,” brought together these leaders to celebrate recent successes in improving maternal, child, and newborn health and to examine new methods to improve health care access in even the most remote parts of the world.   

It was impressive to me to see this broad array of people exchanging ideas, particularly on how to improve the health of women and children around the globe. Dr. Kesete Admasu, the Ethiopian Minster of Health, shared examples of significant strides made in his country including the Health Extension Program, a national strategy for primary health care in Ethiopia. 

A program featured during the gathering was Project Last Mile (PLM), which leverages the Coca-Cola Company’s supply chain expertise to bring medicine to rural African communities. Spearheaded by Coca-Cola the partnership also includes USAID, the Global Fund, Accenture Development Partners and Yale GHLI. Project Last Mile has already seen tremendous results in Tanzania, where the availability of medicines has increased by 20-30% in some cases. Over the next five years the project aims to reach a total of 10 countries with work already starting in Ghana and Mozambique. 

“Acting on the Call’ highlighted the fact that success in maternal and child health requires not only creative solutions, but also strong partnerships between the public and private sectors. By leveraging the unique assets of the private sector, like Coca-Cola, we can see amazing results that truly change lives. 

What Does a Culture of Health Mean?

Elizabeth H. Bradley, Ph.D., faculty director, Yale Global Health Leadership Institute 

Last week, the Vitality Institute released a report offering five recommendations to build a culture of health that motivates Americans to make healthful choices – including strengthening leadership through networks, focusing on the health of the workforce and reframing the word prevention. The report aims to establish health as state of complete mental, physical, and emotional well-being.

I was delighted to participate on the panel at this event that raised thought provoking ideas about leadership for health. How should Americans be thinking about health leadership? Does it start at home, in schools, in the community, or in the workplace? By the time we enter the medical care system, health habits are fairly well established and difficult to shift. Hospitals and doctors influence only a portion of our health; the real drivers of health – how we eat, play, work, and live – have developed long before we ever walk into a medical facility.    

To make headway on improving health care in the United States, we must endorse the broad view of health as a core value of society. We must engage diverse groups of people, companies, organizations, and communities. Expanding the circle of partnerships, beyond the typical players in health care, such as pharmaceutical companies and insurers, may bring a more holistic approach to the culture of health.  For example, partnerships with technology companies that focus on innovations for our future, as well as urban design companies, may be more important to ensure that health issues are addressed at all levels.  Such partners provide leadership focused on innovations that lead people to healthy and sustainable lives through perspectives on health. 

We also need to think differently about what prevention means and when it starts.  We can do this by looking upstream with our prevention efforts –urban planning, early childhood education, safe housing – methods that happen even before some medical preventions.    

This report was inspiring and I think the Vitality Institute has a real opportunity to grow a network that can change the culture of health.  I’m in.  

A Growing Double Burden

Sarah Ali, 2014 GHLI Fellow 

I have now been in Uganda for about a month and each encounter with a new person is always met with surprise when I explain what I am doing here. “Are non-communicable diseases (NCDs) even a problem in Uganda?” The answer is a resounding yes! One quarter of Ugandan deaths are attributable to NCDs, and the burden continues to grow. Conversations with doctors and nurses have highlighted several pressing NCD concerns:

• Awareness needs to be raised about the high burden of NCDs
• There is a need for equipment and practitioner training for screening and management of NCDs
• Perpetual time and human resource constraints are a barrier

The Uganda delegation formed the Uganda Initiative for the Integrated Management of Non-Communicable Diseases (UINCD), a non-profit organization geared toward capacity building of health workers and the integrated care of NCDs. Now entering its second year, UINCD is working toward piloting an NCD integrated management clinic in Mulago Hospital, the national referral hospital located in Kampala. As progress is made on the research for an NCD integrated management pilot clinic, the GHLI forum is slated for October as a way to revisit and move forward with the UINCD agenda.

In addition to welcoming me to the project, one delegation member invited me to see his village. To reach this village, we traveled through over 100 km of farmland covered with tea plants, sugarcane, maize, and a type of banana tree called matoke. Every couple kilometers, we were greeted by people who wait along the road to sell produce such as mangoes, tomatoes and grilled sweet bananas called gonja, roasted meats, and sodas. The visit provided an illustration of the contrasting features of a modernizing Uganda. The lack of electricity and running water in many places, education for only some, showed why communicable diseases have continuously been the focus. This is juxtaposed with an increase in Western influences and the rise of bigger cities leading to a double burden of disease.