Medha Vyavahare pictured on the far right with colleagues

 during a field visit in Clarens, South Africa

Truly Understanding Health Systems Strengthening

Medha Vyavahare (YSPH ’17), 
GHLI Intern

As a GHLI intern, I recently traveled to South Africa to learn about the Chronic Centralized Dispensing and Distribution (CCMDD) Initiative—a national effort to improve access to medicines for South Africans with chronic diseases.

When I learned about the necessity of system-wide approaches in global health as a public health student at Yale the term ‘health systems strengthening’ seemed vague. It wasn’t until I got to South Africa that I realized the nature of system change.

Patients diagnosed with HIV or other chronic diseases face significant challenges accessing their medications in South Africa. Congested public clinics, long waiting times, and stock outs are common. Many patients take days off work to get their medications in crowded clinics—sometimes to find the medicines aren’t even available. 

Project Last Mile—a partnership applying The Coca-Cola Company’s supply-chain expertise to public health systems across Africa — works with the CCMDD to expand the availability of medicine across South Africa. Project Last Mile collaborates with the government and local non-profit organizations to create convenient pick-up-points for medicines in grocery stores, post offices, and other community locations.

Though restructuring wasn’t easy, what I saw in South Africa was impactful. I visited public pharmacies starting to receive shipments of the new, neatly packaged individual parcels of medicine. Through the use of mapping tools and strategic thinking, more accessible pick-up points were identified based on patient demand – a very exciting outcome for the resident pharmacists. There was a pervasive optimism about the program—one pharmacist remarked that the CCMDD was a transformation of the pharmaceutical industry.

The program still faces implementation challenges, but I believe that the emerging health system in South Africa is stronger. The nation’s openness to change makes me hopeful for meaningful improvement on patients’ abilities to lead healthier lives.

The “After Burn” of Lessons Learned in Hospital Administration

Simon Bragg – Executive Director of Finance and Resources, East Coast Community Healthcare 

Now back in the UK, reflecting on my recent participation in the GHLI Health and Social Care Strategic Leadership Programme at Yale – I am thoughtful of the takeaways from my experiences with both the mental – and physical – aspects of my visit. 

I could wax lyrical about the softer benefits of the programme; the contacts made, the relationships forged and the cathartic nature of shared experiences.  It can be incredibly reassuring to meet like-minded individuals battling similar issues elsewhere in the health system. There is nothing like applying raw theory to a practical situation to embed the learning – and from the presentations provided by the course participants it was evident that our class had taken away a great deal from the course – not only about each other, but more about themselves!

The UK and the US are rather languidly referred to as nations divided by a common language, which works on the level of two health care systems divided in their foundations but united by a common purpose and sharing common issues.  The excellent site visits to regional health care facilities demonstrated that although hospitals seem to face some of the same challenges in both countries, the patient experience is at the heart of everything that we do.  The systems appear to be as similar as they are disparate.

I was inspired by the demonstrable, and personally evidenced, the important link between physical health and mental wellbeing on my professional performance in a leadership role.  Early morning exercise sessions were arranged for course participants and both me and my rapidly tightening muscles were heartened to learn that my invigorated metabolism continues to burn calories for many hours after exercise itself has ceased.  Like the continued burning of calories following exercise – the GHLI programme promotes the survival of mental acuity by delivering both an immediate intellectual perspective as well as a slower burn of on-going inquisitiveness; in short a full-on cerebral workout.

Why We Do What We Do: Marguerite M. Callaway

Growing up in Southern Arizona near the Mexican border, Marguerite Callaway was exposed to many cultures, which ultimately influenced her decision to pursue graduate education in international nutrition, cognitive and developmental psychology, and business. Her career includes position in executive leadership and and partnerships in several international management consultancies, which led to Callaway founding her own leadership institute. 

Callaway currently partners with the GHLI on the Advanced Health Management Program in South Africa.  In this role, Callaway says she had to find the balance with her sphere of concern (global) with her sphere of influence (local).

Callaway shares three insights she has learned in her years as a health care professional:  1) Unfamiliar circumstances often cause discomfort. The more aware we are of how core beliefs affect our personal and professional behavior, the greater our capacity to excel in the global community; 2) When working across cultures, our preferred method may seem efficient, but these assumptions can create barriers to ingenuity; 3) Good intentions and the right motivation are important, but practical skills are a necessity in the health care field.

Callaway emphasizes that the success of any health care initiative depends on how well we listen and adapt to meet the needs of our beneficiaries. She notes that GHLI staff hear what our partner’s goals are and don’t apply ‘cookie cutter’ solutions to its various programs around the globe.  She says that workers/educators “from the outside” can offer insight, tools, and, especially, encouragement to help local partners carry the work forward.   She cites GHLI’s South African partner, the Foundation for Professional Development, of which several of the training course graduates have gone to leadership positions with the provincial departments of health.

When asked what she likes most about her work, she offered: “being involved with GHLI long enough to see many of the graduates of our programs move into ever-greater positions of responsibility and impact. I am inspired by each new group of men and women who enroll in our management training programs. I know the GHLI model of engagement works.”