Global Health Nursing: Building and Sustaining Partnerships
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ISBN 13: 9780826118684
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Cherlie Magny-Normilus, PhD, FNP-BC - Google Scholar Citations
During the first fifteen years of this century, global health programmes in high-income countries HICs , especially in United States universities, have grown rapidly [ 1 , 2 , 3 ]. While addressing the health inequalities between HICs and low- and middle-income countries LMICs appears to be a key motivation among many global health programmes, Macfarlane et al.
In this paper we shift our attention to the international partners and examine responses to two questions. One, why did the international partners enter into the partnerships? Two, what do they perceive to be the benefits of the partnerships? First, however, we will introduce an analytical framework which we have found helpful for analysing partnerships. Administration units and centres are also within universities. Considering these individuals within a framework for examining universities may be helpful. It includes funding from non-traditional sources such as industrial firms, local governments, philanthropic foundations, royalty income from intellectual property, earned income from campus services, student fees, and alumni fundraising [ 11 ].
Because these four elements tend to diverge in priorities and modes of operating, their coordination or lack thereof is also important. If a university fails to integrate the four elements sufficiently well, it will not maximize its ability to become an entrepreneurial university. This was a qualitative study based on key informant interviews KIIs and subsequent qualitative analysis.
This paper reports on the perspectives of the international partners. The general characteristics of the partnerships identified by the four focus universities were reported previously [ 4 ]. Representatives were selected based on a variety of criteria beginning with representatives from higher-value partnerships, as perceived by the senior representatives of the four focus universities. Three 3 of the representatives were from medium-valued partners and one 1 from a lower-valued partnership.
The non-higher-value representatives were interviewed to gain the international partner perspective on specific unusual partnership issues. The decision was made to focus primarily on partner universities — 21 of the 26 universities represented in Phase 3 - involved in higher-value partnerships with the four focus East African universities since these were the universities the senior representatives and other representatives of the focus East African universities generally provided the most information about during Phases 1 and 2 of the study, respectively.
As noted above and below, representatives from five additional universities were interviewed to gain additional perspectives on issues considered particularly noteworthy because they were unusual. Others were identified during the literature review, preliminary discussion or main interview of a lead representative of the partnership from the international university, and during conferences and the work of the lead author AY.
Among university administrations involved in the global health work of European and North American universities, only two respondents were interviewed [ 5 ]. In addition, two representatives from two universities newly partnered with one of the four focus universities, but not mentioned by their representatives in Phase 1, were opportunistically identified and interviewed. We developed a semi-structured interview guide for the individual in-depth interviews.
KIs were typically asked additional questions specific to their partnerships. These questions are not presented in the interview guides to better ensure confidentiality. Initial interviews were conducted between March and November Follow-up interviews were conducted and emails exchanged into to gather additional details and clarify issues.
All interviews were transcribed and analysed. In addition, follow-up was done by voice and email communication to clarify anything that was unclear. Thematic content analysis was conducted [ 12 ] on all the transcriptions. One of us AY reviewed each transcript and coded them using Atlas.
Janet L. Larson, PhD, RN, FAAN
Written informed consent was presented, requested and granted by all participants in this study. The most critical ethical issue was preventing attribution of specific comments to specific individuals since the study included relatively few universities, partnerships and representatives. In this phase of this study, we sought to minimize this risk by increasing the number of partner universities and representatives from them interviewed. In those few circumstances when we felt this standard might not be met, we contacted the individual s to determine if they wished to include a clarifying statement or rebuttal.
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In some cases, a representative or representatives of the international partner approached representatives of the focus university directly to propose partnering. In other partnerships, a representative of the focus university approached a representative of the international partner. In still other cases, there was an intermediary; for example, a representative of the World Health Organization WHO , a donor agency, a colleague or a relative who made introductions or encouraged a meeting.
Other times, as in the case of Dalhousie University and MUHAS, a director of a nursing programme in an HIC met a former student now based at an LMIC university at a conference and they agreed to address a need through a joint project partnership [ 13 ]. Each partnership had its unique history that includes a variety of actors, motivations and serendipitous events. Often the stories are long and rich [ 14 , 15 ]. Depending on the specific type of partnership [ 5 , 16 ], the importance of the contextual issues within the East African partner country varied for the international partner.
For example, the stability of the country and resulting security for visiting representatives were important in all cases, although the degree of importance varied to some degree depending on whether or not students, especially undergraduate students, were likely to participate in addition to faculty.
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Some international partners that planned to have their representatives reside on-site for many months or years mentioned that the level of development of the specific locale of the university needed to be sufficient to make it desirable for potential accompanying family members.
Other representatives within the same partnerships considered the quality of primary and secondary schooling available if they had children of school age. Some international partners were interested in a specific area of medicine; for example, ophthalmology, internal medicine, or cardiology. We knew we'd only get one chance at this [idea of establishing a long-term partnership]. We were not experts in global health. As you know, global health wasn't even a term back then. I think we called it international health or international medicine, these sorts of things.
We knew though that we would only get one chance at success here. We were kind of pushing our own school about as far as they could be pushed. Even as far as they could be pushed, even though they weren't really supporting us. These all came from the division.
You do all of that but I support you …. Many international partners were motivated to establish and sustain partnerships with the East African universities by their desire to provide members of their academic heartland, faculty and students, with opportunities to conduct research and to provide trainees with educational opportunities of interest to them. Somewhat less common but still an important theme, however, was the desire expressed by several representatives to be socially responsible.
The need to form partnerships to secure grants was also found to be a motivating factor for establishing new international partnerships. Oversight in terms of guidance to minimize and manage risks associated with international partnerships activities was also observed by the Central Administration within the Steering Core. The examples below illustrate how these themes were articulated by respondents in recounting the histories and importance of the partnerships to their institutions, units, or programs of work.
Research motivated many universities, especially research focused universities, to partner internationally. Harvard representatives indicated that the university tends to lead with research when it comes to partnering internationally, although training and education activities and public health practice i.
The professor asked Duke representatives based at MUHAS if they were interested in partnering with the new medical school. Following this request, a number of Duke representatives started partnering with representatives at KCMC. The starting point of the initiative of the training relationship between the university and hospitals was basically the relationship between Kenyatta Hospital and University of Nairobi and Munich, and it is down to personal initiative of … [one individual — a German ophthalmologist] who spent time in Africa and started with the idea that it could be a good idea to join the two [universities] together.
Though I could have partnered anywhere, or at least in many different places. Other international partner study participants either stated directly or tacitly that it was important to support the development of the focus university and their teaching hospitals as AHSCs, and the tripartite mission of education, research and service that AHSCs embody [ 18 ]. It was really for us a question of how to ethically support an engagement but also how do you ethically provide and ensure that you're just not passing your students off overseas - charging them tuition and making them somebody else's responsibility and relying on their hospitality to do so.
The model by which request for proposals are structured, in such a way that the South to South universities get together to put together a proposal in capacity building that you can then offer to a funder in the Global North is the creme de la creme of capacity building. I brought all deans together. We all have gaps. We sat together to build a proposal. Makerere is strong in Epidemiology. We have to sort of insert HIV periodically into things. Yes, that's important for HIV. Giving people primary care and screening them for their hypertension and diabetics, that's probably important for HIV infected people.
I see this the programme I lead as a global program but I'm also realistic that to get the funding, we have to sometimes direct [our writing] towards an interest [of the donor]. While many representatives stated they learned much through their partnerships with the focus universities there was only one, very limited, example of reverse innovation mentioned by a study participant from an international partner. This leads us to the issue of who specifically at the international partner universities is involved, in whole or in part, in establishing the partnership and the perspective that each of these individuals brings based on their values, life experience and the position they hold at their university.
Education — respond to trainee interest. Development Periphery — centres and programmes engaged in outreach. Diversified Funding Base — additional to traditional government sources and overhead from research grants. Funding a.