R. Weintraub

From a declaration of values to the creation of value in global health: A report from Harvard University's Global Health Delivery Project

Abstract To make best use of the new dollars available for the treatment of disease in resource-poor settings, global health practice requires a strategic approach that emphasises value for patients. Practitioners and global health academics should seek to identify and elaborate the set of factors that drives value for patients through the detailed study of actual care delivery organisations in multiple settings. Several frameworks can facilitate this study, including the care delivery value chain. We report on our efforts to catalyse the study of health care delivery in resource-limited settings in the hope that this inquiry will lead to insights that can improve the health of the neediest worldwide.

Addressing the challenges of diagnostics demand and supply: insights from an online global health discussion platform

Several barriers challenge development, adoption and scale-up of diagnostics in low and middle income countries. An innovative global health discussion platform allows capturing insights from the global health community on factors driving demand and supply for diagnostics. We conducted a qualitative content analysis of the online discussion ‘Advancing Care Delivery: Driving Demand and Supply of Diagnostics’ organised by the Global Health Delivery Project (GHD) (http://www.ghdonline.org/) at Harvard University. The discussion, driven by 12 expert panellists, explored what must be done to develop delivery systems, business models, new technologies, interoperability standards, and governance mechanisms to ensure that patients receive the right diagnostic at the right time. The GHD Online (GHDonline) platform reaches over 19 000 members from 185 countries. Participants (N=99) in the diagnostics discussion included academics, non-governmental organisations, manufacturers, policymakers, and physicians. Data was coded and overarching categories analysed using qualitative data analysis software. Participants considered technical characteristics of diagnostics as smaller barriers to effective use of diagnostics compared with operational and health system challenges, such as logistics, poor fit with user needs, cost, workforce, infrastructure, access, weak regulation and political commitment. Suggested solutions included: health system strengthening with patient-centred delivery; strengthened innovation processes; improved knowledge base; harmonised guidelines and evaluation; supply chain innovations; and mechanisms for ensuring quality and capacity. Engaging and connecting different actors involved with diagnostic development and use is paramount for improving diagnostics. While the discussion participants were not representative of all actors involved, the platform enabled a discussion between globally acknowledged experts and physicians working in different countries.

Implementation of electronic medical records requires more than new software: Lessons on integrating and managing health technologies from Mbarara, Uganda

Implementation lessons: • Technology alone does not necessarily lead to improvement in health service delivery, in contrast to the common assumption that advanced technology goes hand in hand with progress. • Implementation of electronic medical record (EMR) systems is a complex, resource-intensive process that, in addition to software, hardware, and human resource investments, requires careful planning, change management skills, adaptability, and continuous engagement of stakeholders. • Research requirements and goals must be balanced with service delivery needs when determining how much information is essential to collect and who should be interfacing with the EMR system. • EMR systems require ongoing monitoring and regular updates to ensure they are responsive to evolving clinical use cases and research questions. • High-quality data and analyses are essential for EMRs to deliver value to providers, researchers, and patients.

When scaling prevention means scaling demand: Voluntary medical male circumcision in Nyanza Province, Kenya

Abstract Implementation lessons • Generating demand is an important part of the care delivery value chain. When new health interventions are designed based on recent clinical trial findings, demand generation activities prove all the more critical. • Demand generation activities need to iterate on their design, and tailor to the risk profile of target populations. • Leaders need to balance fidelity to a model and local innovation. • Cultural and contextual factors must be considered in designing public health campaigns.

Strategic, value-based delivery in global health care: innovations at Harvard University and Brigham and Women's Hospital.

Investments in global health have more than doubled over the past decade, generating a cadre of new institutions. To date, most of the funded research in global health has focused on discovery, and, more recently, on the development of new tools, which has tightened the implementation bottleneck. This article introduces the concept of global health delivery and the need to catalog and analyze current implementation efforts to bridge gaps in delivery. Global health delivery is complex and context-dependent and requires an interdisciplinary effort, including the application of strategic principles. Furthermore, delivery is necessary to ensure that the investments in research, discovery, and development generate value for patients and populations. This article discusses the application of value-based delivery to global health. It provides some examples of approaches to aggregating implicit knowledge to inform practice. With global health delivery, the aim is to transform global health scale-up from a series of well-intentioned but often disconnected efforts to a value-based movement based upon 21st-century technology, standards, and efficiency.

Evidence-based medicine for all: what we can learn from a programme providing free access to an online clinical resource to health workers in resource-limited settings

The rapidly changing landscape of medical knowledge and guidelines requires health professionals to have immediate access to current, reliable clinical resources. Access to evidence is instrumental in reducing diagnostic errors and generating better health outcomes. UpToDate, a leading evidence-based clinical resource is used extensively in the USA and other regions of the world and has been linked to lower mortality and length of stay in US hospitals. In 2009, the Global Health Delivery Project collaborated with UpToDate to provide free subscriptions to qualifying health workers in resource-limited settings. We evaluated the provision of UpToDate access to health workers by analysing their usage patterns. Since 2009, ∼2000 individual physicians and healthcare institutions from 116 countries have received free access to UpToDate through our programme. During 2013–2014, users logged into UpToDate ∼150 000 times; 61% of users logged in at least weekly; users in Africa were responsible for 54% of the total usage. Search patterns reflected local epidemiology with ‘clinical manifestations of malaria’ as the top search in Africa, and ‘management of hepatitis B’ as the top search in Asia. Our programme demonstrates that there are barriers to evidence-based clinical knowledge in resource-limited settings we can help remove. Some assumed barriers to its expansion (poor internet connectivity, lack of training and infrastructure) might pose less of a burden than subscription fees.

GHDonline.org: an innovative technology to leverage the wisdom of the crowds and improve global health delivery

Abstract Background In 2008, the Global Health Delivery Project at Harvard University launched an online platform to generate and disseminate knowledge in health-care delivery. We borrowed a common instrument from business—professional virtual communities—used for knowledge management and exchange across multiple organisations, industries, and geographies. We adapted the concept for health care to leverage the wisdom of the crowds and create a rapid, practical means for diverse professionals to share insights and tactics. Methods A team of engineers, implementers, and providers built a lightweight platform, accounting for the reality of sporadic electricity service or restricted internet bandwidth in resource-limited settings and launched GHDonline in June, 2008. To foster reliability and engagement, the communities were led by expert moderators, discussions were open to all, and there was no anonymous posting. Findings Even with early successes—membership growth and daily postings to communities—user feedback and analytics encouraged the team to iterate on GHDonline. Nuanced and in-depth conversations in the communities were turned into discussion briefs—summaries of the conversations reviewed by experts. GHDonline launched new public communities based on the most pressing concerns in the specialty, and organised more than 40 virtual expert panels. As of February, 2014, GHDonline hosted more than 11 000 members across 180 countries, in 12 public and 86 private communities. GHDonline is now expanding its offering to launch GHDonline communities for US-based practitioners. Interpretation The increased use of GHDonline by health-care implementers suggests that professional virtual communities can be a valuable instrument to disseminate best practices, support collaboration between colleagues, and improve care delivery. Funding Abundance Foundation.