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Global Health Delivery Project

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The Global Health Delivery Project is a project at Harvard University that aims to improve health among disadvantaged populations worldwide by systematizing the study of global health delivery and rapidly disseminating knowledge to practitioners. GHD was founded in 2007 by Dr. Jim Yong Kim, Dr. Paul Farmer and Harvard Business School Professor Michael Porter. It operates with guidance from four pillars: Harvard Medical School, Harvard School of Public Health, Brigham and Women’s Hospital and Partners in Health.

During the twenty-first century substantial new resources were committed to global health. Between 2003 and 2005 alone, global health spending on HIV/AIDS almost doubled, from USD 4.2 billion to USD 8.3 billion. Some have called this the "golden age of global health."[1] Despite this Many universities are also developing programs aimed at training practitioners to work in the field of "global health."[2]

This new attention to global health is encouraging, yet large gaps remain between aspirations and health outcomes. The largest failings are seen in the delivery of health services, which has not attracted much academic attention. The Global Health Delivery Project at Harvard University (GHD) applies a multidisciplinary approach to studying health care delivery successes and problems in resource-poor settings. GHD shares the knowledge it generates through diverse channels to enable current and future practitioners to design, implement and improve delivery programs that maximize health benefits for vulnerable communities.

The evidence base on effective public health interventions has grown increasingly robust. Too often, however, the implementation of proven interventions still falls short, especially in resource-constrained settings. Closing this gap between knowledge and practice requires building a field of study in health delivery. GHD’s contribution to this research is based on principles developed by the organization’s cofounder, Michael Porter[3]:

  • Program case studies spanning multiple settings, and encompassing both successes and failures, are primary tools for analysis and teaching.
  • In-depth field research focuses on the role of organizational leaders and their choices; studies are conducted in context and employ quantitative and qualitative analysis.
  • Analytic frameworks are developed that can be applied prospectively to guide practice; frameworks are tested and refined in collaboration with practitioners delivering programs in country settings.


Projects

GHD Case Studies

GHD develops global health case studies for the GHD curriculum and education programs, as well as contributing research tools in developing frameworks for health care delivery. GHD has developed more than 26 cases on topics, such as HIV/AIDS, malaria, tuberculosis, polio, maternal and child health, nutrition and tobacco control. The case studies follow the Harvard Business School model[4] to explore successes and failures in health care delivery. They provide a strategic understanding for the creation, scaling-up, and replication of programs and services by documenting the experiences of health care programs and organizations in the field, and examining the role of diverse factors on program strategy, design, and implementation.

GHD Education

GHD offers a health care delivery course for Harvard undergraduates, and graduate courses at Harvard Medical School and the Harvard School of Public Health. The Global Health Effectiveness Program, piloted in 2009, consists of an intensive 3-week session with classes in epidemiology, management science and GHD case studies. The inaugural class included 26 students and 6 visiting faculty from 17 different countries. At Harvard Business School, the GHD curriculum has been included in health care delivery immersion and global health management courses. GHD also teamed up with the MIT Sloan School of Management on its flagship Global Entrepreneurship Lab course. GHD is building executive education programs, and in June 2010, will offer a specialized program designed for the senior-most malaria global policymakers, national program leaders, and practitioners in resource-limited settings.

GHDonline

GHDonline is an open collaboration platform developed by and for a diverse community of global health implementers and practitioners. GHDonline members share proven practices, connect with colleagues, and find tools to improve health outcomes in resource-limited settings. Each of the site’s six public communities focuses on a critical delivery challenge and is guided by a team of expert moderators. GHDonline also hosts more than 20 private communities designed and maintained for specific organizations and collaborative initiatives. Currently, GHDonline has more than 2,400 members from 120 countries, representing 877 organizations and institutions. GHDonline began a partnership with UpToDate®, Inc. to manage their UpToDate® Grant Program. Organizations providing medical services in resource-limited settings will apply for a limited number of free subscriptions to UpToDate®, an online evidence-based, peer-reviewed information resource for clinicians. The Program is being managed and provided via GHDonline.

GHD Research

GHD research focuses on understanding and exploring solutions to the complex biological, social, economic and political problems involved in health care delivery. GHD is developing a series of Care Delivery Value Chains to demonstrate the typical flow of goods, services and patients in resource-limited settings. The resulting information is used to examine the points where patients access preventive and curative care services, where value is either captured or lost, and the effect each step has on patient outcomes and overall value to the system.

Through the World Health Organization’s “Maximizing Positive Synergies Project,” GHD managed a 14-institution academic consortium, which investigated the interactions between Global Health Initiatives and Health Systems to identify synergies that can strengthen health systems. In preparation for the G8 Summit in July 2009, Julio Frenk, Dean of the Harvard School of Public Health, presented results from the consortium’s work to a global audience of Ministers of Health. GHD continued this research effort in collaboration with the Global Fund to Fight AIDS, TB and Malaria. In 2009, GHD began work with the Gates–Avahan India Initiative to examine large-scale HIV prevention. It examined Avahan’s innovative approach to rapidly create a large-scale HIV prevention program and similar efforts elsewhere to document and disseminate lessons around strategy, management and implementation of large-scale HIV prevention programs that can be applied to other public health efforts.

Publications

From a declaration of values to the creation of value in global health: A report from Harvard University’s Global Health Delivery Project, J. Y. Kim; J. Rhatigan; S. H. Jain; R. Weintraub; M. E. Porter Global Public Health: An International Journal for Research, Policy and Practice, December 14, 2009
Venice Statement on global health initiatives and health systems, Atun R, Dybul M, Evans T, Kim JY, Moatti JP, Nishtar S, Russell A. Lancet, September 5, 2009
assessment of interactions between global health initiatives and country health systems, World Health Organization Maximizing Positive Synergies Collaborative Group, Samb B, Evans T, Dybul M, Atun R, Moatti JP, Nishtar S, Wright A, Celletti F, Hsu J, Kim JY, Brugha R, Russell A, Etienne C. Lancet, June 20, 2009
GHIs Impact on the Rwandan Health System: A mixed methods analysis (PDF), Mukherjee JS, JG Jerome, E Sullivan, MA May, A Mayfield, W Lambert, N Dhavan, N Carney, J Rhatigan, LC Ivers World Health Organization, June 2009
Haiti: Maximizing Positive Synergies between Global Health Initiatives and the Health System (PDF), Ivers, Louise C., JG Jerome, E Sullivan, JR Talbot, N Dhavan, M St Louis, W Lambert, J Rhatigan, JY Kim, JS Mukherjee World Health Organization, June 2009
Kenya: The Impact of Global Health Initiatives on the Health System (PDF), Rhatigan, J., E Sullivan, K ole-MoiYoi, G Kimathi, N Dhavan, E Kabiru World Health Organization, June 2009
Applying the Care Delivery Value Chain: HIV/AIDS Care in Resource Poor Settings (Working paper), Joseph Rhatigan, Sachin Jain, Joia S. Mukherjee, and Michael E. Porter Harvard Business School, April 3, 2009
Delivering Global Health, Sachin Jain et al. Student BMJ, June 2008
The Obstacle Source, The most critical roadblock to delivering care in the developing world is not money, but an implementation bottleneck, Jim Yong Kim Harvard Medical Alumni Bulletin, 2007

References

  1. ^ The Research Channel. "The Golden Age of Global Health." 2007 http://www.researchchannel.org/prog/displayevent.aspx?rid=16142
  2. ^ Brown, T. et al. The World Health Organization and the Transition from 'International' to 'Global' Public Health. American Journal of Public Health, 2006; 96(1):62-72.
  3. ^ Porter, ME. "What is Strategy?" Harvard Business Review. http://hbr.org/product/what-is-strategy/an/96608-PDF-ENG?Ntt=what%2520is%2520strategy&referral=00269&cm_sp=endeca-_-spotlight-_-link
  4. ^ Harvard Business School Learning in Practice http://www.hbs.edu/learning/case.html
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