Conference Report: Global Health Education Ireland (GHEI) Symposium 2021

This conference report comes with a clear warning. Global Health is a large and compelling area of healthcare. Should you dip into it in any detail, you might find yourself getting deeply involved before you know it.

GHEI 2021 was hosted by the ICGP on October 22 as an online symposium. Run by the Global Health Committee (chaired by Dr David Weakliam) at the Forum of Irish Postgraduate Medical Training Bodies, this was the third, having been hosted previously by the College of Anaesthesiologists of Ireland, and the RCSI.

While there is a clear focus on educational aspects of Global Health, the Symposium draws from a wide range of project work around the globe.

The GHEI 2021 Management Group at the ICGP was led by Dr Stephen Brennan, who is also Clinical Lead at the ICGP Special Interest Group for Global Health: “In 2018, the Forum of Irish Postgraduate Medical Training Bodies established a Global Health Strategic Working Group. The Forum brings all the medical specialities together with a shared vision and ambition to improve healthcare in less developed countries as well as in Ireland. Our primary focus is on the education and training of health professionals in low and middle-income countries. We also seek to educate health professionals in Ireland with global health competencies so as to better serve patients in our own health service.”

An overarching theme for all of the GHEI Symposia has been the delivery of Sustainable Development Goal 3 (SDG 3) of the WHO, which is access to good health and well-being for all. Hosted by the ICGP, a strong emphasis on Primary Care Global Health was no surprise at GHEI 21. “Some of us are of the view that the key conclusion from Prof Barbara Starfield’s work holds especially true for Global Health, that Health Systems which provide good access to well organised primary healthcare have better population health outcomes, and at lower cost,” observed Dr John Morris, Global Health Fellow at the ICGP, and a key member of GHEI 2021 Management Group at the ICGP. GHEI 21 comprised three plenaries and 10 breakout sessions, seamlessly delivered by ICGP Education.

The Symposium was formally opened by An Tánaiste, Mr Leo Varadkar.

“Today, we are delighted to engage in shared reflections and experiences in Global Health Education, understanding that effective evidence-based education is a key enabler for sustainable improvement, and for better population health outcomes, at affordable cost,” he observed, welcoming over 300 online delegates from home and abroad.

He reached out particularly to those working in health systems in low and middle-income countries. “While we have been successful (in Ireland) in many respects, there have been mistakes along the way. We closely identify with all young and establishing societies, as they endeavour to provide a safe, healthy and secure future for their own citizens, in difficult and uncertain times. Our national consciousness is attuned to the reality of demographic displacement, given periods in our own history, when many Irish people fled famine, persecution and economic depression at home.

“We are keen to share our own experiences with you, both the good ones and the unfortunate ones. We are particularly keen to learn how to improve the experience of all global citizens, working together as individuals, teams, agencies and colleges, as collaborators, and ultimately, as organising societies.”

Chart 1
Note: In some countries, local governments play a key role in financing and providing childcare services. Such spending is comprehensively recorded in Nordic countries, but in some other (often federal) countries it may not be fully captured by the OECD social expenditure data.

In wishing the work of the symposium well, he observed: “The evidence shows that what transacts in community clinics, in villages, in camps, in townships, in mobile clinics, and increasingly through a rapidly expanding network of telemedicine hubs, is at least as important as what transacts in hospitals and in secondary care.”

Plenaries were themed around building resilience in Global Health Systems, Covid-19 and Vaccine Equity, and the development of a Competency-Based Global Health Curriculum, for all Specialty Trainees in Ireland.

Chart 2
Note: In some countries local governments play a key role in financing and providing childcare services. Such spending is comprehensively recorded in Nordic countries, but in some other (often federal) countries it may not be fully captured by the OECD social expenditure data.

The first plenary on resilience was facilitated by Dr Deirdre Collins, Chair at ICGP Educational Governance, and on Board at ICGP, who outlined the growing importance of and commitment to Global Health at the ICGP, as she introduced Prof. Jeoffrey Braithwaite, Prof. Sir Michael Marmot and Dr Mike Ryan, Executive Director of Emergency Programs at the WHO.

In his introduction, Professor Braithwaite, President of ISQua (The International Society for Quality in Healthcare) noted the remarkably low level of investment in early childcare and education in Ireland (see tables).

Remarking on resilience, Dr Mike Ryan observed that for him, ‘being able to move resources rapidly and correctly around the system in a crisis was key for a truly resilient health system’.

The second plenary focused on vaccine equity, or perhaps more accurately, on vaccine inequity. In delivering a Country Report from Zambia, Dr Viktor Mukonka observed that to date, just over 2% of the target population had been fully immunised against Covid-19, compared to close on 90% in many affluent societies.

The third plenary focused on the Global Health Curriculum for Specialty Trainees, and included the background to the development of the curriculum delivered by Dr Niamh McCarthy, Co-Chair of the Strategic Curriculum Development Group at the Forum and Psychiatry Registrar with the HSE.

The work of this is well advanced, including inputs from a wide range of experts and stakeholders, and formal input from Dr Vincent Jumbe (Public Health, Research and Bioethics) and Dr Jane Bates (Family Medicine, University of Malawi), in an earlier breakout session.

Breakout sessions focused on specific projects from around the world. Dr Ide Delargy outlined the development of an education program in Pakistan to support Primary Care Physicians in their care of opiate dependent children, drawing from experience at the ICGP Addiction Management in Primary Care Program. Dr Joe Gallagher, Mr Hastings Gondwe and Dr Vincent Jumbe outlined and commented on the latest developments at The Gorey Malawi Partnership, including a series of collaborative brief training videos designed to assist health services best respond to the destructive impact of the pandemic on community and hospital clinics.

Originally produced with Malawi in mind, they have been downloaded over 2 million times, largely throughout sub-Saharan Africa. Dr Gallagher also outlined the process of online mentoring and collaboration which is a central and long standing feature of the GM partnership, most recently in a regional program to improve medical care for people with Rheumatic Heart disease (RHD).

RHD remains a major cause of excess morbidity and mortality in many LMICs, particularly Africa. In this, the use of bedside portable ultrasonography was demonstrated by Hastings Gondwe, and commented upon by Dr Vincent Jumbe, with particular reference to a range of other tasks and services which are under consideration for Taskshifting directly into the community within the Malawi Health System.

A broad range of other agencies and projects were highlighted throughout the sessions, including the work of Ms Phyllis Kisa, a graduate of COSECSA and now leading her own Unit for Paediatric Surgery at University of Makere Uganda, Prof Clare Nourse (www.maluktimor.org), Dr Ronan McSharry and colleagues in Zambia (www.nericlinics.org), the work of Atlantic Humanitarian Relief (www.atlantichumanitarianerelief.org) in Jordan, and a focused reflection on decolonising Global Health led by Prof. Ann Nolan (Trinity College Dublin) and colleagues. Registrants will be able to view all sessions subsequently on www.icgp.ie, in the ICGP SIG Global Health pages.

“Of course you don’t have to travel at all to be a Global Health Practitioner,” observed Nadine Ferris France at The Irish Global Health Network (www.globalhealth.ie) at a previous GHEI Symposium. “You can campaign, fundraise, research, engage in collaborative education, influence and reach out through a range of projects, with all of the skills, knowledge and experience you have.” The Symposium Anthem was ‘Choose to Dance,’ by Eimear Crehan and also performed by the Suso and Xvandiri Youth Choirs.

References
Chart 1

• (a) Data for Romania and Cyprus refer to 2018 and for Australia to 2016.
• (b) For non-OECD EU member states (Cyprus and Romania), the data are not are not adjusted for any differences in the entry age for primary schooling and cover all public expenditure on childcare and pre-primary education regardless of the age of those using/enrolled in services.
• (c) Data cannot be disaggregated by educational level. The present publication presents time series which end before the United Kingdom’s withdrawal from the European Union on February 1, 2020. The EU aggregate presented here therefore refers to the EU including the UK. In future publications, as soon as the time series presented extend to periods beyond the UK withdrawal (February 2020 for monthly, Q1 2020 for quarterly, 2020 for annual data), the “European Union” aggregate will change to reflect the new EU country composition.
  Source: For OECD countries, OECD Social Expenditure Database; For Cyprus and Romania, Eurostat.

Chart 2

• (a) Data for Australia refer to 2016.
• (b) Data cannot be disaggregated by educational level. The present publication presents time series which end before the United Kingdom’s withdrawal from the European Union on February 1, 2020. The EU aggregate presented here therefore refers to the EU including the UK. In future publications, as soon as the time series presented extend to periods beyond the UK withdrawal (February 2020 for monthly, Q1 2020 for quarterly, 2020 for annual data), the “European Union” aggregate will change to reflect the new EU country composition.
  Source: OECD Social Expenditure Database.