Structural competency and global health education.

Structural competency is a new curricular framework for training health professionals to recognise and respond to disease and its unequal distribution as the outcome of social structures, such as economic and legal systems, healthcare and taxation policies, and international institutions. While extensive global health research has linked social structures to the disproportionate burden of disease in the Global South, formal attempts to incorporate the structural competency framework into US-based global health education have not been described in the literature. This paper fills this gap by articulating five sub-competencies for structurally competent global health instruction. Authors drew on their experiences developing global health and structural competency curricula-and consulted relevant structural competency, global health, social science, social theory, and social determinants of health literatures. The five sub-competencies include: (1) Describe the role of social structures in producing and maintaining health inequities globally, (2) Identify the ways that structural inequalities are naturalised within the field of global health, (3) Discuss the impact of structures on the practice of global health, (4) Recognise structural interventions for addressing global health inequities, and (5) Apply the concept of structural humility in the context of global health.

Entrustable Professional Activities (EPAs) for Global Health.

PURPOSE: As global health education and training shift toward competency-based approaches, academic institutions and organizations must define appropriate assessment strategies for use across health professions. The authors aim to develop entrustable professional activities (EPAs) for global health to apply across academic and workplace settings. METHOD: In 2019, the authors invited 55 global health experts from medicine, nursing, pharmacy, and public health to participate in a multiround, online Delphi process; 30 (55%) agreed. Experts averaged 17 years of global health experience, and 12 (40%) were from low- to middle-income countries. In round one, participants listed essential global health activities. The authors used in vivo coding for round one responses to develop initial EPA statements. In subsequent rounds, participants used 5-point Likert-type scales to evaluate EPA statements for importance and relevance to global health across health professions. The authors elevated statements that were rated 4 (important/relevant to most) or 5 (very important/relevant to all) by a minimum of 70% of participants (decided a priori) to the final round, during which participants evaluated whether each statement represented an observable unit of work that could be assigned to a trainee. Descriptive statistics were used for quantitative data analysis. The authors used participant comments to categorize EPA statements into role domains. RESULTS: Twenty-two EPA statements reached at least 70% consensus. The authors categorized these into 5 role domains: partnership developer, capacity builder, data analyzer, equity advocate, and health promoter. Statements in the equity advocate and partnership developer domains had the highest agreement for importance and relevance. Several statements achieved 100% agreement as a unit of work but achieved lower levels of agreement regarding their observability. CONCLUSIONS: EPAs for global health may be useful to academic institutions and other organizations to guide the assessment of trainees within education and training programs across health professions.

Evaluating the uptake, acceptability, and effectiveness of Uliza! clinicians' HIV hotline: a telephone consultation service in Kenya.

OBJECTIVE: Many clinical sites that serve patients who are HIV positive face challenges of insufficient staffing levels and staff training and have limited access to consultation resources including specialists on site. Uliza! (Swahili for "ask") Clinicians' HIV Hotline was launched in April 2006 in Nyanza province in Kenya as a HIV telephone consultation service for healthcare providers. Hotline users called an Uliza! consultant who discussed the patients' problems and helped the caller work through a solution, as well as reinforced national guidelines. This objective of this study was to evaluate the uptake, acceptability, and effectiveness of Uliza! MATERIALS AND METHODS: Consultants completed a form with details of each call, and healthcare workers completed satisfaction surveys during site visits. All available medical records were audited to determine whether the advice given by the consultant was implemented. RESULTS: After a year of service, Uliza! responded to 296 calls. Clinical officers (64%) followed by nurses (21%) most frequently used the service. Most callers had questions regarding antiretroviral therapy (36%) or tuberculosis (18%). Thirty-six percent of all consults were pediatric questions. Ninety-four percent of users rated the service as useful. Advice given to providers was implemented and documented in the medical records in 72% of the charts audited. CONCLUSION: Healthcare providers in HIV clinics will use a telephone consultation service when easily accessible. Clinicians using Uliza! found it useful, and advice given was usually implemented. Uliza! increased access to current information for quality care in a rural and resource limited setting and has potential for scale-up to a national level.

Shamba Maisha: a pilot study assessing impacts of a micro-irrigation intervention on the health and economic wellbeing of HIV patients.

BACKGROUND: HIV/AIDS negatively impacts poverty alleviation and food security, which reciprocally hinder the rapid scale up and effectiveness of HIV care programs. Nyanza province has the highest HIV prevalence (15.3%), and is the third highest contributor (2.4 million people) to rural poverty in Kenya. Thus, we tested the feasibility of providing a micro-irrigation pump to HIV-positive farmers in order to evaluate its impact on health and economic advancement among HIV-positive patients and their families. METHODS: Thirty HIV-positive patients enrolled in the Family AIDS Care and Education Services (FACES) program in Kisumu, Kenya were provided a micro-financed loan to receive an irrigation pump and farming guidance from KickStart, the developer of the pump. Economic data, CD4 counts, household health and loan repayment history were collected 12 months after the pumps were distributed. RESULTS: Mean annual family income increased by $1,332 over baseline. CD4 counts did not change significantly. Though income increased, only three (10%) participants had paid off more than a quarter of the loan. CONCLUSIONS: We demonstrated the feasibility of an income-generating micro-irrigation intervention among HIV-positive patients and the collection of health and economic data. While family income improved significantly, loan repayment rates were low- likely complicated by the drought that occurred in Kenya during the intervention period.