10 Fixes for Global Health Consulting Malpractice (3)

14 September, 2019

Dear Julie

Thanks so much for highlighting this paper on 10 fixes for global health consulting to avoid the risk of colonialism. I've two reflections:

1. There are models other than university-led or consulting firm-led! I am part of an international clinical network with the ambition to improve clinical behaviour to improve outcomes- in our case in respiratory health outcomes. What we know is that we're dealing with uncertainty. Many consulting models don't handle that well, and universities have a ready solution- more research (I'm not suggesting there isn't a need, but it's not the only need). The vast majority of our network are practising primary care clinicians (and the majority are qualified family physicians) from 35+ countries with a passion for improving respiratory health and,

most importantly, for learning from each other: how do you diagnose with words only; how do you inform people with low health literacy; how do you provide treatment when the drugs.

e.g. asthma inhalers aren't accessible; how do you use all the assets- including patients, carers, pharmacists, nurses, CHWs, family physicians, GPs etc) you have in the community to improve outcomes; how do you address complexity such as poverty, outdoor and indoor air pollution from smoking, biomass and transport and

multi-morbidity and gender inequity in a short consultation when the status of primary care remains low in many countries and the concept of continuity of care is hard to achieve? What many of our colleagues want is to share experience, to find strong role models, to build leaders, teaching capacity and recognition. A clinical network stands more chance of achieving that than a consulting or university model. We don't do so much travelling- it doesn't fit the day job; but we do use Zoom a lot, and we do ask for stories and photos so that we can understand each country context. But it's still very hard to fund.

2. I have a question. In my limited experience, there is a gender bias in this global health world. Whilst the bulk of the world's health care providers are women, it seems to me that there are far more men in senior advisory positions. If travelling and spending time in-country is a requirement (one of the top ten fixes) is that one of the reasons why? My instinct is that even if their experience, communication skills and insight are equal, there are more women than men who are juggling the demands of being a carer at home and aren't able to commit to these requirements.

I truly welcome debate- am I being unfair? If not, how do we overcome it?


HIFA Profile: Sian Williams is Executive Officer at the International Primary Care Respiratory Group in the UK.

Professional interests: Implementation science, NCDs, primary care, respiratory health, education, evaluation, value, breaking down silos.

Email: sian.health AT gmail.com