Our Work

Brazil

Global Health Certificate students spent 10 days in Rio de Janeiro, Brazil learning how an organization there called Saúde Criança helps families improve health outcomes by addressing social factors. 

Brazil

Saúde Criança, which means “Healthy Children,” is a 25-year-old program replicated across 31 countries in Africa, Asia, and Latin America. UMSON Global Health students returned from Brazil with a roadmap to improve conditions in Baltimore.

Liberia

The 14-year civil crisis in Liberia lead to the destruction of hospitals and clinics and the shut down of most educational programs, causing medical professionals to leave the country and a devastated economy. 

Liberia

In collaboration with Mother Patern College of Health Sciences in Liberia, UMSON proposed and helped implement a Primary Health Care Specialist master’s program to increase the competence of workers and quality of patient care. 

Rwanda

In 2012, Rwanda was fighting to train qualified health professionals to address critical global health issues of HIV/AIDS, malaria, chronic disease, and infant mortality. The Rwandan Ministry of Health's solution was to develop a well-educated workforce to provide safe and effective health care.

Rwanda

Through the program, Rwanda partnered with a dozen U.S. colleges and universities, including UMSON, to bring their faculty to schools and hospitals throughout the country. By the time UMSON's five-year participation ended, it had vetted and filled 36 faculty positions, the most of any participating institution.

Nigeria

In Nigeria, the main point of free, accessible health care is the primary health care center. Yet the quality of care available in these centers is often inadequate and contributes to the poor health outcomes found in the Nigerian population.

Nigeria

UMSON's Office of Global Health worked closely with the University of Maryland School of Medicine's Institute of Human Virology to develop the Primary Health Care Specialist Diploma program designed to rapidly and effectively address the immediate need for greater competency and skill development.

Building meaningful partnerships is a critical step in achieving social justice in global health.

UMSON's Office of Global Health is committed not only to advancing nursing skills, knowledge, and practice, but most importantly, collaborating with key institutions to meet identified nursing priorities.

We strive to create programs to improve population health outcomes and address the professional development and capacity of health care workers. The shared vision of all of our partnerships is to strengthen the global health care workforce by making the nursing role more visible, recognized, and valued in the health systems of key countries.

Brazil: Acting on the Social Determinants of Health (2016-Current)

A map of Brazil side-by-side a photo of UMSON students in Brazil.

Highlights

Read a recap of the summer site visit.

Background

Rio de Janeiro, Brazil faces challenges similar to Baltimore city with significant racial ethnic disparities, income inequality, poor health system accessible to the poor, crime, inflation, and rising unemployment. Further similarities between Brazil and Baltimore were highlighted following the death of Freddie Gray, when Brazilians actively responded and participated in the Black Lives Matter Movement. In Brazil, police committed more than 1 in every 6 of Rio de Janeiro's homicides between 2010 and 2013 with 90 percent of individuals slain being of African descent. Brazil is a diverse country with a population that is 47.7 percent white, 43 percent mixed/mulatto, and 7.6 percent black, and — similar to Baltimore — individuals of color disproportionately carry the burden of adverse health and social outcomes.

For the past 25 years, disadvantaged social groups in Brazil have benefited from Saúde Criança (SC), a social organization that has been recognized internationally for its innovative and impactful work, as demonstrated in this video.

SC began in Rio de Janeiro and their methodology has been replicated in 31 countries in Latin America, Africa, and Asia. They use as holistic, co-responsibility model to address the Social Determinants of Health (SDOH) for families of children with chronic diseases. The SC program focuses on building family capacity and developing a family action plan that leverages unique family strengths and relationships. They work with clients to develop goals and objectives for addressing five key areas of the SDOH:

  • Health (coordination of healthcare, psychological support, food, medicine, and nutrition)
  • Income generation (professionalism training and access to eligible income resources)
  • Housing (parent and child)
  • Education (parent and child)
  • Global citizenship (provisions of document necessary to be included in society and legal factors)

With improved access to necessary social resources, the families’ social networks are strengthened and families experience the benefits of increased social inclusion in their communities and society. Overall, the SC program has assisted over 70,000 families with an average of 600 families per year. It has demonstrated that sustainable positive health outcomes can be achieved by:

  1. breaking down barriers to social inclusion by providing resources to address the SDOH
  2. enhancing linkages to available health and social services
  3. empowering families with long-term, self-sustaining strategies to address social isolation and the SDOH.

Collaborative Goals

Since May 2016, the Office of Global Health has been working in partnership with the SA team to examine steps for culturally adapting their successful Brazil-based program model to the local context in Maryland. Our partners share the belief that this important endeavour to identify, prioritize, and eliminate the barriers to addressing the SDOH using a co-responsibility framework has the potential to influence the health of African-American families in Baltimore. SC and UMSON, with local stakeholders and mobilized community counterparts, will collaborate during the pre-implementation, implementation, and post-implementation phases of a feasibility study, which include activities to modify existing program components and develop appropriate evaluation tools for a Baltimore-based program. This model innovated in the Global South offers a fresh evidence-based approach and key lessons to empower communities in the Global North who are also experiencing disproportionate health disparities and encountering persistent health inequity and social injustices. 

Liberia: Filling the Health Care Workforce Gaps (2012-Current)

A map of Liberia with capital, Monrovia, highlighted.

Highlights

  • Assessing barriers to retention in HIV care in Monrovia, Liberia. Grant funded by UMB Center for Global Education Initiatives for interprofessional students to explore the context of care, barriers to HIV/other care, and the impact of the social determinants on HIV care and treatment in a developing country in West Africa. Students compared and contrasted the similarities/differences between Monrovia, Liberia and Baltimore, Maryland as it relates to HIV care, treatment, and support (2017).
  • Post Ebola Health System Strengthening - Neonatal Nurse Training Program (photos). Catholic Relief Services. Development and Implementation of a post-graduate training module for neonatal nurses in collaboration with Catholic Relief Services and Mother Patern College of Health Sciences, Monrovia, Liberia (2016).
  • Presentations prepared for UMB Ebola Symposium: "Ebola: Who is Under the Personal Protective Equipment in Liberia" and "The Impact on Nursing Workforce Locally and Globally" (2014).

Background

The 14-year civil crisis in Liberia lead to the destruction of hospitals and clinics and the shutdown of most educational programs, causing medical professionals to leave the country and a devastated economy. With a life expectancy of 63 years of age and an infant mortality rate of 24th in the world, Liberia is struggling to address the basic health needs of its current population. Registered nurses (RNs), midwives, and physician assistants (PAs) account for 70 percent of the health care workforce and are the backbone of the health sector often working in rural, underserved communities, with a scarcity of physicians. Within these settings, nurses and PAs routinely engage in clinical and public health leadership responsibilities above and beyond their training and education in order to address the high burden of disease presenting at all levels of the health care system.

During the Ebola Virus Disease (EVD) outbreak of 2014, nurses/midwives and non-professional healthcare workers proved to be loyal and committed to the communities that they serve. Despite valiant efforts that saved lives, gaps in nursing capacity and suboptimal competencies became increasingly visible. To build a strong healthcare system that is ready, motivated, and competent to deal with current and unanticipated health challenges, nursing and other health professionals’ capacity and competency must be optimized. By doing so, Liberia can increase its capacity to respond and adapt to planned and unplanned needs, and absorb shocks, such as a disease outbreak, natural disaster, or conflict.

Collaborative Goals

The Office of Global Health, in collaboration with the Mother Patern College of Health Sciences (MPCHS) in Liberia, have adapted and propose to implement a Primary Health Care Clinical Specialist (PHC-CS) master's program to increase the competence of workers and quality of patient care. The initial needs assessment was implemented by UMSON in May-June 2012 through key interviews, curricula reviews, and site visits. The outcome was a customized PHC-CS program framework for the Liberian healthcare context that would offer effective recruitment and workforce retention strategy. The ultimate aim of the master’s program is to reduce child and maternal mortality, improve maternal health, and battle major diseases ravaging the country.

Rwanda: Expanding Nursing Education Nationally (2012-2017)

A map of Rwanda and a collage of photos.

Highlights

Read the blog maintained by UMSON faculty members who worked in Rwanda.

  • The program was successful in building the next generation of nurse leaders as both faculty and clinical educators and leaders. These nurses will continue to lead and improve the quality of care in Rwanda beyond the program. The Rwandan nurses led the U.S. faculty nurses to adapt and develop materials that would function in the real practice setting and be sustainable.
  • Throughout the 5-year period, the infrastructure of the nursing education system greatly advanced with the addition of material resources for simulation education, textbooks, computers, and web access for improved online education and library development.
  • Multiple co-authored publications (e.g., training manuals, book chapters, journal articles, and abstracts) with Rwandan colleagues and UMSON faculty mentors. One example:  Publications by HRH/UMB Faculty and Rwandan Colleagues published in Rwanda Journal of Medicine and Health Sciences: Series F Vol. 2 No. 2, 2015. http://www.ajol.info/index.php/rj/issue/view/13034

Background

August 2012 marked the start of the Human Resources for Health (HRH) Program, launched by the Rwandan Ministry of Health and the Clinton Health Access Initiative in collaboration with 23 U.S. medical, nursing, dentistry, and health management institutions, including the University of Maryland School of Nursing. The initiative aimed to build a sustainable, high-quality health workforce capable of providing the citizens of Rwanda with world-class healthcare (Minster of Health Rwanda, 2012). Funded by the Centers for Disease Control and Prevention and the Global Fund via the Rwandan Ministry of Health, UMSON was a subcontractor with the role to build the capacity of nurses in Rwanda through faculty development to improve the quality and delivery of patient care.

The HRH program came into existence in response to the 1994 genocide, which left the country in dire need of health system restructuring and strengthening. The Rwandan government and Ministry of Health faces several challenges and obstacles in providing health care to the population including lack of an educated workforce, a shortage of skilled health personnel and equipment, and inadequate management of facilities. The HRH program served to address these challenges through pairing Rwandan faculty, clinicians, and students with U.S. faculty in order to provide mentorship and increase knowledge and skill base in specific health fields. 

HRH promotes the "twinning model" to enhance the effective transfer of knowledge and skills between U.S. faculty and Rwandan faculty who will then continue to educate future nursing professionals (Ndenga et al., 2016). Each UMSON faculty in Rwanda was matched with a twin nurse educator, resulting in at least 27 Rwandan nurse clinicians and/or nurse faculty mentees.

Collaborative Outcomes

A total of 27 UMSON faculty clinical instructors were deployed to Rwanda from 2012-2017 on a 1-year contractual basis. A majority of these faculty members extended their employment and served for more than one year; therefore during UMSON’s 5-year participation36 U.S. Institution (USI) Nursing Faculty Positionswere filled, serving as clinical educators in critical care, neonatal intensive care, mental health, medical surgical training, and increased evidence-based practices at numerous clinical sites. High-level faculty were deployed, leading the development of simulation centers at University of Rwanda School of Nursing and launching online teaching and simulation education programs for the Masters in Nursing program at the University of Rwanda.

  • Developed clinical, teaching, and research skills of current and future nursing and midwifery faculty
  • Improved quality of nursing and midwifery education at clinical sites
  • Developed capacity of the Nursing and Midwifery Council to license and register nurses and midwives, develop professional standards, accredit educational programs, provide for continuing education, and all other functions necessary to maintain a professional nursing and midwifery workforce
  • Created clear pathways for nursing and midwifery students to advance from diploma to Bachelor’s degree to Master’s Degree through curriculum development, development of distance learning technology and content, and development of national policy to support advancement efforts

Additional Research

  • Hepatitis C treatment outcomes using Interferon- and Ribavirin-based therapy in Kigali, Rwanda. Partial funding provided by UMSON Office of Global Health and Carolyn F. Waltz Endowment fund to support Global Health Certificate student travel and ongoing collaborative research led by David Riedel and Emmanuel Musabeyezu (2015).
  • Interprofessional student needs survey development in Rwanda. Grant funded by UMB Center for Global Education Initiatives for interprofessional student team to assist administrators at the University of Rwanda College of Medicine and Health Sciences (URCMHS) in assessing the needs of their students and how to target their fundraising efforts to address cost of and financing their education, housing, academics, and technology (2014).
  • HP00049812: Rwanda Human Resources for Health Program: UMB Nursing Mentor Evaluation(2013). 

Nigeria: Improving Primary Health Care (2011-2014)

a map of Nigeria and photos of UMSON staff in Nigeria.

Highlights

  • Development of the Primary Health Care Specialist (Midlevel Provider) Curriculum for Nigeria. Centers for Disease Control, Grant # 5-D43 TW 01041 (03/15/11­–12/29/12) IHV University of Maryland AIRTRP in Nigeria, Brazil, the Caribbean grant Subcontract to School of Nursing. Development of an innovative, advanced practice nurse and community health officer curriculum for sub-Saharan Africa. The Primary Health Care Specialist Award. Johnson, PI; Ogbolu Co-Investigator (2011-2012).
  • Impact of Hospital Organizational Characteristics on Neonatal Mortality and Prevention of Maternal to Child Transmission in Nigeria. Centers for Disease Control, Grant # 5-D43 TW 01041 (03/15/10–03/29/11) IHV University of Maryland AIRTRP in Nigeria, Brazil, the Caribbean grant; Fogarty Fellow Award Mixed Method Study to Examine the Impact of Hospital Organizational Characteristics on Neonatal Mortality in Nigeria and Prevention of Maternal to Child Transmission of HIV. Ogbolu PI-Dissertation Research (2010-2011).
  • Lived experiences of health care providers caring for neonates in Nigeria. Qualitative study. Funder, University of Maryland School of Medicine, Global Health Network Grant. Ogbolu, PI (2008).

Background

Primary obstacles to meeting the Millenium Development Goals (MDGs) and now the Sustainable Development Goals (SDGs) are often linked to weak healthcare infrastructure and scarcity of human resources for health, including the lack of a qualified health care workforce to provide for the needs of maternal and child health and populations with HIV/AIDS, malaria, and tuberculosis. In Nigeria, the main point of free, accessible health care is the primary health care center, yet the quality of care available in these centers is often inadequate and contributes to the poor health outcomes found in the Nigerian population. Today, Nigeria has one of the highest mortality rates worldwide, particularly among women and children. The majority of these deaths are preventable.

Like many developing countries in Africa and throughout the world, nurses and community health officers (CHOs) are the backbone of Nigeria’s health care system. Nurses and CHOs are often asked to engage in clinical and public health leadership responsibilities for which they have no education or training. This is particularly common at the primary health care level, where a nurse and/or CHO is often the sole health care worker in the facility. Expanding the capacity of frontline workers is a critical aspect of building sustainable health care systems and will require innovative educational programs based on the specific realities that exist in Nigeria.

Collaborative Outcome

One innovative educational initiative is the Primary Health Care Specialist (PHC-S) Diploma Program developed by UMSON's Office of Global Health working closely with the UMB School of Medicine’s Institute of Human Virology (IHV) in Baltimore and in Nigeria; Nigerian nurse leaders from Obafemi Awolowo University, Ile Ife; University of Nigeria, Nsukka; and Ahmadu Bello University, Zaria. This 12-month advanced diploma program was designed to rapidly and effectively address the immediate human resource needs that exist in Nigeria and meet the need for greater competency and skill development in the primary health care sector. The PHC-S program specifically addresses the burden of disease in Nigeria, including essential aspects of prevention and treatment for HIV, tuberculosis, malaria, infant and child health, as well as common adult health problems such as diabetes and hypertension. The PHC-S will serve primarily as an expert independent clinician who can conduct assessments and diagnoses and provide treatment and personalized health care for individuals and families.

Haiti: Institutional Strengthening Through Advanced Nursing Training (2010-2014)

a map of Haiti and photos from UMSON's time there

Highlights

The impoverished country of Haiti has some of the worst health indicators in the world — and a severe shortage of health care providers. The School of Nursing worked to improve life for Haitian citizens, such as these irrepressible young girls, through a new postgraduate certificate program in infectious diseases that’s aimed at teaching experienced nurses in Haiti the best practices and most current knowledge related to HIV, tuberculosis, malaria, and other diseases. 

Read more in A Small World After All (p. 18), an article about this partnership from Nursing magazine.

Background

Known as the Institutional Strengthening Project - Haiti, the CDC-funded program aimed to elevate effectiveness and competence in Haitian healthcare focusing on the leading causes of mortality. The dire need for services resulting from the January 12, 2010, earthquake catalyzed a collaborative project to develop advanced training curriculum for Haiti’s principal nursing school to prepare and respond to future disasters and epidemics. Given the burden of HIV and infectious diseases on population health and many challenges encountered in the Haitian health care system, a training network consisting of UMSON, the Institute of Human Virology at the UMB School of Medicine, the University of Notre Dame d’Haiti (UNDH) nursing and medical schools, Catholic Relief Services (CRS), and four Haitian hospital partners (Foyer St. Camille, St. Bonifant, Sacre Coeur-Milot, and St. Damien) was formed. Together, we were charged to provide post-graduate training to physicians and nurses and offer laboratory and other infrastructure support to the network of hospitals.

Very few options exist for advanced nurse training in Haiti. The Infectious Disease Specialty Certificate was the first post-baccalaureate certificate program for nurses recognized by the Haitian Ministry of Health and housed in a renowned health sciences educational institution, UNDH. The primary goal of the ID Certificate Training was to teach registered nurses additional skills for the diagnosis and treatment of HIV and other infectious diseases, including tuberculosis and Malaria, and tp enhance overall levels of nursing practice. An initial Train-the-Trainers cohort of six nurse faculty instructors completed training in Maryland and Haiti in 2011. The certificate program enrolled a total 70 nurses to serve as nurse educators and advanced practice nurses.

Collaborative Outcomes

Infectious Disease Nurse Specialist in Haiti. Development and Implementation of curriculum and training modules for an Infectious Disease Nursing Certification as part of CDC-funded collaborative project with Catholic Relief Services and the University of Notre Dame d’Haiti School of Nursing, Port au Prince, Haiti in collaboration with the Institute of Human Virology at UMSOM. Moen, PI, Barrows, Co-Investigator (2010–2014).

  • UNDH School of Nursing was strengthened by the addition of six nursing faculty that were trained as educators and able to deliver educational materials beyond ID training.
  • With each cohort, the pass-rate, scores, and pre-post test results improved.
  • Nurses graduated from the cohorts were satisfied with the training and reported gaining a strong knowledge base in nursing care on HIV and IDs, learning new skills such as physical examination, writing detailed documentation, and feeling comfortable advocating for their patients to physicians. They also understand better what the doctors do, ask questions regarding the treatment plan, and better manage their patients
  • An additional component of the certification was added which included a Refill Clinic training component – a task shifting approach where nurses are trained to intermittently manage stable patients (according to specified criteria) who are only in clinic for prescription refills.
  • Hospital directors noticed that nurses who graduated from the ID Certificate Program have a strong background in patient care/management for those with HIV, and have an increased consciousness and greater ethic to their work and are able to provide a higher level of patient care. 

Additional Research

  • Preventing Needlestick Injury in Healthcare workers in HaitiMPower Research and Innovation Seed Grant between SON and UMCP SPH. Lipscomb PI; Barrows, Co-Investigator. Building on relationships with international partners that allowed for continued research collaborations between University of Maryland and Haiti partners, a translational research project was implemented to protect the healthcare workforce by reducing the risk of blood borne pathogen (BBP) transmission among healthcare workers employed in Haitian hospitals (2014-2016).
  • HP-00053333: Evaluation of post-graduate curriculum and training modules for an Infectious Disease Nursing Certification as part of CDC-funded collaborative project with Catholic Relief Services and the University of Notre Dame d’Haiti School of Nursing, Port au Prince, Haiti (2012).