Guest Post: Global Health Initatives – Are They Working?

When searching for the proverbial answer to any given global health problem, one of the currently most celebrated methods commonly involves some form of education. Such education seems to take several different forms, through traditional schooling as well as through separate personal health training. Though this model has become so commonplace that it resembles a refrain, it still strangely feels fresh and exciting, as though overflowing with possibility in its applications.

As it should be; the potential for the effects of education holds that magical power of sustainability captured in the colloquial “teach a man to fish” phrase. But how can we truly measure the effects of education in behaviour modification? And if education just does not make the grade, is there another viable option? I feel that too often, education is viewed as the definitive solution to a problem that is not even fully understood. Especially when working in a developing country, proper research and statistics may not exist for a given issue, making anecdotal evidence the most, if not only, reliable source of information.

I am currently in La Romana, Dominican Republic working with a North American-based non-governmental organization (NGO) called the 53rd Week. After working with the local El Buen Samaritano (“Good Samaritan Hospital”) on multiple occasions, several Canadian and American doctors formed this organization to help improve research capabilities and sustainability of short-term medical volunteer teams with the hospital. Founded in 1990, El Buen Samaritano is a private hospital with a focus on bringing outreach programs to bateyes, which are small rural sugarcane worker communities occupied largely by Haitian immigrants. As a virtually stateless population under Dominican law, the Dominican-Haitians are not even able to own the property that they inhabit and are continually at the mercy of the sugarcane companies who barely pay them enough to feed their families. While primary and secondary education is provided by the Dominican government, as is public health care, distance and access to both of these are just two of the many issues that continue to confront many people living in the smaller and more rural bateyes. In addition to the other projects organized by the hospital, an important stakeholder has a proposition for a new peer mentorship program targeted at women aged 12-19 in five pilot bateyes. She feels very strongly that family planning is a major issue that needs to be addressed because girls are getting pregnant very young, and this interferes with them completing their education. While this may be more than accurate, there really is no quantifiable way of determining if this is a real concern, or if the proposed project will address the concern.

This is where the needs
assessment conducted by myself and my team comes in. Working with the
input of several local health care authorities and the supervision of
the 53rd Week, we have created a survey tool designed to deliver those
quantifiable ways of assessing the situation that are needed to justify
the creation of the program. However, even this begs the question of the
reliability of collected data, and the justifiability of dedicating
precious resources to it. And if an education program is going to be the
answer to the research regardless, does the uncertainty about its
potential effectiveness justify the means?

me, this is clarified by several beliefs. Firstly, I feel that that any
global health initiative should ideally have a method in place for
measuring its effectiveness to ensure adequate and responsible use of
resources. Secondly, the data to be gained from this research is unique
in its kind, and potentially has applications to not this project, but
also future endeavors unforeseeable now. Finally, I believe that a vital
aspect for the success of any global health initiative is the passion
and support of those investing themselves in it. These beliefs have
stemmed from the success that I feel will be achieved by our project.


Guest Author Julianne Zandberg is currently a third year Bachelor of Health Sciences student in the Global Health Specialization at McMaster University. For the entire Fall 2013 semester, she is in La Romana, Dominican Republic on her Embedded Learning Experience, in which students have the opportunity to engage with global health outside the traditional academic environment.


2 Comments on "Guest Post: Global Health Initatives – Are They Working?"

  1. People first; programme second | October 11, 2013 at 2:48 am | Reply

    Great post! Thank you for sharing Julianne! You touched upon this briefly with there being "no quantifiable way of determining if this is a real concern, or if the proposed project will address the concern". I totally agree that in order to assess any project’s effectiveness we need to understand the people’s culture, beliefs, lifestyles, struggles, values, joys, etc. What is a point of blinding starting a program to "educate" people in another country without knowing what they even care about – what are they even being educated in? I think with global health initiatives, we need to use the values and lives of the local people as a starting point (i.e., risk assessment!), rather than a "side consideration" or "barrier to helping them achieve better health" – it’s these latter beliefs that can lead tension and distrust in a lot of global health organizations!

  2. Although this article brings up a good point, I think that anecdotal evidence does have some merit in bringing about a positive change in a community. Many people tend to regard volunteer experiences to be large-scaled initiatives that impact many people and "will make a difference". The problem with this approach, though, is that it can result in individuals not being able to make personal connections with the people they believe are helping.

    "Making a difference" is not limited to large initiatives. The small contributions to a community also can add up to make a difference. It is equally as valuable, in my opinion, to strive to make changes that address the anecdotal issues that impact a few individuals’ lives. It is these experiences that also provide valuable opportunities for growth and learning for the volunteers themselves.

    It may be true that large-scale Global Health initiatives can benefit from evidence in order to track their progress and effectiveness. However, I don’t think it is as necessary for individuals participating in short-term volunteer experiences to try and "quantify" concerns in order to categorize them as "real issues". Sometimes, it can be enough to identify an issue and strive to improve it, regardless of the context or number of people that the initiative impacts.

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