When physician, anthropologist and global health entrepreneur Paul Farmer describes something as “the only terminus” of “a lifelong dream,” that’s a cue to start paying attention.
This week 27 students opened the school year as the inaugural class of master’s degree candidates at the University of Global Health Equity in Kigali, Rwanda, a new university owned and operated by Partners in Health, the nongovernmental organization Farmer co-founded in 1987. While currently without a permanent campus, UGHE represents the next step in Farmer’s relentless vision to ignore the common mantra that when it comes to health care for the poor, certain things are affordable and certain things aren’t.
World-class health training, for example, should not be beyond the reach of low-income countries.
“It would be really terrific if more resources were put in this kind of effort rather than others, even if we had to choose,” Farmer told Devex, noting that making that argument often creates an “undertow of censorious opinion in development circles.”
“I can’t say how many times we’ve heard, ‘why is the university a priority?’”
At this point, Farmer has a pretty good answer.
Paul Farmer was once known as "the man who would cure the world." Devex spoke with the global health luminary during his latest trip to Washington, D.C., to learn more about what it will take to cure the foreign aid industry of its own destructive pathology.
He recalled a meeting with the president of the University of Liberia, where Partners in Health has explored opportunities to expand the health equity university model. Before the Ebola crisis, the country’s medical school had 25 faculty members. After the crisis there were 15. Five died of Ebola and five left, the president told Farmer.
“We have 11,000 affiliated faculty [members] at Harvard, and there are many billions of dollars that have gone into development assistance to Liberia and Sierra Leone since the civil wars there were ended,” Farmer said. “It’s just painful to look around and see no vibrant, well-resourced institutions of higher education when there’s so much talent there.”
With the University of Global Health Equity, Partners in Health is seeking to help correct an imbalance Farmer and others see in the way health education happens today — that is, largely divorced from the actual practice of health service delivery and underexposed to scientific exploration of what makes delivery work or not.
“Can you imagine if doctors, nurses, managers knew the evidence behind … cash transfers or community health workers or the course of disease without accompaniment? Can you imagine? … It really hasn’t happened anywhere,” Farmer said.
Even some of the very best health degree programs, he added, suffer from isolation, from a sense that education happens “here” and global health is what happens “somewhere else.”
“At Harvard one of the chief complaints students at the School of Public Health who are doing global health have is that they don’t have any global health opportunities. This [university] is built around the opportunity to serve,” Farmer said. “We’re focused on health and we’re focused on equity. That’s why I think this is an exciting and novel project.”
An institution of higher learning for better global health
UGHE, which some have dubbed “PIH University,” will draw on Partners in Health’s identity as an “academic NGO” closely affiliated with Harvard to recruit the “best minds” to the cause. At the outset, about half of the initial cadre of professors are Harvard faculty and the other half are Rwandan health care leaders, according to Peter Drobac, UGHE’s executive director.
The part-time, two-year course of study leads to a master of science in global health delivery. The only other universities currently offering this degree, which Drobac likened to an executive MBA for working professionals, are Dartmouth and Harvard, he said, adding that “as we grow and get into the game of more typical degrees,” UGHE will look to secure broader accreditation for its offerings.
The makeup of UGHE’s first class, comprising 26 Rwandans and one American, might belie the institution’s ultimate goal of becoming an explicitly international “epicenter” of global health equity education, but that is the idea. Without a permanent campus in place, the university has so far been limited to students already in country.
“It’s a new institution of [higher] learning for better health globally. It’s not focused on Rwanda. Rwanda is a good place because we can demonstrate this type of approach. We have done it,” Rwanda’s Minister of Health Agnes Binagwaho told Devex.
“We need that approach to be more global, more known, because if our partners have that idea they will understand better … they will stop [being] the traditional donor, they will be more the partner, the people who give us a hand on our way, and not the people who try to dictate us on the way to go,” Binagwaho said.
Farmer too stresses Rwanda’s achievement in turning one of the developing world’s most dismal health records into one of its best. Rwanda’s health and development achievements are often weighed against the government’s heavy-handed approach to policymaking. President Paul Kagame has indicated he might seek a constitutional referendum that would allow him to serve a third term. Nonetheless, in seeking to locate the new university in a place where health service delivery reigns supreme, Farmer said it would be more of a risk to launch UGHE somewhere other than Rwanda, where it is well-positioned for success.
“When you’re talking about what is the place that’s had the greatest turnaround … the greatest success in promoting global health equity, there’s only going to be one No. 1 spot, and I think Rwanda occupies it,” he said.
Binagwaho attributes that success to the government’s integrated approach to development, which, she said, emphasizes the integration of policies across social domains, so that ministers of health, culture, agriculture, education and other sectors jointly collaborate on plans and strategies to achieve common alignment.
“This is the future,” Binagwaho told Devex. “Everybody asks how to make the money work,” she said, noting the ministry’s goal of producing “more health” with $1.
“We hope that this approach and this philosophy of care will be contagious, and of course, I believe that because we are known for what we do, PIH is known for what they do, we are going to be globally known,” she said.
The goal: Attract the ‘best minds’ to a ‘world class’ university
The government of Rwanda has contributed the land that will eventually house UGHE’s campus, and the government has agreed to pay the institution’s taxes, Binagwaho told Devex. The Rwandan health minister is an affiliate faculty member of both Harvard’s and Dartmouth’s schools of medicine. She will teach a course on social justice in health at UGHE and supervise junior academics.
“We have people who, without having big academic knowledge, have a huge knowledge of how to do things on the ground,” Binagwaho said, adding that the goal will be to impart the “rigor of academic teaching” that will allow Rwanda’s health leaders to engage as university instructors.
The goal, according to Drobac, is to attract the “best minds” to the cause of equitable global health delivery and to be a “world class, but also an international university.” Over the next two years UGHE intends to transform much of its academic content to be available online, he told Devex.
Drobac pointed out that many of the major successes in global health over the past decade, the new vaccines and diagnostics, have happened in “discovery,” and with a lot of funding.
“What we see so often is that there’s a big gap between the discovery … and actually getting them to the people that need them the most,” he said. “Delivery is really about bridging that gap.”
For Farmer, the University of Global Health Equity represents a chance to realize, at least in part, the vision that was baked into PIH’s mission from the outset, and which it has tried to stick to “with varying degrees of success.” The organization strives to do three things wherever it works: treat people, train people and generate knowledge about the problems it tackles.
“I think we were lucky that we got that into our mission statement. We were, after all, inexperienced and young,” Farmer said. In Farmer’s vision, mission statements are not taken lightly. They have a way of quickly turning around on you, appearing as aspiration and suddenly transforming into a reminder that you haven’t done what you said you were going to do.
“Anywhere there’s a Partners in Health project where we’re not engaged in formal training programs, like residencies for doctors or nurses … everywhere we’re engaged and don’t generate new knowledge … everywhere we don’t do those three things together, we’re still falling short of our mission,” Farmer said.
UGHE’s incoming class of health delivery master's candidates would be well-advised not to expect an easy A.