Wednesday, September 21, 2011

Keeping in Touch: Making International Partnerships Work

The posts to Santé Carolina have been few in the past months due to some shifts in my work patterns and the end of the Gillings Visiting Professorship. There’s much more to be said about the French health system and I will post more materials in the coming weeks.

I’d like to talk a bit about managing international projects and the difficult process of connecting institutions with different cultures separated by many miles. The EHESP is both a new school of public health but also an established component of the French public health scene. It was deeply embedded in the system of training managers of hospitals and public health structures in France. It’s transformation into the EHESP and its turn toward a more academic direction have not been without problems.

The University of North Carolina’s Gillings School of Global Public Health has also undergone a recent transformation with the change in name and a conscious effort to make itself globally relevant. The UNC school has been connected tightly to the public health structure of North Carolina and the region for many years and served as the primary training grounds for many local and state health directors and program leaders for many years. It has developed over recent decades a strong academic and research enterprise. Some might say that it has replaced its emphasis on community programs with a more detached academic style.

My goal for the Gillings Visiting Professorship was to try to bring these two institutions closer together as I saw interesting parallels between the two. Both institutions were trying to mix a tight connection to the formal, government roles of public health with an academic and research culture. Both had engendered creative solutions to the problems of their health care systems beyond public health and within prevention and public health. And both were stretching to link to global health issues in Africa and Asia.

I also saw how the two institutions were approaching similar challenges in different ways. UNC was pioneering work in leadership training and on-line delivery of classes. The EHESP was organizing teaching in more effective units of instruction—week-long modules and special part-time work spread over a year. UNC was creating new emphasis areas in informatics and data for decision making while the EHESP was organizing focused training in humanitarian program leadership and management and has organized a graduate program that spanned multiple countries in Europe.

Both institutions had much to learn from each other. Unfortunately, that challenge has only partly been taken up. Both institutions must cope with and service their local communities and live with the bounds of their funding and activity constraints. At UNC the budget for the school is strongly party controlled by the North Carolina General Assembly. The state is facing a time of strain in its finances and the legislature has chosen to cut the University’s allocation. This directly affects the school and it absorbed an 18% cut in its state funds. This is a challenge as well as good reason to pay less attention to international work that may distract leaders from the time consuming work on getting to know international partners.

The EGHESP has been challenged by the clash of cultures that emerged when it quickly pivoted toward new masters and doctoral programs, hired in new people and created new programs. The school was moving very quickly and some felt left behind. Its troubles were highlighted by public demonstrations by staff that prompted an external review.

These challenges are transient in the long run and likely to be replaced by others. But the conditions and characteristics of the two institutions that would make them useful partners, remains.

Some strong and persistent connections have been built and there is a continuing flow of faculty and students between the two institutions I will continue to teach in the MPH program in Paris and others will join me as their time is available. We have brought students from he MPH program to Chapel Hill for their practica and that will continue. We have taken doctoral students to share their work with their counterparts in Paris and Rennes and that should continue.

No one can deny the extra effort it takes to work on different continents and the costs of that distance are real. I remain convinced that the effort is worth the pay off.