Division of Global Health, Service Delivery

As part of its aim to reduce health disparities and achieve optimal health for children and adolescents in resource-limited settings of the developing world, the Division of Global Health at MassGeneral Hospital for Children focuses on a number of service delivery initiatives.

Addressing the needs of children in conflict and crisisChildren are among the first and most severely impacted by the consequences of conflict and crisis. In fact, as a result of their inherent vulnerability, children are disproportionately impacted by war, social unrest, disaster and economic crisis. Brett Nelson, MD, MPH, DTM&H, presently serves as the director of the Harvard Humanitarian Initiative’s program on Children in Conflict and Crisis, which was established to specifically address the unmet needs of these hyper-vulnerable children by highlighting opportunities for improving the operational and policy response of service providers. Current projects include addressing child mental health issues in Iraq and raising awareness of the needs of children born of sexual violence in the Democratic Republic of Congo.

Training front-line providers in critical newborn and maternal care

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The most dangerous moments in life are those around the time of birth. Newborn and maternal mortality are among the leading burdens of disease in resource-limited settings. Meanwhile, effective and simple interventions are available to prevent the vast majority of these perinatal/peripartum deaths. Antenatal care, facility-based deliveries, management of maternal complications, neonatal resuscitation, etc., are all cost  effective. Nevertheless, these efforts have had limited reach in resource-limited settings, where the interventions are most needed.

Over the last several years, Patricia Hibberd, MD, PhD; Archana Patel, MD; Brett Nelson, MD, MPH, DTM&H; Kristian Olson, MD, MPH, DTM&H; Jonathan Spector, MD, MPH; Thomas Burke, MD, FACEP, and others have been closely involved in building capacity among front-line birth attendants through training in many developing settings, including India, Liberia, Southern Sudan, Indonesia, Cambodia, Kenya, Zambia, Haiti and Ethiopia.

Partnering with communities to provide health care and local capacity building While country-level health and economic indicators may give the impression that the populace is healthy, a closer examination of the communities where Doctors for Global Health (DGH) work reveals many stark disparities:

  • The majority of people in rural communities in El Salvador live in extreme poverty (less than $1/day);
  • The indigenous residents of Chiapas are destitute in terms of access to the basic necessities of life (e.g. clean water, sanitation, sufficient food, suitable housing) and health care;
  • Chiapas has the highest infant mortality rate of any Mexican state; and
  • In Uganda, it is estimated that there are nearly 1 million children orphaned as a consequence of AIDS. 

DGH was born in Estancia, El Salvador, with a mission “to promote health and other human rights with those most in need by accompanying communities, while educating and inspiring others to action.” DGH currently has health, public health, community development, and local capacity-building projects in partnership with communities in El Salvador, Guatemala, Peru, Uganda, Burundi and Chiapas, Mexico. Jennifer Kasper, MD, MPH, has been an active board member since 1996; she is the current chair of the International Volunteer Committee.

An innovative pediatric educational initiative in Mbarara, Uganda Sub-Saharan Africa faces a most daunting challenge: it accounts for 25 percent of the global burden of disease but has only 3 percent of the world’s health workers. Training and retention of professional health staff is a serious problem, and Uganda is no exception. The pediatric staff at Mbarara Rural Referral Hospital have asked Jennifer Kasper, MD, MPH; David Bangsberg, MD, MPH; and Vanessa Bradford Kerry, MD, MSc, to explore innovative educational initiatives for strengthening the foundational knowledge and diagnostic skills of the pediatric post-graduates.

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