A University of Michigan-led study published May 1 in the American College of Surgeons Bulletin reported partnerships between the Obstetrics and Gynecology departments of high-income academic institutions and corresponding departments of sub-Saharan African institutions have the potential to greatly improve maternal and neonatal medical care. The study referenced several U-M collaborations that enrich ob-gyn training and improve access to women’s health care in sub-Saharan nations.
According to Timothy R.B. Johnson, ob-gyn chair at Michigan Medicine, the University has a long history of academic partnerships with medical institutions in other countries, especially Ghana. Johnson founded an ob-gyn clinic in Ghana in 1989 during an epidemic of maternal morbidity, starting a partnership that has helped expand access to women’s health care. The University now participates in other initiatives with the mission of improving international ob-gyn training. The 1000+ OBGYNS project, founded in 2014, is working to educate new doctors about maternal and newborn health in sub-Saharan Africa. Also founded in 2014, the Center for International Reproductive Health Training works with 10 institutions in Ethiopia and one in Rwanda to improve reproductive health care education. In the future, it aims to extend its work to Southeast Asia.
The University’s efforts in Ghana and Ethiopia have expanded to other medical fields, such as emergency medicine, but women’s health remains a central focus. Johnson said Sub-Saharan African countries suffer from high rates of maternal deaths. In a joint email interview, CIHRT Program Director Lia Gebremedhin and CIRHT Managing Director Janet Hall added underprivileged women in these areas also lack safe abortion methods and contraceptives.
"Women and girls in developing countries disproportionately suffer from maternal morbidity and mortality due to unsafe abortion," Gebremedhin and Hall wrote. "In addition, they lack adequate access to comprehensive family planning services to prevent unwanted pregnancies."
Johnson said women’s health issues are more chronic than short-lived outbreaks and believes it to be one reason the University’s partnerships have stood the test of time. He said maternal and neonatal care is a complex field of medicine that fosters deep connections between international communities.
“Taking care of women and their lifespan issues and their lifelong issues and their children and their families really develops lifelong partnerships,” Johnson said. “These are family issues, and community issues, and not just acute infectious issues, so that’s one reason I think that these partnerships have worked over the long term.”
U-M experts involved in ob-gyn initiatives cite several other factors that make an academic partnership successful and sustainable, one key idea being partnerships must be mutually beneficial. For example, Johnson said, some American universities send their students abroad but aren’t willing to host students from the lower-income partner institution, whereas the University accepts students and residents from institutions like the University of Ghana. Laura Rozek, the associate director of the U-M Office of Global Public Health, said this emphasis on bilateral exchange prevents the University from becoming extractive or patronizing toward its partners.
“There’s a little bit of colonialism that can sometimes happen with global health — that we’re going to go and fix other people’s problems,” Rozek said. “We learn just as much from other countries, at least, as we feel like we’re giving to them. I think it’s the attitude here at Michigan.”
Gebremedhin and Hall also noted the importance of establishing equitable, transparent partnerships, writing that CIRHT makes sure not to take advantage of its partner establishment.
“CIRHT’s principle of partnership is grounded on mutual, respectful, need-based and authentic collaboration,” Gebremedhin and Hall wrote. “During early phases of establishing collaborations, CIRHT ensures that the in-country partner institutions take ownership and are at the forefront, leading the program with CIRHT having a supportive role.”
According to Johnson, effective collaborations are focused on education, just as the University’s ob-gyn projects are centered around training primary care providers in sub-Saharan Africa. That way, ob-gyn care sees long-term improvements as newly trained doctors educate their peers. One common concern is that well-educated doctors will leave their country of origin after training — a phenomenon known as “brain drain” — but in fact, Johnson said, the U-M medical training initiatives have seen high-levels of retention. Last summer, Frank Anderson, a U-M ob-gyn who directs the 1000+ OBGYNS project, found that of the 246 people trained in Ghana since 1989, only one has relocated.
“In West Africa, where I’ve done most of my work, the governments are happy to support programs that train doctors and keep those doctors in the country,” Johnson said. “There are lots of public health benefits of training doctors who can lead programs.”
According to U-M health experts, the study published May 1 found universities are particularly well-equipped for supporting ob-gyn health care initiatives with sub-Saharan countries partly because many U.S. universities have large endowments, ample resources and global connections. Johnson also said universities can form durable partnerships because they are well-established fixtures.
“Once a university is started, it tends to dig deep roots and become an important institution for the country, as opposed to NGOs and some of these other more transitory institutions,” Johnson said. “You have to find long-term support, because if you go in and you set up a program and 5 years later the program collapses, then you’ve actually done more of a disservice than a service.”
According to Rozek, many people in academia are genuinely passionate about what they do, so global health projects spearheaded by universities can be uniquely successful. Gebremedhin and Hall agreed academic institutions are well-suited for starting public health partnerships because the core values of teaching and development are shared by universities worldwide.
“Academic institutions (in health), be it in developed or developing world, share similar principles and vison (sic) … advancement in academia, clinical care and research,” Gebremedhin and Hall wrote. “Partnerships between academic institutions grounded on building capacity in these mutual areas of interest result in sustainable change because these is (sic) where generations are trained, groomed and developed.”