Up Close and Policy — Changing global health policy
Colleagues, academics, policy professionals, students and clinicians stretching from Nigeria to New York tuned in to the first seminar in a new series of Up Close and Policy.
In this seminar, we heard from Dr Sohier Elneil (UCLH) and Dr Lauri Romanzi (Harvard Medical School), who discussed how their work in caring for women with birth complications has led to changes to global health policy in the area of women’s health. Drs Elneil and Romanzi’s work focusses on obstetric fistula, a hole between the birth canal and bladder and/or rectum caused by prolonged, obstructed labour. With their work often aligning, they have collaborated on numerous projects, co-authored papers and been involved with the same organisations throughout the years.
Dr Sohier Elneil, BSc, MBChB PhD (Cantab.), FRCOG
Consultant Urogynaecologist and Uro-neurologist, University College Hospital and the National Hospital for Neurology and Neurosurgery, London
Honorary Associate Professor, UCL Institute for Women’s Health and UCL Medical School
Dr Elneil’s journey of academic-policy engagement started when she was invited by the International Federation for Gynaecology and Obstetrics (FIGO) to prepare a manual for fistula training. After that, she set up training programmes, receiving support and input from the United Nations Population Fund (UNFPA), a funding agency, and the United States Agency for International Development (USAID). The development of this training and the availability of funding enabled a clear policy ask; that all women need access to the same basic care regardless of where in the world they live. This need for greater access and equity in care underscored and motivated subsequent activities, such as a collaborative research and professional development programme adopted by the West African College of Surgeons (WACS).
From her involvement at both governmental and non-governmental levels, Dr Elneil recognises the role that universities play in driving sustainable change. She advises to leverage existing capacity within local institutions, such as the WACS, to work with them to achieve greater uptake across relevant bodies. In building these cross-border partnerships, Dr Elneil acknowledges that it can be challenging to know who to approach and how to approach them. She suggests that researchers should tap into their universities’ existing relationships, networks and initiatives. Exchange programmes between academics and clinicians in Africa and Europe can also be very helpful in fostering international relationships and knowledge sharing.
Dr Lauri Romanzi, MD, MScPH, FACOG, FPMRS
Faculty, Program in Global Surgery and Social Change
Lecturer, Department of Global Health and Social Medicine, Harvard Medical School
A past Project Director of Fistula Care Plus, Dr Romanzi continues to advocate for fistula health and women’s health. Recognising the need to move toward prevention and safe surgery principles, she told the audience how she has worked to develop a more holistic model of care that also encompasses infrastructure (i.e. electricity, clean water) and architecture.
She sketched how out moving beyond the intricacies of surgery and the healthcare setting to include engineers, architects and social scientists is essential to delivering good fistula prevention policies. This development also benefits from a ‘perfect storm’ of academics and clinicians across the US, UK and Africa who are able to mobilise their collective drive to improve women’s health to impact different spheres internationally.
Dr Romanzi notes that one of the biggest challenges when undertaking academic-policy engagement for global health is the ethics requirements across different countries and institutions. She warns that any work must be adapted to the culture, policies and ethical guidelines specific to the host country. Equally, being sensitive, and a willingness to listen and learn are critical in establishing a positive interpersonal dynamic between researcher and colleagues overseas and helps immensely in forging paths together. The biggest asset of any collaboration is the people you work with. Identifying the key ‘gatekeepers’ or knowledge brokers is not a linear process and may take several efforts, but the advice is to persist and take every opportunity that presents itself.
Lastly, academic-policy engagement in global heath is not a one-way street. Dr Romanzi recommends that if you really want to have an impact, invest in the team and facility you are working with and they will invest in you. People coming from clinical backgrounds, or indeed any more specialised discipline, will benefit from participating in programmes and/or degrees in Public Health or International Relations. Subsequently, sharing your learning from the academic-policy engagement process — both the good and the bad — is critical for advancing the field.
What our audience were keen to know
How did you generate interest in your research so that you could secure funding?
Since the UNFPA began dedicating funding to addressing obstetric fistula in 2003, money has been available to fund research in this field. Our research and clinical work aligned with priorities recognised at a global scale, so we were able to benefit from this momentum and the funding opportunities. However, it is important that funding does not drive clinical practice as this can have unintended effects. For example, we are now seeing an increase in the number of Caesarean-sections being performed.
What do you believe is the best way for researchers working in a specific health field to disseminate findings in a way that will be useful, practical and impactful?
Academic output can help “make your case” for policy development and validate the changes you are working to bring about. If funders and other key organisations have established research priorities, ensure that your research can align to these. Secondly, when publishing, consider who your audience is and what journals people may have access to in low- and middle-income countries (LMICs) and publish in those. Additionally, working with colleagues throughout LMICs to disseminate your research is key.
What does success in this area look like to you?
Drs Elneil and Romanzi explained that obstetric fistula care is an essential indicator of maternal health and an indicator of women’s place in society — while obstetric fistulae are treatable with surgery, they are also entirely preventable. If a country gets this part right, then it shows the whole approach to women is getting better. Unfortunately, there is still so much work to do in the field of women’s health and fistula. An incredible amount of research is needed before we have equitable access to care — so success will be when obstetric fistula is no longer a research or policy issue to discuss.
What are your final thoughts for early career researchers and people looking to get involved with global health policy?
As a researcher or clinician, you start with a passion and an interest. There is often no way to predict whether your work will impact public policy and even if your work does lead to policy change, you might not be aware of this until much later. Having an intrinsic passion and drive is therefore crucial for motivating you forward. While having institutional support from your university, for example, with funding, licensing, upholding ethical requirements, is needed, you also need to keep your heart and mind open to the needs of your global partners and patient populations. Global academic-policy engagement requires a multi-disciplinary and cross-sectoral approach and you need to work with partners to build capacity from the ground up.
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By Audrey Tan, Dr Sohier Elneil and Dr Lauri Romanzi
This seminar and blog are part of the Up Close and Policy series hosted by UCL Public Policy. This series features UCL researchers in open conversation with policy professionals drawn from a wide range of organisations and subject disciplines.
