October 27, 2008

UCSF School of Nursing Seeks to Create Model Health System in Malawi

Under a new grant program aimed at strengthening vulnerable health systems in Africa, the UCSF School of Nursing is hoping to take on some of the major health care challenges in densely populated Malawi, where patients outnumber physicians roughly 52,000 to 1. The school, in partnership with the nonprofit Global AIDS Interfaith Alliance (GAIA), is one of 11 applicants to receive a six-month planning grant from the New York-based Doris Duke Charitable Foundation under its African Health Initiative. Nearly 140 groups applied for grants, and ultimately six projects will receive $8 million to $16 million in funding over five to seven years. The UCSF-GAIA project focuses on Malawi’s Zomba region, which, like the rest of the country, is plagued by high maternal and infant mortality and high rates of HIV/AIDS, malaria and tuberculosis. Nearly 15 percent of the country’s roughly 14 million residents were living with HIV/AIDS in 2003, according to the CIA World Factbook. “Malawi has been struggling with an underfinanced health system for a long time,” said Teri Lindgren, RN, PhD, a UCSF assistant adjunct professor in the Department of Family Health Care Nursing and one of the Malawi project leaders. “Our goal is to work with the [existing] system to try to strengthen and improve access to health care, the way things function, and the delivery of medicine and supplies, and therefore improve the overall health of the population.” The project ties into the UCSF Strategic Plan, which was created in 2007 and includes the University’s goal of collaborating with global partners to eliminate health disparities and reduce the burden of disease on the world’s most vulnerable populations. To create lasting changes in Malawi, Lindgren and her colleagues plan to work closely with the University of Malawi Kamuzu College of Nursing and the various Ministry of Health systems and facilities that are already in place in the Zomba district. They also will collaborate with churches and religious groups, which operate about 40 percent of Malawi’s health facilities, said Ellen Schell, RN, PhD, GAIA’s international programs director and an assistant researcher in the UCSF Department of Physiological Nursing. “GAIA already had a strong connection to the religious community in Malawi, and now we want to see how we can utilize those powerful relationships and work with communities in different ways,” Schell said.

Monitoring Outcomes

In addition to the service component of the project – delivering and working to improve health care – there is an equally important research component, largely spearheaded by UCSF, Lindgren said. “We’ll be really monitoring and evaluating what works and what doesn’t,” she said. “The connection between GAIA, with its strong, community-based approach, and UCSF, with its strong research [contribution], will make for a really powerful partnership.” Understanding what works and what doesn’t is a major goal of the African Health Initiative, said Elaine Gallin, PhD, the Doris Duke Charitable Foundation’s program director for medical research. She said a project’s potential to expand into other regions or countries is one of the things the foundation will be looking for as it selects the final grant recipients. The African Health Initiative was announced in September 2007, and the response exceeded the foundation’s expectations, Gallin said. The UCSF-GAIA project, which is the only one to include schools of nursing, has until March 31 to complete its $8 million grant request and comprehensive work plan. The Doris Duke Charitable Foundation hopes to announce the six grant recipients in the summer or early fall of 2009, Gallin said. The UCSF-GAIA project is being led by GAIA President William Rankin and the nonprofit’s Malawi country director, Jones Laviwa. In addition to Lindgren, other key UCSF participants include Sally Rankin, RN, PhD, professor and chair of the Department of Family Health Care Nursing, and Wendy Max, PhD, professor in residence and co-director of the Institute for Health & Aging.

Monitoring Outcomes

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