Publications

    Hannah H Leslie, Denisse Laos, Cesar Cárcamo, Ricardo Pérez-Cuevas, and Patricia J García. 2021. “Health care provider time in public primary care facilities in Lima, Peru: a cross-sectional time motion study.” BMC Health Serv Res, 21, 1, Pp. 123.Abstract
    BACKGROUND: In Peru, a majority of individuals bypass primary care facilities even for routine services. Efforts to strengthen primary care must be informed by understanding of current practice. We conducted a time motion assessment in primary care facilities in Lima with the goals of assessing the feasibility of this method in an urban health care setting in Latin America and of providing policy makers with empirical evidence on the use of health care provider time in primary care. METHODS: This cross-sectional continuous observation time motion study took place from July - September 2019. We used two-stage sampling to draw a sample of shifts for doctors, nurses, and midwives in primary health facilities and applied the Work Observation Method by Activity Timing tool to capture type and duration of provider activities over a 6-h shift. We summarized time spent on patient care, paper and electronic record-keeping, and non-work (personal and inactive) activities across provider cadres. Observations are weighted by inverse probability of selection. RESULTS: Two hundred seventy-five providers were sampled from 60 facilities; 20% could not be observed due to provider absence (2% schedule error, 8% schedule change, 10% failure to appear). One hundred seventy-four of the 220 identified providers consented (79.1%) and were observed for a total of 898 h of provider time comprising 30,312 unique tasks. Outpatient shifts included substantial time on patient interaction (110, 82, and 130 min for doctors, nurses, and midwives respectively) and on paper records (132, 97, and 141 min) on average. Across all shifts, 1 in 6 h was spent inactive or on personal activities. Two thirds of midwives used computers compared to half of nurses and one third of doctors. CONCLUSIONS: The time motion study is a feasible method to capture primary care operations in Latin American countries and inform health system strengthening. In the case of Lima, absenteeism undermines health worker availability in primary care facilities, and inactive time further erodes health workforce availability. Productive time is divided between patient-facing activities and a substantial burden of paper-based record keeping for clinical and administrative purposes. Electronic health records remain incompletely integrated within routine care, particularly beyond midwifery.
    Shailendra Prasad, Elizabeth Sopdie, David Meya, Anna Kalbarczyk, and Patricia J Garcia. 2019. “Conceptual Framework of Mentoring in Low- and Middle-Income Countries to Advance Global Health.” Am J Trop Med Hyg, 100, 1_Suppl, Pp. 9-14.Abstract
    Although mentoring is not a common practice in low- and middle-income countries (LMICs), there is a strong need for it. Conceptual frameworks provide the structure to design, study, and problem-solve complex phenomena. Following four workshops in South America, Asia, and Africa, and borrowing on theoretical models from higher education, this article proposes two conceptual frameworks of mentoring in LMICs. In the first model, we propose to focus the mentor-mentee relationship and interactions, and in the second, we look at mentoring activities from a mentees' perspective. Our models emphasize the importance of an ongoing dynamic between the mentor and mentee that is mutually beneficial. It also emphasizes the need for institutions to create enabling environments that encourage mentorship. We expect that these frameworks will help LMIC institutions to design new mentoring programs, clarify expectations, and analyze problems with existing mentoring programs. Our models, while being framed in the context of global health, have the potential for wider application geographically and across disciplines.
    Andres G Lescano, Craig R Cohen, Tony Raj, Laetitia Rispel, Patricia J Garcia, Joseph R Zunt, Davidson H Hamer, Douglas C Heimburger, Benjamin H Chi, Albert I Ko, and Elizabeth A Bukusi. 2019. “Strengthening Mentoring in Low- and Middle-Income Countries to Advance Global Health Research: An Overview.” Am J Trop Med Hyg, 100, 1_Suppl, Pp. 3-8.Abstract
    Mentoring is a proven path to scientific progress, but it is not a common practice in low- and middle-income countries (LMICs). Existing mentoring approaches and guidelines are geared toward high-income country settings, without considering in detail the differences in resources, culture, and structure of research systems of LMICs. To address this gap, we conducted five Mentoring-the-Mentor workshops in Africa, South America, and Asia, which aimed at strengthening the capacity for evidence-based, LMIC-specific institutional mentoring programs globally. The outcomes of the workshops and two follow-up working meetings are presented in this special edition of the . Seven articles offer recommendations on how to tailor mentoring to the context and culture of LMICs, and provide guidance on how to implement mentoring programs. This introductory article provides both a prelude and executive summary to the seven articles, describing the motivation, cultural context and relevant background, and presenting key findings, conclusions, and recommendations.
    Christopher W Belter, Patricia J Garcia, Alicia A Livinski, Fabiola Leon-Velarde, Kristen H Weymouth, and Roger I Glass. 2019. “The catalytic role of a research university and international partnerships in building research capacity in Peru: A bibliometric analysis.” PLoS Negl Trop Dis, 13, 7, Pp. e0007483.Abstract
    OBJECTIVE: In Peru, the past three decades have witnessed impressive growth in biomedical research catalyzed from a single research university and its investigators who secured international partnerships and funding. We conducted a bibliometric analysis of publications by Peruvian authors to understand the roots of this growth and the spread of research networks within the country. METHODS: For 1997-2016, publications from Web of Science with at least one author affiliated with a Peruvian institution were examined by year, author affiliations, funding agencies, co-authorship linkages, and research topics. RESULTS: From 1997-2016, the annual number of publications from Peru increased 9-fold from 75 to 672 totaling 6032. Of these, 56% of the articles had co-authors from the US, 13% from the UK, 12% from Brazil, and 10% from Spain. Universidad Peruana Cayetano Heredia (UPCH) was clearly the lead research institution noted on one-third of publications. Of the 20 most published authors, 15 were Peruvians, 14 trained at some point at UPCH, and 13 received advanced training abroad. Plotting co-authorships documented the growth of institutional collaborations, the robust links between investigators and some lineages of mentorship. CONCLUSIONS: This analysis suggests that international training of Peruvian physician-scientists who built and sustained longstanding international partnerships with funding accelerated quality research on diseases of local importance. The role of a single research university, UPCH, was critical to advance a culture of biomedical research. Increased funding from the Peruvian Government and its Council for Science, Technology and Innovation will be needed to sustain this growth in the future. Middle-income countries might consider the Peruvian experience where long-term research and training partnerships yielded impressive advances to address key health priorities of the country.
    Cheryl A Moyer, Nauzley C Abedini, Jessica Youngblood, Zohray Talib, Tanvi Jayaraman, Mehr Manzoor, Heidi J Larson, Patricia J Garcia, Agnes Binagwaho, Katherine S Burke, and Michele Barry. 2018. “Advancing Women Leaders in Global Health: Getting to Solutions.” Ann Glob Health, 84, 4, Pp. 743-752.Abstract
    BACKGROUND: Women comprise 75% of the health workforce in many countries and the majority of students in academic global health tracks but are underrepresented in global health leadership. This study aimed to elucidate prevailing attitudes, perceptions, and beliefs of women and men regarding opportunities and barriers for women's career advancement, as well as what can be done to address barriers going forward. METHODS: This was a convergent mixed-methods, cross-sectional, anonymous, online study of participants, applicants, and those who expressed an interest in the Women Leaders in Global Health Conference at Stanford University October 11-12, 2017. Respondents completed a 26-question survey regarding beliefs about barriers and solutions to addressing advancement for women in global health. FINDINGS: 405 participants responded: 96.7% were female, 61.6% were aged 40 or under, 64.0% were originally from high-income countries. Regardless of age or country of origin, leading barriers were: lack of mentorship, challenges of balancing work and home, gender bias, and lack of assertiveness/confidence. Proposed solutions were categorized as individual or meta-level solutions and included senior women seeking junior women for mentorship and sponsorship, junior women pro-actively making their desire for leadership known, and institutions incentivizing mentorship and implementing targeted recruitment to improve diversity of leadership. INTERPRETATION: This study is the first of its kind to attempt to quantify both the barriers to advancement for women leaders in global health as well as the potential solutions. While there is no shortage of barriers, we believe there is room for optimism. A new leadership paradigm that values diversity of thought and diversity of experience will benefit not only the marginalized groups that need to gain representation at the table, but ultimately the broader population who may benefit from new ways of approaching long-standing, intractable problems.