Introduction: In the new century, worldwide health professionals face new pressures for changes towards more cost-effective and sustainable health care for all populations. Globalization creates daunting challenges as well as new opportunities for institutions and health professionals being more connected and rethink their strategies toward an interprofessional practice. Although Health professionals are paying increased attention to issues of global health, there are no current competency assessment tools appropriate for evaluating their competency in global health. This study aims to assess global health competencies of family medicine residents, nursing, physiotherapy and occupational therapy students in five universities across Ontario, Canada Methods: A total of 429 students participated in the Global Health Competency Survey, drawn from family medicine residency, nursing, physiotherapy and occupational therapy programs of five universities in Ontario, Canada. The surveys were evaluated for face and content validity and reliability. Results: Factor analysis was used to identify the main factors to be included in the reliability analysis. Content validity was supported with one floor effect in the “racial/ethnic disparities” variable (36.1%), and few ceiling effects. Seven of the twenty-two variables performed the best (between 34% and 59.6%). For the overall rating score, no participants had floor or ceiling effects. Five factors were identified which accounted for 95% of the variance. Cronbach’s alpha was >0.8 indicating that the survey items had good internal consistency and represent a homogeneous construct. The results of the survey demonstrated that self-reported knowledge confidence in global health issues and global health skills were low for family medicine residents, nursing, physiotherapy and occupational therapy’ students. The percentage of residents and students who self-reported themselves confident was less than 60% for all global health issues. Conclusion: The Global Health Competency Survey demonstrated good internal consistency and face and content validity. The new century requires professionals competent in global health. Improvements in the core competencies in global health can be a bridge to a more equal world. Institutions must offer interprofessional approaches and a curriculum that exposes them to a varied learning methods and opportunities to improve their knowledge and skills in global health.

Background: In many countries, a significant proportion of medicines traded and consumed are of poor or variable quality. Meanwhile, failures in appropriately framing and responding to the problem have led to a proliferation of public health and governance challenges. Objective: To examine the issues exacerbating the trade and consumption of medicines of poor or variable quality, as well as present locally relevant strategies. Methods: Analytic triangulation was applied to the synthesis of publicly available documents. Results: Where economic and regulatory environments are less structured, supply chain security strategies that fixate on ‘counterfeits’ often fail in limiting the prevalence of poor quality medicines. In addition to a multivariate drug quality classification chart, three quality frameworks are presented for examining appropriate policy strategies in mediating drug quality. Conclusion: These tools can assist stakeholders in determining more locally relevant and context-specific strategies, while interrogating the proposition for greater transparency vis-à-vis drug quality.

Background: In many countries, a significant proportion of medicines traded and consumed are of poor or variable quality. Meanwhile, failures in appropriately framing and responding to the problem have led to a proliferation of public health and governance challenges. Objective: To examine the issues exacerbating the trade and consumption of medicines of poor or variable quality, as well as present locally relevant strategies. Methods: Analytic triangulation was applied to the synthesis of publicly available documents. Results: Where economic and regulatory environments are less structured, supply chain security strategies that fixate on ‘counterfeits’ often fail in limiting the prevalence of poor quality medicines. In addition to a multivariate drug quality classification chart, three quality frameworks are presented for examining appropriate policy strategies in mediating drug quality. Conclusion: These tools can assist stakeholders in determining more locally relevant and context-specific strategies, while interrogating the proposition for greater transparency vis-à-vis drug quality.

Dengue is a mosquito-borne disease that has gone from isolated sylvatic spill-overs to a pathogen of global public health importance in less than a century. Surveillance and control efforts have continually lagged behind contemporary needs and this thesis investigates the pressing need to reassess the current geographic limits and case burden of dengue including how these are measured. First, the global distribution of reported dengue infections was mapped. In many areas dengue reporting is sparse as it can be asymptomatic or clinically similar to other diseases. The maps identified surveillance gaps, particularly in Africa and the Middle East, where targeted efforts are needed to reliably measure the contemporary global extent of dengue transmission. Second, the global case burden of dengue was estimated by pairing risk maps with longitudinal cohort study data. This gave the first cartographic estimate of dengue cases and at 390 million per year (95% CI: 284-528) was over three times the World Health Organization official estimate. Reconciling these estimates with reported case data allowed an assessment of existing national surveillance strategies. Third, existing methods for outbreak identification were compared. High burden dengue outbreaks are preventable if timely and appropriate measures are applied. This analysis suggested, however, that commonly used outbreak definitions are not consistent, which could have an adverse effect on outbreak response. An alternative framework for outbreak identification based on healthcare capacities is thus outlined. Fourth, an analysis was undertaken that quantified how mosquito vectors place geographic and seasonal limits on dengue transmission. This involved updating estimates of mosquito longevity which were integrated with temperature-dependent dynamic transmission models to produce global maps. These suggested that while temperature places strong limits on the distribution of dengue in some settings, mosquito ecology may be more important in others. Finally, these findings are discussed in the context of global dengue surveillance gaps, with recommendations of how these can be addressed at a time when providing an evidence base for deployment of new control strategies will be critical.

Neglected Tropical Diseases (NTDs) are both causes and manifestations of poverty in developing countries. Recent advocacy efforts have increased the profile of NTDs, and led to bold new control and elimination targets set for 2020 by the World Health Organisation. However there are multifaceted challenges in effectively implementing NTD interventions in resource-poor contexts that need to be understood and engaged. While there is a growing call by researchers and international agencies for a science of global health delivery to understand these complexities, the exact nature of this science remains contested. This thesis contributes to these debates by advancing a critical social science perspective on the factors that mediate intervention effectiveness for NTD control. Grounded in a social constructivist approach using mixed methods, it critiques prevailing orthodoxies by unpacking the nature, processes and outcomes of three large-scale NTD prevention programmes in Eastern Africa. Focused on different diseases, these case studies represent different types of intervention approaches: top-down, participatory and public-private partnership. The thesis traces the social, technical and environmental processes that mediate the delivery, adoption and use of particular health technologies, such as pit latrines, insecticides and vaccination. Together, these case studies reveal surprisingly similar reasons for why many interventions do not perform according to expectations. Despite new approaches that claim to overcome stereotypical challenges of top-down planning, narrow technocratic perspectives continue to play a defining role in maintaining disjunctions between global aspirations, local realities and intervention outcomes. New perspectives and changes in orientation are needed that emphasise flexibility, learning and adaptability to local contexts. Towards this end, the thesis outlines a conceptual framework based on a comparative analysis of the case studies that highlights five interrelated domains where effectiveness is determined: geographical/livelihood variation, local agency, incentives, the socio-materiality of technology and planning/governance. I argue that addressing the shortcomings of contemporary interventions requires that programme planners actively engage these domains by seeking to “order complexity.” Greater integration of social science perspectives into the management of NTD programmes would provide significant benefit. In these ways, the thesis contributes to wider debates about the nature of global health interventions and the influence of local contexts in mediating efforts to improve the health and wellbeing of the world’s poor and marginalised.

Introduction: In the new century, worldwide health professionals face new pressures for changes towards more cost-effective and sustainable health care for all populations. Globalization creates daunting challenges as well as new opportunities for institutions and health professionals being more connected and rethink their strategies toward an interprofessional practice. Although Health professionals are paying increased attention to issues of global health, there are no current competency assessment tools appropriate for evaluating their competency in global health. This study aims to assess global health competencies of family medicine residents, nursing, physiotherapy and occupational therapy students in five universities across Ontario, Canada Methods: A total of 429 students participated in the Global Health Competency Survey, drawn from family medicine residency, nursing, physiotherapy and occupational therapy programs of five universities in Ontario, Canada. The surveys were evaluated for face and content validity and reliability. Results: Factor analysis was used to identify the main factors to be included in the reliability analysis. Content validity was supported with one floor effect in the “racial/ethnic disparities” variable (36.1%), and few ceiling effects. Seven of the twenty-two variables performed the best (between 34% and 59.6%). For the overall rating score, no participants had floor or ceiling effects. Five factors were identified which accounted for 95% of the variance. Cronbach’s alpha was >0.8 indicating that the survey items had good internal consistency and represent a homogeneous construct. The results of the survey demonstrated that self-reported knowledge confidence in global health issues and global health skills were low for family medicine residents, nursing, physiotherapy and occupational therapy’ students. The percentage of residents and students who self-reported themselves confident was less than 60% for all global health issues. Conclusion: The Global Health Competency Survey demonstrated good internal consistency and face and content validity. The new century requires professionals competent in global health. Improvements in the core competencies in global health can be a bridge to a more equal world. Institutions must offer interprofessional approaches and a curriculum that exposes them to a varied learning methods and opportunities to improve their knowledge and skills in global health.

The covid-19 pandemic confronted the world with one of the biggest challenges of the future: global health security. Analyzing the pandemic through the lens of securitization theory can create a deeper understanding of the connection between global health and international politics. This thesis underlines the deeply political character of (de)securitization and the impact that new types of security threats can have on the international system. It analyzes the effects of (de)securitization on the behavior of states towards each other and argues for a more comprehensive and cooperative approach to the threats of the future. This can be achieved by incorporating the concept of risk into the framework of securitization as well as by broadening the political understanding of the process.

Cholera is a diarrhoeal disease caused by the infection of the intestine with bacterium vibrio cholera. The diarrhoeal disease is a recurrent feature of Zimbabwe's post 1990s history. From 1993 to 2018, the country has experienced several cholera outbreaks in both rural and urban areas. The country's worst cholera outbreak occurred in 2008/2009 and resulted in over 4000 deaths. The dissertation analyses three global health actors' responses to persistent cholera outbreaks in Harare, the capital city of Zimbabwe. Building on previous scholarship of water, cholera and politics, the dissertation compares global health actors' responses to the 2008/2009 and September to November 2018 cholera outbreaks. The dissertation used the qualitative research method including analysis of existing academic literature, Zimbabwean national legislation, non-governmental organisation (NGO) publications and conference reports, news articles and Zimbabwean government policy documents. In-depth interviews with personnel from the World Health Organisation, United Nations Children's Fund, Médecins Sans Frontierès (Doctors without Borders) and the Harare City Council Health Department were conducted in Harare, Zimbabwe from June to July 2019. The dissertation demonstrates that the scope and speed of global health actors' emergency cholera interventions in Harare are shaped by Zimbabwe's political climate and the state of Harare's health, water and sanitation infrastructure.

Engaging students in class when first-hand experience is not available is challenging. Three teaching strategies, flipped classroom, a guest speaker, and technology, engaged students during a global health class. Students were given a graded preclass assignment, which was used to guide the class session when an expert physician from Zambia joined us using technology. On the day of class, students were engaged and asked questions of the physician related to global health and culture. Combining the three strategies was an innovative and effective way to engage students, with many sharing with faculty that this was their favorite class day.

Background: The direct and indirect impact of the SARS-CoV-2 virus and its mitigation measures have exacerbated the global mental health crisis. Digital mental health interventions (DMHIs) may have the potential to address health system gaps and global health inequalities in low-and middle-income countries (LMICs). Purpose: This thesis aims to map the current state of DMHIs available in Nigeria and illustrate their progress, limitations, and challenges. This study aims to expand upon the findings of recent studies in LMICs by incorporating the perspectives of individuals who play a prominent role in global mental health. The lessons learned in the Nigerian context can inform the delivery of DMHIs in other low-resource settings. Methods: This research was conducted using case study methodology. Twenty semi-structured interviews were conducted with mental health researchers, healthcare providers, digital health experts and policy makers. Data sources such as news articles, websites, research papers, and interviews were used. Interviews were recorded and transcribed, and data from multiple sources were then converged, coded, and analyzed using Dedoose via thematic analysis. Findings: The vast majority of DMHIs in Nigeria are private mental health service delivery platforms that connect directly to mental health professionals. The target audience for most DMHIs are broad and encompass all mental health conditions and ages. Advantages of DMHIs include increasing efficiency, accessibility, addressing stigma, and filling the mental health service gap. Disadvantages include skepticism in DMHIs, limitations of applicability, lack of accessibility to internet and technology, lack of sustainability, and lack of infrastructure, funding, and policies. Conclusions: There is a need to leverage DMHIs within the Nigerian population for mental health promotion. Future research should examine feedback from users and providers of DMHIs to allow for comparative analysis, more conclusive and replicable results to inform DMHI design and implementation. / Thesis / Master of Science (MSc)