LCDR Margaret Brewinski-Isaacs, MD, MPH Medical Officer/HRSA MEPI Team Lead

1. The United States President’s Emergency Plan for AIDS ReliefMedical Education Partnership Initiative:A Global Health Career Example for a USPHS Commissioned Corps Medical Officer LCDR Margaret Brewinski-Isaacs, MD, MPH Medical Officer/HRSA MEPI Team Lead Department of Health and Human Services Health Resources and Services Administration HIV/AIDS Bureau USPHS Annual Symposium – Physician Category Day June 21, 2012

2. Presentation Outline • PEPFAR Summary • MEPI Overview, Background and Activities • Personal background and relevance for a USPHS Commissioned Corps Medical Officer

3. The US government’s contribution to the global fight against HIV/AIDS Also works to alleviate suffering from tuberculosis, malaria and other diseases across the global health spectrum Cornerstone and largest component of the U.S. President’s Global Health Initiative Special focus on improving the health of women, newborns and children PEPFAR Overview

4. Began in 2003 with a 5 year commitment of $15 billion Reauthorized in 2008 for up to $48 billion through 2013 Originally included 15 ‘focus’ countries with current activities in more than 30 countries/regions Technical areas include HIV care, treatment and prevention services as well as health systems strengthening and human resource capacity building PEPFAR Background

5. PEPFAR Structure • Led by the US State Department Office of the Global AIDS Coordinator, Ambassador Eric Goosby • Headquarters (US based) and in-country teams • Interagency collaboration including State Department, USAID, DoD, DoC, DoL, Peace Corps, HHS (HRSA, CDC, FDA, NIH, SAMHSA) • Working Groups for various areas to provide technical input and updates on programming

6. PEPFAR Goals • Transition from an emergency response to promotion of sustainable country programs. • Strengthen partner government capacity to lead the response to this epidemic and other health demands. • Expand prevention, care, and treatment in both concentrated and generalized epidemics. • Integrate and coordinate HIV/AIDS programs with broader global health and development programs to maximize impact on health systems. • Invest in innovation and operations research to evaluate impact, improve service delivery and maximize outcomes

7. Medical Education Partnership Initiative (MEPI) The PEPFAR MEPI program is a 5 year collaborative effort initiated by the U.S. State Department Office of the Global AIDS Coordinator in 2010 and co-implemented by the • Health Resources and Services Administration • National Institutes of Health

8. Rationale for MEPI Great need for human resources for health: • 3% of the world’s health workers address 24% of the global burden of disease is Sub-Saharan Africa • Sub-Saharan Africa Medical Schools Study (SAMSS) • Survey and analysis of Sub-Saharan African medical schools • 1/3 of medical graduates leave country within 5 years • 1/3 of faculty posts are vacant • 30% of faculty must supplement their income • 50% of medical schools are < 20 years old • Relates to all of the PEPFAR goals previously discussed

9. MEPI Goal: Provide direct support to African institutions to transform medical education in Sub-Saharan Africa, strengthening and building clinical and research capacity and thereby strengthening human resources for health. Where: 13 Awardee Institutions in 12 African Countries and 1 Coordinating Center at George Washington University in partnership with the African Center for Global Health and Social Transformation Funding: $130 million over 5 years

10. Addis Ababa University Kwame Nkrumah University University of Nairobi University of Ibadan Makerere University Kilimanjaro Christian Medical Centre University of Malawi University of Zambia University of Botswana University of Eduardo Mondlane Stellenbosch University University of KwaZulu-Natal University of Zimbabwe

11. MEPI Expected Outcomes: • Increase capacity, including quantity and quality, of health professionals in Africa, particularly physicians. • Increase retention of health professionals and faculty in their home countries. • Increase capacity for locally/regionally relevant research.

12. MEPI: Highlights of Year 1 • Increasing student enrollment • Curriculum revision and reform – training health professionals to meet the needs of the local population • Introduction of new teaching/learning methodologies such as team-based, problem-based, and organ system focused • Improving ICT infrastructure including internet connectivity and online learning/exams • Focus on rural clinical rotations and student recruitment • Strengthened research capacity including mentorship for students, IRB, management strategies

13. MEPI: Year 2 Activities • Implementation of new curricula • Continued increases in enrollment, often with emphasis on recruiting female students and students from rural/underserved areas • Ongoing recruitment of faculty members to respond to critical shortages • Further strengthening involvement, support and collaboration with Ministries of Health and Education to address national health priorities • Strengthening collaboration among MEPI institutions in Africa • Increased collaboration with other international agencies and donors to strengthen sustainability of MEPI

14. PEPFAR/MEPI as an example of a global health career opportunity for a USPHS Commissioned Corps Medical Officer

15. Brief educational and professional background • Physician board certified in Pediatrics and General Preventive Medicine • Additional international health training/MPH • Previous work experience in global health through WHO/PAHO and USAID • Experience/comfort working abroad, particularly in ‘hardship’ areas

16. Some personal attributes that help • Interest in and familiarity with global health issues • Flexibility, adaptability and curiosity – personally and professionally • Sense of adventure – comfort in less than ideal conditions with limited resources

17. Some personal attributes that help • Patience and ability to find satisfaction in small achievements – sustainable change takes time • Ability to work effectively in an often politically sensitive environment • Stay alert to potential opportunities • Supportive family!

18. Things to consider • Where – US based with travel vs living abroad • Clinical vs public health • Areas of interest/expertise…but be flexible! • Motivation • Cultural competency • Network, network, network

19. Possible agencies to consider DoD Coast Guard State Department Others?? • CDC • HHS/OGA • NIH • IHS

20. For more information…. • PEPFAR website www.pepfar.gov • MEPI Websites USG: www.pepfar.gov/initiatives/mepi/index.htm MEPI Network: www.mepinetwork.org

21. Contact Information LCDR Maggie Brewinski-Isaacs, MD, MPH Medical Officer/HRSA MEPI Team Lead Office: 301-443-0978 mbrewinski-isaacs@hrsa.gov

22. Thank you!