Scott Barnhart

Scott Barnhart, MD, MPH, has an extensive background as Professor of Global Health and former Director of Global Health Programs for I-TECH at the University of Washington. He has had responsibility for leading nine country offices, projects in 14 countries, and more than 500 staff. This experience and training has included extensive clinical work, research and program management in pulmonary and environmental and occupational medicine, and more than eight years as Medical Director of a safety net/Level 1 Trauma Center hospital.

Ensuring health systems can quickly detect and respond to emerging health threats is a critical challenge in both domestic and global health. Dr. Barnhart’s major implementation projects include scale-up of voluntary medical male circumcision (VMMC) in Zimbabwe and Malawi, OpenMRS, and laboratory information systems. Dr. Barnhart deploys his expertise in multiple African countries and Haiti to strengthen health systems and health care.

A goal of Dr. Barnhart’s work is to promote country-led, country owned sustainable development. Consistent with the principles of the Paris Declaration, the goal is to transition the bulk of development work and the associated leadership, ownership, technical direction and control of funding into the countries where development occurs. This approach ensures that the entire continuum of skills necessary for development (technical expertise, administration (human resources, operations, and management and accountability for funds) is transitioned to local partners. A key indicator is to have 75% or more of a grant’s funding expended in-country on local programs and local citizens and to support the local economies in these highly resourced constrained countries. Dr. Barnhart has worked closely to advance this model through projects in Haiti with a goal to shift the majority of a project to a local organization and in Zimbabwe where the VMMC program is largely run through local partners.

Program Highlights

Driving Collaboration with Local Implementation Partners in Zimbabwe

I-TECH builds local ownership and sustainability through collaborations throughout Zimbabwe. Under the CDC and PEPFAR awards, I-TECH has formed and leads two consortia – ZAZIC and ZimPAAC ...
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Ensuring High-Quality Service Provision in Zimbabwe

Describing Adverse Events within VMMC Programs at Scale I-TECH works diligently to review and revise procedures to identify, manage, and report adverse events (AEs). I-TECH’s previous publications on AEs reveal efforts to maintain high quality programming and emphasize patient safety alongside achievement of targets. An evaluation published in the Journal ...
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Health Information Systems in Haiti

Electronic medical record (EMR) systems have the capacity to improve clinical decision making and quality of care at site level but can also be leveraged to make data-driven, population-level public health decisions. At the request of the MSPP ...
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Increasing VMMC Delivery and Safety in Zimbabwe

Employing modern medical male circumcision within traditional settings may increase patient safety and further male circumcision scale up efforts in Sub-Saharan Africa. ZAZIC established a successful, culturally sensitive, partnership with the VaRemba, an ethnic group in Zimbabwe that practices traditional male circumcision. The VaRemba Camp Collaborative (VCC) was created to ...
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Clinical Mentoring in Haiti

Posted on May 1, 2017May 14, 2019

I-TECH introduced its clinical mentoring program in Haiti in 2006. A team of physicians, nurses, and psychologists provide technical assistance to 20 sites in the MSPP care and services network to help strengthen HIV- and AIDS-related services. During site visits, CHARESS mentors conduct clinical rounds Continue reading “Clinical Mentoring in Haiti”

Facilitator’s Guide Breaks New Ground in Ukraine

Health Systems Strengthening HIV Care and Treatment Human Resources for Health Nursing/HCW Cadres Tuberculosis Ukraine

Posted on June 30, 2016May 2, 2023

Dr. Chris Behrens (center) and participants at a pilot training event in Uzhgorod.

In June 2016, the academic and professional communities involved in training family physicians and general practitioners in Ukraine received another valuable guide to a highly sensitive topic.

The International Training and Education Center for Health (I-TECH) in Ukraine, the Ukrainian Family Medicine Training Center (UFMTC) at the Bogomolets National Medical University (NMU), and the International Renaissance Foundation, all under the auspices of the Ministry of Health (MoH) of Ukraine, published “Use of Narcotic, Psychotropic Substances and their Precursors in the Practice of Family Medicine.” This facilitator’s guide (published in Ukrainian) was developed by Ukrainian and international experts in the fields of palliative care, controlled drug use, and pain management.

“The uniqueness of this publication is its extremely topical and, until recently, understated issue in Ukraine: provision of medical care with the use of controlled drugs, including opioid analgetics,” said Kateryna Amosova, Rector of the Bogomolets NMU.

The guide incorporates recent, groundbreaking updates in Ukrainian legislation. Resolution #333 of the Cabinet of Ministers of Ukraine and Order #494 of the MoH legitimize primary health care providers to prescribe and manage opioids for pain management in palliative care and opioid substitution therapy (OST).

“I-TECH Ukraine was honored to be able contribute to the development of the in-service training course that promotes most progressive principles of palliative care and OST provision for patients, including those with HIV, tuberculosis, and other HIV-associated diseases,” said Anna Shapoval, Country Representative for I-TECH Ukraine. “As always, we express our profound gratitude to the Ministry of Health of Ukraine, HRSA of the U.S. Department of Health and Human Services, CDC in Ukraine, and the International Renaissance Foundation for supporting this project.”

The goal of this training curriculum is to provide participants with the skills and knowledge required to form competencies in applying narcotic, psychotropic substances, and their precursors in the practice of family medicine, specifically in combination with treatment of drug addiction, tuberculosis, and hepatitis.

Participants work at the pilot training in Uzhgorod.

The guide is based on the results of three pilot training events that took place in October through December 2015 in Uzhgorod and Kyiv. Dr. Chris Behrens, Clinical Associate Professor in the University of Washington’s Department of Global Health, co-facilitated the first event in Uzhgorod. Dr. Behrens also co-authored the guide, along with leading experts from the Bogomolets NMU, the Ministry of Internal Affairs of Ukraine, the National Police of Ukraine, the State Service of Ukraine for the Drug Use Control, the Ivano-Frankivsk Oblast Clinical Center for Palliative Care, the Kyiv and Kryvyi Rih City AIDS Centers, and the International Renaissance Foundation.

The course covers such essential themes as:

The role of family physicians and primary health care facilities in using narcotic and psychotropic drugs and their precursors;
Legal and organizational principles of applying narcotic and psychotropic drugs and their precursors in primary health care practice in Ukraine;
Mental health; pre-conditions and types of opioid addiction; HIV/AIDS and other infectious diseases in IDUs; palliative and hospice care;
Principles and use of opioid maintenance therapy in primary health care, including the patients living with HIV/AIDS; and
Principles and use of narcotic and psychotropic drugs and their precursors in provision of palliative and hospice care, including patients living with HIV/AIDS.

The MoH of Ukraine recommends this guide as a tutorial for clinical interns and doctors enrolled in in-service or continuous medical education training programs, as well as for faculty of the Ukrainian medical universities and colleges that train doctors and nurses as general practitioners and family doctors. The guide has been already disseminated to about 60 medical universities and the largest medical colleges in Ukraine.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under U91HA06801, the International AIDS Education and Training Center (IAETC). The content of this post is the author’s and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.

I-TECH Shares Research at CUGH 2015

Haiti Health Information Systems Health Systems Strengthening Kenya Malawi Male Circumcision Nursing/HCW Cadres Quality Improvement

Posted on March 19, 2015August 1, 2017

On March 26-28, Boston University will host the Sixth Annual Consortium of Universities for Global Health (CUGH) Conference.

The theme of this year’s conference is “Mobilizing Research for Global Health,” and featured speakers include Olusoji Adeyi, Director, Health, Nutrition and Population, World Bank; Paul Farmer, Co-Founder, Partners in Health; and Stephen Morrison, Vice President, Center for Strategic and International Studies.

Staff members from the International Training and Education Center for Health (I-TECH) will attend to present research on several topics:

Malawi

Quality improvement practices decrease adverse event rates in a surgical male circumcision program in Malawi
Kohler PK, Chilongozi DA, Namate D, Barr BA, Msungama W, Phiri O, Tenthani L, Chalulu K, Perdue T, Barnhart S, Krieger JN

Improving nursing and midwifery clinical education by developing local faculty mentoring capacity in Malawi
Holman J, Muyaso M, Msiska G, Namate D, Wasili R

Haiti

An assessment of data quality in Haiti’s multi-site electronic medical record system
Puttkammer N, Baseman JG, Devine EB, Hyppolite N, France G, Honoré JG, Matheson AI, Zeliadt S, Yuhas K, Sherr K, Cadet JR, G. Zamor, Barnhart S

Kenya

Evolution of the KenyaEMR training program: Towards efficiency and quality in scale-up
Atelu C, Antilla J, Muthee V, Puttkammer N

About CUGH

Founded by leading North American university global health programs, CUGH aims to:

Define the field and discipline of global health;
Standardize required curricula and competencies for global health;
Define criteria and conditions for student and faculty field placements in host institutions;
Provide coordination of projects and initiatives among and between resource-rich universities and less-developed nations and their institutions.

CUGH is dedicated to creating balance in resources and in the exchange of students and faculty between institutions in rich and poor countries, recognizing the importance of equal partnership between the academic institutions in developing nations and their resource-rich counterparts in the planning, implementation, management and impact evaluation of joint projects.

Faculty Partnerships with University of Namibia Lead to Strengthened School of Public Health

eLearning/Distance Learning Health Systems Strengthening Human Resources for Health Leadership & Management Namibia Nursing/HCW Cadres

Posted on February 23, 2015August 1, 2017

UNAM School of Nursing Science and Public Health

Despite a decrease in the estimated annual HIV/AIDS incidence since 2001, HIV/AIDS remains a significant source of morbidity and mortality in Namibia.[1]

In 2008, the International Training and Education Center for Health (I-TECH) at the University of Washington (UW) was invited to conduct a rapid assessment of the University of Namibia (UNAM) master’s degree program in public health, with the goal of identifying ways to strengthen UNAM’s School of Nursing Science and Public Health. Dr. Virginia Gonzales, Senior Lecturer in the UW’s Department of Global Health and Senior Technical Specialist with I-TECH, led that study along with Lee Pyne-Mercier, UW Affiliate Instructor and former I-TECH Country Program Manager.

New award based on study findings

Recommendations included the suggestion that UNAM attract lecturers from outside the university to strengthen teaching in subjects such as research methods, epidemiology, and biostatistics. Based on these and other findings from the assessment, UNAM and UW/I-TECH submitted a joint application to the US Centers for Disease Control and Prevention (CDC) and were awarded a five-year cooperative agreement in 2010, with Dr. Ann Downer, Executive Director of I-TECH, serving as principal investigator.

The goal of the agreement was to improve and enhance the UNAM School of Nursing Science and Public Health. Objectives for this project included:

Plan for sustainability and transfer of resources to UNAM.
Strengthen professional development and faculty support at UNAM.
Strengthen content and delivery of the MPH program at UNAM.
Improve research capacity and output of lecturers and students at UNAM.
Strengthen institutional capacity and infrastructure for teaching public health at UNAM.

With this new award, I-TECH/UW and UNAM embarked upon a series of faculty partnerships. The group also began to explore how to separate the UNAM School of Nursing Science and Public Health into two programs, creating both a School of Nursing and a School of Public Health. The UNAM Senate issued a proclamation in 2014 that this would occur.

“The focus of curriculum [in the new School of Public Health] will be needs-driven,” says Dr. Käthe Hofnie Hoëbes, Associate Dean of the UNAM School of Nursing Science and Public Health, “and it will support new job growth in Namibia, as it promotes the creation of new cadres of public health specialization.”

From partnership comes growth

Retreat with UW and UNAM faculty, 2009

The CDC award has now come to an end; however, through this project, UW and UNAM created 16 strong faculty partnerships, all determined by the priorities of the UNAM faculty through a Public Health Working Group (PHWG).

“The benefit of working with the PHWG was one of the key takeaways from this project,” says Dr. Gonzales. “It ensured that UNAM was in the position to offer continual input, guide project activities, and truly lead the project.”

The faculty partnerships occurred in health policy, bioethics, nutrition, research, environmental health, and epidemiology, linking interested faculty at UW and UNAM. Through these relationships, UW faculty visited the main UNAM campus in Windhoek to facilitate workshops and review curriculum, and the UNAM faculty visited UW to observe classes and work on curriculum revision.

As a result of the trust among faculty at both universities, partnerships evolved in unexpected areas as well, including social work, nursing, medicine, pharmacy, teaching technologies, and with the Namibian Ministry of Health and Social Services’ (MOHSS) Primary Health Care Program.

“Working in partnership was a cross fertilizing, fulfilling and enriching exercise for all of us who were involved,” says Magdaleena Nghatanga, former Director of the Directorate of Primary Health Care, MOHSS. “Across the ocean we shared experiences and professional expertise. Utilizing technology such as Skype, Dropbox, and e-learning helped the team in developing and revising the curriculum, as well as in building and improving teaching at the university level. As a result, the Primary Health Care Program and curriculum were revised and updated, and the students were thrilled with the new lectures.”

Outcomes echo throughout the country

Leaders in Health–Namibia! working group, 2010

The collaboration also focused attention on teaching skills, and evaluations of faculty by students at UNAM improved considerably. In addition, UNAM graduates reported improved skills and knowledge in HIV/AIDS, nutrition, health policy, epidimiology, and research and increased knowledge of and interest in public health. Thesis supervisors at UNAM reported greater skills in supervision and student mentoring, and UNAM lecturers reported increased knowledge, skills, and confidence in teaching course materials.[2]

The workshops offered on learning theory and teaching skills were later scaled to all of UNAM, including remote campuses. Several faculty also participated in the Leaders in Health – Namibia! (LIH) program that was designed by I-TECH/UW in collaboration with the MOHSS in order to strengthen the health care delivery system in Namibia through effective mentoring of health leaders and managers. The UNAM faculty who participated in LIH later improved course content on leadership and management at UNAM by using material and content from LIH.

“This partnership has yielded benefits on many fronts,” says Dean Hofnie Hoëbes. “Lines of collaboration have been initiated with other world-class universities, and technical support was provided for the roadmap for establishing a standalone School of Public Health. This will benefit the nation as a whole by supporting public health care in the country and preparing a larger, professional workforce with specialized skills to address shortages in public health practitioners in Namibia.”

_________________

[1] Namibia Global Health Initiative, 2011-2015/16.

[2] University of Namibia and I-TECH Namibia. Evaluation of the Impact of the UNAM/I-TECH Collaboration upon the Master of Public Health Program, 2009-2012. 2013.

Ukrainian Medical University Delegation Visits I-TECH HQ

Health Systems Strengthening HIV and STI Prevention HIV Care and Treatment Human Resources for Health Nursing/HCW Cadres Quality Improvement Ukraine

Posted on July 8, 2014May 2, 2023

Ukraine_MOU_image

From L to R: Dr. King Holmes, Dr. Olga Vystoska, and Dr. Ann Downer present the signed MOU.

On June 12 and 13, representatives from Ukraine’s Bogomolets National Medical University (NMU) visited I-TECH HQ offices at Harborview Medical Center and the University of Washington (UW) Department of Family Medicine.

NMU is the leading medical school in Ukraine, with more than 150 years of history. This visit formally launched the partnership between NMU and the UW’s I-TECH, Department of Global Health, School of Nursing, School of Medicine, and Family Medicine Department. Steps toward partnership began this spring, with a Memorandum of Understanding (MOU) signed by all parties.

The visit started off with a two-hour planning meeting, during which Dr. King Holmes, chair of the UW Department of Global Health (DGH), gave an introduction to the department. This was followed by presentations by Olga Vystoska, Director of the Ukrainian Family Medicine Training Center at NMU, and other UW department representatives, who explored possible areas of collaboration. The meeting wrapped up with the exchange of signed originals of the MOU.

The Ukrainian delegation particularly appreciated the opportunity to meet I-TECH’s Executive Director, Dr. Ann Downer, and staff; learn about I-TECH’s activities; and tour the UW’s Family Medicine Clinic and Harborview Madison Clinic, which provides medical care and social services for persons living with HIV/AIDS. The group was especially impressed by a tour of the UW Institute for Simulation and Interprofessional Studies (ISIS) lab at Harborview, and Dr. Vystoska expressed interest in starting a similar lab at NMU.

The delegation also had a working meeting with Dr. Chris Behrens to discuss next steps in developing an HIV in-service training curriculum for family practitioners that I-TECH plans to pilot in Kyiv in October with Dr. Behrens’s co-facilitation.

The new Project Director of I-TECH Ukraine, Anna Shapoval, was a driving force behind this collaboration and visit.

“The I-TECH Ukraine team is excited to promote the HIV response and health care reform in Ukraine,” said Ms. Shapoval, who added that she was very pleased with how the meetings went. “We look forward to growing I-TECH’s presence in country, focusing on the most urgent issues of streamlining HIV into primary health care, advancing quality assurance and quality improvement models — as continuation of its unique experience with CLASS.”

Other potential areas of collaboration include joint research activities, publications, and library exchanges; the exchange of faculty members and students for study, teaching, and research; and joint hosting of distance education broadcasts and online courses and seminars.

Julie Stein, Technical Officer for Training Development on the I-TECH Ukraine team, expressed enthusiasm as well. “This visit was incredibly fruitful,” said Ms. Stein. “The meetings and tours generated a lot of excitement from everyone about possible future collaboration.”

HRSA Delegation Witnesses I-TECH’s Vital Work in South Africa

Health Systems Strengthening Nursing/HCW Cadres South Africa

Posted on April 17, 2014May 1, 2017

Members of the HRSA delegation and officials from a Department of Correctional Services (DCS) health facility in Witbank, South Africa

In late March, I-TECH South Africa hosted a delegation from the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA).

Led by Dr. Mary Wakefield, HRSA Administrator, the delegation also included Ambassador Jimmy Kolker, Assistant Secretary for Global Affairs, U.S. Department of Health and Human Services (HHS); Dr. Austin Demby, Director – PEPFAR, Office of Global Affairs, HHS; and Dr. Jose Rafi Morales, Director HRSA/HAB PEPFAR Global HIV/AIDS Program.

The group was accompanied in-country by Steven T. Smith, Health Attaché and HHS Regional Representative for Southern Africa; Dr. Nancy Knight, CDC Country Director; Rehmeth Fakroodeen, CDC HSS lead and HRSA Activity Manager; and the I-TECH Senior Management Team.

The purpose of the visit was to observe the following activities, funded by HRSA through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).

Training Correctional Health Workers

With 165,000 inmates incarcerated in 237 correctional facilities, South Africa has the fourth-highest global incarceration rate, and the country’s facilities are operating at 137% of intended capacity.[1]Overcrowding leads to insufficient ventilation and poor physical and mental health, all of which fuel the spread of HIV and tuberculosis (TB). HIV prevalence in these facilities is as high as 34.6%,^[2] and the reported TB cure rate is less than 40%, compared to 70% in the general population.[3]

Ensuring adequate skills among health care providers in correctional facilities is essential to fight the spread of HIV and other communicable diseases. During its first visit, to a DCS health facility in Witbank, the HRSA delegation witnessed first-hand I-TECH’s work to conduct a situational analysis and support the training of health care workers on the care and management HIV and AIDS, tuberculosis, and sexually transmitted infections (STIs). This work was conducted in two regions: Limpopo, Mpumalanga, and North West (LMN) and KwaZulu-Natal.

Supporting Continuing Professional Development for Nurses

In 2012, the SANC started the process of developing a Continuing Professional Development (CPD) Program for the 262,000 nurses in South Africa[4]; however, due to funding constraints and lack of capacity, I-TECH South Africa was asked to support them in the program’s development. Through the CPD Program, nursing practitioners will be required to attain a minimum number of CPD points as a prerequisite for annual renewal of their license to practice.

The HRSA delegation met with the Chair of the Board of Directors of SANC and its Registrar, as well as representatives from the National Department of Health and academic institutions. Members of the delegation were briefed on achievements to date, which include technical assistance to establish a CPD technical working group and a draft CPD framework for nurses, a situational analysis of feasibility and acceptability of CPD, and a CPD pilot study outline developed for two provinces.

[1] Institute of Medicine. Key Populations, Key Solutions – A Gap Analysis & Recommendations for Key Populations and HIV in South Africa. Accessed 17 March 2013. http://southafrica.iom.int/publication/key-populations-key-solutions-a-gap-analysis-recommendations-for-key-populations-and-hiv-in-sa/

[2] South African Department of Correctional Services. 2007 Prevalence Survey for HIV.

[3]Verbal communication with South African National Department of Correctional Services on 28 March 2013.

[4] South African Nursing Council Licensure Register.