Third Symposium on Integration Science speakers found reasons for optimism amid global health’s shifting financial and social landscapes, as they urged precision in how integration is approached and a greater focus on patient empowerment.
Dr. Gene Bukhman, executive director of the Center for Integration Science in Global Health Equity, and Dr. Una Osili from Indiana University’s Lilly Family School of Philanthropy enjoy a lighthearted moment during their fireside chat on philanthropy and global health. (Photo: Kate Flock/MGH Photo Lab)
In an afternoon of expansive discussions about global health, speakers at the Third Symposium on Integration Science found reasons for optimism despite dramatically shifting financial landscapes. They also explored sources of innovation and emphasized a focus on patient-centric health systems and care above all.
“The minute you design systems to serve the elite, you lose equity,” said Dr. Allyala Nandakumar, director of the Global Social Work and Public Health Lab at Boston University’s School of Social Work. “What can integration science tell you about designing systems and care pathways that enhance equity and empower the poor?” That remark drew applause in a rotunda packed with more than 90 participants at the Joseph B. Martin Conference Center, part of the Harvard Medical School campus. The Center for Integration Science in Global Health Equity, based at Brigham and Women’s Hospital, hosted the symposium to explore how new approaches to global health can improve patient outcomes worldwide.
“We’re interested in applying what we’ve learned in these two sciences—the science of health care delivery models and the science of social movements—to other areas,” said Dr. Gene Bukhman, executive director of the Center for Integration Science and a professor of medicine at Harvard Medical School. Dr. Bukhman noted that a primary focus of the Center’s work is serving as the Boston co-secretariat of the NCDI Poverty Network, which already collaborates with 29 countries. The Center directly supports clinics in 14 of those countries; together, those 37 clinics provide care for more than 30,000 patients.
Dr. Bukhman also credited his fellow Network co-chair, Dr. Ana Mocumbi, with fostering a critical partnership for the Network at Universidade Eduardo Mondlane in Maputo, Mozambique—the Maputo co-secretariat—as the Network strives to build international collaborations for the integration of health care delivery with related social impact.
Dr. Mocumbi, an associate professor at Universidade Eduardo Mondlane, told the symposium audience that global health is “a social movement toward justice,” and should strive for equity among all patients, regardless of where they were born or where they live.
“Each of our 30,000 patients is a story,” she said. “Many times, they are stories of resilience. And we think that these stories together can change the world.”
Scalpels Rather than Sledgehammers
In addition to the audience gathered in the rotunda, dozens of people watched the symposium online. All the attendees heard speakers describe global health financing that is at once beset by billions of dollars lost from disappearing public sector contributions, but perhaps ultimately buoyed by potential philanthropy from new private sector revenue, primarily in the booming artificial intelligence field. In the opening fireside chat, Dr. Una Osili from Indiana University’s Lilly Family School of Philanthropy told Dr. Bukhman that $100 billion in new funding will soon come into philanthropy, primarily because of initial public offerings and AI-related ventures.
“With the dismantling of USAID, we’ve seen a lot more interest in global health and people looking at private philanthropy,” said Dr. Osili, who also serves as executive director of philanthropy, strategy, and operations for the Eli Lilly and Company Foundation. “With the growth of new forms of capital, and new capital coming into the philanthropic ecosystem, I would say there’s a lot of opportunity to study these new donors and where they’re going to give.”
Opportunities for new revenue would be a boon for beleaguered global health practitioners. Dr. KJ Seung, an assistant professor of medicine at Harvard Medical School and co-lead of the endTB Project, which has expanded access to new tuberculosis drugs and generated clinical trials for treatment of drug-resistant tuberculosis around the world, said “integration” as a buzzword has opened the door to misconceptions that the emerging science is a magic bullet.
Dr. Seung said initiatives such as implementing networks of community health workers to support rural patients, boosting training and staffing at low-resource health facilities, and strengthening referral systems for specialized care are all aspects of integration science, a tool for health care delivery that should be wielded much more like a scalpel than a sledgehammer. To be effective, integration efforts need to be precise and based on a solid foundation of evidence.
“The point is not integration; that’s not the goal,” Dr. Seung said. “The goal is to scale up, to provide access to something that patients have not had access to.”
In a panel discussion on identity and power, Rachel Gasana, senior director of advancement for the Center for Integration Science, noted that staying stuck in fixed ideas about identity and responsibility further weakens our ability to respond to the current moment collectively and to make the funding and financing changes necessary to make progress. Gasana concluded by identifying an antidote: Staying curious.
“How do we as a global health community stay curious and become more flexible in this moment of momentous change?” she asked. “How do we not take for granted the pathways that have been established, but rather build on them?”
Resetting the Focus on Patients
Dr. Biraj Karmacharya, an associate professor at the Kathmandu University School of Medical Sciences in Nepal, acknowledged the complexity of care. “The nature of different diseases and conditions that we are handling now are much more complex than in the past, and the systems we need have to match that,” said Dr. Karmacharya, who also directs public health and community programs at Dhulikhel Hospital, near Kathmandu. “Our systems have never been patient centric; they always have been provider centric.” Reorganizing services toward patient-centric models, Dr. Karmacharya added, “is where the science of integration starts.”
The consistent themes of new possibilities, innovations, and opportunities expressed by symposium speakers, amid withdrawals of public-sector global health funding that are creating crisis-level impacts around the world, drew a resonant remark from Dr. Emily Wroe, an assistant professor of medicine at Harvard Medical School and senior director of programs for the Center for Integration Science.
“I think some of the best resources for big ideas are the frontline care providers,” Dr. Wroe said. “This is a business for optimists, right?”
Guiding Lights
Building health systems that are rooted in patients and their communities was also on the mind of Dr. Sania Nishtar, the symposium’s closing fireside chat with Dr. Bukhman. Dr. Nishtar is chief executive officer of Gavi, the Vaccine Alliance, a $2 billion global health initiative that has provided access to lifesaving vaccines for more than 1.3 billion people since 2000, including more than 73 million children in 2025 alone.
Dr. Nishtar joined the symposium virtually from Rome, where, earlier in the day, she had represented Gavi as it received a De Sanctis Social Health Award at the Palazzo Spada. Reflecting on a career of more than 30 years in health reform, poverty alleviation, and social protections in her native Pakistan and around the world, Dr. Nishtar said her experiences as a cardiologist spurred her to work in advocacy, after seeing people struggle with “catastrophic health expenditures” and enormous barriers to accessing care. After describing a woman shouldering the costs and long travel to reach a rural health facility, Dr. Nishtar said those personal, life-altering situations are too often overlooked in the halls of power.
“Everything on the ground is so different than the discourse in New York and Geneva and Washington,” Dr. Nishtar said, adding that high-level funding and policy decisions often are not rooted in the true needs of rural, frontline health facilities, care providers, and patients.
“We should start thinking about global health from the eye of that woman who has to go to a rural facility and from the eye of the minister of health who has to manage a budget on a shoestring,” Dr. Nishtar said. “That should be our North Star.”