DPH 830 Module 8 Human Rights and Ethics in Global Health Example

Whose Program, Whose Benefit? Human Rights and Ethics in a Global Cervical Cancer Screening Partnership

Student Name

Doctor of Public Health Program, Aspen University

DPH 830: Global Health

Instructor Name

Month Day, Year

Whose Program, Whose Benefit? Human Rights and Ethics in a Global Cervical Cancer Screening Partnership

Global health interventions cross borders, cultures and inequalities of wealth and power. Good intentions do not guarantee ethical practice. This paper examines human rights and ethics in a composite partnership in which a US university plans a cervical cancer screening program and research study with a district hospital in a lower-income country, and it proposes an ethical plan for the partnership.

The Partnership

The university proposes to train nurses in visual inspection with acetic acid and same-day treatment of precancerous lesions, screen 5,000 women over two years, study the program's effectiveness and host short-term visits by US students. The district hospital has limited staff, no pathology service and a long waiting list for cancer treatment at the national referral center.

Health and Human Rights

Health and human rights are linked in two directions: violations of rights harm health, and health programs can respect or violate rights. Gruskin et al. (2007) describe a practice that applies principles such as nondiscrimination, participation, accountability and attention to the most vulnerable. For this program, that means reaching women in remote villages, involving them in design and reporting results to the community.

Principles for Global Health Ethics

Pinto and Upshur (2009) propose principles to guide students and practitioners in global health: humility about one's knowledge and role, introspection about motives, solidarity with those affected and commitment to social justice. These principles ask the university team to examine why it wants the program and whose interests it serves.

Benchmarks for Ethical Research

Emanuel et al. (2004) propose eight benchmarks for ethical research in developing countries: collaborative partnership, social value, scientific validity, fair selection of participants, a favorable balance of risks and benefits, independent review, informed consent and respect for participants and communities. The table applies each to the study.

Short-Term Trainees

Short-term visits by students raise ethical concerns: burdening host staff, practicing beyond competence and benefiting visitors more than hosts. Crump and Sugarman (2008) recommend preparation, supervision, clear learning objectives, limits on clinical roles and reciprocity, including opportunities for host trainees. The plan limits students to observation and data support under local supervision.

Power and Decolonization

Critics argue that global health often reproduces colonial patterns, with institutions in high-income countries setting agendas, controlling funds and claiming credit while partners in lower-income countries do the work. Abimbola and Pai (2020) call for shifting power to people and institutions in the places where programs operate. For this partnership, that means local leadership, shared budgets and first authorship for local investigators. Meetings will be held at the hospital, not only online from the United States, and local staff will chair them.

Informed Consent

Consent must be meaningful. Many women may not read, may defer to husbands or elders and may fear stigma associated with cancer. Consent will be sought in the local language by trained female nurses, with time for questions and assurance that refusing will not affect other care. Community leaders will be consulted about the process without substituting for individual consent. Consent forms will be tested with a small group of women before use.

The Duty to Treat

Screening creates obligations. Finding a cancer without a path to treatment raises serious ethical problems. The program must secure a referral pathway to the national cancer center, support transport costs and track outcomes. If treatment cannot be assured, the scope of screening must be reconsidered. Women with positive results will be followed until treatment is complete.

After the Program Ends

Ethical partnerships plan for sustainability from the start. The program will train nurses employed by the ministry, integrate screening into routine services, supply equipment the hospital can maintain and help the ministry budget for continuation. The university's commitment will extend at least three years beyond the study.

Data and Benefit Sharing

Data belong to the partnership, not to the university alone. Agreements will specify local data storage, shared access and joint decisions about publication. Benefits, including training, equipment and any revenue from the work, will be shared fairly. Results will be presented first to the ministry and the community before international publication.

An Ethical Plan

The plan includes co-leadership by the hospital, local ethics approval, community advisory input, consent procedures designed with local women, a guaranteed treatment pathway, limits on trainee roles, shared data and authorship and a sustainability commitment. These steps turn principles into practice.

Remaining Tensions

Tensions will remain. Funding comes from US sources with their own reporting demands; academic incentives reward publications; and the hospital's needs may shift. Regular joint reviews of the partnership, with the power to change course, help address these tensions openly.

Community Engagement

Before the program begins, the partners will hold meetings with women's groups, village leaders and health committees to explain the purpose, hear concerns and adjust plans. A community advisory board, including women who have been screened, will meet quarterly. Engagement continues throughout, not only at the start.

Cultural Considerations

Cervical screening involves an intimate examination that may raise concerns about modesty and stigma. Using female providers, private spaces and clear explanations respects cultural norms. Messages will avoid linking cervical cancer to sexual behavior in ways that stigmatize women.

Ethics Review

Both the US university's institutional review board and the national ethics committee will review the study. Local review is essential, since it brings knowledge of context that distant committees lack. Disagreements between committees will be resolved in favor of the stricter protection.

Evaluating the Partnership

The partners will evaluate not only screening results but the partnership itself: whether decisions were shared, whether local staff gained skills and authority and whether benefits were fairly distributed. A short annual survey of hospital staff and community advisors will inform adjustments.

Reciprocity

Partnerships should benefit both sides. Hospital staff will be offered training opportunities at the US university, joint grant applications will list local investigators as principal investigators and the hospital will receive a share of indirect cost funds. Reciprocity turns a one-directional project into a partnership of equals.

Conclusion

Human rights and ethics require that global health interventions respect participants, benefit communities, share power and last beyond the project. Applying rights principles, ethics frameworks for practitioners and research benchmarks to the cervical cancer partnership yields a plan that places local leadership, treatment access and sustainability at its center.

References

Abimbola, S., & Pai, M. (2020). Will global health survive its decolonisation? The Lancet, 396(10263), 1627-1628. https://doi.org/10.1016/S0140-6736(20)32417-X

Crump, J. A., & Sugarman, J. (2008). Ethical considerations for short-term experiences by trainees in global health. JAMA, 300(12), 1456-1458. https://doi.org/10.1001/jama.300.12.1456

Emanuel, E. J., Wendler, D., Killen, J., & Grady, C. (2004). What makes clinical research in developing countries ethical? The benchmarks of ethical research. The Journal of Infectious Diseases, 189(5), 930-937. https://doi.org/10.1086/381709

Gruskin, S., Mills, E. J., & Tarantola, D. (2007). History, principles, and practice of health and human rights. The Lancet, 370(9585), 449-455. https://doi.org/10.1016/S0140-6736(07)61200-8

Pinto, A. D., & Upshur, R. E. G. (2009). Global health ethics for students. Developing World Bioethics, 9(1), 1-10. https://doi.org/10.1111/j.1471-8847.2007.00209.x