In the universe of Geneva’s global health hub, which includes dozens of international NGOs and WHO as the brightest star in the solar system, a parallel universe of locally-grown health and humanitarian collaborations have also developed around the University of Geneva and Geneva University Hospitals.

GENEVA – Ten years ago, two medical professionals from Madagascar met up with Dr Alexandra Calmy, a leading infectious disease expert at the Geneva University Hospitals (HUG in French) at the Geneva Health Forum to tell her about the bane of TB-meningitis that they were confronting in their country among people with HIV or weakened immunity – a disease that has a 40% mortality rate. 

“They told me ‘we are really in trouble in Madagascar with TB-Meningitis – we don’t know what to do and we have no way to diagnose and treat them efficiently,” recalled Calmy.  

That chance meeting proved to be the beginning of a major collaboration between the HUG and a hospital in Madagascar that introduced, firstly, more accurate GeneXpert diagnostics for earlier intervention, and later, two alternative treatment options for TB-meningitis. 

That eventually led to a grant from the European Union’s EDCTP, and a randomized, multi-country trial of the new treatments  in Madagascar as well as three other African countries – Ivory Coast, South Africa and Uganda (INTENSE-TBM), now underway. 

International Geneva’s ‘global health hub’ 

The story is one of dozens of examples of research innovations and health and international development success stories that have emerged out of a unique ecosystem of the University of Geneva and its university hospital affiliate, working in partnership with the city’s many NGOs and international aid organizations, all part of the constellation known as “International Geneva”.  

Others call it the Geneva ‘Global Health Hub’- with the World Health Organization as the center of the solar system –  around which dozens of other planets and satellites revolve.  

The projects stimulated by the University-HUG collaborations, per se, range from new medicine regimes like the one being tested for TB, to new, easy-to-use diagnostic tools for conditions such as cervical cancer, long-neglected in developing regions. 

They also span an enormous range of initiatives to actually introduce innovations into health systems and build the capacity of medical professionals. Examples of the latter include educating nurses to provide diabetes control information and training community health workers in refugee settings.   

In fact, the labyrinth of collaborations, particularly in the health and humanitarian arena, is so extensive and complex that it is difficult to map and describe. At the core are the HUG, the University of Geneva Faculty of Medicine and the University’s Geneva Centre of Humanitarian Studies.  

Around these, are a satellite array of collaborations and partnerships with WHO, ICRC, Médecins Sans Frontières and other, smaller, but influential Swiss-based NGOs, such as Terre des Hommes. The Geneva Health Forum, convening this year on 27-29 May, historically has played a key role as a platform to showcase many of the initiatives and bring stakeholders together.  

And finally, the ‘State’ of Geneva, and its “Service of International Solidarity” stand as the backbone behind all of these efforts – funding directly and indirectly over CHF 40 million in international health and development projects in the name of the “State of Geneva” – a title reflecting the influence it wields. And that is in addition to financial support from the Swiss national government’s department of Development and Cooperation (DDC)

HUG equalization fund ‘kickstarts’ innovative projects

A report on the HUG’s collaborations cites a total of 97 international health projects, entirely or partly funded by the Hospital, in the most vulnerable countries of sub-Saharan Africa and the world, over the past six years for a total of more than 3 million CHF, says Calmy. Some 43 projects are currently ongoing, with 20 new projects approved in 2023, she adds.  

The HUG finances start-up projects based on a “Fond de Péréquation” capitalized by doctors’ income from private patient visits to the hospital, Calmy notes. (The English translation is “Equalization Fund” – with all that implies). 

The fund enables HUG-affiliated staff to propose and launch innovative projects from the grassroots in their areas of expertise, notes Calmy, providing a unique laboratory for creative collaborations. Proposals can be submitted by any health professional – from doctors and  nurses to psychologists and dieticians.

“We are here to provide the kickstart,” added Calmy who is co-chair of the HUG Commission of Humanitarian Affairs and International Cooperation, that administers the medical facility’s programme – in collaboration with a parallel Commission at the University of Geneva. 

“You want to do cervical cancer detection in Cameroon.  You have to map what is going on there, what is the expertise, who are your contacts.  So we’ll give you the money to kickstart – after that you can go to the Canton, the ICRC, the Confederation for help in obtaining larger grants for research and implementation.”  

A nurse-led project launched in education about chronic diseases is one such example that she cites. A noteworthy feature of the HUG approach is its eclectic sponsorship of a very diverse portfolio, she adds.  

“We are well aware that we are funding diverse projects, there is no line in terms of themes, countries, or types of projects. Anyone in this hospital that has expertise, identified partners, and wants to do a project, can make a proposal,” she said. 

Seeking coherence amidst diversity

At the same time, there is growing recognition that more coherence and coordination amongst a wide array of initiatives would be useful – to share lessons learned and ensure maximum impact. 

That plethora of programmes and projects led all of the partners to hold a first-ever stocktaking event in October 2023, to seek a common direction and way forward. 

Called simply the Assises de L’Humanitaire (Humanitarian Conference)” the one-day encounter brought together stakeholders from the HUG and University system, along with the Swiss Confederation, Geneva State, WHO, ICRC and a wide array of other international organizations working with the Geneva-based institutions.

Now, six months later, a report on the findings and recommendations for a way forward is soon to be published. 

“I think the conclusion was that ours is still a good approach. But we wanted to explore new ways of doing things better,” said Blanchet.  

Key themes that emerged as recommendations include an increased focus on facilitating south-south along with north-south collaborations, and in-country partnerships that emphasize the education and training of local actors to ensure sustainability and scale up of projects. 

“But we want to remain a laboratory of ideas,” Calmly said.

‘Assises de l’Humanitaire was the triangle’  

The day was particularly important in terms of helping the University and the HUG share experiences between themselves and better align, said Karl Blanchet, who is the director of the university’s Geneva Centre for Humanitarian Studies. 

“The Assises de l’humanitaire was this triangle of the Geneva Centre, the Faculty of Medicine and the HUG. There were two objectives to all meet and all be aware to make sure that we are aware of what we do in different parts of the world,” he said.

“The next step is to formalize relationships and contribution to these programmes,” he added, noting the wide range of UN and NGO actors, like MSF and ICRC involved in individual projects.

The same network of collaborations underpins many of the events featured in the Geneva Health Forum, co-founded by the HUG, the University of Geneva and its Faculty of Medicine in 2006. 

This year’s GHF takes place 27-29 May, and coincides with the kickoff of the 77th World Health Assembly.  Health and Environment, Migration Health and Equity and Malaria Elimination are the key themes.  But a day-long session on  “International Hospital Collaborations” is also taking place on 29 May. Held in French, it will look even more deeply at some of the topics discussed at the conference last October.   

“The aim of the seminar is to collectively question the way partnerships between hospitals in the global north and global south are designed, and how to promote ethics and sustainable solutions within the frame of these partnerships,” said Bruno Lab, head of Humanitarian and International Cooperation Affairs at the HUG. 

“It’s a dive into the specific domain of long-term technical assistance projects. Through multi-year collaborations, the objectives are set around capacity building, teaching and research.”

Many HUG staff also have joint appointments in the University of Geneva’s Medical Faculty, which also hosts an array of international health research initiatives, under the research portfolios of various departments. 

The Centre for Humanitarian Studies, therefore, collaborates with both institutions, and others, in a range of health and humanitarian research and education projects, says Blanchet. 

Examples of the former include a research study on reducing the impact of attacks on healthcare, as well as a five-university initiative on re-imagining the future of global health, he adds

But there are also collaborations in field settings on priorities like teaching doctors how to perform war surgery or a new programme in community health for refugees. 

The latter, targeting long-time refugees in Jordan and Kenya, provides students with a basic education that allows them to gain employment as health workers, as well as to qualify for further university training in their host countries, Blanchet says. 

The end result is better integration into local communities and health systems after decades as refugees.  

“During the COVID pandemic, the first settings that were closed in lockdown were in refugee camps,” Blanchet recalls. “”So we created a course not only to help refugees deal with health issues in their community, but to be able to get jobs.

“It’s the first advanced course on community health accredited by a University Faculty of Medicine, for students and refugees who cannot demonstrate their level of studies.  If they finish the certificate, they can go onto national university,” he said. 

University ‘open to the world’

Blanchet himself has a strong public health background. He came to the centre as an academic from the London School of Tropical Hygiene and Medicine.

He found the pace much faster and topical than the usual university ivory tower.    

“I can’t tell you how amazing this environment is,” he said. “When I arrived at this new post, where we are grappling with some of the most challenging environments, people would tell me, over and over, ‘just tell me what you need.’

That led to initiatives such as a website publishing briefs on the latest scientific knowledge about  COVID in Ukrainian after  the 2022 Russian invasion; as well as the hosting of leading Afghan health experts in the Centre, including the former minister of health, following the Taliban’s takeover of Kabul. 

The centre is likewise involved in an initiative to help medical students in conflict-ridden regions such as Gaza, Iran, Pakistan and Afghanistan to complete their studies in host countries abroad.  And there are now plans now in the works to host an international symposium soon on the rebuilding of Gaza’s health system, he confides.  

“These are all examples of the agility of the teams and the faculty,” he said. “The University of Geneva is so anchored in the news and what is going on – and they want to make sure that they can contribute, not only to research but as a university open to the world.” 

Paula Dupraz-Dubois contributed reporting to this story

Image Credits: Hopitaux Universitaires de Genève, Hopitaux Universitaires de Genève, Geneva University Hospitals , Paula Dupraz-Dubois.