How medical training and knowledge-sharing can help close the health equity gap

“Where you live shouldn’t impact your health outcomes,” said Dr. Tamas Andras Koncz, chief medical officer for Pfizer’s Accord for a Healthier World. However, in lower-income countries, there are often systemic barriers that prevent patients from receiving timely, effective treatment, he explained. 

Resource constraints mean some countries have too few trained specialists in medical fields where the health burden is highest. General practitioners, especially in rural areas, may lack access to the education needed to recognize disease symptoms in their early stages when the right intervention could be most impactful and cost-effective. Collaborating with country governments to ensure health workers have the knowledge and skills to diagnose, refer, and treat populations with the most effective medications is, therefore, a key focus of Pfizer’s accord.

“Our foundational goals are to make the initiative collaborative and sustainable based on country-identified health care needs,” Koncz said. This means working with ministries of health, medical associations, and multisector health organizations to understand a country’s health priorities, identify capacity gaps, and co-create sustainable medical education plans that aim to deliver maximum patient impact.

Devex spoke with three health care experts in Malawi, Rwanda, and Ghana about the challenges they face and how they are collaborating through the accord to support medical education and professional development.

The accord aims to provide access to prevention and treatment options for many of the most significant infectious and noncommunicable diseases impacting lower-income countries. This includes antimicrobial resistance, or AMR — one of today's top global public health threats. AMR is driven by the overuse and misuse of antibiotics and is exacerbated by inequality. It disproportionately impacts those living in sub-Saharan Africa, where more than 1 million people die each year due to associated AMR — more than the combined deaths from HIV and tuberculosis in the region.

In Malawi — where AMR is estimated to have contributed to around 19,000 sepsis deaths in 2019 — limited diagnostic and bacteriology testing capacities often lead to delays in identifying resistant bacteria, increasing the risk that patients are treated with the wrong antibiotic, said Dr. Titha Dzowela, Fleming Fund country grant manager at the University of North Carolina Project-Malawi. Even in facilities with sufficient equipment and laboratory capacity, health workers do not always have access to the training and education necessary for interpreting laboratory data.

Children, health care workers, and people living in limited-resource settings or with chronic diseases such as HIV or malaria are most at risk of AMR, said Dzowela. AMR is also an economic burden for Malawi’s health system, as ineffective medications are wasted, second- or third-line treatments are often more expensive, and patients require longer hospital stays, he added.

To further Malawi’s national efforts to help address AMR and enhance antimicrobial stewardship, or AMS, its Ministry of Health has collaborated with the accord and diagnostic manufacturer bioMérieux for the country’s first multisectoral initiative in AMR. 

Pfizer has provided a grant to UNC Project-Malawi to support technical assistance and training for health workers on infection prevention, control, diagnosis, and treatment, and to help dedicated committees at four central hospitals lead facilities’ AMR response, monitor their use of antibiotics, and develop antibiograms — tables that show how susceptible organisms are to different antimicrobials — to better understand AMR prevalence.

This is intended to complement the TEACH AMS digital education program that Pfizer already supports in Malawi in collaboration with Project ECHO. As a part of TEACH AMS, training is designed to be low-cost but high impact, said Dzowela. For example, online forums allow health care workers from multiple facilities to engage in peer-to-peer training sessions.

“The idea is that if we build the capacity of the staff, they’re better able to interpret the results that are coming out of the lab, manage the patients in a quicker turnaround time, and use the antibiotics that are readily available in the system,” he said.

Through the accord, Pfizer is funding the collection of AMR surveillance data that UNC hopes will help the government craft effective policies around antibiotics use, Dzowela said. The data will also help the Ministry of Health and individual health facilities make evidence-informed decisions on the most effective antibiotics.

In Rwanda, patients face numerous barriers to accessing vital dermatology care, mainly due to the limited number of trained dermatologists. According to Dr. Amani Uwajeni Alice, head of dermatovenereology at the University Teaching Hospital of Kigali, there are 13 dermatologists in Rwanda — a country with a population of nearly 14 million — almost all of whom are currently based in Kigali.

This shortage means that when patients are referred, they may have to travel over 100 kilometers for consultation and treatment. It also limits specialists’ availability for knowledge-sharing and peer-to-peer training, both within hospitals and smaller health facilities outside the capital.

Limited knowledge about skin diseases among general medical practitioners and health workers in other fields of medicine can lead to delays in getting an accurate diagnosis or result in misdiagnosis, Amani said. Low public awareness about skin diseases can also cause people to ignore a condition or seek care from a traditional healer.

The impact on patients and health systems can be devastating. If certain dermatological diseases are not detected early and managed appropriately, they can cause disfigurement — resulting in patients facing discrimination, exclusion from work and community life, poor mental health, and even death, she added.

Further training about dermatological conditions for health care professionals throughout the health care system would increase awareness and help enable health workers at every level to start managing some conditions, Amani argued. 

More specialists should also be trained and retained to help ensure district hospitals have a resident dermatologist, who can also educate workers in nearby facilities, she added. This work is already underway through a collaboration between the University of Rwanda and the Ministry of Health, where dermatovenerologists can serve in referral and district hospitals across Rwanda, helping to reduce patient travel to health facilities and delayed diagnoses while also providing peer-to-peer training. 

Dermatology care is one of three areas — including breast cancer and COVID-19 — where Pfizer has collaborated with Rwanda’s Ministry of Health to provide medical training sessions for more than 200 health care professionals.

In May 2024, Pfizer supported the Rwanda Dermatology Society’s first annual scientific conference, where more than 90 attendees — including dermatologists but also general practitioners, nurses, pediatricians, physiotherapists, epidemiologists, pharmacists, pathology residents, and medical students from Rwanda and other countries — discussed the latest research and case studies on hundreds of dermatological conditions.

Multidisciplinary knowledge-sharing is also key to improving breast cancer care in lower-income countries, including in Ghana, where the accord has focused on collaborating with Ghana’s Ministry of Health to provide group trainings and symposiums for health care workers.

There are significant barriers to breast cancer care in Ghana, according to Dr. Florence Dedey, general surgeon at Korle-Bu Teaching Hospital and senior lecturer at the Department of Surgery, University of Ghana Medical School. Limited treatment facilities, especially for radiotherapy — which is available only at three health centers, in Accra and Kumasi — mean patients often need to travel for care. And while most people are covered by Ghana’s national health insurance, which pays for part of the cost of breast cancer care, additional out-of-pocket costs can deter some from seeking treatment.

Insufficient knowledge about breast cancer, especially at the primary care level, can also result in delayed referral or treatment, because health workers do not recognize symptoms, or misdiagnose and treat with inappropriate medications, Dedey said.

Additionally, lack of public awareness means some patients delay seeking medical care because they fail to notice symptoms or attribute them to something else, she added. Misconceptions about the causes of cancer mean some turn to spiritual healers, while fear of treatment means others do not return for care following consultation and initial diagnosis.

Alongside public educational and awareness-raising campaigns, ongoing medical education for health care workers is critical, including regular updates about advances in diagnostic tools or therapies. “You may be sitting in a regional hospital, a district hospital, or a private clinic somewhere, and you may not be so abreast with the new developments that are going on in the space of breast cancer,” Dedey said. For example, while the treatment plan for breast cancer used to be almost identical for everyone, treatment is becoming more personalized, based on a patient’s specific type of cancer, and knowledge is advancing fast. 

Collaboration between different disciplines — such as through peer-to-peer training sessions or conferences — can also be very important for patient outcomes. Dedey participated in an educational symposium that Pfizer co-organized with the Society of Family Physicians of Ghana in October 2023, which brought together oncologists, surgeons, radiologists, pathologists, nurses, and other health care professionals from Ghana to discuss the latest developments in diagnosis, therapies, and treatments.

Additionally, in April 2024 Tech Care for All Africa, or TC4A Africa, announced a collaboration with Pfizer to provide in-person and online education to health care professionals in Ghana, Rwanda, and Senegal, initially on breast cancer detection and treatment.

Pfizer is now communicating with more governments in accord-eligible countries, with the goal of co-creating similar educational initiatives with their ministries of health as training needs are identified. It believes this will help improve access to health care.

“No one government, organization, or company can close the health equity gap alone. The evolution of the accord will always be informed by local country needs and insights and by collaboration with ministries of health and other multisector health organizations,” stressed Koncz.

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