Global Health

Professor Kay works on issues of global health, in particular, health systems, health and culture, health and development, and reproductive health and rights.

In “Toward A Multidimensional Understanding of Culture for Health Interventions.” Social Science & Medicine. 144:79-87 (with Asad L. Asad), she examines scholars’ and practitioners' understandings of culture in relation to health interventions. She offers a tripartite definition of culture -- as knowledge, practice, and change -- and how they are deployed at each stage of a health intervention. This work sets forth concrete recommendations for practitioners working to achieve robust improvements in health outcomes.

In “Theorizing the Relationship Between NGOs and the State in Medical Humanitarian Development Projects” (also with Asad L. Asad), she asks: how do NGOs work and build relationships with different types of states and — of particular relevance to practitioners — what kinds of relationship building lead to more successful development outcomes on the ground? Drawing on in-depth interviews with members of Partners in Health and Oxfam America, she argues that NGOs and their medical humanitarian projects are more likely to succeed when they adjust how they interact with different types of states through processes of interest harmonization and negotiation. By identifying how NGOs can increase the likelihood of project success, this research is of interest to activists, practitioners, and scholars.

A Novel Organizing Strategy for Achieving Social Goals: The Case of Project ECHO

In 2016, Professor Kay began a project that extends her research on innovative organizational forms and organizing strategies by examining the case of Project ECHO (Extension for Community Healthcare Outcomes) that innovated a telementoring model to disseminate specialty medical knowledge in rural and underserved areas of New Mexico. Project ECHO was created by Dr. Sanjeev Arora at the University of New Mexico’s School of Medicine. The model has four key components: it employs teleconferencing technology to bring dispersed members of a team together remotely; it uses case-based learning by holding discussions of the cases of real (but anonymized) patients; it promotes best practices, and; it monitors outcomes. What began as a local innovation spread quickly, facilitated by Project ECHO's ambitious replication goal of affecting one billion lives by 2025. By early 2020, Project ECHO was well on its way. The ECHO model has been replicated in more than 800 clinics and programs from Montevideo to Mumbai, training more than 96,000 practitioners in nearly 40 countries, reaching more than 20,000 target users—community clinics and clinicians. 

Project ECHO is a compelling empirical case because of its novel organizing model and innovative organizing strategy that can save business and government money and simultaneously achieve social goals by harnessing the power of technology. For example, Project ECHO was able to have a significant and unexpected impact disseminating medical knowledge during the COVID-19 pandemic. Its success presents a compelling puzzle: lacking the power or organizational scale of a public agency, or the profit motive of private enterprises, how did a funding-constrained non-profit from New Mexico, one operating without a clear central organizational hierarchy, manage to nimbly shift operations so rapidly at scale to address COVID-19 related medical education, training, and social service delivery, particularly in such a heavily regulated industry that also requires highly specialized human capital investment? 

In a coauthored 2021 article (with Jason Spicer) titled “A Nonprofit Networked Platform for Global Health" in the Stanford Social Innovation Review, they identify the organizational features and mechanisms which enable Project ECHO’s organization-as-a-movement structure, and which in turn made its rapid response to the COVID-19 crisis possible.