“Building Peace Through Infection Prevention: Lessons from UNC to the Global South”
By Abdulhafiz Kedir (UNC MPH ’25)
Summer 2025 AFE Blog Post Series
As a Rotary Peace Fellow completing my Master of Public Health at the University of North Carolina, I have learned that infection prevention is a primary form of peacebuilding. The statistics are startling: worldwide, one in ten patients is affected by hospital-acquired infections (HAIs), while 136 million cases of healthcare-associated antibiotic-resistant infections happen around the world every year [1]. These statistics highlight more than just the adversities faced in the healthcare arena; they represent a breach of our social stability and, consequently, a threat to peace.
My Applied Field Experience (AFE) / practicum at UNC Hospitals, which involves working on adapting hospital infection surveillance methodologies for use in international contexts, shed light on the significant connection between strong health systems and sustainable peace. When health systems fail to prevent infections, it causes communities to lose faith in their institutions, strains community resources, and pushes social tensions to the brink.
Undertaking my practicum under Dr. Emily Sickbert-Bennett’s supervision has altered my perspective on hospital infection prevention. As Director of Hospital Epidemiology for UNC Hospitals and Administrative Director of the Carolina Antimicrobial Stewardship Program, Dr. Emily possesses vast expertise in hospital infection surveillance and outbreak response. Her mentorship emphasizes adapting evidence-based practices across resource settings, challenging me to consider behavioral and infrastructural contexts beyond simple technology transfer.
The activities I’m undertaking in my practicum have direct connections to the principles of peacebuilding. I’m analyzing UNC’s healthcare-associated infection surveillance data and creating a comparative document detailing the US HAI surveillance systems alongside global HAI surveillance systems. The goal is not to replicate the US model, as seen in UNC’s efforts, in low- and middle-income countries, but to articulate the adaptable core principles that underpin the strengthening of health security systems, regardless of available or limited resources.
Comparisons between infection prevention in high-income and low and middle-income countries (LMICs) offer valuable insights but also highlight significant barriers. On the one hand, UNC’s real-time surveillance efforts continuously demonstrate their need for substantial infrastructure and support availability. On the other hand, many of the underlying and core principles that guide various infection prevention activities, such as systematic data collection, rapid response to threats, and community engagement are relevant across all settings. In African contexts, mobile health technologies and community health worker networks can achieve similar objectives. The evidence indicates that infection prevention interventions can reduce healthcare-associated infections (HAIs) by 35-70%, demonstrating cost-effectiveness regardless of income level [1].
This adaptation process embodies the principles of positive peace. When communities trust health systems to detect and respond to outbreaks transparently, they cooperate during crises rather than retreat into suspicion. The fact that 63.5% of antibiotic-resistant infections are healthcare-associated [1] underscores how institutional failures in infection prevention can undermine public trust and social cohesion.
One of my deliverables is to create a charter for implementing quality improvement projects that focus on adapting evidence-based infection prevention strategies internationally, representing the practical application of these insights. The charter will guide the development of surveillance methodologies for adaptability in contexts where peace remains fragile. The economic argument is compelling: data indicate that every US$1 spent on improving hand hygiene in healthcare settings yields US$ 24.60 in economic benefits (i.e., both in healthcare expenditure and productivity in the broader economy) [1].
The work at UNC prepares me to consider how mechanisms can be developed to enhance health security for Ethiopia and East Africa, utilizing pragmatic tools that foster the institutional trust essential for sustainable peace. Every surveillance system that is built is a foundation for strong, resilient institutions, which is only the beginning of the real potential for lasting peace.
References: [1] WHO. Key facts and figures. https://www.who.int/campaigns/world-hand-hygiene-day/key-facts-and-figures
