Small, well prepared, culturally competent, and embedded health engagement teams (EHET) tailored to work within a partner health system, rather than outside of it, will achieve greater mutual benefit, desired military objectives, and better health outcomes for the United States Department of Defence and its partners. EHETs have significant advantages over traditional methods of choice for health security cooperation and humanitarian assistance missions. These advantages include enhanced capability and capacity building, greater trust through intentional cultural expertise, a ready platform for enduring relationships, enhanced host nation legitimacy, and flexibility to target specific issues with greater fidelity. We must first define a prototype EHET, compare the concept against prior units that have executed health engagement, and test it prospectively in employment. The U.S. military and the civilian business world each have extensive experience in employing small teams that the health community can emulate. The ideal EHET should have the following nine characteristics: 12 people or fewer, skillsets for the tasks, global health knowledge, be multidisciplinary, a balance of experience, local language capability, geopolitical and cultural competence, targeted preparation for specific security and health objectives, and joint representation. This paper will explore these components of the prototype EHET as it will be tested in our research project.
Background The U.S. DoD is a multidimensional agency of the government that employs health engagement activities within partner nations for medical operations, humanitarian assistance, threat reduction, and improved health outcomes toward sustainable global health and security. The composition and size of a health engagement team is critical for effective implementation; however, an ideal team makeup to achieve optimal operational readiness, health outcomes, and security cooperation objectives has not been established. This study was conducted to retrospectively describe and analyze medical mission activities in relation to ideal team characteristics in El-Salvador, Guatemala, and Honduras between 2012 and 2017. Methods A retrospective analysis was conducted on data from unclassified versions of the Global-Theater Security Cooperation Management Information System), Overseas Humanitarian Assistance Shared Information System databases, and mission files provided by U. S. Southern Command and its component commands. Data included 565 mission activities carried out by U.S. Military health teams in the selected host nations between 2012 and 2017. The mission activities were stratified and coded into nine distinct analyzable categories with subelements including but not limited to year, country, mission type, mission duration, team size, team language capability, team joint representation, and team member skillset. The analysis identifies mission objectives in the three subcategories of operational readiness, security cooperation, and health outcomes although the analysis did not include measurement of those objectives. Global Health Engagement mission types were broken down into five categories: direct care, health project, education & training (E&T), engineering, veterinary, or a combination. Data were analyzed using Excel. Results A total of 414 health engagement activities were found in the data analyzed during 2012 and 2017 accounting for duplication among the sources. Team size was documented in 23.4% (n = 97); team skillset makeup in 17.1% (n = 71); 2.7% (n = 11) showed that at least one team member had language capability for the country visited; and 3.6% (n = 15) documented that professional interpretation was available. The types of health engagement activities were broken down as follows: 64.3% were direct care, 12.2% were health projects, 10.9% were engineering, 9.1% were E&T, and 1.3% were veterinary. Overall, only 20.8% (n = 86) of the missions had a clear mission objective from the three categories of security cooperation, operational readiness, and health outcomes objectives. Individually, each category of objective was noted with the following: 74 with security cooperation (17.9%), 82 with operational readiness (19.8%), and 71 with health outcome objectives (17.1%). Conclusion Findings from this study reveal a broad spectrum of health and medical missions conducted in El Salvador, Guatemala, and Honduras between 2012 and 2017 by DoD. Critical elements indicative of overall team capability for successful engagement such as team size, team member skillset, global health expertise, and appropriate language capability were rarely documented. Team characteristics could not be well-correlated with the Global Health Engagement type or desired mission outcomes. In the future, deliberate crafting and preparation of health engagement teams aimed at attaining desired security cooperation impact, operational readiness development, and positive health outcomes is essential for more effective Global Health Engagement.
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