The World Health Organization estimates a global deficit of about 12.9 million skilled health professionals (midwives, nurses, and physicians) by 2035. These shortages limit the ability of countries, particularly resource-constrained countries, to deliver basic health care, to respond to emerging and more complex needs, and to teach, graduate, and retain their future health professionals—a vicious cycle that is perpetuated and has profound implications for health security. The Global Health Service Partnership (GHSP) is a unique collaboration between the Peace Corps, President’s Emergency Plan for AIDS Relief, Seed and host-country institutions, which aims to strengthen the breadth and quality of medical and nursing education and care delivery in places with dire shortages of health professionals. Nurse and physician educators are seconded to host institutions to serve as visiting faculty alongside their local colleagues. They serve for 1 year with many staying longer. Educational and clinical best practices are shared, emphasis is placed on integration of theory and practice across the academic–clinical domains and the teaching and learning environment is expanded to include implementation science and dissemination of locally tailored and sustainable practice innovations. In the first 3 years (2013–2016) GHSP placed 97 nurse and physician educators in three countries (Malawi, Tanzania, and Uganda). These educators have taught 454 courses and workshops to 8,321 trainees, faculty members, and practicing health professionals across the curriculum and in myriad specialties. Mixed-methods evaluation included key stakeholder interviews with host institution faculty and students who indicate that the addition of GHSP enhanced clinical teaching (quality and breadth) resulting in improved clinical skills, confidence, and ability to connect theory to practice and critical thinking. The outputs and outcomes from four exemplars which focus on the translation of evidence to practice through implementation science are included. Findings from the first 3 years of GHSP suggest that an innovative, locally tailored and culturally appropriate multi-country academic–clinical partnership program that addresses national health priorities is feasible and generated new knowledge and best practices relevant to capacity building for nursing and medical education. This in turn has implications for improving the health of populations who suffer a disproportionate burden of global disease.

Several Sustainable Development Goals (SDGs) (3, 16, 17) point to the need to systematically address massive shortages of human resources for health (HRH), build capacity and leverage partnerships to reduce the burden of global illness. Addressing these complex needs remain challenging, as simple increases in absolute numbers of healthcare providers trained is insufficient; substantial investment into long-term high-quality training programs is needed, as are incentives to retain qualified professionals within local systems of care delivery. We describe a novel HRH initiative, the Global Health Service Partnership (GHSP), involving collaboration between the US government (President’s Emergency Plan for AIDS Relief [PEPFAR], Peace Corps), 5 African countries, and a US-based non-profit, Seed Global Health. GHSP was formed to enlist US health professionals to assist in strengthening teaching and training capacity and focused on pre-and in-service medical and nursing education in Malawi, Tanzania, Uganda, Eswatini and Liberia. From 2013-2018, GHSP sent 186 US health professionals to 27 institutions in 5 countries, helping to train 16 280 unique trainees of all levels. Qualitative impacts included cultivating a supportive classroom learning environment, providing a pedagogical bridge to clinical service, and fostering a supportive clinical learning and practice environment through role modeling, mentorship and personalized learning at the bedside. GHSP represented a novel, multilateral, public-private collaboration to help address HRH needs in Africa. It offers a plausible, structured template for engagement and partnership in the field.

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Program/Project Purpose: Maldistribution of health care workers is a global health challenge that exacerbates health disparities especially in resource-limited settings. Interventions to assuage the problem have targeted qualified personnel with little focus on medical students. However, studies have demonstrated that rural rotations positively influence students to practice in rural settings upon graduation. Within this context, the Kilimanjaro Christian Medical University College introduced a 13-week clerkship rotation in rural hospitals for third-year medical (MD3) students in 2012. To assess students' perceptions, and attitudes toward rural practice after graduation, we surveyed them after their rural rotation. Structure/Method/Design: Anonymous questionnaires were administered to MD 3 students in April 2014. The questions assessed perceptions of the experience, and attitudes towards rural practice upon graduation. The perceptions were assessed using strength of consensus measures (sCns). The effect of the experience on likelihood for rural practice was assessed using Crude Odds Ratio (COR) at 95% Confidence Interval (CI), and 5% level of significance. Binary logistic regression analysis was used to determine predictors accepting rural practice after graduation with Adjusted Odds Ratio (AOR) at 95% CI, and variation assessed with Nagelkerke R2. Outcomes & Evaluation: One hundred and eleven MD3 students participated; 62% male; 62% < 25 years; and 72% direct from secondary school students. Overall, 81% MD3 students were satisfied with rural rotations,(sCns¼ 83%). Likelihood of accepting to be deployed in rural practice after graduation was predicted by being satisfied with the rural rotation program (AOR, 4.32; 95% CI, 1.44-12.96; p, 0.009) and being male (AOR, 2.73; 95% CI, 1.09-6.84; p, 0.032). Also, being an in-service student increased the likelihood of accepting rural practice after graduation by 300% compared to enrolment direct from school, although the difference was not significant (AOR, 4.99; 95% CI, 0.88-28.41; p, 0.070). 29% of variation was explained these variables (Nagelkerke R2, 0.289). However, students who joined school after health-related practice were almost 3X more likely to be satisfied than students direct from school, with no significant difference (COR, 2.6; 95% CI, 0.7-9.4; p, 0.310). Likewise, in-service students were more 2X more likely to be satisfied than direct from school students with insignificant difference (COR, 2.4; 95% CI, 0.9-6.4; p, 0.073). No significant difference was exhibited for students born in rural or urban areas. Going Forward: The rural rotation program increased the likelihood of rural practice after graduation. More effort should be undertaken to further improve the program to increase student satisfaction with rural rotations, and hence likelihood for rural practice after graduation.

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