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Objective: This evaluation examined the effectiveness and cultural compatibility of a community health worker (CHW) training programme on water, sanitation and hygiene (WASH) in Haiti. Design: Mixed-methods including pre- and post-course tests of WASH knowledge, focus group discussions and semi-structured observation. Setting: Haiti is among the world’s most underdeveloped nations for WASH infrastructure. In rural areas of the country, fewer than half of households have access to clean water and 22% have adequate sanitation facilities. The study evaluated a ‘train-the-trainer’ programme in rural southeast Haiti. Methods: Participants were 22 CHW supervisors responsible for training and monitoring the work of rural junior health agents (JHAs). The training programme was delivered by international trainers and consisted of 1 week of classroom training and 1 week of community-based experiential learning. Paired-samples t-tests were used to assess changes in knowledge, and robust qualitative methods were used to analyse focus group discussion and observation data. Results: Participants showed statistically significant improvement in WASH knowledge from pre- to post-test. In experiential supervisor-led training sessions, participants effectively conveyed course content to JHAs, and successful home visits demonstrated the potential for content to reach community members. The programme would benefit from providing educational materials to enhance dissemination. Participants expressed dissatisfaction with translations of course content and requested more frequent training, more emphasis on leadership development and specific content areas for future training. Conclusion: The CHW training programme enhanced trainees’ WASH knowledge and capacity to educate JHAs to disseminate the knowledge to local residents. The train-the-trainer model offers a cost-effective strategy for building local capacity for health education.

Background Global health interest has grown among medical students over the past 20 years, and most medical schools offer global health opportunities. Studies suggest that completing global health electives during medical school may increase the likelihood of working with underserved populations in a clinical or research capacity. This study aimed to assess the association of global electives in medical school on subsequently working in global health and with underserved populations in the United States (U.S.), additionally considering students’ interests and experiences prior to medical school. We also examined whether respondents perceived benefits gained from global electives. Methods We surveyed medical school graduates (classes of 2011-2015) from a large public medical school in the U.S. to describe current practice settings and previous global health experience. We evaluated work, volunteer, and educational experiences preceding medical school, socioeconomic status, race and ethnicity using American Medical College Application Service (AMCAS) data. We assessed the association between students’ backgrounds, completing global health electives in medical school and current work in global health or with underserved populations in the U.S. Results In the 5 to 8 years post-graduation, 78% of 161 respondents reported work, research, or teaching with a focus on global or underserved U.S. populations. Completing a global health elective during medical school (p = 0.0002) or during residency (p = 0.06) were positively associated with currently working with underserved populations in the U.S. and pre-medical school experiences were marginally associated (p = 0.1). Adjusting for pre-medical school experiences, completing a global health elective during medical school was associated with a 22% greater prevalence of working with an underserved population. Perceived benefits from global electives included improved cultural awareness, language skills, public health and research skills, and ability to practice in technology-limited settings. Conclusion Medical school graduates who participated in global electives as students were more likely than their peers to pursue careers with underserved populations, independent of experiences prior to medical school. We hypothesize that by offering global health experiences, medical schools can enhance the interests and skills of graduates that will make them more likely and better prepared to work with underserved populations in the U.S. and abroad.