A Framework for Applying Global Learning to Improve Primary Health Care in the United States

Abstract

Background and objectives: Lessons from global health have long informed efforts to improve primary health care (PHC) in the United States (US). Despite this history, no generalizable framework exists to guide US stakeholders in the identification and application of ideas from abroad related to the key PHC components of community engagement and service delivery. We sought to develop such a framework. Methods: We reviewed the experience of Global to Local, a community-based organization (CBO) founded with a mission to apply global health strategies to improve the health in vulnerable populations in the US, and examined the experience of care delivery organizations in the US that have successfully implemented global-to-local solutions. Based on that experience, and supported by the advice of an expert panel, we developed a framework for applying global learning to improve US PHC. Findings: The framework includes six change concepts under three broad categories. The first category focuses on the need to actively and intentionally incorporate a global perspective in organizational program design and improvement activities. The second category addresses approaches to identifying global solutions related to community engagement and to health service delivery. The third category focuses on adaptation and implementation of lessons from global health in domestic contexts by applying relevant insights from dissemination and implementation science and diffusion of innovation theory. Conclusions: In the absence of a robust literature providing implementation guidance to US health systems and CBOs open to adopting or adapting PHC strategies and practices from other countries, the proposed framework synthesizing the experience of organizations that have done so can inform efforts to apply lessons from global health to improve PHC in the US.

Reversing the trend: a scoping review of health innovation transfer or exchange from low- and middle-income countries to high-income countries

“…In Table 1, we report on some of the characteristics of the included articles. We identified eight articles that report on primary research of innovation transfer/exchange from LMIC to HIC6 22–28 and four articles report on secondary research on the same topic 2 3 5 29. Specific models, theories and frameworks (MTFs) and study designs identified in the articles are reported in table 1.…”

“…While none of the articles used the same MTFs, some articles reported using a combination of two or three MTFs to guide their study of the innovation transfer/exchange2 6 7 22 and only two articles did not report using any framework 23 28. New MTFs were proposed in three articles that were secondary reports 2 3 5–7 22 24 25 27 29. Two-thirds of the articles also used both qualitative and quantitative methods of data collection 3 5 22–24 26 28 29.…”

“…New MTFs were proposed in three articles that were secondary reports 2 3 5–7 22 24 25 27 29. Two-thirds of the articles also used both qualitative and quantitative methods of data collection 3 5 22–24 26 28 29. In seven articles, a clear description of the process for innovation transfer included who was engaged for the transfer, how they were engaged and what strategies were used in the engagement process were provided 6 7 22–24 26–28.…”

“…In seven articles, a clear description of the process for innovation transfer included who was engaged for the transfer, how they were engaged and what strategies were used in the engagement process were provided 6 7 22–24 26–28. Three articles provided a summary of articles and projects that had successfully transferred an innovation and/or guidance to transfer innovations, including an article on reciprocal innovation by Sors et al 5 and two articles on LMIC to HIC innovation transfer by DePasse and Lee2 and Sugarman and Reed 3. These three articles2 3 5 did not contain any details about the scientific process involved with the innovation transfer or innovation exchange.…”

“…Health innovation transfer can be unidirectional, for example, from LMICs to HICs2–4 and bidirectional or multidirectional, mutually beneficial exchanges recently coined ‘reciprocal innovation’5 and ‘reciprocal learning’ 6 7. Reciprocal innovation ‘explicitly harnesses a bidirectional, coconstitutive and iterative exchange of resources, knowledge and innovation among global health partners’5 and can be between LMIC and HIC, HIC and LMIC, or LMIC and LMIC.…”