Development of a neurology training program in Haiti

Abstract

From 2004 to 2015, the average number of neurologists in high-income countries increased from 3 to 5.14 per 100,000 population; the number of neurologists in low-income countries (LICs) remained static at 0.03 per 100,000. 1,2 This disparity is likely due in large part to the paucity of neurology training programs in LICs, 3 leading physicians interested in neurology to train abroad, where many stay (the brain drain phenomenon). 4 Neurologic disorders are the leading cause of disability-adjusted life-years and the second leading cause of mortality worldwide, 5 requiring expansion of the global neurology workforce. Here we describe the development of the first neurology training program in Haiti (an LIC), supported by a visiting faculty model.There is only one neurologist in Haiti (population ;11 million), limiting access to neurologic care for patients and neurology education for providers. Hôpital Universitaire de Mirebalais (HUM) is a 300-bed public academic hospital in Haiti, run through a partnership among the Haitian Ministry of Health, the nongovernmental organization Partners In Health (PIH), and PIH's Haitian sister organization Zanmi Lasante (ZL). HUM has residency programs in internal medicine, pediatrics, obstetrics/gynecology, surgery, and emergency medicine; a primary catchment area of ;185,000; a tertiary catchment area of ;3 million; and daily outpatient volume of ;700 patients. Program establishmentPrior to the development of the neurology training program, we established a neurology rotation for HUM internal medicine residents. e1 The rotation demonstrated sufficient volume and variety of neurologic patients and the efficacy of a visiting faculty model to train local providers. The Director of Graduate Medical Education (GME) at HUM (K.I.), the Deputy Chief Medical Officer for PIH in Haiti (M.E.M.), and the visiting neurologist who ran the rotation (A.L.B.) developed a proposal for a neurology fellowship program.From Partners in Health/Zanmi Lasante (K.

Number of Neurologists and Neurology Training Programs available in the Public Health System of Ecuador: Analysis and Recommendation.

“…19 Funding is necessary for effective neurology training. Even though international initiatives and funding have proved to be successful in this task, 20,21 the most effective systems in providing a higher number of medical specialists are the ones that are mainly financed by governmental initiatives and are part of public policies, as is the case of the Graduate Medical Education (GME) program in the United States and the Medical Specialists in training (MIR) program in Spain. 22,23 Ecuador is in imperative need of implementing a similar health policy as the aforementioned.…”

Developing Systems of Emergency and Inpatient Neurologic Care in Resource-Limited Settings

“…However, these endeavors necessitate substantial investment in strong, equitable, long-lasting collaborations between experts from HICs and LMICs, typically requiring several years to develop a sustainable partnership. Nevertheless, these collaborations can be mutually beneficial, offering valuable learning opportunities for trainees from both LMIC and HICs 112 113 114 115…”

“…However, these endeavors necessitate substantial investment in strong, equitable, long-lasting collaborations between experts from HICs and LMICs, typically requiring several years to develop a sustainable partnership. Nevertheless, these collaborations can be mutually beneficial, offering valuable learning opportunities for trainees from both LMIC and HICs [112][113][114][115] 2. Task redistribution: In the interim, broadening the healthcare workforce by training non-neurologists to undertake some inpatient care responsibilities can mitigate critical gaps.…”