Short term global health experiences and local partnership models: a framework

Abstract

Contemporary interest in in short-term experiences in global health (STEGH) has led to important questions of ethics, responsibility, and potential harms to receiving communities. In addressing these issues, the role of local engagement through partnerships between external STEGH facilitating organization(s) and internal community organization(s) has been identified as crucial to mitigating potential pitfalls. This perspective piece offers a framework to categorize different models of local engagement in STEGH based on professional experiences and a review of the existing literature. This framework will encourage STEGH stakeholders to consider partnership models in the development and evaluation of new or existing programs.The proposed framework examines the community context in which STEGH may occur, and considers three broad categories: number of visiting external groups conducting STEGH (single/multiple), number of host entities that interact with the STEGH (none/single/multiple), and frequency of STEGH (continuous/intermittent). These factors culminate in a specific model that provides a description of opportunities and challenges presented by each model.Considering different models, single visiting partners, working without a local partner on an intermittent (or even one-time) basis provided the greatest flexibility to the STEGH participants, but represented the least integration locally and subsequently the greatest potential harm for the receiving community. Other models, such as multiple visiting teams continuously working with a single local partner, provided an opportunity for centralization of efforts and local input, but required investment in consensus-building and streamlining of processes across different groups.We conclude that involving host partners in the design, implementation, and evaluation of STEGH requires more effort on the part of visiting STEGH groups and facilitators, but has the greatest potential benefit for meaningful, locally-relevant improvements from STEGH for the receiving community. There are four key themes that underpin the application of the framework: Meaningful impact to host communities requires some form of local engagement and measurementSingle STEGH without local partner engagement is rarely ethically justifiedModels should be tailored to the health and resource context in which the STEGH occursSending institutions should employ a model that ultimately benefits local receiving communities first and STEGH participants second.Accounting for these themes in program planning for STEGH will lead to more equitable outcomes for both receiving communities and their sending partners.

The Practitioner’s Guide to Global Health: an interactive, online, open-access curriculum preparing medical learners for global health experiences

“…Short-term experiences in global health (STEGH) [1,2] – including clinical rotations, research, language immersion, and volunteer work – are becoming more common at all levels of USA (US) medical education. Medical student participation in STEGH increased from 8% in 1986 to 31% in 2015 [3,4].…”

The Role of Medical Students in Short-Term Experiences in Global Health: A Perspective from São Tomé Island

“…4 Despite this, the volunteers found that technical resources remain scarce in São Tomé, which resulted in significant variation in medical practice as compared to their home country, highlighting the need for optimization of pre-departure training. The lack of knowledge of local practices was most evident in the unknown algorithms to which the volunteers were expected to abide, which resulted in insecurity and doubt.…”

“…3 This popularity has given rise to hundreds of organizations responsible for STEGH, with students from high-income countries visiting low and middle income settings, on experiences that vary in length and frequency of visits, team composition, focus of activities, and resources. 4 Exact data on popular destinations is limited but in general, many countries throughout the world host STEGH in some form or another.…”

“…4 Proposed principles to address these critiques suggest that all STEGH should be based on cross-cultural understanding, bidirectional collaboration, strengthening of local health systems and promotion of sustainability. 5 The intent behind these principles is to ensure that STEGH are conducted with a focus on host community development and autonomy rather than only accomplishing the personal interest of volunteers.…”

Avoiding pitfalls in overseas medical educational experiences

“…16 There is a growing body of literature on best practice guidelines, curriculum development, and ethical frameworks for short-term medical experiences in global health. 3,5,7,14,[17][18][19][20][21] Recommendations for medical students embarking on international electives include recognizing that the primary purpose of the trip is medical education, communicating level of training clearly to all parties, practicing cultural humility, ensuring personal safety, and focusing on activities relevant to and needed by the host. This article serves to offer practical advice aimed at medical students participating in international rotations in order to make trips maximally beneficial to both students and their host communities.…”