Global Health Service Partnership: First Year Findings

24 Global Health Service Partnership: First Year Findings Vanessa Kerry, MD, MSc Seed Global Health, Massachusetts General Hospital Boston MA Libby Cunningham, MPH Seed Global Health Boston, MA Pat Daoust, MSN, RN Seed Global Health, Massachusetts General Hospital Boston, MA Sadath Sayeed, MD, JD Seed Global Health, Boston Children’s Hospital Boston, MA Correspondence may be directed to: Vanessa Kerry Email: [email protected] Abstract The Global Health Service Partnership (GHSP) is a public-private-partnership between Seed Global Health, a US non-profit; Peace Corps, a US Government agency; and host country health education systems. The program attempts to address the global shortage of skilled health professionals by sending US doctors and nurses as medical and nursing educators to training institutions in Uganda, Malawi and Tanzania. The program has sent 73 volunteers of myriad specialties over two years to 13 institutions. Through volunteer self-reporting and stake- holder interviews, the program was evaluated for early quantitative outputs and W o r l d H e a lt H & P o P u l at i o n • V o l .16 n o .1 Global Health Service Partnership: First Year Findings 25 qualitative impact. Volunteers improved clinical and classroom teaching, new teaching methods, reduced local faculty workloads and modelled professionalism. Challenges cited included difficulty adapting to the setting and existing practice. GHSP is a new program whose full impact will be better understood over time. The first year revealed numerous opportunities for pedagogical innovation, professional modelling and infrastructure investment. Introduction but they have even fewer to teach their Many models of engagement between global successors. north and the global south healthcare enti- In many countries, the human resource gap ties/institutions have proliferated over the in healthcare delivery is driven by persistently past two decades. Many aim to address dis- low production of newly graduated profes- parities in healthcare access and outcomes sional providers. Thirty-one of the 83 between economically advantaged and disad- aforementioned countries are in Africa vantaged populations through direct service (WHOGHWA 2013), yet sub-Saharan Africa provision, whereas others focus on biomedi- does not train enough medical professionals. cal or biosocial research. Few, however, focus The continent produces only 6,000 physicians primarily on improving the formal education and 26,000 nurses and midwives annually for a and training of the next generation of the population of one billion (Frenk et al. 2010; local healthcare workforce. To help address Kinfu et al. 2009). This represents less than 2% Africa’s growing shortage of healthcare pro- of the current estimated deficit of 1.8 million fessionals, in 2012, Seed Global Health, a skilled health professionals in the region US-based not-for-profit, collaborated with (WHOGHWA 2013). Of the 2420 medical the US Government agency Peace Corps to schools worldwide, there are only 168 medical develop an innovative public-private pilot schools in sub-Saharan Africa. Furthermore, partnership called the Global Health Service 11 of the 47 countries in the region have no Partnership (GHSP). GHSP sends US health medical school; 24 countries have only one professionals to serve as faculty for one year (WHO 2013). Within an already small pool of to resource-limited countries institutions to institutions, average annual class sizes are help train their future physicians and nurses. small, resulting in low total enrolment at a According to a 2013 World Health national level (Frenk et al. 2010; Greysen et al. Organization (WHO) report, 83 countries do 2011; Mullan et al. 2011; Soucat et al. 2013). not meet the minimum threshold of 23 health High student attrition rates also contribute to workers per 10,000 people needed to provide the production shortage; and the dropout basic services (World Health Organization tendency has been associated with a lack of Global Health Workforce Alliance academic infrastructure, inadequate student [WHOGHWA] 2013). The shortages are mentoring and support and increasing cost profound among skilled health professionals of education (Chen et al. 2012; Soucat et al. such as doctors, nurses and midwives. In 2013). Liberia for example, there are only 2.8 such Shortage of healthcare professionals in skilled health professionals for every 10,000 these settings also results from emigration. people (Global Health Workforce Statistics A significant number of professionals seek 2014). Countries with a shortage of skilled careers in, or are actively recruited to, higher- health professionals not only lack enough income countries (Hagopian et al. 2004; doctors, nurses and midwives to provide care, Sawatsky et al. 2014). In a cross-sectional W o r l d H e a lt H & P o P u l at i o n • V o l .16 n o .1 26 Global Health Service Partnership: First Year Findings survey of medical and nursing students, 26% need. GHSP is funded in part by PEPFAR, a of African medical students and 33% of US Government program organized primar- African nursing students surveyed reported ily to combat the HIV/AIDS epidemic. that it was very likely they would work abroad Operationally, GHSP approaches potential in the first five years post-training (Silvestri et host country Ministries of Health and al. 2014). Reasons for emigration include push Education to assess receptivity to the pro- and pull factors. Pull factors lure professionals gram. Once invited, GHSP works with school away and are frequently defined as higher and faculty leadership at bi-laterally identi- wages, better working conditions, better fied training institutions to further refine professional development and continuing pre-clinical and clinical teaching investments education opportunities or active recruitment for any given year. by institutions inside or outside of the country Eligible US citizen physicians and nurses (Liese and Dussault 2004; Soucat et al. 2013; are recruited to serve as Peace Corps WHO 2013). Push factors drive health profes- Volunteers (termed “GHSP volunteers”) sionals from their current setting and include within these host African training institutions poor or unstable social, economic or political for a minimum of one full year. Physicians conditions in home countries. must be board-eligible or board-certified and The shortage of new practitioners coupled nurses must have a Bachelor in Nursing with internal and external “brain drain” of a degree, an additional advanced degree as well country’s brightest healthcare providers is as a minimum of three years of clinical experi- problematic for health education systems. In ence. Sites review the recommended many sub-Saharan countries, there is a crisis candidates prior to final placement. As of a massive shortage of qualified faculty to embedded pre-clinical and clinical-educator staff medical and nursing schools. In a survey faculty, GHSP volunteers fully integrate into of sub-Saharan African medical schools, a institutional roles, serving as lecturers, course majority reported a shortage of faculty in basic directors and clinical mentors and and clinical sciences, with substantial loss of supervisors. staff over five years (Mullan et al. 2011). The All GHSP volunteers undergo a compre- nursing profession faces similar challenges. hensive orientation both in the US and in their For example, in Tanzania, only 14 host country. They are introduced to tropical PhD-educated nurses work in the country, yet medicine, refreshers on core clinical skills and roughly 4000 new nurses graduate from procedures, challenges to working and training programs annually (Mselle 2015). teaching in resource-limited settings, the local The main issues challenging the physician and health and education systems, local culture nursing production and retention of physician norms and basic language training. Seed and nurse faculty include low salaries, provides technical educational and clinical increased teaching load, limited teaching support throughout the year of service, and resources and poor potential for career offers debt repayment stipends of up to advancement (Mullan et al. 2011). In addition, US$30,000 for each year served. there is little opportunity for faculty to In its inaugural year 2013-2014, 169 appli- develop and improve pedagogical skills cations were received, 52 offers extended and (Greysen et al. 2011). 31 volunteers (15 nurses and 16 physicians) placed in Malawi, Uganda and Tanzania at 11 The Global Health Service Partnership host institutions. In its second year, the The broad aims of GHSP are to assist in program expanded. While 179 applications increasing the supply of available healthcare were received and 54 offers extended, providers and to enhance the quality of cur- 42 (23 nurses and 19 physicians) were placed rent healthcare education in regions of great at 13 institutions in the same countries; this W o r l d H e a lt H & P o P u l at i o n • V o l .16 n o .1 Global Health Service Partnership: First Year Findings 27 included four first-year volunteers who surgical nursing, midwifery, paediatrics, peri- renewed their service for a second term. In operative nursing, psychiatric nursing and addition, Seed placed two physician educator women’s health. In the second year, nursing volunteers in Uganda and Malawi outside of specialties added intensive care and emergency the GHSP program. Recruitment involved medicine (Table 1). outreach through traditional Peace Corps GHSP physician volunteers

Load more