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.

Highlights

  • Short-term experiences in global health (STEGH) abroad are becoming increasingly popular among healthcare trainees and practitioners [1, 2]

  • A ever-growing contemporary number of organizations based in high-income countries (HICs) offer various STEGHs to low and middle-income settings (LMICs) which vary in length, from weeks to months, as well as purpose, be it educational, research, or community service

  • This review examines different models of local partnerships employed by STEGH, and proposes a framework for categorization, outlining pros and cons of each model

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Summary

Background

Short-term experiences in global health (STEGH) abroad are becoming increasingly popular among healthcare trainees and practitioners [1, 2]. Adding to these concerns around this model of partnership is that the nature of work undertaken by each individual STEGH is still limited by their intermittent presence At worst, these are essentially multiple singlevisiting partner STEGH that might have a narrow focus on downstream, episodic care, with similar intended impacts but a much more significant resource burden to the host partner and community. Groups that successfully coordinate multiple local stakeholders on a continuous basis can create meaningful community planning dialogue that leverages expertise, provided they remain committed to accurately representing potentially competing local needs This partnership model has the most potential to impact lasting changes in community context; in turn, many of the visiting partners that undertake such efforts are well resourced, well-staffed and well financed. Broad principles in application From the consensus discussions around various models described, the panel members identified four key principles to consider in the application of this partnership framework: 1. Meaningful impact to host communities requires some form of local engagement and measurement

Single STEGH without local partner engagement is rarely ethically justified
Conclusions
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