The Gauntlet Is Thrown Down
In the early morning hours, in a speech at the University of Michigan 3 weeks before his election, Senator John F. Kennedy challenged US citizens to engage in public service (Figure 1):
How many of you who are going to be doctors are willing to spend your days in Ghana? Technicians or engineers, how many of you are willing to work in the Foreign Service?...I think Americans are willing to contribute. But the effort must be far greater than we have ever made in the past.[1]
Figure 1. Senator Kennedy at the University of Michigan, October 14, 1960.
Fifty-two years later, the Global Health Service Partnership (GHSP) was launched to help realize the full scope of Kennedy's vision. The program, a public/private partnership between the Peace Corps and Global Health Service Corps (GHS Corps), will send physicians and nurses abroad as healthcare educators. These educators will work closely with countries to help meet their health system human resource needs. In this pioneering model, GHS Corps will be the exclusive medical partner to the Peace Corps, creating the most comprehensive global clinical capacity-building program to date.
In time, the GHSP will deploy other healthcare professionals as well. The program's model focuses on partnerships: a public/private partnership between the US government and GHS Corps to enhance existing efforts with flexibility awarded to private organizations; partnerships with resource-limited countries to meet their needs and invest in their long-term sustainability; and partnerships with the volunteer educators deployed globally.
A Desperate Situation
A confluence of factors contributed to the GHSP's development -- desperate shortages of health professionals in many parts of the world, growing interest in global health among health professionals in the United States, and a commitment on the part of the Peace Corps to expand the scope of their critical work.
Many developing countries suffer from significant shortages of health personnel that limit the ability of health systems to deliver even basic healthcare. In 2006, the World Health Organization (WHO) released a study that identified 57 countries with critical shortages of health workers and described a global deficit of 2.4 million physicians, nurses, and midwives.[2] Compared with such countries as India, which has 60 physicians per 100,000 people, or the United States, with 280 physicians per 100,000 people, sub-Saharan Africa has an unacceptably low physician-to-population ratio of only 18 per 100,000. Some sub-Saharan African countries face ratios of only 1 physician per 100,000 people.[3] The situation is similarly alarming for nurse/midwives; several countries on the subcontinent have as few as 20 nurses or midwives per 100,000 people. The United States, in contrast, has on 980 per 100,000 US citizens.[4]
Compounding this crisis, shortages are most dire where the global burden of disease is highest -- sub-Saharan Africa has 24% of the global burden of disease, but only 3% of the world's workforce and only 1% of the world's health expenditure.[5] Although significant aid has been directed towards global health goals over the past several decades, historically, funds have targeted responses to health epidemics and disease-specific campaigns around the world.
Today, there is an increasing understanding that vertical, disease-focused programs, although needed, would be most effectively augmented by broader engagement in elements that strengthen health systems, such as human resources. Investments in health professional education and training will be critical to the scale-up of healthcare delivery programs and the ability to respond effectively to more complex care needs as well as to unforeseen epidemics.
The Global Brain Drain
Healthcare worker shortages have been fueled by both insufficient numbers of personnel trained as well as emigration of trained and qualified healthcare professionals from resource-limited settings to areas with greater resources, a phenomenon known as "brain drain." According to the Organization of Economic Cooperation and Development (OECD), this emigration follows an economic trend, in which OECD-defined low-income countries suffer disproportionately from brain drain.[6] In general, countries with the lowest per capita gross domestic product have the highest rates of emigration, with more than 20% of university graduates leaving their countries after completing their education.[7] This emigration can have potentially severe consequences in resource-limited countries for critical sectors, such as education, health and engineering.[6] The education of professionals in many of these countries reflects a significant financial and resource investment within fragile and constrained systems and is, in effect, wasted when these skilled, trained professionals emigrate.
Economic drivers, such as job security, safety, and wages, are not the only influences on emigration. Migration of indigenous healthcare professionals from lower-resource health systems is also motivated by lack of career mobility or training opportunities.[2,8] For example, in Cameroon, lack of opportunities for promotion and the desire to gain advanced training ranked above poor wages as reasons why healthcare professionals chose to migrate.[9] Furthermore, even if health professionals return to their home countries after receiving training abroad, although they may have gained requisite skills, the health systems still lack the infrastructure and support necessary to practice their trade. Many of these health professionals will also lack access to international academic discourse.[10,11]
An Increasingly Engaged Volunteer Base
Although the need for health professionals in resource-limited settings is widely acknowledged, a parallel phenomenon is the rapidly growing interest in global health and international service on the part of US healthcare professionals. The past decade has witnessed an unprecedented growth in global health activity, interest, and funding, particularly among universities and academic medical centers. A recent survey by the Consortium for Universities for Global Health found that the number of university-based global health programs more than quadrupled between 2003 and 2009,[12] growth that was driven largely by demand.
Medical students, residents, physicians, nurses, and other health professionals increasingly seek programs and organizations that offer opportunities in global health. This interest is observed in many healthcare specialties, including pharmacy, physical therapy, and health administration. Among physicians alone, the interest and commitment to global health can be seen in myriad clinical disciplines.
A recent national survey of pediatric graduate medical education programs found that one half of these programs have a global health curriculum.[13] A survey from the University of San Francisco found that 90% of surgical residents expressed interest in global health,[14] and that global health rotations improved skills in history-taking, exposure to a broader scope of surgical conditions, and an appreciation for sociocultural aspects of healthcare provision.[15] The opportunities do not yet match the demand nor correspond to global service needs. Since the GHSP was announced in March, health professionals of all backgrounds and levels of training have reached out enthusiastically for the opportunity to serve.
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Cite this: Global Health Service Partnership: A Model for Global Health - Medscape - Nov 07, 2012.
