Skip to main content
Top
Published in: Globalization and Health 1/2019

Open Access 01-12-2019 | Debate

A Comprehensive Framework to Optimize Short-Term Experiences in Global Health (STEGH)

Authors: Shivani Shah, Henry C. Lin, Lawrence C. Loh

Published in: Globalization and Health | Issue 1/2019

Login to get access

Abstract

Increasing demand for Short-term Experiences in Global Health (STEGH), particularly among medical trainees, has seen a growth in programming that brings participants from high-income countries to low and middle-income settings in order to engage in service, teaching or research activities. Historically the domain of faith-based organizations conducting “missions”, STEGH are now offered by diverse groups including academic institutions, non-profit organizations, and the private sector, either as dedicated for-profits or through corporate social responsibility arms.
The growing popularity of STEGH has resulted in concerns about their negative impacts on host communities. Traditional STEGH are often crafted with little or no input from host community leaders, and this results in activities that do not address locally identified priorities. Other concerns include culturally incongruent programming and the creation of parallel systems that disrupt established local services and redirect scarce local resources, which fosters dependency instead of building capacity. One concern specific to trainees also includes trainee provision of services beyond their scope and training level.
To address these concerns, this paper presents a comprehensive framework that aims to categorize promising interventions that might promote greater responsibility in STEGH. Based on the micro-meso-macro framework, this paper proposes various interventions as incentives and disincentives to be deployed at the individual, program, and societal levels to promote greater responsibility in STEGH. Deployed altogether, the interventions contemplated by this framework would foster the optimal context  required to encourage responsibility, minimize harms, and optimize host community outcomes for STEGH.
Literature
1.
go back to reference Melby MK, Loh LC, Evert J, Prater C, Lin H, Khan OA. Beyond medical “missions” to impact-driven short-term experiences in Global Health (STEGH). Ethical principles to optimize community benefit and learner experience. Acad Med. 2016;91:633–8.CrossRef Melby MK, Loh LC, Evert J, Prater C, Lin H, Khan OA. Beyond medical “missions” to impact-driven short-term experiences in Global Health (STEGH). Ethical principles to optimize community benefit and learner experience. Acad Med. 2016;91:633–8.CrossRef
2.
go back to reference Anderson KC, Slatnik MA, Pereira I, Cheung E, Xu K, Brewer TF. Are we there yet? Preparing Canadian medical students for global health electives. Acad Med. 2012;87:206–9.CrossRef Anderson KC, Slatnik MA, Pereira I, Cheung E, Xu K, Brewer TF. Are we there yet? Preparing Canadian medical students for global health electives. Acad Med. 2012;87:206–9.CrossRef
3.
go back to reference Maki J, Qualls M, White B, Kleefield S, Crone R. Health impact assessment and short-term medical missions: a methods study to evaluate quality of care. BMC Health Serv Res. 2008;8:121.CrossRef Maki J, Qualls M, White B, Kleefield S, Crone R. Health impact assessment and short-term medical missions: a methods study to evaluate quality of care. BMC Health Serv Res. 2008;8:121.CrossRef
4.
go back to reference Sykes KJ. Short-term medical service trips: a systematic review of the evidence. Am J Public Health. 2014;104:e38–48.CrossRef Sykes KJ. Short-term medical service trips: a systematic review of the evidence. Am J Public Health. 2014;104:e38–48.CrossRef
5.
go back to reference Popham G. Boom in 'voluntourism' sparks concerns over whether the industry is doing good: Thomas Reuters World News; 2015. Popham G. Boom in 'voluntourism' sparks concerns over whether the industry is doing good: Thomas Reuters World News; 2015.
6.
go back to reference Evans T, Akporuno O, Owens KM, Lickers B, Marlinga J, Lin HC, Loh LC. Using Maslow's hierarchy to highlight power imbalances between visiting health professional student volunteers and the host community: an applied qualitative study. Educ Health (Abingdon). 2017;30:133–9.CrossRef Evans T, Akporuno O, Owens KM, Lickers B, Marlinga J, Lin HC, Loh LC. Using Maslow's hierarchy to highlight power imbalances between visiting health professional student volunteers and the host community: an applied qualitative study. Educ Health (Abingdon). 2017;30:133–9.CrossRef
7.
go back to reference Dowell J, Merrylees N. Electives: isn’t it time for a change. Med Educ. 2009;43:21–6.CrossRef Dowell J, Merrylees N. Electives: isn’t it time for a change. Med Educ. 2009;43:21–6.CrossRef
9.
go back to reference Crump JA, Sugarman J. Working group on ethics guidelines for Global Health T. Ethics and best practice guidelines for training experiences in global health. Am J Trop Med Hyg. 2010;83:1178–82.CrossRef Crump JA, Sugarman J. Working group on ethics guidelines for Global Health T. Ethics and best practice guidelines for training experiences in global health. Am J Trop Med Hyg. 2010;83:1178–82.CrossRef
10.
go back to reference Provenzano AM, Graber LK, Elansary M, Khoshnood K, Rastegar A, Barry M. Short-term global health research projects by US medical students: ethical challenges for partnerships. Am J Trop Med Hyg. 2010;83:211–4.CrossRef Provenzano AM, Graber LK, Elansary M, Khoshnood K, Rastegar A, Barry M. Short-term global health research projects by US medical students: ethical challenges for partnerships. Am J Trop Med Hyg. 2010;83:211–4.CrossRef
11.
go back to reference Bauer I. More harm than good? The questionable ethics of medical volunteering and international student placements. Trop Dis Travel Med Vaccines. 2017;5. Bauer I. More harm than good? The questionable ethics of medical volunteering and international student placements. Trop Dis Travel Med Vaccines. 2017;5.
12.
go back to reference Cherniak W, Latham E, Astle B, Anguyo G, Beaunoir T, Buenaventura J, et al. Visiting trainees in global settings: host and partner perspectives on desirable competencies. Ann Glob Health. 2017;83:359–68.CrossRef Cherniak W, Latham E, Astle B, Anguyo G, Beaunoir T, Buenaventura J, et al. Visiting trainees in global settings: host and partner perspectives on desirable competencies. Ann Glob Health. 2017;83:359–68.CrossRef
13.
go back to reference Frieden, TR. A Framework for Public Health Action: The Health Impact Pyramid. 2010;100: 590–595. Frieden, TR. A Framework for Public Health Action: The Health Impact Pyramid. 2010;100: 590–595.
14.
go back to reference Golden SD, Earp JA. Social ecological approaches to individuals and their contexts: twenty years of health education & behavior health promotion interventions. Health Educ Behav. 2012;39:364–72.CrossRef Golden SD, Earp JA. Social ecological approaches to individuals and their contexts: twenty years of health education & behavior health promotion interventions. Health Educ Behav. 2012;39:364–72.CrossRef
15.
go back to reference American Society of Clinical Oncology. American Society of Clinical Oncology policy statement update: tobacco control--reducing cancer incidence and saving lives 2003. J Clin Oncol 2003;21(14):2777–2786. Epub 2003 May 31. American Society of Clinical Oncology. American Society of Clinical Oncology policy statement update: tobacco control--reducing cancer incidence and saving lives 2003. J Clin Oncol 2003;21(14):2777–2786. Epub 2003 May 31.
17.
go back to reference Graham RG, Martin G. Health behavior: a Darwinian reconceptualization. Am J Prev Med. 2012 Oct;43(4):451–5.CrossRef Graham RG, Martin G. Health behavior: a Darwinian reconceptualization. Am J Prev Med. 2012 Oct;43(4):451–5.CrossRef
18.
go back to reference Lasker JN. Hoping to help: the promises and pitfalls of global health volunteering: Cornell University Press; 2016 Jan 29. Lasker JN. Hoping to help: the promises and pitfalls of global health volunteering: Cornell University Press; 2016 Jan 29.
20.
go back to reference Lough B, McBride AM, Sherraden MS, O’Hara K: capacity building contributions of short-term international volunteers. J Comm Practice. 2011;19:120–37. Lough B, McBride AM, Sherraden MS, O’Hara K: capacity building contributions of short-term international volunteers. J Comm Practice. 2011;19:120–37.
21.
go back to reference Elnawawy O, Lee AC, Pohl G. Making short-term international medical volunteer placements work: a qualitative study. Br J Gen Pract. 2014;64:e329–35.CrossRef Elnawawy O, Lee AC, Pohl G. Making short-term international medical volunteer placements work: a qualitative study. Br J Gen Pract. 2014;64:e329–35.CrossRef
22.
go back to reference Loh LC, Valdman O, Dacso MM. Coalicion de Salud Comunitaria (COSACO): using a healthy community partnership framework to integrate short-term global health experiences into broader community development. Glob Health. 2016;12:15.CrossRef Loh LC, Valdman O, Dacso MM. Coalicion de Salud Comunitaria (COSACO): using a healthy community partnership framework to integrate short-term global health experiences into broader community development. Glob Health. 2016;12:15.CrossRef
23.
go back to reference Suchdev P, Ahrens K, Click E, Macklin L, Evangelista D, Graham E. A model for sustainable short-term international medical trips. Ambul Pediatr. 2007;7:317–20.CrossRef Suchdev P, Ahrens K, Click E, Macklin L, Evangelista D, Graham E. A model for sustainable short-term international medical trips. Ambul Pediatr. 2007;7:317–20.CrossRef
24.
go back to reference Rozier MD, Lasker JN, Compton B. Short-term volunteer health trips: aligning host community preferences and organizer practices. Glob Health Action. 2017;10:1267957.CrossRef Rozier MD, Lasker JN, Compton B. Short-term volunteer health trips: aligning host community preferences and organizer practices. Glob Health Action. 2017;10:1267957.CrossRef
30.
go back to reference Hillman AL. Managing the physician: rules versus incentives. Health Aff (Millwood). 1991 Winter;10(4):138–46.CrossRef Hillman AL. Managing the physician: rules versus incentives. Health Aff (Millwood). 1991 Winter;10(4):138–46.CrossRef
31.
go back to reference Rowthorn V, Loh LC, Evert J, Chung E, Lasker J. From carrot to stick: a legal analysis of medical missions in low-resourced countries and recommendations. Ann Glob Health. (in press). Rowthorn V, Loh LC, Evert J, Chung E, Lasker J. From carrot to stick: a legal analysis of medical missions in low-resourced countries and recommendations. Ann Glob Health. (in press).
32.
go back to reference Diemert L, Dubray J, Babayan A, Schwartz R. Strategies affecting tobacco vendor compliance with youth access Laws: a review of the literature. Toronto: Ontario Tobacco Research Unit, October; 2013. Diemert L, Dubray J, Babayan A, Schwartz R. Strategies affecting tobacco vendor compliance with youth access Laws: a review of the literature. Toronto: Ontario Tobacco Research Unit, October; 2013.
33.
go back to reference World Health Organization. World Health Organization framework convention on tobacco control. Switzerland: Geneva; 2003. World Health Organization. World Health Organization framework convention on tobacco control. Switzerland: Geneva; 2003.
36.
go back to reference Flegel K, MacDonald N, Hébert PC. Volunteering overseas made easy. Can Med Assoc J. 2010;182:1493.CrossRef Flegel K, MacDonald N, Hébert PC. Volunteering overseas made easy. Can Med Assoc J. 2010;182:1493.CrossRef
Metadata
Title
A Comprehensive Framework to Optimize Short-Term Experiences in Global Health (STEGH)
Authors
Shivani Shah
Henry C. Lin
Lawrence C. Loh
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Globalization and Health / Issue 1/2019
Electronic ISSN: 1744-8603
DOI
https://doi.org/10.1186/s12992-019-0469-7

Other articles of this Issue 1/2019

Globalization and Health 1/2019 Go to the issue