Increasing numbers of practicing physicians, residents, and students are participating in international experiences. These programs span a broad array of venues and formats, including education, service, and research, but share some basic issues.
The American Academy of Family Physicians encourages and provides services to support members’ global and international health activities. These Guiding Principles for Global Health Service Learning Programs provide a framework for creating equitable and sustainable international activities that are ethically and morally responsible. Additionally, these principals should be the basis for establishing and evaluating such programs while acknowledging global health as the crossroads where public health, globalization, politics, and human rights interact (McGill Medical Journal, 2009).
Short-term experiences and activities should be designed and planned to lay the foundation for long-term, collaborative, equitable relationships that address the true needs of international communities and health systems and contribute to their further development and sustainability.
The vision should equally emphasize the benefits for US participants and priorities of the international partner or community. A clearly defined mission statement should guide any program, delineating goals, responsibilities, motivation, and the anticipated effect on participants and the host community. Mutual, reciprocally beneficial focus should be clear in the mission. Goals must reflect equitable responsibility and contribution, anticipated influence on all involved, including the community at large, altruistic motivation and service, benefits, costs, and methods for assessment and revision.
A collaborative attitude and approach while exploring and developing international relationships is essential. Interactions while in-country and during the intervals between trips must facilitate ongoing communication and service to partner communities. Internet and cell phone technology make communication feasible anywhere on the globe. Communities and international partners should be active collaborators in all studies and evaluations. They should receive results and reports of participants’ experiences and any studies conducted.
Address health needs, including public health, and the priorities of the community. Assure resources are consistent with goals. Recognize that a community’s need may not involve direct care primarily. Collaboration with a government agency, a non-government agency, or a community organization is essential.
Enhance and develop the skills, abilities, competence, and stature of our international colleagues, local caregivers, members of the health care system of the country, as well as volunteers/participants. Prepare all participants for the experience. Assess their skill and knowledge so as to limit responsibility to the appropriate level of capability. The curriculum should include a review of the mission, the participant’s role, personal and social impact of the project, risks and personal safety, standards of social and professional behavior, and respect for privacy and confidentiality. Note the need for language proficiency among the delegation.
The program should show a commitment to an ongoing relationship, contributing to sustained improvement in health outcomes of the community, not self-serving to the participants, and consistent with the community’s cultural standards. Through long-term relationships, collaboration, and cooperation with in-country organizations and entities strive to augment, enhance, or develop local services for long-term impact.
Assess the benefits, liabilities, and deficits of the program through ongoing re-evaluation. Analysis of the effects on the hosts, as well as the participants should avoid exploitation, cultural inappropriateness, exacerbating poverty or insufficiencies and minimize or avoid unintentional adverse consequences. Evaluate the outcomes for all involved parties, both positive and negative, including remaining challenges. Programs should actively collect feedback from participants regarding the relationship, service, education and sustainability of the project. The community should evaluate the program’s impact and share leadership and responsibility for the program.