Global Health Partnerships and the Brocher Declaration: Principles for Ethical Short-Term Engagements in Global Health.

Short- term experiences in global health (STEGH), also known as short-term medical missions continue to be a popular mode of engagement in global health activities for students, healthcare providers, and religious groups, driven primarily by organizations from high-income countries. While STEGH have the potential to be beneficial, a large proportion of these do not sustainably benefit the communities they intend to serve, may undermine local health systems, operate without appropriate licenses, go beyond their intended purposes, and may cause harm to patients. With heightened calls to "decolonize" global health, and to achieve ethical, sustainable, and practical engagements, there is a need to establish strong guiding principles for global health engagements. The Advocacy for Global Health Partnerships (AGHP), a multi-sectoral coalition, was established to reflect on and address the concerns relating to STEGH. Towards this end, AGHP created the Brocher Declaration to lay out six main principles that should guide ethical and appropriate STEGH practices. A variety of organizations have accepted the Declaration and are using it to provide guidance for effective implementation of appropriate global health efforts. The Declaration joins broader efforts to promote equity in global health and a critical reevaluation of volunteer-centric, charity-based missions. The current state of the world's health demands a new model of collaboration - one that sparks deep discussions of shared innovation and builds ethical partnerships to address pressing issues in global health.

Guidelines for responsible short-term global health activities: developing common principles.

BACKGROUND: Growing concerns about the value and effectiveness of short-term volunteer trips intending to improve health in underserved Global South communities has driven the development of guidelines by multiple organizations and individuals. These are intended to mitigate potential harms and maximize benefits associated with such efforts. METHOD: This paper analyzes 27 guidelines derived from a scoping review of the literature available in early 2017, describing their authorship, intended audiences, the aspects of short term medical missions (STMMs) they address, and their attention to guideline implementation. It further considers how these guidelines relate to the desires of host communities, as seen in studies of host country staff who work with volunteers. RESULTS: Existing guidelines are almost entirely written by and addressed to educators and practitioners in the Global North. There is broad consensus on key principles for responsible, effective, and ethical programs--need for host partners, proper preparation and supervision of visitors, needs assessment and evaluation, sustainability, and adherence to pertinent legal and ethical standards. Host country staff studies suggest agreement with the main elements of this guideline consensus, but they add the importance of mutual learning and respect for hosts. CONCLUSIONS: Guidelines must be informed by research and policy directives from host countries that is now mostly absent. Also, a comprehensive strategy to support adherence to best practice guidelines is needed, given limited regulation and enforcement capacity in host country contexts and strong incentives for involved stakeholders to undertake or host STMMs that do not respect key principles.

Short-term volunteer health trips: aligning host community preferences and organizer practices.

BACKGROUND: Short-term medical missions (STMMs) are quite common and largely understood to be a response to health needs in low-income countries. Yet most information about STMM practices is anecdotal. Even less is known about the preferences of in-country host communities regarding STMMs. OBJECTIVE: We aimed to gather enough quantitative and qualitative information from both STMM organizers and host community staff to compare dominant practices of organizers as well as preferences of host community staff. We use these data to discover differences between practices and preferences and suggest ways in which STMMs can be more responsive to the communities they serve. METHODS: Researchers gathered online survey responses from 334 STMM organizers and conducted interviews to determine existing practices. Similar methods were used to collect 49 online survey responses from, and conduct 75 interviews with, host community staff. RESULTS: Organizer practices and host community staff preferences are different in several areas. Organizers admit to minimal screening and preparation of volunteers whereas host staff have clear ideas of topics that should be covered in preparation, including culture and basic language skills. Organizers prioritize provision of clinical care during trips whereas host staff prioritize capacity building. Practices and preferences also differ in relation to the length of STMMs, the nature of the partnership itself, and the type of assessment and evaluation that is needed. CONCLUSIONS: The large amount of data gathered for this study allows us to confidently say that organizer practices are often not aligned with host community staff preferences. Several concrete changes can be made to STMMs to bring practices more in line with the desires of the communities they serve.

Thinking Globally: To Welcome 2017, Stop and Reflect on Our Vocation.

The new year is an invitation to renewal, conversion, reflection. For those of us working in global health, it's an opportunity to go forward, unwavering, in the belief that we are to share the Earth's resources with all of God's people, be it by reaching out in times of disaster, medical mission experiences, twinning programs, funding or other means.

Thinking Globally: To Welcome 2017, Stop and Reflect on Our Vocation.

The new year is an invitation to renewal, conversion, reflection. For those of us working in global health, it's an opportunity to go forward, unwavering, in the belief that we are to share the Earth's resources with all of God's people, be it by reaching out in times of disaster, medical mission experiences, twinning programs, funding or other means.

Thinking Globally: To Welcome 2017, Stop and Reflect on Our Vocation.

The new year is an invitation to renewal, conversion, reflection. For those of us working in global health, it's an opportunity to go forward, unwavering, in the belief that we are to share the Earth's resources with all of God's people, be it by reaching out in times of disaster, medical mission experiences, twinning programs, funding or other means.

Join the Mission-Margin Discussion.

Recently I traveled with Sr. Carol Keehan, DC, CHA's president and chief executive officer, to St. Francis de Sales Hospital in Port-au-Prince, Haiti, where we met with the three priests who have responsibility for management and direction of the hospital. In the course of our conversation, they voiced their struggles in managing the hospital's mission of being the hospital for the poorest of Port-au-Prince's population while attempting to maintain any semblance of a financial margin. It was fascinating to listen to their deliberations ­ the challenges and possibilities of seeking sustainability ­ in terms of attracting those who can pay while always serving those who are unable to do so.

Children Use Art, Puppetry To Express Themselves.

Children are resilient. For those of you who have participated in medical mission trips or other programs where you have traveled to low- and middle-income countries, you most likely have noted or commented upon the children you encounter. I often hear, "They're so happy!"