- What problems would Peace Care address?
- How would Peace Care address Global Health Disparities?
- How would Peace Care address the U.S. understanding of Global Health?
- What is the Vision of Peace Care?
- What are the advantages of working through Peace Corps and U.S. Health Care Training Programs?
- How would Peace Care work?
- Are commitments long-term and focused on Public Health Initiatives?
- How Could Peace Care Benefit Communities in Low and Middle Income Countries (LMIC)?
- How could Peace Care benefit U.S. Health Care Training Programs?
- How does Peace Care fit in with the goals of Peace Corps?
- How is Peace Care different from a Global Health Corps?
- What Potential does Peace Care offer in the future?
- How Sustainable is Peace Care?
The key problems that this collaboration addresses are twofold. Primarily, Peace Care will address global health disparities. With nearly 5,000 children dying daily from diarrhea related illnesses; with HIV/ AIDS ravaging communities worldwide and the under-recognized threat of chronic diseases overwhelming the health of the world’s communities; with health disparities widening in all corners of the globe, there is a dire need to build health care capacity in low and middle income countries. In addition, Peace Care creates an opportunity to improve the U.S. role in Global Health.
As concerns Global Health Disparities, Peace Care addresses the global burden of disease. Low income countries continue to be gravely affected by unabated epidemics of malaria, tuberculosis, diarrhea related illnesses, and, of course, the ravages of HIV. As well, chronic diseases are the leading cause of death in the world, causing an estimated 35 million deaths worldwide in 2005, approximately 67% of all-cause mortality. As an example, the global prevalence of diabetes is expected to increase from 171 million to 366 million between 2000 and 2030. Further, while the impact of chronic diseases is growing substantially around the globe, the greatest increase is located in low and middle income countries.
The World Health Organization estimates that there is a shortage of about 4.3 million health care workers globally. Peace Care has potential to have a positive impact on this worldwide shortage. Africa has only about 10% of the world’s population and is affected by about 24% of the global disease burden but has only 3% of the global health workforce. Sub-Saharan Africa is deficient the 1.5 million workers that would be necessary to provide adequate health care.
Peace Care, as well, addresses the need for primary health care proficiency in low income countries. Countries with better developed primary health care systems have been found to have better health indicators. There is a correlation between primary care and age-standardized mortality. With a 20% increase in the number of primary care physicians there is a resulting 5% decrease in mortality. As well, each additional family physician per 10,000 people results in 70 fewer deaths per 10,000. This is an estimated 9% decrease in the mortality rate. Therefore, greater access to primary health care results in improved health outcomes and lower costs.
According to the Global Forum for Health Research, of the 73 billion U.S. dollars invested annually in global health research by the public and private sectors, less than 10% is devoted to research into the health problems that account for 90% of the global disease burden. Peace Care provides a unique opportunity to greatly expand the amount of community health research in low income countries.
Toward the need for a broader and more informed Global Health View, there exists a considerable need for global health training for health professions trainees. In evidence of this, there has been considerable growth in interest in this realm in the last 30 years. In 1984, 6.2% of U.S. medical students participated in an international experience and in 2007, 26.3% of U.S. medical students did likewise. While these statistics speak to medical students, this interest continues into residency, and this trend is seen through training in other health disciplines. There are a great number of benefits of health professions training in global health including improved physical exam skills, increased resource consciousness when making diagnostic and treatment decisions, valuable experience working with underserved populations, increased interest in primary care, improved cultural competency, and increased first-hand exposure in working with medical issues that are uncommon in the U.S.
As well, there is great importance of a U.S. active role in Global Health initiatives. Now, more than ever, the health of other nations affects global productivity, stability, security, and good governance. Therefore, the development of a program such as Peace Care demonstrates generosity on the part of the U.S. and could be effectively used as a foreign-policy tool.
Peace Care’s vision is of a world with health equity. This equity will come through Peace Care reshaping how the resource-rich minority interfaces with the resource-poor majority. This interface will be grass-roots, accessible and sustainable. It will empower and inspire communities as well as healthcare and development agencies worldwide to meet their needs and accomplish their goals. The result of this collaboration is a better trained and more accessible health care workforce in all parts of the world.
What are the advantages of creating linkages between development agencies in the field and U.S. health care training programs?
The established trust, infrastructure, and resources of the Peace Corps are in place to assure the community-oriented nature of the intervention and the sustainability of the project by working with established host country public and private organizations. Peace Care acts to connect U.S. Health Care Training Programs with the resources and infrastructure of Peace Corps.
The partners who act as core pillars of a Global Community Health Collaborative (a development agency such as the Peace Corps and U.S. health care training programs) are well-established and well-respected around the globe. The U.S. health care training programs that could be collaborative partners through Peace Care include family medicine, internal medicine, pediatrics, and Obstetrics and Gynecology Residencies, public health schools, medical schools, nursing schools, physician assistant training institutions, and others.
The process through which the GCHC model functiosn begins within a community where a Peace Corps Volunteer (PCV) with a background and focus on health is currently working. At the behest of the community, the PCV performs a community health assessment, and, along with local health care workers, identifies the assets and needs of the local community. This work will be accomplished through the local board of health for the purposes of sustainability and in keeping local interests as paramount. (The PCV is equipped to help organize this local board if one is not already in place). These officials then communicate this information to the partnered U.S. health care professionals with particular expertise in community-based or primary care interventions designed for the identified needs of the community. The U.S. health care professionals in collaboration with the local health care workers, design an intervention or decide to adapt and implement an established community based or primary care intervention that will address the local health needs, as identified by the community. This intervention occurs by way of a training seminar during the course of a visit by the U.S. professionals to the host country. Community interventions and seminars are conducted whereby significant and sustainable skills and/or knowledge transfer occurs, setting in place the potential for sustainable local capacity building. Through this model, local health leaders will be certified educators or organizers in the focus issue. In addition, during the visit, U.S. professional trainees and faculty are able to participate in clinical practice or perform immediately recognizable goodwill community service activities. After the U.S. health professional's visit, the PCV, along with his or her counterpart and the local board of health, are able to study the effects and impact of the intervention that was implemented. The community, Peace Corps itself, and the U.S. health care training institution, as well, have an opportunity to evaluate the intervention. After the intervention, there will be opportunity for the collaboration to continue between the host community and the U.S. health care professionals with the agency field worker as the liaison through the creative use of information technology. As host country health leaders are certified, they will, in turn, be equipped to propagate the acquired knowledge to surrounding communities and within the existing health care structure with minimal outside support.
Through this collaboration, Peace Care leverages the training resources and rigorous scientific approach of the Global Community Health Collaborative model including U.S. health and medical professionals and academicians, as well as, the well respected institution of the Peace Corps (or other development agencies) with volunteers currently living and working alongside community health leaders in over 75 countries worldwide. Through this developed infrastructure, the impact and reach will be extraordinary in years to come. The model, is applicable to multiple categories of disease and illness, and, therefore, significantly advances disease-specific research in LMIC communities while impacting, broadly, the local health care systems. The potential for significant impact comes from the ability to transfer the training capacity of the GCHC, in collaboration with local physicians and existing health care workers, to the improving of health care capacity within the LMIC community. Community health workers are trained to participate within and support the local health system and detailed community health education programs are implemented.
Peace Care, in essence, brings together the two worlds of medicine and public health by including professionals (or professionals in training) in each locale through the respected and well-engrained structure of the Peace Corps. In essence, this program extends the "community," so to speak, to build a long-term relationship that enables all to benefit from the resources present in each locale. In addition, Peace Care makes it possible for health care training programs to quickly and efficiently set up Global Health Tracks that hold these values and strive for sustainability. This would be possible simply by applying for an affiliated site through Peace Care and organizing the relationship. This could be accomplished in a matter of months with reasonable effort as opposed to the, now, routine and burdensome process of a few years--including finding a site by establishing contacts, visiting, setting up expectations, designing a process of intervention, discovering local resources, etc.--all of which is sometimes done from afar with little local input, thus sustainability and appropriate technology is often overlooked. Programs, currently, may often be designed primarily with the needs of the health care training program in mind -- instead of a collaborative effort. Again, Peace Care, has in place, a primary focus on the community, as much of the organization would take place in the field via the Peace Corps Volunteer in communication with the local health care workforce. While visits to the host community for interventions would likely last only one month at a time, the focus of Peace Care is a continued collaboration over time including long-term planning of initiatives and appropriate follow-up of interventions.
Developed collaboratives through Peace Care are with the LMIC community, a health care training institution (tied to a larger academic institution), and a U.S. school of public health. While trained health care workers in LMICs are just as proficient as U.S. trained staff, all health care personnel need Continuing Medical Education. The teaching capacity to offer, plan, and institute this type of training is much more readily available in U.S. institutions than it often is in rural LMIC communities. Thus, the ability of U.S. institutions to assist in the continued education of health professionals around the world will make a considerable impact.
However, the potential for greater impact comes from the ability to also transfer the training capacity of the U.S. institution, in collaboration with local physicians and existing health care workers, to the building of health care capacity within the LMIC community. Community health workers are trained to participate within and support the local health system and detailed community health education programs are developed and implemented. The evidence-based manner in which Peace Care develops or adapts best practices from around the globe ensures that programs have the best opportunity for success when combined with the motivation and request of the community, itself.
Peace Care is one solution to the difficulty that U.S. Academic Programs face in the process of organizing Global Health Tracks and Global Health Experiences. Peace Care offers consultation for a standardized process for establishing an affiliated site in a manner that fosters community-centered, sustainable projects while providing, for academic programs without global health expertise, the guidance of global public health experience specialists to facilitate the process. This support is extremely valuable to all academic programs seeking to organize a global health experience while is, as well, beneficial to those with an existing global health structure in the following ways...
The Peace Care model...
- Facilitates initial contact with global communities as possible sites for affiliation with interested academic programs.
- Is flexible in consideration of the strengths and challenges of inpidual academic programs in providing an affiliated global community site.
- Encourages reliably sustainable solutions in the organization of Global Health programs.
- Provides a structured framework for academic programs that would emphasize the public health components of global health experiences.
- Provides access to developed technology to facilitate long-term collaboration with global community sites.
- Conducts standardized evaluations (process and outcomes) for all affiliated academic programs and host communities.
- Provides reliable and professional translation services for participating programs.
- Organizes reliable transportation in country.
- Provides assurance of a clear and precise role for the academic program, trainee participants, and the host community.
- Assures the safety of all trainee participants through a well-established protocol -- including an established evacuation plan.
- Provides a means of reliable communication for participants.
- Assures a satisfactory living environment of all participants during their global experience to protect the health and safety of the participants.
- Provides standardized tools for the evaluation of the trainee participants themselves.
- Facilitates the exchange of ideas and feedback between participating programs including experiences of interventions and organization of educational seminars.
- Organizes the dissemination of evaluation outcomes among participating institutions and communities.
- Facilitates collaboration between academic programs working in different areas of the world.
Peace Care aligns well with the Goals of Peace Corps, as established in 1961 by John F Kennedy. The first goal of Peace Corps is helping the people of interested countries in meeting their need for trained men and women. Peace Care has the potential to greatly impact education in the realm of primary health care for workers in low and middle income countries. The second goal is helping promote a better understanding of Americans on the part of the peoples served. Peace Corps volunteers are more deeply attuned to the Health Care needs of the communities they are serving. As well, the health professions trainees who participate, develop a more global view and become more sensitive to a broader range of cultural and socioeconomic considerations. The third goal of Peace Corps is helping promote a better understanding of other peoples on the part of Americans. Peace Care responds to this, as experiences by health care training program participants will be brought back to be shared with colleagues and applied in clinical practice in the U.S.
Our review of previous policy proposals reveals that the need for a more active U.S. role in global health has been addressed in various forms in the past including through the Global Health Corps Act of 2005 as proposed by Senator William Frist, the Global Poverty Act of 2005, the United States Commitment to global Child Survival Act of 2007, and the Global Poverty Act of 2007. Other proposals include the Global Service Fellowship Program Act of 2008, and the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/ AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008.
The Global Health Corps Act of 2005 is the program most closely aligned with many of the goals of the Peace Care. Though it did not make it out of committee, the purpose of the Global Health Corps was to improve the health, welfare, and development of communities in certain foreign countries and regions, to advance United States public diplomacy in these locations, and to provide inpiduals in the United States with the opportunity to serve communities by providing a broad range of needed health care and related services in these communities. The Global Health Corps would have been comprised of non-federal volunteers, employees through the National Health Service Corps, and Peace Corps Volunteers. While this particular proposal is comprehensive and broad-reaching in its effect, there are many disadvantages to this program that the alternative of Peace Care would address. The Global Health Corps Act would have been administratively very large and for this reason quite expensive. In addition, this program would rely on a long term commitment or volunteerism from U.S. professionals who, after extensive schooling, are often in great debt.
As the Global Health Corps Act called for the establishment of a separate office within the Department of Health and Human Services, it did not fully take advantage of the efficiency and integration of existing structures such as Peace Corps. In contrast, the established trust, infrastructure, and resources of the Peace Corps are in place, through the proposed Peace Care, to assure the community-oriented nature of the intervention and the sustainability of the project by working with established host country public and private organizations. U.S. health care training programs, as well, benefit by exposing their trainees to the type of service that will assure their preparedness to address community health in their own communities back home. Peace Care is much more feasible, initially, as minimal funding would be necessary to have a significant impact quickly. The program may easily be expanded in the future to encompass a wide range of impacts and interventions that could have a lasting and significant positive effect on global health. As concerns impact, Peace Care has the potential to reach the 75 corners of the globe where Peace Corps is currently well established.
What is the process of evaluation for Peace Care?
In order to reliably evaluate the success of the program and the impact of the interventions, Peace Care would adhere to the SMART principles (specific, measurable, attainable, relevant, and time bound) for data collection. The strategic objectives for each collaborative body are integrated into the overall evaluation process and the community and clinical research, integral to Peace Care, through collaboration with agency field workers will encourage development of successful interventions, and the program’s impact will be readily tracked. The monitoring of the impact on a larger scale is tracked through the established indicators and benchmarks through the World Health Organization and the Global Health Workforce Alliance.
The future direction of Peace Care would be limited only by creativity. There are many potential projects that could connect enthusiastic health professionals with community health workers, worldwide. Beyond addressing the health of inpiduals within low income countries, Peace Care may creatively impact health systems through the development of patient-centered medical homes, group visits, and home visits. Through expansion of the program, other departments at U.S. institutions may also be able to collaborate in the spirit of improving community health. Fine Arts Departments could collaborate on the successful presentation of health themes, and Engineering Departments could help improve built environments, as examples.
The potential for sustainability of having health care training programs collaborate through a PCV or agency field worker is excellent for several reasons. Peace Care directly connects a community with a U.S. institution for a long-term collaborative relationship that can easily continue even while the institution is not visiting. Information technology (which will be an important aspect of this project as it moves forward) will be critical for this relationship--and nowadays is much more possible even in remote villages. In addition, the program can very easily be "inpidualized" for each collaborative relationship and can grow and mold to fit the needs of the community and the U.S. institution. As well, Peace Corps believes strongly in sustainability, and, to this end, all projects are carried out directly with a counterpart from the local community--this ensures that the relationship will continue even after the PCV has finished his or her service. The fact that Peace Corps remains in country continuously, the Peace Corps Volunteer is well trained in cultural competence, and that the PCV completes a two year service working closely with a community counterpart who can continue the work after the PCV leaves all ensures greater sustainability for the collaborative relationship. Through this relationship, the input and needs of the community are requisite, and the health care training program can utilize the resources available to it to collaborate with the community in finding a solution. This could be as simple as the health care training program presenting a knowledge or skill curriculum through a conference for the health workers at that community, or if a knowledge gap is not the issue--aiding in scholarly activity to study an aspect of the health of the community to design health interventions that address the health challenge, or collaborating with other departments on campus to address other aspects of the health of that particular community. In essence, this program expands our current definition of community and pulls persons from the various corners of the globe together to act in unison for the betterment of all--creating one "community" that is able to utilize the resources in each geographic location.