This organization is primarily concerned with partnership development and management. As such, it principally addresses the problem of resource disparity by creatively leveraging existing institutions. Through this partnerships the organization is poised to impact global health equity, healthcare workforce shortages, community health systems, access to primary health care services, global health research, and global health education. The partnership framework is broad and flexible allowing each partnership to be unique in its scope. However, the three primary objectives of any partnership are:
Community Health Systems Strengthening
Sustainably strengthen community health systems capacity to improve community health status by ensuring access to quality primary health care services.
Global Health Research
Advance the science of strengthening decentralized community health systems in low and middle income countries through the study of global health partnerships, health services quality, and the implementation and dissemination of evidence-based primary health care solutions.
Global Health Education
Educate US health care trainees and local community health workers on global health themes including capacity strengthening, collaboration and partnerships, ethical reasoning and professionalism, health equity and social justice leadership, program management, cultural awareness, and strategic analysis and evaluation1,2 through bi-directional knowledge exchange within the arranged longitudinal partnership.
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.
Peace Care is focused on partnerships. Through its projects, community driven change is accomplished through sustainable exchange between educators and community members. Peace Care strives to provide concise management through its sustainable model and reliable funding to link educators and communities in need with knowledge and resources. Local volunteers will facilitate that exchange. Peace Care works to serve both universities who provide required resources and international communities in need of knowledge exchange.
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 Partnership (GCHP) 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 partnership approach links 1) LMIC community members and local health care providers to 2) U.S. and LMIC university faculty through the assistance of the 3) Peace Corps. The approach incorporates CBPR, empowering the community to set priorities and guide the implementation of the research. The Peace Corps facilitates the partnership by offering community expertise, cultural guidance, onsite project coordination, and community advocacy. The universities offer professional technical and public health training resources and evaluation support. Partnership project planning meetings occur longitudinally through distance communication and document sharing. Community Advisory Board (CAB) meetings, focus groups, data collection, policy discussions, and technical trainings occur primarily during biannual university site visits. The participatory partnership and CAB meetings guide the health service adaptation, implementation, quality improvement, and the evaluation. The outcome of a partnership is a sustainable health service, trained health care providers, service guidelines directed at a locally-prioritized health issue, and health service implementation research using mixed methods to evaluate the process and impact of the health service. The expansion of a community-Peace Corps-academic approach will continue to foster the development of global health partnerships that 1) consistently use participatory approaches to address the need of sustainable health systems in low resource communities and 2) focus on primary health care services implementation research.
Many U.S. academic institutions are engaged in partnerships with LMIC communities, local health structures, or academic centers. The scope of the aims of projects implemented through these collaborative arrangements is broad, the methodologies diverse, and the reported successes of these existing relationships varied. Considering methodology, the use of community-based participatory research (CBPR) is frequently utilized and has been shown to improve delivery of primary health care services at the local level. It is well accepted that the use of a systematic participatory process strengthens global health partnerships. CBPR improves the delivery of primary health care services at the local level and can be used to carry out implementation research by engaging communities in the process of both service implementation and quality improvement. The outcome of CBPR depends on the quality of the partnership, and well-positioned partners improve synergy, through leveraging combined influence. In consideration of the aforementioned barriers to implementation research in LMICs through traditional university-community partnerships, the inclusion of the Peace Corps in a global health partnership could improve synergy, by facilitating a community-centered approach that results in sustainable impact.
This model is innovative in terms of the unique collaborative partnership facilitating local health service delivery policy and the building of research capacity in low and middle income countries (LMICs). The potential for significant impact comes from the ability to transfer the training capacity of the academic center, in collaboration with local physicians and existing health care workers, to the strengthening of the health care system within the LMIC community. It places an emphasis on selective decentralization in the management and sustainability of the projects by functioning within the host country’s existing health structure with direct communication with the Ministry of Health. Thus, the projects require strong local and national buy-in. At the same time, it encourages local community involvement and ownership of the projects by working directly with local health officials and the local board of health longitudinally, pre- and post- intervention, with the on-site long-term liaison being the Peace Corps Volunteer or other agency field worker. In this light, there is minimal distortion of government health programs as interventions are necessarily in line with the Ministry of Health objectives, and siphoning of host country personnel is avoided entirely as the primary goal is to train the local health care workforce. The structure of this model avoids the possibility of U.S. professionals primarily acting on their own agenda to the detriment of the host community. Instead, the needs and priorities of the local community are fostered.