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

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.

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.