Evaluating Team Characteristics for Health Engagements in Three Countries in Central America: 2012-2017.

BACKGROUND: The U.S. DoD is a multidimensional agency of the government that employs health engagement activities within partner nations for medical operations, humanitarian assistance, threat reduction, and improved health outcomes toward sustainable global health and security. The composition and size of a health engagement team is critical for effective implementation; however, an ideal team makeup to achieve optimal operational readiness, health outcomes, and security cooperation objectives has not been established. This study was conducted to retrospectively describe and analyze medical mission activities in relation to ideal team characteristics in El-Salvador, Guatemala, and Honduras between 2012 and 2017. METHODS: A retrospective analysis was conducted on data from unclassified versions of the Global-Theater Security Cooperation Management Information System), Overseas Humanitarian Assistance Shared Information System databases, and mission files provided by U. S. Southern Command and its component commands. Data included 565 mission activities carried out by U.S. Military health teams in the selected host nations between 2012 and 2017. The mission activities were stratified and coded into nine distinct analyzable categories with subelements including but not limited to year, country, mission type, mission duration, team size, team language capability, team joint representation, and team member skillset. The analysis identifies mission objectives in the three subcategories of operational readiness, security cooperation, and health outcomes although the analysis did not include measurement of those objectives. Global Health Engagement mission types were broken down into five categories: direct care, health project, education & training (E&T), engineering, veterinary, or a combination. Data were analyzed using Excel. RESULTS: A total of 414 health engagement activities were found in the data analyzed during 2012 and 2017 accounting for duplication among the sources. Team size was documented in 23.4% (n = 97); team skillset makeup in 17.1% (n = 71); 2.7% (n = 11) showed that at least one team member had language capability for the country visited; and 3.6% (n = 15) documented that professional interpretation was available. The types of health engagement activities were broken down as follows: 64.3% were direct care, 12.2% were health projects, 10.9% were engineering, 9.1% were E&T, and 1.3% were veterinary. Overall, only 20.8% (n = 86) of the missions had a clear mission objective from the three categories of security cooperation, operational readiness, and health outcomes objectives. Individually, each category of objective was noted with the following: 74 with security cooperation (17.9%), 82 with operational readiness (19.8%), and 71 with health outcome objectives (17.1%). CONCLUSION: Findings from this study reveal a broad spectrum of health and medical missions conducted in El Salvador, Guatemala, and Honduras between 2012 and 2017 by DoD. Critical elements indicative of overall team capability for successful engagement such as team size, team member skillset, global health expertise, and appropriate language capability were rarely documented. Team characteristics could not be well-correlated with the Global Health Engagement type or desired mission outcomes. In the future, deliberate crafting and preparation of health engagement teams aimed at attaining desired security cooperation impact, operational readiness development, and positive health outcomes is essential for more effective Global Health Engagement.

Foreign health sector capacity building and the U.S. military.

The U.S. joint military medical community has an increasing role in collaborative health sector engagement internationally as part of a whole of government approach to successful operations. The military must master the ability to catalyze health sector gains that can be developed by hosts, U.S. Government, and international agencies in both permissive environments and conflict zones. Capacity building is helping a partner develop their own capabilities, standards, and resources to the point of self-sufficiency. Optimal effects will come through understanding the military and civilian health sectors of nations and regions, grasping the importance of health to stability and security, and integrating efforts with global health initiatives. The goal is to cultivate military and civilian relationships that assist host nation-led sustainable health sector effects that result in enduring positive U.S. national security outcomes.

Tiers for Education and Training in Global Health for Military Engagement.

This article describes four tiers for knowledge required by U.S. military personnel to effectively execute global health activities. Department of Defense policy does not identify a formal global health education path for personnel responsible for global health activities. Department of Defense must implement formal education programs to improve mission success and favorable health outcomes.

Developing the Prototype Embedded Health Engagement Team.

Small, well prepared, culturally competent, and embedded health engagement teams (EHET) tailored to work within a partner health system, rather than outside of it, will achieve greater mutual benefit, desired military objectives, and better health outcomes for the United States Department of Defence and its partners. EHETs have significant advantages over traditional methods of choice for health security cooperation and humanitarian assistance missions. These advantages include enhanced capability and capacity building, greater trust through intentional cultural expertise, a ready platform for enduring relationships, enhanced host nation legitimacy, and flexibility to target specific issues with greater fidelity. We must first define a prototype EHET, compare the concept against prior units that have executed health engagement, and test it prospectively in employment. The U.S. military and the civilian business world each have extensive experience in employing small teams that the health community can emulate. The ideal EHET should have the following nine characteristics: 12 people or fewer, skillsets for the tasks, global health knowledge, be multidisciplinary, a balance of experience, local language capability, geopolitical and cultural competence, targeted preparation for specific security and health objectives, and joint representation. This paper will explore these components of the prototype EHET as it will be tested in our research project.

An Embedded Health Engagement Team Pilot Test.

INTRODUCTION: As an innovative test of an alternative health engagement method during CONTINUING PROMISE 2011 a joint embedded health engagement team (EHET) was created and executed. EHETs may serve as US military alternatives for improved outcomes in global health engagement activities. MATERIALS AND METHODS: The EHET concept was to integrate into the host nation's public health system to collaborate in direct patient care, contribute to comprehensive preventive health, and achieve intellectual exchange between professionals of similar disciplines. RESULTS: EHET resulted in greater satisfaction on behalf of the host nation and US health professionals, smaller footprint of US personnel and equipment, emphasis on host nation existing infrastructure and system, action upon needs already identified by the host nation health strategy, and optimal US military and security cooperation outcomes. Although this pilot test was a military to civilian engagement the concept is applicable for military to military engagement and across the full range of US military operations. The pilot test was well received by the host nation. Participants on both sides expressed positive feedback that EHETs should be the preferred method for health engagements. CONCLUSIONS: Thoroughly planned and executed EHET engagements should bring greater, measurable positive effects than typical mass patient care activities. EHETs are especially suitable for longer duration or recurrent missions to build partnership, capacity, and security. EHETs should replace legacy mass care missions as the primary health engagement capability to achieve mutual goals while using US military resources on legitimate local health needs.

Global Health Engagement and The Department of Defense as a Vehicle for Security and Sustainable Global Health.

The Unites States Department of Defense (DoD) is viewed by many in the general public as a monolithic government entity whose primary purpose is to coordinate this country's ability to make war and maintain a military presence around the world. However, the DoD is in fact a multidimensional organization whose global impact is as expansive as it is varying and is responsible for far-reaching global health interventions. The United States has worked toward providing long-term care among host nation populations by providing training in several areas related to medicine, with positive results. These efforts can be built upon with substantial positive effects. Building health infrastructure and capacity around the world is essential. The DoD is the most generously funded agency in the world, and the resources at its disposal provide the opportunity to make great gains in the long term in terms of both health and security worldwide. With efficient and careful use of DoD resources, and partnerships with key non-governmental organizations with specialized knowledge and great passion, partnerships can be forged with communities around the world to ensure that public health is achieved in even the most underserved communities. A move toward creating sustainable health systems with long-term goals and measurable outcomes is an essential complement to the already successful disaster and emergency relief that the United States military already provides. By ensuring that communities around the world are both provided with access to the sustainable health care they need and that emergency situations can be responded to in an efficient way, the United States can serve its duty as a leader in sharing expertise and resources for the betterment and security of all humankind.