Brain Gains: a literature review of medical missions to low and middle-income countries

Abstract

BackgroundHealthcare professionals’ participation in short-term medical missions to low and middle income countries (LMIC) to provide healthcare has become common over the past 50 years yet little is known about the quantity and quality of these missions. The aim of this study was to review medical mission publications over 25 years to better understand missions and their potential impact on health systems in LMICs.MethodsA literature review was conducted by searching Medline for articles published from 1985–2009 about medical missions to LMICs, revealing 2512 publications. Exclusion criteria such as receiving country and mission length were applied, leaving 230 relevant articles. A data extraction sheet was used to collect information, including sending/receiving countries and funding source.ResultsThe majority of articles were descriptive and lacked contextual or theoretical analysis. Most missions were short-term (1 day – 1 month). The most common sending countries were the U.S. and Canada. The top destination country was Honduras, while regionally Africa received the highest number of missions. Health care professionals typically responded to presenting health needs, ranging from primary care to surgical relief. Cleft lip/palate surgeries were the next most common type of care provided.ConclusionsBased on the articles reviewed, there is significant scope for improvement in mission planning, monitoring and evaluation as well as global and/or national policies regarding foreign medical missions. To promote optimum performance by mission staff, training in such areas as cross-cultural communication and contextual realities of mission sites should be provided. With the large number of missions conducted worldwide, efforts to ensure efficacy, harmonisation with existing government programming and transparency are needed.

Cooperación internacional ¿en qué estamos y hacia dónde vamos?

“…Para subsanar este problema se organizan equipos de personal de salud para resolver casos seleccionados, por lo general patologías quirúrgicas, que no pueden ser resueltos por el sistema local 5,13,14 . Este tipo de misiones tienen las ventajas de la optimización del trabajo, porque se trata de equipos compenetrados (aunque muchos pueden no conocerse con anticipación), la posibilidad de resolver patologías complejas e intentar asegurar un nivel de atención estándar a los pacientes.…”

“…Martiniuk et al 14 realizaron una revisión sistemática de la literatura evaluando los OM. En esta refieren que los países que más OM envían son Estados Unidos de Norteamérica, Canadá, Reino Unido y Australia, siendo las regiones beneficiadas de este apoyo, principalmente, África, América Central y Asia.…”

“…Maki et al 15 resumen los problemas de algunos OM en la siguiente frase: "la falta de seguimiento, la pobre relación con el sistema de salud local y la escasa sustentabilidad pueden desafiar las buenas intenciones de las misiones". Martiniuk et al describen las principales críticas encontradas en la literatura, luego de una revisión sistemática, destacando la sustentabilidad, costo-efectividad, seguridad y consideraciones éticas relacionadas con la praxis 14 . Caldron et al incorporan también la profesionalización como elemento a considerar 5 .…”

“…Por otra parte, factores como los déficits de leyes o formalidades de regulación harían de estas instancias un buen escenario para que profesionales menos preparados en sus países de origen, interesados en mejorar sus habilidades técnicas, o motivados por el "turismo médico", participen de este tipo de actividades 14 .…”

Con: Pure service delivery is no longer needed in global surgical missions

“…The authors' review revealed the paucity of literature providing quantitative data on costs, quality, regulation, and outcome. 5 More recently, Sykes reviewed articles about MSTs in an effort to evaluate specific indicators, including treatment interventions, cost effectiveness, quality assessment, factors limiting MSTs from performing evaluations, reasons healthcare providers participate, role of education, and how those affected by MSTs perceive the visiting teams and their activities. Most of the author's questions were left unanswered, so he concluded that ''reporting has dealt largely with outputs rather than outcomes''.…”