Sustainable International Partnership Building for Academic Medical Centers: Experiences with the Botswana-UPenn Partnership

Abstract

The world faces a global health workforce shortage of almost 4 million professionals, with the most severe gaps in sub-Saharan Africa [1]. Improvements in health, including meeting the health-related Millennium Development Goals, are linked with the density of skilled health workers [2]. In the U.S., the reauthorizing bill for the President's Emergency Plan for AIDS Relief (PEPFAR) requires the U.S. to support training of 140,000 new health workers in PEPFAR focus countries. The participation of U.S. academic medical centers (AMCs) will greatly help to close the workforce gap and expand training of health professionals in low-and middleincome countries.Many partnerships have developed between AMCs and ministries of health in resource-limited countries. These programs range in depth, longevity, and sustainability. While some U.S. academic medical institutions focus on sending trainees abroad for electives, others have more comprehensive programs encompassing the tripartite mission of patient care, medical education, and research. Examples of robust, long-term partnerships include the University of Indiana-Moi University partnership, the Muhimbili University-UCSF project, and the Botswana-UPenn Partnership (BUP). Our experience with the BUP program has led us to believe it can serve as a useful model for such relationships because it possesses the qualities of successful international collaborations. Auspicious BeginningsThe University of Pennsylvania (Penn) School of Medicine's involvement in Botswana began in 2001 at the request of ACHAP (African Comprehensive HIV AIDS Partnership), a collaboration involving the Government of Botswana, the Bill and Melinda Gates Foundation, and the Merck Company Foundation. The Government of Botswana had decided to make antiretroviral drugs available to its citizens. Doctors with experience using these drugs were needed to help train the local health care workers. The circumstances that led to the formation of BUP highlight an important principle: partnerships that develop at the invitation of the host country rather than at the request of the AMC are more likely to succeed.A memorandum of agreement is critical for an ongoing relationship between an AMC and a developing country. Such an agreement establishes the legality of the program and sets parameters for the collaboration. In our experience, developing a memorandum of agreement helps to define the focus of the collaboration, which for

Training Global Oncologists: Addressing the Global Cancer Control Problem

“…Medicine residents pursue individually tailored curriculums in the form of short-term elective rotations at cancer centers in LMICs partnered with a US based institution, such as Botswana – University of Pennsylvania ( 9 ) and Yale/Stanford Johnson & Johnson Global Health Scholars Programs ( 10 ).…”

Internationalization of Medical Education—a Scoping Review of the Current Status in the United States

“…Despite this relatively low count, we found a diversity of internationalization efforts described, including narratives of individual international experiences [ 42 ], research on student initiatives [ 61 ], description of single school programs [ 24 , 25 , 37 , 43 ], institutional partnerships [ 24 , 25 , 67 ], cultural learning at home [ 21 , 30 ], reviews on school websites [ 54 ], and international GH programs [ 32 , 51 ]. As the goal of the study was to determine the current status of IoME in the US via viewing of published literature, the authors identified three overarching themes that summarized the articles, to help in identifying current practices in IoME—institutional partnerships, international learning at home, and student mobility programs.…”

“…With few exceptions, most described reports focused on partnerships between US schools and institutions in the LMICs, the majority in South America and Africa [ 25 – 27 , 37 , 41 , 56 , 60 , 63 , 67 ], and some in South East Asia [ 34 , 49 ]. Rybak described a partnership with the Ukraine [ 56 ], and there were two reports of the same partnership with Israel [ 26 , 27 ].…”

“…High variability of international options found Cohn, J. [ 37 ] 2010 √ √ Description of a partnership between University of Pennsylvania and Botswana; 24 students sent per year Little information on student activities; no outcomes mentioned Vora, N. [ 38 ] 2010 √ √ Report on student-initiated preclinical elective with learning objectives at Chicago Medical School; with student placements in LMIC and Europe (Armenia and Czech Republic) Chin-Quee, A. [ 39 ] 2011 √ √ Surgery elective for medical students at Emory University, in Haiti, 1 week Learning outcomes based on general medical skills and surgical goals Jeffrey, J.…”

Global Health Training in US Graduate Psychiatric Education

“…For many institutions, establishing partnerships with African institutions for the purposes of learning, scholarship, and/or clinical care is a relatively new undertaking. Models of successful partnerships with formally signed memoranda of understanding have rarely been described in the literature (35–37). We speculate that the relative paucity of global health programs in psychiatry may also be related to cultural and/or language barriers to U.S. medical graduates’ practice of psychiatry in non-U.S. settings (12, 14), a challenge that is relatively unique to psychiatry compared to other specialties where greater importance may be placed on procedural aspects of clinical practice.…”