Systems Thinking in Short-term Health Missions: A Conceptual Introduction and Consideration of Implications for Practice

Abstract

A strong tradition of short-term health missions (STHMs) exists around the world. STHMs have positive and negative effects on local health systems, and these consequences are often unanticipated and unintended. Conceptualizing local health systems as complex adaptive systems (CASs) may help global health actors approach global health activities, including health missions with a greater appreciation for local cultural and environmental context, leading to increased local capacity and impact while minimizing unintended negative consequences. For some, this might entail a shift in practice as it relates to short-term humanitarian work. In this paper, we introduce readers to health as a complex adaptive system (CAS). We then consider implications for practice, including adopting a "learning health system approach," that engages local stakeholders in an ongoing, iterative process of mutual learning and self-organization.

Principles to guide a volunteer humanitarian faith-based short-term medical mission in Nepal: A case study

“…This serves to provide the most benefit: the ultimate goal of the majority of STMMs. 5,16 This principle is also acknowledged as important in the global health literature when addressing the needs of visiting student trainees and hosts. 17 Throughout this partnership, the visiting NGOs have actively sought and valued the involvement of the host staff and community.…”

“…As a result, this reflects the need for a paradigm shift away from only assessing the volunteer experiences, and toward the inclusion of the host community experiences. 16 Another aspect of the paradigm shift needed leads to Lasker's fifth principle of a "focus on prevention." 5 Lasker describes this as a move away from a traditional medical mission model and towards a population based model that addresses the underlying causes, which is in line with upstream thinking.…”

“…Therefore, the integration and collaboration of a variety of services from volunteer and host organizations has the potential to move away from "isolated, episodic interventions" to a "global network of shared learning and positive innovation." 16 The seventh principle to "build local capacity" emphasizes the importance of bidirectional learning and training. 5 In this case study, this could include training host country staff, including local community health care workers, to ensure the ongoing delivery of healthcare once the international volunteers have left.…”

Avoiding pitfalls in overseas medical educational experiences

“…16 There is a growing body of literature on best practice guidelines, curriculum development, and ethical frameworks for short-term medical experiences in global health. 3,5,7,14,[17][18][19][20][21] Recommendations for medical students embarking on international electives include recognizing that the primary purpose of the trip is medical education, communicating level of training clearly to all parties, practicing cultural humility, ensuring personal safety, and focusing on activities relevant to and needed by the host. This article serves to offer practical advice aimed at medical students participating in international rotations in order to make trips maximally beneficial to both students and their host communities.…”

Should Christian Global Health Be Distinctive? A Reflection

“…4 However, a major tenet of this approach, community participation, is not a distinctly Christian notion; it draws more from democratic and socialist political notions. Current needed modifications to this PHC approach, an ecological paradigm 4 and a systems approach 5 . .…”