Global surgery, universal health coverage and the spirit of Ubuntu

This editorial on global surgery provides an overview of this rapidly developing field, its origins, and its links to the discourse on universal health coverage

Designing pedagogically-driven approaches to technology-enhanced learning for community health workers

Technology-enhanced learning (TEL) is well established as a teaching modality. However, there is a lack of evidence for the pedagogical approaches used to design TEL for community health workers (CHWs). This chapter highlights the importance of contextualizing CHW learning within the wider health system. Theoretical approaches to consider when designing a TEL-based education and training programme for CHWs are presented, with practical examples of how these approaches might be most appropriately embedded in the delivery of CHW training. Finally, a framework for the design of pedagogically-grounded TEL-based learning for CHWs is presented, which may be used to help guide the design of TEL-based educational interventions for CHWs

A scoping review of the ethical impacts of international medical electives on local students and patient care

Background: International electives are often considered a valuable learning opportunity for medical students. Yet, as travelling to lower and middle income countries (LMICs) becomes more common, ethical considerations of such practices emerge. We conducted a scoping review to assess the extent to which five ethical themes were addressed in existing literature about electives, with the aim of investigating the ethical impacts of medical student electives on local resources, patients and clinicians in LMICs. Methods: We systematically searched PubMed, Global Health and Embase databases using the search terms “(ethics) AND (medical electives)”. Thematic content analysis was undertaken using a combination of deductive and inductive themes. The deductive themes included: exceeding clinical competence, use of limited local resources, respect for patients and local culture, collaboration with local community/colleagues, and one-sided benefits in partnership. In addition, we also allowed for emerging themes within the data, and conducted a narrative synthesis of the results. Results: A total of 37 papers discussed ethical issues relating to medical student international electives to LMICs. More publications were written from the medical student perspective (n = 14), than by the host-institution (n = 5), with nearly half written from third-party perspectives (n = 18). Negative impacts on local host students and impact upon patient care were identified as additional ethical considerations. Conclusions: Our review demonstrated that while there is a degree of awareness in the existing literature of the potential negative impacts of medical electives to local LMIC students’ access to medical education and patient care, continued work is needed to ensure equitable partnerships. We recommend that these ethical themes should be further explored in pre-departure elective teaching courses and post-elective debriefs to increase medical students’ awareness of the impact of their presence on host communities

Women as a driver to address gaps in the global surgical workforce

Five billion people around the world lack access to safe and affordable surgical, anaesthetic, and obstetric care. There is a link between countries in which women are underrepresented in the surgical workforce and those struggling to meet their surgical need. In this commentary article, the underrepresentation of women in low- and middle-income country’s (LMIC) surgical workforce is discussed. It is argued that the issue is self-reinforcing. On one hand, active change requires a sufficient number of female surgeons to initiate it. On the other, women can only start to penetrate the surgical workforce once they are safe, healthy, and motivated enough to do so, in turn depending on the presence of female surgeons to advocate for their female patients and empower future generations of young girls and women

A landscape analysis of the key global stakeholders working on interventions around preterm birth that improve neonatal mortality and morbidity

Background Over a decade after the landmark ‘Born too Soon’ report, preterm birth remains a leading cause of under-five mortality. Addressing its global burden is key to meeting United Nations Sustainable Development Goal 3; to end preventable deaths of newborns and children by 2030. We conducted a landscape analysis to explore the types of organisations addressing preterm birth, highlight the scope of interventions and initiatives, and identify gaps and opportunities for shared learning. Methods We combined google searches with citation searching, and opinion of experts in child health, to identify the major global stakeholders working to improve outcomes of preterm birth, with evidence of activity since 2012. We conducted a thematic analysis and narrative synthesis of key stakeholder websites to categorise their functions and priorities, and the types of interventions they were implementing. Results A total of 38 key organisations and 28 interventions were derived from the searches. Organisations were thematically grouped into knowledge sharing (n = 15), knowledge production (n = 12), funders (n = 6), legislation and advocacy (n = 15), implementer (n = 14) and network organisations (n = 11). Interventions covered a wide scope of functions including education (n = 11), research (n = 10), resources (n = 7), legislation (n = 2), and health systems (n = 2) interventions. The majority of global stakeholders were funded from and headquartered within high-income settings. Discussion There is scope for significant learning across global stakeholders, in particular to support carers in low-resource settings. Further opportunities for impact include a need for community-based initiatives and whole systems approach that address the long-term needs of preterm babies and their families, particularly in low- and middle-income countries (LMIC) settings. Greater knowledge production and funding from LMICs is needed to create contextually relevant resources and address implementation challenges

A scoping review of the post-discharge care needs of babies requiring surgery in the first year of life

Congenital anomalies are among the leading causes of under-5 mortality, predominantly impacting low- and middle-income countries (LMICs). A particularly vulnerable group are babies with congenital disorders requiring surgery in their first year. Addressing this is crucial to meet SDG-3, necessitating targeted efforts. Post-discharge, these infants have various care needs provided by caregivers, yet literature on these needs is scant. Our scoping review aimed to identify the complex care needs of babies post-surgery for critical congenital cardiac conditions and non-cardiac conditions. Employing the Joanna Briggs Institute’s methodological framework for scoping reviews we searched Pubmed, EMBASE, CINAHL, PsychINFO, and Web of Science databases. Search terms included i) specific congenital conditions (informed by the literature and surgeons in the field), ii) post-discharge care, and iii) newborns/infants. English papers published between 2002–2022 were included. Findings were summarised using a narrative synthesis. Searches yielded a total of 10,278 papers, with 40 meeting inclusion criteria. 80% of studies were conducted in High-Income Countries (HICs). Complex care needs were shared between cardiac and non-cardiac congenital conditions. Major themes identified included 1. Monitoring, 2. Feeding, and 3. Specific care needs. Sub-themes included monitoring (oxygen, weight, oral intake), additional supervision, general feeding, assistive feeding, condition-specific practices e.g., stoma care, and general care. The post-discharge period poses a challenge for caregivers of babies requiring surgery within the first year of life. This is particularly the case for caregivers in LMICs where access to surgical care is challenging and imposes a financial burden. Parents need to be prepared to manage feeding, monitoring, and specific care needs for their infants before hospital discharge and require subsequent support in the community. Despite the burden of congenital anomalies occurring in LMICs, most of the literature is HIC-based. More research of this nature is essential to guide families caring for their infants post-surgical care

Factors influencing the development, recruitment, integration, retention and career development of advanced practice providers in hospital health care teams: a scoping review

Background: Advanced practice providers (APPs), including physician assistants/associates (PAs), nurse practitioners (NPs) and other non-physician roles, have been developed largely to meet changing healthcare demand and increasing workforce shortages. First introduced in primary care in the US, APPs are prevalent in secondary care across different specialty areas in different countries around the world. In this scoping review, we aimed to summarise the factors influencing the development, recruitment, integration, retention and career development of APP roles in hospital health care teams. Methods: We conducted a scoping review and searched Ovid MEDLINE, Ovid Embase, Ovid Global Health, Ovid PsycINFO and EBSCOhost CINAHL to obtain relevant articles published between Jan 2000 and Apr 2023 that focused on workforce management of APP roles in secondary care. Articles were screened by two reviewers independently. Data from included articles were charted and coded iteratively to summarise factors influencing APP development, recruitment, integration, retention and career development across different health system structural levels (macro-, meso- and micro-level). Results: We identified and analysed 273 articles that originated mostly from high-income countries, e.g. the US (n = 115) and the UK (n = 52), and primarily focused on NP (n = 183) and PA (n = 41). At the macro-level, broader workforce supply, national/regional workforce policies such as work-hour restrictions on physicians, APP scope of practice regulations, and views of external collaborators, stakeholders and public representation of APPs influenced organisations’ decisions on developing and managing APP roles. At the meso-level, organisational and departmental characteristics, organisational planning, strategy and policy, availability of resources, local experiences and evidence as well as views and perceptions of local organisational leaders, champions and other departments influenced all stages of APP role management. Lastly at the micro-level, individual APPs’ backgrounds and characteristics, clinical team members’ perceptions, understanding and relationship with APP roles, and patient perceptions and preferences also influenced how APPs are developed, integrated and retained. Conclusions: We summarised a wide range of factors influencing APP role development and management in secondary care teams. We highlighted the importance for organisations to develop context-specific workforce solutions and strategies with long-term investment, significant resource input and transparent processes to tackle evolving healthcare challenges

The role of medical support workers during the Covid-19 pandemic in the National Health Service in the UK: a qualitative service evaluation at the Oxford University Hospitals NHS Foundation Trust

We conducted a service evaluation of the Medical Support Worker (MSW) role at Oxford University Hospitals NHS Foundation Trust following the COVID-19 pandemic. The aim was to explore the roles of MSWs, their contributions to the NHS, factors influencing their career choices, and the position's goals, to inform quality improvement in relation to their integration into the Trust. The perspectives of MSWs, their supervisors, and recruiters were analysed through nine semi-structured interviews and two focus group discussions involving 18 participants. Results were categorized into micro, meso, and macro levels of the health system. At the micro level, MSWs were recognised as a diverse group of highly qualified international medical graduates (IMGs) who played a crucial role during the pandemic. At the meso level, participants emphasized the importance of a comprehensive induction by the hospital, to clarify responsibilities and familiarize MSWs with the health system. At the macro level, the role facilitated MSWs’ integration within the NHS, with the aim of practising as doctors. The importance of comprehensive hospital induction, with role clarity for both MSWs and their teams, supportive supervision, and assistance with applying for registration with the General Medical Council, were highlighted as key quality improvement areas