E. Cunningham

F. May

F. Mullan

J. Anathan

J. Scott

K. Mitha

L. Foradori

P. Daoust

S. Sayeed

V.B. Kerry

Annals of Global Health

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34 Edu c a t i o n/T r a i n i n g /Capa c i t y Bu i l d i n gRural rotation of medical students: Move towardsreducing health care disparities in TanzaniaG.E. Kapanda1, C. Muiruri2, A. Kulanga1, C.N. Tarimo3, E. Lisasi4,L. Mimano1, J. Bartlett2; 1Kilimanjaro Christian Medical Centre-MEPI,Durham, NC/US, 2Duke University, Durham, NC/US, 3KilimanjaroChristian Medical University College (KCMUCo)-MEPI, Durham, NC/US, 4Kilimanjaro Christian Medical Centre (KCMC)-MEPI, Durham,NC/USProgram/Project Purpose: Maldistribution of health care workersis a global health challenge that exacerbates health disparities espe-cially in resource-limited settings. Interventions to assuage the prob-lem have targeted qualified personnel with little focus on medicalstudents. However, studies have demonstrated that rural rotationspositively influence students to practice in rural settings upon grad-uation. Within this context, the Kilimanjaro Christian MedicalUniversity College introduced a 13-week clerkship rotation in ruralhospitals for third-year medical (MD3) students in 2012. To assessstudents’ perceptions, and attitudes toward rural practice after grad-uation, we surveyed them after their rural rotation.Structure/Method/Design: Anonymous questionnaires wereadministered to MD 3 students in April 2014. The questionsassessed perceptions of the experience, and attitudes towards ruralpractice upon graduation. The perceptions were assessed usingstrength of consensus measures (sCns). The effect of the experienceon likelihood for rural practice was assessed using Crude Odds Ratio(COR) at 95% Confidence Interval (CI), and 5% level of significance.Binary logistic regression analysis was used to determine predictorsaccepting rural practice after graduation with Adjusted Odds Ratio(AOR) at 95% CI, and variation assessed with Nagelkerke R2.Outcomes & Evaluation: One hundred and eleven MD3 studentsparticipated; 62% male; 62% < 25 years; and 72% direct from sec-ondary school students. Overall, 81% MD3 students were satisfiedwith rural rotations,(sCns¼ 83%). Likelihood of accepting to bedeployed in rural practice after graduation was predicted by beingsatisfied with the rural rotation program (AOR, 4.32; 95% CI, 1.44-12.96; p, 0.009) and being male (AOR, 2.73; 95% CI, 1.09-6.84; p,0.032). Also, being an in-service student increased the likelihood ofaccepting rural practice after graduation by 300% compared toenrolment direct from school, although the difference was not sig-nificant (AOR, 4.99; 95% CI, 0.88-28.41; p, 0.070). 29% of variationwas explained these variables (Nagelkerke R2, 0.289). However, stu-dents who joined school after health-related practice were almost 3Xmore likely to be satisfied than students direct from school, with nosignificant difference (COR, 2.6; 95% CI, 0.7-9.4; p, 0.310). Like-wise, in-service students were more 2X more likely to be satisfied thandirect from school students with insignificant difference (COR, 2.4;95% CI, 0.9-6.4; p, 0.073). No significant difference was exhibitedfor students born in rural or urban areas.Going Forward: The rural rotation program increased the likelihoodof rural practice after graduation. More effort should be undertaken tofurther improve the program to increase student satisfaction with ruralrotations, and hence likelihood for rural practice after graduation.Funding: HRSAAbstract #: 01ETC048Equitable access to global health internships: A pilotprogramme at the World Health OrganizationHeadquarters (WHO-HQ)T. Kedia1, J.D. Jarvis2, K. Ragins3, A. Barnett-Vanes4; 1Geisel School ofMedicine at Dartmouth, Hanover, NH/US, 2Young ProfessionalsChronic Disease Network, Boston, MA/US, 3Yale University, Torrance,CA/US, 4Imperial College London, Londo, UKProgram/Project Purpose: The World Health OrganizationHeadquarters (WHO-HQ) office in Geneva, Switzerland, runs acompetitive unpaid internship programme accepting over 400 internsper year, that can help launch careers in global health. However,access to these internships is not equitable. The vast majority of in-terns come from countries with a Very High Human DevelopmentIndex - 72% of interns in 2011 and 80% in 2013. The high cost ofliving in Geneva and lack of salary are likely among the factors pre-venting those from low- and middle-income countries (LMICs) fromcompleting internships at WHO-HQ. This inequitable representationsquanders a valuable opportunity to build human resources for healthin LMICs through experiential education. The Network of WHOIntern Alumni (NWIA), an organization of former WHO interns, ispiloting a programme to promote equitable access to WHO-HQ in-ternships by financially supporting interns from LMICs and advo-cating within the wider international community.Structure/Method/Design: The NWIA is collaborating with theWHO Intern Board, an organization of current WHO-HQ interns,to develop this initiative. In the pilot phase in summer 2015, theNWIA aims to support 3 interns from LMICs, with the aim ofexpanding to support 15 interns per year. Funds for the pilot will beraised through online crowd-sourced platforms and publicizedamongst former WHO interns. This initiative benefits from interac-tion with stakeholders at WHO-HQ, the support of the UK-basedRoyal Society for the Arts, and advisors affiliated with WHO andother global health agencies. Our objective is to advocate for all majorglobal health agencies to provide more equal training opportunitiesfor students from LMICs as part of their mandates for health systemsstrengthening through capacity building.Outcomes & Evaluation: The pilot programme will be evaluatedqualitatively and quantitatively. Supported interns will write an essayfollowing their internship to dicuss the impact of their experience.Additionally, they will be required to share their learnings from theirinternship upon return to their home country. Finally, the de-mographics of current WHO-HQ interns will be surveyed annually.Such surveys have been conducted in 2011 and 2013 in partnershipwith the WHO Intern Board.Going Forward: This initiative’s success is highly dependent upon thefunds that can be raised for the pilot programme. An additional chal-lenge is maintaining communication with current WHO-HQ interns,as the pool of interns is in constant turnover. To ensure long-termsuccess, the NWIA is seeking support from additional partners whomay play a longitudinal role in the initiative. We hope to build strongerrelationships with organizations with similar aims to our own and withglobal health agencies, to raise awareness of equitable internship accessas a critical method of investing in human resources for health inLMICs.Funding: None.Abstract #: 01ETC049Evaluating the global health service partnership: Yearone and future directionsV.B. Kerry1, P. Daoust1, F. May2, E. Cunningham1, F. Mullan3,J. Scott4, J. Anathan1, K. Mitha1, L. Foradori5, S. Sayeed6; 1Seed GlobalHealth, Boston, MA/US, 2Department of Medicine, David Geffen Schoolof Medicine at UCLA, Los Angeles USA, Los Angeles, CA/US, 3TheGeorge Washington University School of Public Health and The GeorgeWashington University School of Medicine, Washington, DC/US,Anna l s o f G l o b a l He a l t h 354Department of Emergency Medicine, The George Washington UniversitySchool of Medicine and Health Sciences, Washington, DC/US, 5PeaceCorps, Washington, DC/US, 6Seed Global Health and Harvard MedicalSchool, Boston, MA/USProgram/Project Purpose: There is a critical shortage of health-care professionals in 57 countries around the globe. To address thisshortage, the Peace Corps, the President’s Emergency Plan forAIDS Relief (PEPFAR), and Seed Global Health launched theGlobal Health Service Partnership (GHSP), an innovative public-private partnership to place nurses and physicians as faculty inmedical or nursing schools in resource-limited countries. In itsinaugural year, GHSP sent 30 US doctors, nurses and midwives toserve for one year as faculty in training schools in Uganda,Tanzania and Malawi.Structure/Method/Design: GHSP instituted a comprehensivemonitoring, reporting and evaluation plan to understand outcomesand assess early impact. The primary quantitative tool was a quarterlyvolunteer reporting form, collecting data on volunteer activities,hours, number of trainees and deliverables. Qualitative data wascollected at the end of year one through 68 interviews (individual andsmall group) with 110 stakeholders, including Volunteers, institu-tional leadership, faculty, and students. Ongoing process evaluationwas conducted through post-event feedback surveys and analysis ofthe volunteer and site application database.Outcomes & Evaluation: One hundred and seventy applicationswere received for the first GHSP cohort: 70 physicians and 100 nurses.Physician applicants were largely divided between early and late careerwhile most nurse applicants were mid to late career. Eleven Africaninstitutions requested volunteers. The most common physician spe-cialties requested were internal medicine, OB/GYN and pediatrics; themost common nursing specialties requested were medicine/surgery,intensive care, and midwifery. In July 2013, 30 Volunteers were placedat the 11 institutions. Volunteers taught 85 courses/workshops to over2,800 trainees, including faculty, staff, postgraduates, and students, withover 35,000 activity-hours during a one-year period. Volunteers intro-duced new educational methods, procured new resources, andmodeledprofessional behavior for faculty and students. The most cited impact ofGHSP was on students’ education through the provision of high qualityclinical supervision and increased student confidence after workingwith volunteers. The most cited challenges for volunteers includedunfamiliarity with clinical decision-making in a resource-poor settingand difficulty framing lectures.Going Forward: Early outcomes indicate GHSP had an initial posi-tive impact on training at its partner sites. Next steps for the evaluationof GHSP include further development of standardized tools to evaluateimpact and processes on five different levels, including: 1) country-levelstatus of human resources for health and the impact of GHSP,particularly related to recruitment, retention, and migration; 2) insti-tutional impact and experience with GHSP; 3) student and facultyimpact and experience; 4) volume, scope and quality of volunteerteaching and capacity building activities; and 5) management and op-erations of GHSP.Funding: PEPFAR, Covidien, Draper Richards Kaplan Foundation,Exxon Mobil Foundation, the Engelhard Foundation, FedEx Foun-dation, GE Foundation, and Pfizer Foundation.Abstract #: 01ETC050

Evaluating the global health service partnership: Year one and future directions

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Evaluating the global health service partnership: Year one and future directions

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