Nwadiuko Joseph, James Keyonie, Switzer Galen E, Stern Jamie
Johns Hopkins School of Medicine, 4640 Eastern Avenue, Baltimore, MD, 21202, USA.
Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15213, USA.
Global Health. 2016 Jun 14;12(1):33. doi: 10.1186/s12992-016-0165-9.
There is increased interest in the capacity of US immigrants to contribute to their homelands via entrepreneurship and philanthropy. However, there has been little research examining how immigrant physicians may support health systems and what factors facilitate or raise barriers to increased support.
This study used an observational design with paper questionnaire and interview components. Our sample was drawn from attendees of a 2011 conference for US Based Nigerian physicians; respondents who were not US residents, physicians, and of Nigerian birth or parentage were excluded from further analysis. Respondents were randomly selected to complete a follow-up interview with separate scripts for those having made past financial contributions or medical service trips to support Nigerian healthcare (Group A) and those who had done neither (Group B). Survey results were analyzed using Fischer exact tests and interviews were coded in pairs using thematic content analysis.
Seventy-five of 156 (48 %) individuals who attended the conference met inclusion criteria and completed the survey, and 13 follow-up interviews were completed. In surveys, 65 % percent of respondents indicated a donation to an agency providing healthcare in Nigeria the previous year, 57 % indicated having gone on medical service trips in the prior 10 years and 45 % indicated it was "very likely" or "likely" that they would return to Nigeria to practice medicine. In interviews, respondents tended to favor gifts in kind and financial gifts as modes of contribution, with medical education facilities as the most popular target. Personal connections, often forged in medical school, tended to facilitate contributions. Individuals desiring to return permanently focused on their potential impact and worried about health system under-preparedness; those not desiring permanent return centered on how safety, financial security and health systems issues presented barriers.
This study demonstrates several mechanisms by which health systems may benefit from expatriate engagement. Greater identification of reliable local partners for diaspora, deeper collaboration with those partners and a focus on sustainable interventions might improve the quantity and impact of contributions. Ethnic medical associations have a unique role in organizing and facilitating diaspora response. Public-private partnerships may help diaspora negotiate the challenges of repatriation.
美国移民通过创业和慈善为其祖国做出贡献的能力越来越受到关注。然而，很少有研究探讨移民医生如何支持卫生系统，以及哪些因素促进或阻碍了更多的支持。
本研究采用了包含纸质问卷和访谈部分的观察性设计。我们的样本来自2011年美国尼日利亚医生会议的参会者；非美国居民、非医生以及非尼日利亚出生或祖籍的受访者被排除在进一步分析之外。受访者被随机挑选进行后续访谈，针对过去曾进行过经济捐助或医疗服务旅行以支持尼日利亚医疗保健的受访者（A组）和未曾进行过此类活动的受访者（B组）使用不同的访谈脚本。调查结果采用费舍尔精确检验进行分析，访谈采用主题内容分析成对编码。
156名参会者中有75人（48%）符合纳入标准并完成了调查，13次后续访谈也已完成。在调查中，65%的受访者表示前一年向尼日利亚提供医疗保健的机构进行了捐赠，57%的受访者表示在过去10年中进行过医疗服务旅行，45%的受访者表示“非常可能”或“有可能”返回尼日利亚行医。在访谈中，受访者倾向于实物捐赠和资金捐赠作为贡献方式，医疗教育设施是最受欢迎的捐赠对象。通常在医学院建立的个人关系往往有助于做出贡献。希望永久回国的个人关注其潜在影响，并担心卫生系统准备不足；不希望永久回国的人则关注安全、财务安全和卫生系统问题如何构成障碍。
本研究展示了卫生系统可能从侨民参与中受益的几种机制。更好地识别可靠的侨民当地合作伙伴、与这些合作伙伴进行更深入的合作以及关注可持续干预措施，可能会提高贡献的数量和影响。种族医学协会在组织和促进侨民回应方面具有独特作用。公私伙伴关系可能有助于侨民应对回国的挑战。
