Trent Fleming School of Nursing, Trent University, 1600 West Bank Dr, Peterborough, ON, K9L 0G2, Canada.
Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
Global Health. 2022 Feb 19;18(1):19. doi: 10.1186/s12992-022-00815-7.
In the past decade, there has been increasing guideline development for short-term medical missions (STMMs) traveling from high-income to low- and middle-income countries for the purpose of supporting health care services. The ethics of STMMs is criticized in the literature and there is frequently a lack of host country collaboration. This typically results in guidelines which are developed through the lens of the sending (high-income) countries' staff and organizations. The aim of this paper is to evaluate an existing best practice guideline document from the perspective of host country participants with knowledge of STMMs from Honduras, Malawi, and the Philippines.
The guideline used for the evaluation consisted of nine best practice elements that were discerned based on literature and the experience of those working within the field. Semi-structured interviews were conducted in a cross-sectional study with participants (n = 118) from the host countries. Thematic analysis was conducted by two researchers and the results were assessed by working group members to confirm interpretations of the data.
Overall, participants expressed a strong interest in having more structured guidance surrounding STMM practices. There was a positive response to and general acceptance of the proposed STMM guidelines, although participants found the 24-page document onerous to use; a companion checklist was developed. The key themes that emerged from the interviews included collaboration and coordination, care for hard-to-reach communities, capacity building, critical products and essential medical supplies, and opportunity and feasibility.
Host input suggests that the guidelines provide structured regulation and coordination of the medical mission process and have the potential to improve the way STMMs are carried out. The guidelines have also proven to be a useful tool for the actual implementation of STMMs and can be a tool to strengthen links and trust between mission teams and local health staff. However, local contexts vary considerably, and guidelines must be adapted for local use. It is recommended that STMM teams work in conjunction with host partners to ensure they meet local needs, increase capacity development of local health workers, and provide continuity of care for patients into the local system.
在过去十年中，越来越多的短期医学使命（STMM）从高收入国家前往中低收入国家，目的是支持医疗服务，相关指导方针也在不断发展。STMM 的伦理道德在文献中受到批评，而且往往缺乏东道国的合作。这通常导致指导方针是通过派遣（高收入）国家的工作人员和组织的视角制定的。本文的目的是从洪都拉斯、马拉维和菲律宾有 STMM 经验的东道国参与者的角度评估现有的最佳实践指导方针文件。
用于评估的指南由基于文献和该领域工作人员经验的九个最佳实践要素组成。采用横断面研究对来自东道国的参与者（n=118）进行半结构式访谈。两位研究人员进行主题分析，工作组成员评估分析结果以确认对数据的解释。
总体而言，参与者对更具结构性的 STMM 实践指导表现出浓厚兴趣。参与者对拟议的 STMM 指南表示积极响应和普遍接受，尽管他们认为 24 页的文件过于繁琐；随后制定了一份配套检查表。访谈中出现的主要主题包括合作与协调、为难以到达的社区提供服务、能力建设、关键产品和基本医疗用品，以及机会和可行性。
东道国的意见表明，该指南为医疗使命过程提供了结构化的监管和协调，并有潜力改善 STMM 的实施方式。该指南也已被证明是实施 STMM 的有用工具，可以加强使命团队与当地卫生人员之间的联系和信任。然而，当地情况差异很大，因此必须根据当地情况调整指南。建议 STMM 团队与东道国合作伙伴合作，确保满足当地需求，加强当地卫生工作者的能力发展，并为患者提供进入当地系统的持续护理。
