Research: Foreign Research Expands Healthcare Students’ World View
Jan 01, 2019 06:43PM
● By MED Magazine
Developing countries have challenges in maintaining their healthcare systems because of a lack of education, poor healthcare access, and a deficiency in government support. Resources are critical for developing countries to create sustainable healthcare systems. Health services are difficult to sustain in developing countries but increased education, improved access to care, research and outreach along with government support can create a better environment for sustainable healthcare in the developing world. University student research investigators provide meaningful data for agencies and governments to make informed decisions. “The bulk of a college education is understanding stats from other people & organizations. The unique part about this experience is that we, the students, conducted our own research regarding material that we learn in the classroom. This research opened an entire new view on my education & has enhanced my world view” (Coss, 2018).
Health care is big business, especially in the United States. Many health care systems and conglomerates are increasingly expanding their global footprint with initiatives to develop, operate, and brand on the global stage. Health services are becoming an increasing burden all over the world mainly due to risings costs of care and the aging population (Balkrishnan, Jongwha, Patel, Fang, & Merajver, 2013). Countries are researching and finding ways to increase sustainability, however the countries that have the best resources for research do not necessarily have translatable solutions to underdeveloped nations (Balkrishnan, Jongwha, Patel, Fang, & Merajver, 2013). According to Mutchnick, Stern, and Moyer (2005), developing health systems in low income countries is a robust opportunity. New technologies allow for improved communication and increased availability to reach all areas of the world and therefore there are resources to improve healthcare services in developing countries, but there are pieces that need to be in place to ensure sustainable healthcare in developing countries. Developing countries are vulnerable and have different healthcare problems than do industrialized nations. These range from a lack of resources, poverty, poor infrastructure, and illiteracy (Manzoor & Ali, 2018). Healthcare in developing countries is typically poor quality, expensive, and undersupplied (Fossati, 2017). Research and resources for improving sustainability in developing countries need to be developed but there needs to be sufficient support for this to occur (Balkrishnan, Jongwha, Patel, Fang, & Merajver, 2013).
Health services are difficult to sustain in developing countries but increased education, improved access to care, research and outreach along with government support can create a better environment for sustainable healthcare in the developing world. University researchers and student investigators
Review of Literature
Awareness and Education
An essential piece to sustainable healthcare in developing countries is basic education and awareness. According to Portman & Martin (2015), people in the poorest nations do not always have access to proper healthcare services, supplies, or knowledge. Lack of access to information is one area which prevents developing countries from becoming healthier (Schirnding & Mulholldand, 2002). There are basic health and safety measures such as washing hands after going to the bathroom and using nets to sleep under during the rainy season that help prevent the spread of infection and disease that may not be well known throughout the developing world. Improving sanitation and decreasing exposure to hazardous items could be accomplished by cultivating healthcare education in the developing world (Portman & Martin, 2015). Students that are engaged in outreach through research during short term study abroad are given the opportunity to experience problems that require critical thinking and idea development (South-Winter, 2018).
These skills develop into transferable “hands-on” attributes that benefit health care professional careers. Students not only survey regarding health care needs but also teach the importance of handwashing and dental hygiene as well as blood sugar and blood pressure checks. One student on their second comparative health care research -based short-term study abroad commented, “the research we conducted opened my eyes to the health care system. This was my favorite short-term study abroad because the community was very passionate about improvements. The island outreach was very beneficial even though we did not survey there. They were thankful for education” (Orton, 2018).
A prevalent example of education leading to sustainable healthcare is the correlation between gastrointestinal issues and lack of education. For example, gastrointestinal nematodes are parasites that cause gastrointestinal infection, disturb 50% of the world’s population, and contribute worldwide to a large amount of morbidity and mortality (Stepek, Buttle, Duce, & Behnke, 2006). Almost all gastrointestinal nematodes can be eliminated with proper education, hygiene, and sanitation, because humans are the only host for all but one species of gastrointestinal nematodes (Stepek, Buttle, Duce, & Behnke, 2006). Therefore, these parasites can be eliminated with education.
A study in Accra, Ghana shows that parents with more education are less likely to have children with intestinal parasitic infection. In addition, children from large families with parents without knowledge of intestinal parasitic infection prevention and treatment are more likely to have intestinal parasitic infection (Forson, Arthur, & Ayeh-Kumi, 2018). Engaging students in research is not only beneficial to the student’s world view but also to shine a lens on those surveyed. Student reflections such as “I noticed immediately how impoverished the community was, and in poor sanitary conditions I knew it was important that we gather the necessary data to possibly bring these individuals health care”, demonstrate that the experience is life-changing for both communities served as well as the student (Beck, 2018).
Access to Care
According to Schirnding & Mulholldand (2002), many deaths in developing countries can be avoided by improving access to primary care. Primary healthcare is the first point of contact for patients and healthcare workers and it is the most accessible, comprehensive, and continuous healthcare that a patient will have (Davy, Bleasel, Hueiming, Tchan, Ponniah, & Brown, 2015). Portman & Martin (2015), state that to in order to improve the health of the populations of developing countries, increasing access to healthcare needs to be the top priority. Student investigators are tasked by Sanford World Clinics to find out how long are patients willing to wait in line (queue) for health care. Students found out some will wait three days, “visiting with people who live in shanty towns & have no money but have a strong desire & passion for healthcare, even though they had to walk 2 hours to a clinic & wait for care, in some cases for multiple days made me realize that material possessions don’t determine happiness and fulfillment” (Coss, 2018).
This is accomplished by improving supplies and facilities, increasing the healthcare workforce, and educating the population to demand better healthcare (Portman & Martin, 2015). Supply chain management offers a unique set of challenges, “logistics planning requires identifying how resources will be procured in a developing country, including the transportation and storage of everything from medicine and bandages to office supplies and light bulbs” (South-Winter & Tihrart, 2018 p. ). Careful supply chain management is essential, requiring managerial skill throughout the process.
Another important consideration to improving access is making sure there are enough healthcare workers throughout the country. According to Portman and Martin (2015), there is a strong correlation between a deficiency of healthcare workers and lower healthcare quality. It is very common in developing countries to have “Short Term Medical Brigades” (p. 91), in which people from outside countries provide medical services to those in developing countries (Portman & Martin, 2015). These brigades are well-intended but do not fix the healthcare system and can create problems with continuity, finances, and cultural barriers (Portman & Martin, 2015). Programs or missions that build and provide service are not sustainable; when the program is finished the community is left with lack of healthcare delivery, poor healthcare access, shortage of education, and deficiency in the healthcare workforce. To ensure that healthcare is sustainable in a developing country, it is important to implement local capacity building to ensure that providers come from the areas they will be serving (Vincent, Pearce, Leasher, Mladenovich, & Patel, 2007).
Success has been experienced through “growing your own” by training organic health care workers in the culture in your mission and values and investing in the workforce. This can best ensure cultural understanding by hiring indigenous professionals who will have spent significant time within your organization, as close as possible to where you make initiative-related decisions (South-Winter & Tihart, 2018). That experience bridges both worlds in ways that are difficult to match with other arrangements to increase the sustainability success chances. One student reflection sees their sustainable impact first-hand the “clinic at Cape Coast has a way in which we can not only see how past research is working and how they are implementing results of past research but also future research to improve the over all healthcare in their community” (Miller, 2018).
Finally, another important way to improve access and sustainability is to increase access to health informatics systems (Balkrishnan, Jongwha, Patel, Fang, & Merajver, 2013). According to Haghi (2017), health information systems can fix and improve healthcare economic constraints, poor healthcare infrastructure, geographic barriers, and shortage in resources in developing countries. For example, financial burdens can be decreased if people did not have to travel great distances for healthcare by accessing telehealth services (Haghi, 2017). Healthcare could also be more efficient with health information systems because these records are more easily accessible and portable compared to the paper systems present in developing countries. Health informatics systems make health systems more efficient and can track the health of the population. The most attractive development is the potential of smartphones to improve healthcare outcomes (Kahn, Yang, & Kahn, 2010). Telemedicine is not new but it has been cost prohibitive because of hardware infrastructure needs; today the technology available through cellular towers and smart phones make this a contributing factor to sustainability (South-Winter & Tiahrt, 2018). Many developing nations simply skipped ethernet and telephone wires due to infrastructure and resource challenges and jumped into the electronic technology with cell phones and now smart phones. Monitoring the effectiveness of telemedicine in the areas of cost, access and quality can be surveyed using student investigators. One student researcher said “allowing students to be a part of the research process within the Sanford World Clinics is an amazing way to experience first-hand just how important the work they are doing is. It was a major learning experience for me to see the real-life differences in each clinic’s health care facility and their services. As a student who plans on entering the health care field, the opportunity to conduct research in a developing nation has increased my passion and overall desire to help communities, such as the ones we visited, gain quality health care” (Vandry, 2018).
Another important piece to a sustainable health system in developing countries is a strong government backing. Many believe that universal healthcare is the best way to improve morbidity and mortality around the world, but universal healthcare cannot be implemented in countries that do not have the proper infrastructure as well as strong government backing (Fossati, 2017). Fossati explains that developing countries have difficulty coordinating universal healthcare because the governments are not organized enough and do not have enough money to time policies properly, therefore healthcare policies in developing countries often fall short (2017). Ghana is a prime example where the National Health Insurance Scheme (NHIS) which is established in 2003 as a result of an unsteady history of healthcare access in Ghana. However, NHIS use in Ghana is declining, somewhat due to operational issues that are likely to be present in other underdeveloped countries as well (Dietrich-O’Connor, 2010).
According to Mutchnick, Stern, and Moyer (2005), health systems in developing countries are being challenged because of a lack of regulation and enforcement from governments. The United Nations has established Millennium Development Goals to improve global health and make global healthcare more sustainable (Portman & Martin, 2015). The Millennium Development Goals aim to address health concerns but the goals cannot be met without improving national infrastructure in addition to national healthcare (Portman & Martin, 2015). These goals focus on roads, agriculture, education, power, and environment in addition to healthcare and therefore need the backing of a strong government (Portman & Martin, 2015).
According to Portman & Martin (2015), the most effective health initiatives provide free services that create equal access; this increases access to primary care which is of highest need in developing countries. For these free services to occur, the government of the country needs to be able to support this sort of service. In addition, roads, bridges, and medical centers are key to improving healthcare services and these items are usually made better though government support (Portman & Martin, 2015). Governments also need to allocate resources to helping their healthcare systems grow and change with the rest of the medical world (Vincent, Pearce, Leasher, Mladenovich, & Patel, 2007). According to Mutchnick, Stern, and Moyer (2005), various projects, such as Sanford World Clinics, POET biofuels, the Bill and Melinda Gates Foundation and the Human Genome Project, in developing countries are demonstrating the vast problem-solving capacity in developing nations. Successful countries are able to do a lot with little money compared to their population density with a strong central and supportive government is needed to sustain healthcare independently (Mutchnick, Stern, and Moyer, 2005).
Improving healthcare education, increasing healthcare access and improving government support in developing countries are essential pieces to making healthcare more sustainable in the developing world. Health education enhancement will improve the health of those in the developing world and increase access to care by increasing the number of providers, expanding healthcare facilities, and increasing the use of health information systems to generate a sustainable healthcare system. Health education and healthcare access cannot be dramatically with sustained improvement, however, without proper government support. “Student research benefits both the students & the company they are doing research for. In Jamestown, we were able to dive into the Ghanaian culture and experience it first-hand. I had the pleasure of playing a game of chess with one of the locals, he destroyed me but that’s not the point. I was brought into their culture with a simple game. Without research, I would’ve never been given that opportunity. Research gives students the ability to learn about more than just statistical evidence, they learn about life” (Rudenik, 2018).
Balkrishnan, R., Jongwha, C., Patel, I., Fang, Y., & Merajver, S. D. (2013). Global comparative healthcare effectiveness research: Evaluating sustainable programmes in low & middle resource settings. Indian Journal of Medical Research, 137(3), 494-501.
Davy, C., Bleasel, J., Hueiming, L., Tchan, M., Ponniah, S., & Brown, A. (2015). Factors influencing the implementation of chronic care models: A systematic literature review. BMC Family Practice, 16(1), 1-12. doi:10.1186/s12875-015-0319-5
Dietrich-O’Connor, F. (2010). An Evaluation of the National Health Insurance Scheme in Ghana. Retrieved from http://www.academia.edu/1873350/An_Evaluation_of_the_National_Health_Insurance_Scheme_in_Ghana
Forson, A. O., Arthur, I., & Ayeh-Kumi, P. F. (2018). The role of family size, employment and education of parents in the prevalence of intestinal parasitic infections in school children in Accra. Plos ONE, 13(2), 1-10. doi:10.1371/journal.pone.0192303
Fossati, D. (2017). From Periphery to Centre: Local Government and the Emergence of Universal Healthcare in Indonesia. Contemporary Southeast Asia: A Journal Of International & Strategic Affairs, 39(1), 178-203. doi:10.1355/cs39-1f
Haghi, M. (2017). The neglected value of health information technologies in universal health coverage in developing countries. Technology & Health Care, 25(1), 167-169. doi:10.3233/THC-161291
Jeet, G., Thakur, J. S., Prinja, S., & Singh, M. (2017). Community health workers for non-communicable diseases prevention and control in developing countries: Evidence and implications. Plos ONE, 12(7), 1-21. doi:10.1371/journal.pone.0180640
Manzoor, S., & Ali, M. (2018). Disaster and mental health: A need for multipronged approach. Indian Journal of Health & Wellbeing, 9(3), 483-488.
Mutchnick, I. S., Stern, D. T., & Moyer, C. A. (2005). Trading Health Services Across Borders: GATS, Markets, And Caveats. Health Affairs, 2442-51. doi:10.1377/hlthaff.W5.42
Portman, M. T., & Martin, E. J. (2015). MEDICAL BRIGADES, GLOBAL HEALTH AND THE UNITED NATIONS: MILLENNIUM DEVELOPMENT GOALS AND DEVELOPING NATIONS. Journal of Health & Human Services Administration, 38(1), 90-107.
Schirnding, Y., Mulholldand, C. (2002). Health and Sustainable Development: Key Health Trends. Retrieved from http://www.who.int/mediacentre/events/HSD_Plaq_02.2_Gb_def1.pdf
Stepek, G., Buttle, D. J., Duce, I. R., & Behnke, J. M. (2006). Human gastrointestinal nematode infections: are new control methods required. International Journal of Experimental Pathology, 87(5), 325-341. doi:10.1111/j.1365-2613.2006.00495.x
Vincent, J. E., Pearce, M. G., Leasher, J., Mladenovich, D., & Patel, N. (2007). The rationale for shifting from a voluntary clinical approach to a public health approach in addressing refractive errors. Clinical & Experimental Optometry, 90(6), 429-433. doi:10.1111/j.1444-0938.2007.00193.x