Adaptation of the CUGH global health competency framework in the Chinese context: a mixed-methods study

BACKGROUND

In 2014, the Consortium of Universities for Global Health (CUGH) developed a global health competency framework and called for its validation. Given China's increasing engagement in global health over the past decade, there is a need for a tailored competency framework to enhance the capacity of its workforce. This study aimed to localize the CUGH global health framework within the Chinese context, offering guidance to public health professionals in China to bolster their capabilities for international endeavors.

METHODS

Employing a modified Delphi consultation approach, this study adapted the CUGH global health competency framework through three consultation rounds and a panel discussion. A questionnaire employing a five-point Likert scale was developed to gather opinions from 37 experts on the significance and feasibility of each competency within the Chinese setting. Profiling information, judgment criteria, and familiarity with each competency were collected to assess experts' authority levels. Furthermore, a priority survey was administered to 51 experts to identify key competencies and provide recommendations for bolstering the capabilities of China's public health professionals. Data analysis was performed using Microsoft Excel.

RESULTS

The adapted framework comprises 10 domains and 37 competencies including: 1. Global Burden of Disease; 2. Social-economic, Environmental and Behavioral Determinants of Health; 3. The Impact of Globalization on Population Health, Health Systems, and Healthcare; 4. Major Global health initiatives and efforts; 5. Ethics, Health Equity and Social Justice; 6. Sociocultural, Political Awareness and Policy Promotion; 7. Personal Competencies and Professional Practice; 8. Capacity strengthening; 9. Collaboration, Partnering and Communication; 10. Programme Management. The priority survey underscored Domain 9, 10, and 4 as the foremost concern for Chinese public health professionals, urging active learning, critical thinking, open communication, experiential learning, and case-based studies. Institutions were advised to enhance their capacity, foster partnerships, and discern China's distinct role in the global health arena.

CONCLUSIONS

This study adapted the CUGH framework within the Chinese context, evaluating the significance and feasibility of each competency. The adapted framework can serve as a tool for developing global health curricula and delineating roles for Chinese public health professionals. To ensure contextual compatibility, testing of the framework with diverse public health professionals is recommended, enabling precise refinement of competencies based on empirical results.

Perspective of asylum-seeking caregivers on the quality of care provided by a Swiss paediatric hospital: a qualitative study

OBJECTIVES

This study investigated the perspective of asylum-seeking caregivers on the quality of healthcare delivered to their children in a qualitative in-depth interview study. The health of asylum-seeking children is of key interest for healthcare providers, yet knowledge of the perspective of asylum-seeking caregivers when accessing healthcare is limited.

SETTING

The study took place in a paediatric tertiary care hospital in Basel, Switzerland.

PARTICIPANTS

Interviews were done with 13 asylum-seeking caregivers who had presented with their children at the paediatric tertiary care hospital. Nine female and four male caregivers from Tibet, Eritrea, Afghanistan, Syria, Iraq, Albania and Macedonia were included. A diverse sample was chosen regarding cultural and social background, years of residence in Switzerland and reasons for seeking care. A previously developed and pilot-tested interview guide was used for semistructured in-depth interviews between 36 and 92 min in duration. Data analysis and reporting was done according to Consolidated Criteria for Reporting Qualitative Research. The number of interviews was determined by saturation of data.

RESULTS

The interviewees described a mismatch of personal competencies and external challenges. Communication barriers and unfamiliarity with new health concepts were reported as challenges. These were aggravated by isolation and concerns about their child's health. The following factors were reported to strongly contribute to satisfaction of healthcare delivery: a respectful and trusting caregiver-provider relationship, the presence of interpreters and immediate availability of treatment.

CONCLUSIONS

A mismatch of personal competencies and external challenges importantly influences the caregiver-provider relationship. To overcome this mismatch establishment of confidence was identified as a key factor. This can be achieved by availability of interpreter services, sufficient consultation time and transcultural trainings for healthcare workers. Coordination between the family, the government's asylum system and the medical system is required to facilitate this process.

A systematic literature review of reported challenges in health care delivery to migrants and refugees in high-income countries - the 3C model

BACKGROUND

Migrants and refugees have important health needs and face inequalities in their health status. Health care delivery to this patient group has become a challenging public health focus in high income countries. This paper summarizes current knowledge on health care delivery to migrants and refugees in high-income countries from multiple perspectives.

METHODS

We performed a systematic literature review including primary source qualitative and quantitative studies between 2000 and 2017. Articles were excluded if the study setting was in low- or middle-income countries or focused on skilled migration. Quality assessment was done for qualitative and quantitative studies separately. Predefined variables were extracted in a standardized form. Authors were approached to provide missing information.

RESULTS

Of 185 identified articles, 35 were included in the final analysis. We identified three main topics of challenges in health care delivery: communication, continuity of care and confidence. All but one study included at least one of the three main topics and in 21/35 (60%) all three topics were mentioned. We further developed the 3C model and elaborated the interrelatedness of the three topics. Additional topics identified showed that the specific regional context with legal, financial, geographical and cultural aspects is important and further influences the 3C model.

CONCLUSIONS

The 3C model gives a simple and comprehensive, patient-centered summary of key challenges in health care delivery for refugees and migrants. This concept is relevant to support clinicians in their day to day practice and in guiding stakeholders in priority setting for refugee and migrant health policies.

Addressing fragility through community-based health programmes: insights from two qualitative case study evaluations in South Sudan and Haiti

BACKGROUND

Fragility can have a negative effect on health systems and people's health, and poses considerable challenges for actors implementing health programmes. However, how such programmes, in turn, affect the overall fragility of a context is rarely considered. The Swiss Red Cross has been active in South Sudan and Haiti since 2008 and 2011, respectively, and commissioned a scoping study to shed new light on this issue within the frame of a learning process launched in 2015.

METHODS

The study consisted of a document review, qualitative field research undertaken between June and August 2015 in South Sudan and Haiti, and two data triangulation/validation workshops. Semi-structured key informant interviews and focus group discussions included 49 purposively sampled participants who helped build a deeper understanding of what constitutes and drives fragility in the respective countries. Moreover, interviews and focus group discussions served to grasp positive and negative effects that the Swiss Red Cross's activities may have had on the overall state of fragility in the given contexts.

RESULTS

Qualitative data from the two case studies suggest that the community-based health programmes implemented in South Sudan and Haiti may have influenced certain drivers of fragility. While impacts cannot be measured or quantified in the absence of a baseline (the projects were not originally designed to mitigate overall fragility), the study nevertheless reveals entry points for designing programmes that are responsive to the overall fragility context and contain more specific elements for navigating a more sustainable pathway out of fragility. There are, however, multiple challenges, especially considering the complexity of fragile and conflict-affected contexts where a multitude of local and international actors with different goals and strategies interfere in a rapidly changing setting.

CONCLUSIONS

Health programmes may not only reach their health objectives but might potentially also contribute towards mitigating overall fragility. However, considerable hurdles remain for aid agencies, especially where scope for action is limited for a single actor and where engagement with state structures is difficult. Thus, cooperation and exchange with other aid and development actors across the spectrum has to be strengthened to increase the coherence of aid policies and interventions of actors both within and across the different aid communities.

Quality assurance in transnational higher education: a case study of the tropEd network

INTRODUCTION

Transnational or cross-border higher education has rapidly expanded since the 1980s. Together with that expansion issues on quality assurance came to the forefront. This article aims to identify key issues regarding quality assurance of transnational higher education and discusses the quality assurance of the tropEd Network for International Health in Higher Education in relation to these key issues.

METHODS

Literature review and review of documents.

RESULTS

From the literature the following key issues regarding transnational quality assurance were identified and explored: comparability of quality assurance frameworks, true collaboration versus erosion of national education sovereignty, accreditation agencies and transparency. The tropEd network developed a transnational quality assurance framework for the network. The network accredits modules through a rigorous process which has been accepted by major stakeholders. This process was a participatory learning process and at the same time the process worked positive for the relations between the institutions.

DISCUSSION

The development of the quality assurance framework and the process provides a potential example for others.

Fifteen years of the tropEd Masters in International Health programme: what has it delivered? Results of an alumni survey of masters students in international health

OBJECTIVES

In 2010-2011, recent graduates (2008 or earlier) of the Masters in International Health (MIH) (as offered by over 30 universities and institutions collaborating in the tropEd network) were surveyed. We aimed to examine whether the competencies gained proved appropriate for alumni's current positions and to develop the programme according to alumni's needs.

METHODS

An online questionnaire was sent to 327 alumni. One hundred and seventy-seven responded and 99 met the inclusion criteria. We calculated frequency distributions of the answers and performed a bivariate analysis of certain variables.

RESULTS

Alumni feel confident in all areas covered by the MIH. Most competencies acquired are perceived as essential or very relevant to their current position. Many respondents (77%) changed jobs after graduation, mostly from curative care to public health. More African and Asian alumni work in their country of origin (66% and 63%, respectively) than alumni from other continents (42%). The respondents had mostly worked at a national or provincial level, but after graduating mostly worked at international or national level. Alumni said that the network's mobility and flexibility had important advantages and disadvantages.

CONCLUSIONS

This is the first alumni survey of the MIH programme offered through the international network tropEd. The results suggest that competencies gained by graduates are relevant for their current careers. We recommend offering better guidance to students planning modules and to improve administration.