Educational institutions, foundations, and governmental and non-governmental organizations have shown a growing interest in applying their technical expertise, energy, talent, research capability, and resources to addressing global health challenges and disparities.1–4
Students increasingly request global health content in curricula and often wish to experience global health challenges firsthand.5–7
Accordingly, global health educational programs frequently include field experiences that often involve crossing international borders and during which trainees often encounter ethical challenges related to cultural and professional differences.8
Health science students participating in global health field experiences have been shown to be more likely to care for the poor and ethnic minorities, to change focus from sub-specialty training to primary care medicine, to report improved diagnostic skills, and to express increased interest in volunteerism, humanitarianism, and public health.9–14
For these and other trainees, such experiences may form the foundations for a career focused on or oriented toward global health or may help them to decide against such a career.15
By offering short-term global health field experiences, sending institutions may strengthen their position to recruit trainees interested in global health and to benefit from the appeal of such programs to funders and philanthropists.
Because global health is inherently interdisciplinary and multidisciplinary,16
students from a growing range of disciplines directly and indirectly related to health seek training in short-term experiences. Students also represent a range of levels and experience and may include undergraduate students, graduate students, and faculty wishing to expand their work into the global health arena. Bi-directional exchange programs offer trainees the opportunity to experience health issues in each other's environments. Experiences may vary in duration from as short as a few days to as long as 12 months and may vary considerably in quality.17
The goals of training experiences also vary; some can be viewed as training opportunities for the primary benefit of the trainee, whereas others claim to provide some form of service to the host or may involve research.18,19
However, little is known about the benefits and unintended consequences of global health training experiences to host institutions and host trainees and, if a component of service is anticipated, whether benefit is realized and at what cost.20–22
Global health training that benefits the trainee at the cost of the host is clearly unacceptable; mutual and reciprocal benefit, geared to achieving the program goals of all parties and aiming for equity, should be the goal.1
Exploitation of one partner for the benefit of another must be avoided.
Although global health training experiences offer potential benefits to trainees and to sending institutions and appear to be growing rapidly in scale, these experiences are sometimes problematic and raise ethical challenges.1,18,23–25
Such challenges include substantial burdens on the host in the resource-constrained setting; negative impact on patients, the community, and local trainees; unbalanced relationships among institutions and trainees; and concerns related to sustainability26,27
and optimal resource utilization. Although considerable attention has been given to ethical issues surrounding research conducted across international borders28
and under circumstances of unequal wealth or power, much less attention has been given to the ethical issues associated with education and service initiatives of global health programs and no formal ethical guidelines are available for global health training experiences. To develop ethics and best practice guidelines, we formed the Working Group on Ethics Guidelines for Global Health Training (WEIGHT). The WEIGHT members were selected by JAC and JS through a process of consultation with leaders in global health and ethics. The goal was to select members with experience and expertise with global health training and ethics from a range of perspectives and geographic locations. Of 13 initial membership invitations, 10 (77%) accepted. Those who declined were replaced by persons with similar expertise and experience to create a balanced membership.
• Academic global health programs are growing rapidly in scale and number.
• Global health curricula often include field experiences that involve crossing international and socio-cultural borders.
• Although global health training experiences offer potential benefits to trainees and to sending institutions, these experiences are sometimes problematic and raise ethical challenges.
• The Working Group on Ethics Guidelines for Global Health Training (WEIGHT) developed a set of guidelines for institutions, trainees, and sponsors of field-based global health training on ethics and best practices in this setting.
• The WEIGHT guidelines address the need for structured programs between partners; the importance of a comprehensive accounting for costs associated with programs; the goal of mutual and reciprocal benefit; the value of long-term partnerships for mitigating some adverse consequences of short-term experiences; characteristics of suitable trainees; the need to have adequate mentorship and supervision for trainees; preparation of trainees; trainee attitudes and behavior; trainee safety; and characteristics of programs that merit support by sponsors.
• To refine the guidelines, WEIGHT encourages work aimed at developing and implementing means of assessing the potential benefits and harms to institutions, personnel, trainees, patients and the community in host countries of global health training programs.