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1.  Time to go global: a consultation on global health competencies for postgraduate doctors 
International Health  2016;8(5):317-323.
Background
Globalisation is having profound impacts on health and healthcare. We solicited the views of a wide range of stakeholders in order to develop core global health competencies for postgraduate doctors.
Methods
Published literature and existing curricula informed writing of seven global health competencies for consultation. A modified policy Delphi involved an online survey and face-to-face and telephone interviews over three rounds.
Results
Over 250 stakeholders participated, including doctors, other health professionals, policymakers and members of the public from all continents of the world. Participants indicated that global health competence is essential for postgraduate doctors and other health professionals. Concerns were expressed about overburdening curricula and identifying what is ‘essential’ for whom. Conflicting perspectives emerged about the importance and relevance of different global health topics. Five core competencies were developed: (1) diversity, human rights and ethics; (2) environmental, social and economic determinants of health; (3) global epidemiology; (4) global health governance; and (5) health systems and health professionals.
Conclusions
Global health can bring important perspectives to postgraduate curricula, enhancing the ability of doctors to provide quality care. These global health competencies require tailoring to meet different trainees' needs and facilitate their incorporation into curricula. Healthcare and global health are ever-changing; therefore, the competencies will need to be regularly reviewed and updated.
doi:10.1093/inthealth/ihw019
PMCID: PMC5039817  PMID: 27241136
Diversity and health; Global health; Health promotion; Medical education; Postgraduate education; Workforce development
2.  Voluntary Health Insurance expenditure in low- and middle-income countries: Exploring trends during 1995–2012 and policy implications for progress towards universal health coverage 
Background
Most low- and middle-income countries (LMIC) rely significantly on private health expenditure in the form of out-of-pocket payments (OOP) and voluntary health insurance (VHI). This paper assesses VHI expenditure trends in LMIC and explores possible explanations. This illuminates challenges deriving from changes in VHI expenditure as countries aim to progress equitably towards universal health coverage (UHC).
Methods
Health expenditure data was retrieved from the WHO Global Health Expenditure Database to calculate VHI, OOP and general government health (GGHE) expenditure as a share of total health expenditure (THE) for the period of 1995–2012. A literature analysis offered potential reasons for trends in countries and regions.
Results
In 2012, VHI as a percentage of THE (abbreviated as VHI%) was below 1 % in 49 out of 138 LMIC. Twenty-seven countries had no or more than five years of data missing. VHI% ranged from 1 to 5 % in 39 LMIC and was above 5 % in 23 LMIC. There is an upwards average trend in VHI% across all regions. However, increases in VHI% cannot be consistently linked with OOP falling or being redirected into private prepayment. There are various countries which exhibit rising VHI alongside a rise in OOP and fall in GGHE, which is a less desirable path in order to equitably progress towards UHC.
Discussion and Conclusion
Reasons for the VHI expenditure trends across LMIC include: external influences; government policies on the role of VHI and its regulation; and willingness and ability of the population to enrol in VHI schemes. Many countries have paid insufficient attention to the potentially risky role of VHI for equitable progress towards UHC. Expanding VHI markets bear the risk of increasing fragmentation and inequities. To avoid this, health financing strategies need to be clear regarding the role given to VHI on the path towards UHC.
Electronic supplementary material
The online version of this article (doi:10.1186/s12939-016-0353-5) contains supplementary material, which is available to authorized users.
doi:10.1186/s12939-016-0353-5
PMCID: PMC4836104  PMID: 27089877
Private health insurance; Voluntary health insurance; Universal health coverage; Low- and middle-income countries; Health expenditure
6.  Tips for GP trainees wishing to undertake an international experience 
doi:10.3399/bjgp12X636263
PMCID: PMC3310027  PMID: 22520908
7.  An interview with Médecins Sans Frontières 
The British Journal of General Practice  2011;61(592):e761-e762.
doi:10.3399/bjgp11X606753
PMCID: PMC3207094  PMID: 22054340
8.  Combining general practice with international work: online survey of experiences of UK GPs 
JRSM Short Reports  2012;3(7):46.
Objectives
To conduct an exploratory study to learn about the experiences of GPs who have undertaken international work.
Design
Cross-sectional survey
Setting
Online survey of UK-based GPs. Members of all UK RCGP faculties were invited to participate by email and the survey was publicised on the RCGP website
Participants
All UK-based GPs
Main outcome measures
Types of UK and international work undertaken, barriers, competencies gained, influence on career and future plans.
Results
The study identified 439 respondents, in a variety of GP roles at all career stages, who had undertaken international work in their role as a doctor. GPs are undertaking international work in both high and low/middle-income countries, engaging in a wide range of clinical and non-clinical activities. Respondents reported gaining a range of competencies from international work, which could be transferred back to the UK setting to a variable degree. Commonly cited barriers to international work were having to leave friends and family, and concerns regarding future employment and pension. Most reported that engaging in international work had influenced the direction of their career, with the largest proportion stating that they wish to work predominantly in the UK, with some international work in the future.
Conclusion
The study highlights the variety of ways in which UK GPs are combining UK general practice and international work, competencies gained with such work, and ability to transfer these back to the UK setting. Historical barriers to international work still exist and future research could further examine the value of such work.
doi:10.1258/shorts.2012.012054
PMCID: PMC3422855  PMID: 22908027
11.  The three official language versions of the Declaration of Helsinki: what's lost in translation? 
Journal of Medical Ethics  2007;33(9):545-548.
Background
The Declaration of Helsinki, the World Medical Association's (WMA's) statement of ethical guidelines regarding medical research, is published in the three official languages of the WMA: English, French and Spanish.
Methods
A detailed comparison of the three official language versions was carried out to determine ways in which they differed and ways in which the wording of the three versions might illuminate the interpretation of the document.
Results
There were many minor linguistic differences between the three versions. However, in paragraphs 1, 6, 29, 30 and in the note of clarification to paragraph 29, there were differences that could be considered potentially significant in their ethical relevance.
Interpretation
Given the global status of the Declaration of Helsinki and the fact that it is translated from its official versions into many other languages for application to the ethical conduct of research, the differences identified are of concern. It would be best if such differences could be eliminated but, at the very least, a commentary to explain any differences that are unavoidable on the basis of language or culture should accompany the Declaration of Helsinki. This evidence further strengthens the case for international surveillance of medical research ethics as has been proposed by the WMA.
doi:10.1136/jme.2006.018168
PMCID: PMC2598189  PMID: 17761826
Declaration of Helsinki; ethics; research; linguistics; international health problems; World Medical Association
12.  A Snapshot of General Practice in Europe 
doi:10.3399/bjgp09X420716
PMCID: PMC2673167  PMID: 19401024
13.  WONCA Europe 2009: reflections and personal highlights 
London Journal of Primary Care  2009;2(2):169-171.
Why this matters to us
In April 2009 we launched the RCGP Junior International Committee, the UK representative body to the Vasco da Gama Movement. Since then we have worked hard to establish a network of UK trainees and junior GPs with an interest in international primary care, as well as promote international exchange and research. This year's WONCA Europe conference was a great success for the group with the presence of a strong UK contingent. We hope to repeat this success next year and inspire an even greater number of trainees and junior GPs to take part in international conferences and clinical exchange.
PMCID: PMC4222150  PMID: 25949600

Results 1-13 (13)