Conclusions

The past decade has brought a sea change in the attention focused on global health problems, and a determination to take action to alleviate the distress. There is a broadening of political will and support beyond the traditional humanitarian base to include economic, security, diplomatic, scientific, ecologic, and other self-interests that favor aid growth of global health assistance. The entire spectrum of government and non-government organizations is increasingly focused on global health, as evidenced by the setting of the UN Millennium Development Goals to be achieved over the next decade, and dramatic commitments of additional funds by government (e.g. PEPFAR - $15 billion) and nongovernment (e.g. the Bill and Melinda Gates Foundation, supplemented by the Warren Buffet fortune) sources.

A critical limiting factor in the response to the formidable global health challenge is the paucity of human (and institutional) resources in most low- and middle-income nations. Help is needed at all levels, from national leadership and planning to the most downstream interactions of health workers with individuals and communities. We believe that certain key factors/principles are core to the success of health-training activities, whether the focus is clinical, research, public health, or administration/infrastructure building. They are as follows:

1. In establishing a training program, the initial planning should encompass and be responsive to local needs and priorities.

2. Workforce capacity building requires long-term commitment and stability together with flexibility to adapt as needs, priorities, and circumstances change.

3. A partnership and commitment must be established at both the individual and institutional levels, with increasing empowerment of the foreign partner as the collaboration matures.

4. Human resources must be nurtured by long-term mentoring, follow-on opportunities to update and reinforce skills, attention to career development and working conditions, as well as professional and financial rewards.

5. Multidisciplinary centers of excellence, which are catalysts for training and research activities in the developing world, must be developed.

Two examples of successful programs are presented in this chapter.

There is a growing consensus in the scientific community that the determinants of infectious diseases are much more complex than simply the traditional host-pathogen interaction, and that social, economic, ecological, and political factors are powerful forces. We discuss the need for new training paradigms that are transdisciplinary and system-based, and cite some efforts now underway at US universities to integrate their global health activities.

Finally, we have addressed, with some caution, the proposals to generate a medical Peace Corps to provide services and training in areas of great need. Pitfalls to be avoided are discussed, and the need to integrate such efforts into each country's national manpower training program is stressed.

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