What are the health system impacts of engaging with global health activity? A qualitative study

Abstract Background Global health partnerships between high-income health systems and low- and middle-income countries (LMICs) are becoming more common as there is an appreciation of the need for collaboration to solve global health issues through knowledge and skill exchange. However, partnership evaluations largely focus on the benefits to individual participants and recipient systems, with little evidence of the impacts on the high-income system. Therefore, the aim of this study was to explore the health system-wide impacts of engaging with global health activity and consider the arguments for and against adopting these partnerships. Methods We carried out semi-structured interviews with individuals from three UK health systems that engage with global health activity to explore their motivations to in doing so. Transcripts were thematically analysed. Results We found that engagement in global health activity can contribute to workforce recruitment, retention, development, and upskilling, benefiting the system. Examples were also given of system-wide clinical, reputational, and economic benefits. However, this activity impacts short term staffing and can cause personal emotional issues that systems need to support. We also explored facilitators of engaging in global health work which included operational support, supporting healthcare staff to engage, and system acceptance. Barriers included lack of senior buy-in, opportunity access inequities, operational challenges, and the current UK health system challenges. Conclusions This study demonstrated the potentially significant system-level benefits of engaging in global health activity. These focused on improved workforce, which is a major public health issue worldwide. We have also identified system characteristics, such as buy-in and operational support, which influence success. We hope this work provides a building block demonstrating there are benefits to be had for donor health systems, but barriers must be overcome. Key messages • The potential benefits and drawbacks that may arise from high-income health systems engaging in global health, as well as facilitators and barriers, are explored. • This study creates a foundation to understand donor-system benefits and encourages further research, particularly in systems who do not engage with global health activity to understand why this is.