Kilimanjaro Christian Medical Center residents and an HVO volunteer take a break from surgery.
Courtesy of Glen Crawford, MD


Published 2/1/2018
Katie McMullen

Addressing Critical Shortages of Care through Training

Volunteers work with local providers to improve the quality and availability of orthopaedic care
The number of appropriately trained healthcare providers in resource-scarce countries across the globe is dangerously low.

According to the World Health Organization (WHO), the current global health workforce shortage stands at more than 7.2 million providers and is expected to increase to 12.9 million by 2035.

This shortage directly impacts the delivery of care. WHO estimates that at least 400 million people globally lack access to one or more essential health services. In low- and middle-income countries, for example, individuals regularly go without care, including essential orthopaedic services.

Limited access to healthcare impacts the larger community as well, particularly in economic growth and development. The Lancet Commission on Investing in Health reports that around one quarter of economic growth between 2000 and 2011 in low- and middle-income countries resulted from the value of improvements to health. The current and growing shortage will negatively impact the availability of health and could stymie economic development.

Addressing the shortage
WHO identified several key causes for the life-threatening shortage of health workers, including an aging health workforce, increasing demands from a growing world population, and shifting disease burdens. Underlying each of these issues is a key factor in addressing the shortage: the need for training.

"Health systems in resource-scarce settings face significant challenges," said Nancy Kelly, MHS, executive director of Health Volunteers Overseas (HVO). "The delivery of healthcare services depends on the presence of trained health professionals, yet there is the limited number of health workers in these areas and few opportunities for their continued professional education and growth."

HVO is a U.S.-based, nonprofit organization that has spent more than 30 years working with partners in resource-scarce countries to provide teaching, training and professional opportunities to health workers. HVO recruits orthopaedic volunteers to travel to project sites across the world. In 2016, 104 volunteers traveled to HVO's orthopaedic project sites, bringing training and professional opportunities to nearly 900 providers.

While on these short-term assignments, the volunteers give lectures, provide surgical training, and mentor local health workers. They also establish ongoing, beneficial professional relationships with overseas colleagues.

"The professional relationships that our volunteers cultivate with their overseas colleagues while on assignment often lead to an ongoing exchange of information," Ms. Kelly observed.

"These connections create an important resource for providers in resource-scarce countries, better ensuring they can provide the care their patients need," she added.

In Bhutan, for example, HVO began working with the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) in Thimphu nearly three decades ago when there was not a single orthopaedic doctor in the country. Over the years, the orthopaedic training and support provided by HVO volunteers has evolved as the health system has invested in expansion of orthopaedic services.

Richard Fisher, MD, who first traveled to Bhutan in 2009, has returned to the site on five separate occasions, maintaining a relationship with the staff. Following his trip this past October, he reported, "[JDWNRH] orthopaedics department is now fully staffed with seven Bhutanese orthopaedists, one resident, and two interns. This environment makes a big difference in the stress level of the staff who previously struggled to keep up with the clinical load."

Dr. Fisher also observed that the house staff strongly supports a teaching environment, leading to more effective conferences, literature reviews, and case presentations.

Bhutan continues to make improvements in orthopaedic care and training. In 2017, JDWNRH launched a new orthopaedic residency training program, and HVO will work with the orthopaedic department to provide additional training and support for the new program.

Long-term impact
The ultimate goal of the professional exchange of information and collaborative partnerships is to improve patient care for the long term.

In 2016, HVO on-site coordinators—local professionals who volunteer their time to coordinate HVO projects—reported on the impact of HVO volunteers. Of those who submitted reports, 91 percent reported significant or moderate improvements in staff skills, and 85 percent reported significant or moderate improvement in patient outcomes.

Volunteers also witness this impact when on assignment. Glen Crawford, MD, has served as the director of HVO's orthopaedic project at Kilimanjaro Christian Medical Center (KCMC) in Moshi, Tanzania since 2009. After his February 2016 trip to the site, Dr. Crawford reported, "It is very gratifying to see that my teaching efforts are having a substantial effect on the care of patients. The long-term burden of disabled Tanzanian citizens is much less due to the care being given at KCMC, improved in large part by HVO volunteers."

Dr. Rogers Temu, the on-site coordinator for Tanzania, agreed with Dr. Crawford. In a 2016 survey of the project, Dr. Temu reported that the training provided by HVO volunteers has improved care through new surgical approaches and they have seen specific improvements in arthroscopy.

He reported, "It is a very useful project, and it should be continued."

Katie McMullen is communications manager, Health Volunteers Overseas.

HVO has many short-term volunteer opportunities available at projects sites in Bhutan, Bolivia, China, Costa Rica, Ghana, Malawi, Myanmar, Nicaragua, the Philippines, St. Lucia, Tanzania, and Uganda. Assignments generally last 2-4 weeks and volunteers are placed throughout the year. For more information, visit


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