Standards for Medical Mission

Partnerships and Practices

(Sending and Host Organizations)

Healthcare System Strengthening/Medical Mission Initiative

October 2019
Guidelines revised September 2018

TABLE OF CONTENTS
Sections Page number
‐ Introduction 3
‐ Overview 4
‐ PQMD HSS/MM Standards
o Assessment 5
o Partnership/Alliance 6
o Governance 7
o Code of Conduct 9
o Preparation 10
o Implementation 12
o Training and Capacity Building 13
o Sustainability 14
o Monitoring and Evaluation 15
‐ References 17
‐ Appendix A List of Definitions 19
With support from:
Dr. Julie Varughese, Americares; Dr. Patti Tracey, Trent University; Elizabeth Ashbourne,
Partnership for Quality Medical Donations
Dr. Timothy Amukele, Pathologists Overseas & Johns Hopkins University; Veronica Arroyave,
Baxter Foundation; Darnelle Bernier, Catholic Medical Mission Board; Doug Fountain, Christian
Connections for International Health; Judy Hastert, Heart to Heart International; Samuel Ingram,
Medtronic; Kim Keller, Johnson & Johnson; Carla Orner, Heart to Heart International; Dr. Anne
Peterson, Americares; Juliemarie Vander Burg, Partnership for Quality Medical Donations;
David Obando Venegas, Trent University; Randy Weiss, Americares; Dr. Philip Wendschuh,
North Ohio Heart Ohio Medical Group; Julie Winn, Americares
Myron Aldrink, Partnership for Quality Medical Donations; Dr. Sarah Brown, Pathologists
Overseas & Washington University; Wade Jones, Medtronic; Claudia Sighomnou, HPIC Canada

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INTRODUCTION
Medical Mission – Current Practice
The literature reveals that Short-Term Medical Mission contributions are valued yet fragmented
in their current state with largely unknown outcomes or well documented practices. On the
positive side, medical missions provide valuable medical services to people who might not have
access to healthcare otherwise. This is especially prevalent in rural and remote regions where
poverty may be extreme. Medical missions also provide benefit to the volunteers themselves by
gaining personal satisfaction from participating in humanitarian efforts and an opportunity to
reconnect to why they chose to pursue a health focused profession. Medical missions can also
support student experiences as they gain exposure in the field of international medicine through
opportunities as part of their education.
Challenges occur however when doctors and other health care professionals from high-income
countries (HIC) demonstrate a lack of awareness about the realities of healthcare in low middle
– income countries (LMICs) or show a lack of respect for local health workers. Often because of
the short-term nature of MMs, visiting health care providers often have little time to dedicate to
understanding local health needs and culture. Furthermore, insufficient attention is given to
imminent local issues, adequate follow-up and ongoing care – often not knowing the local health
system well enough to refer patients for ongoing care. Short-term medical missions are also
often criticized for not being the best use of financial resources.2 An average medical mission
cost is $USD 41,359 -65,000 for a team of 20 people (Tracey, 2015).
The number of medical professionals participating on medical missions is large and increasing.
It is estimated that annually, over 16% of US doctors go on medical missions with medical
mission costs and related expenses totaling over $US 3.7 billion (Caldron, 2016).
PQMD Medical Mission Standards - Purpose
PQMD recognizes the dilemma regarding short-term medical missions and understands that
medical missions can be beneficial and provide appropriate and quality health services. PQMD
further believes that medical missions should help support and strengthen local healthcare
systems. Therefore, in May 2016, PQMD announced the 3-year initiative called the PQMD
Healthcare System Strengthening/Medical Mission Initiative (PQMD HSS/MM). This initiative
reviewed the complex nature of medical missions and the relationship between different
stakeholders. It noted that many of the problems seem to pertain to lack of alignment between:
‐ Sending Organizations (NGOs, churches/religious organizations and universities)
‐ Host Organizations (INGOs, In-country churches/religious organizations and
universities)
Therefore, PQMD and supporting member stakeholders have developed a set of standards that
seek to better align the purpose and practices of sending and host organizations. The standards are
intended to help create common understanding of directives of sending and host organizations and
to help form better partnerships. They provide high-level principles for improving the quality of
medical mission practices including the encouragement to provide training and capacity building.
These standards are not intended to be draconian and judgmental in nature but instead to
encourage improvement in medical mission efforts over time.

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OVERVIEW OF STANDARDS
The PQMD standards are based on the following premises:
Support for the World Health Organization
The PQMD medical mission standards are designed to support World Health Organization
(WHO) directives.
Health Development Focus (not Disaster Relief)
The PQMD standards pertain to long-term health development - not disaster relief efforts. The
WHO has established standards for foreign medical teams for disaster relief (2013 Classification
and Minimum Standards for Foreign Medical Teams in Sudden Onset Disasters). However, the
WHO does not currently have standards regarding medical missions for long-term health
development.
Healthcare – Area of Emphasis
The PQMD Initiative is focused on primary care however, the standards are designed to be
general principles applicable across medical disciplines.
Medical Mission trip – Time Durations
Most medical mission trips are short term (4 weeks or less). However, the PQMD standards are
also applicable to medium-term mission (5 weeks to 6 months) and long-term missions (7 months
to 2 years). (Martiniuk et al, 2012).
Local Health Systems - Scope
The PQMD standards cover medical missions supporting the entire healthcare system (Primary,
Secondary and Tertiary facilities). Note: Some medical missions are conducted in churches,
schools and rural community facilities, these locations pose challenges as they typically are not
connected to the healthcare system.
Medical Mission efforts- Increasing Commitment
The standards also encourage increasing the level of commitment towards sustainable local
health programs. The standards include steps to move organizations from one-time medical
mission trips  to regular ongoing program support  to developing sustainable in-county
health operations. These different levels of commitment are described below.
o One-time medical mission trips or infrequent trips. Driven by the desire to conduct trips
to serve an appropriate local need when volunteers can be organized to serve. These
one-time trips are typically medical service oriented.
o Regular ongoing trips and program support. Driven by the desire to provide regular,
dependable, ongoing support for local health programs. These trips are closely
coordinated with the host to provide support as needed. These ongoing trips have a
greater emphasis on providing training and capacity building.
o Permanent In-country health programs. These ongoing local efforts often have local
boards. However, these programs are augmented by occasional medical mission trips
Driven by a commitment to create sustainable locally run programs (without
dependency) these permanent programs are typically well integrated within the local
healthcare system

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PQMD HSS/MM STANDARDS
The PQMD HSS/Initiative has created a set of standards designed to better align sending
organizations and host organizations. The 9 PQMD standards outline the general principles to
help create partnership and mutual respect. These standards also focus on improving the
process and practice of medical missions and programs including training and capacity building
efforts.

1) ASSESSMENT
The essential first step is to conduct a general assessment to determine if a medical mission
effort is appropriate and viable. There are different types of assessments, including:
population assessments, health assessments and needs assessments. Pre-trip
assessments also include a costs and benefit analysis.

While assessments are customized to the specific programs and type of medical intervention,
the general need to obtain upfront information applies to all medical disciplines and groups
(NGOs/INGOs, small churches/religious organization, Universities, individual volunteers etc.).
The key to success is for the host organizations to be an active partner and genuinely
involved in these assessments.

Sending Organization Host Country Organization

‐ Work with host to assess population profile ‐ Describe local population (social,
‐ Clarify and understand health economics etc.)
situation/culture ‐ Provide history/context of local health
‐ Develop an awareness of people living with system
disabilities in the communities where the MM ‐ Identify and prioritize health and wellness
is taking place (are services accessible?) needs
‐ Work with host on health/wellness ‐ Describe local resources currently available
assessment and help determine needs (asset mapping)
‐ Ascertain resources available to build ‐ Assessment of training needs (medical,
capacity process, IT, biomedical training etc.) as
‐ Identify where local assets are weak or they relate to current and future program
missing goals.
‐ Assessment of the capabilities of in-country ‐ Provide current and future program goals
heath facilities (both host organization and ‐ Describe program and local health system
local health system) needs
‐ Work with host on program needs ‐ Describe building, process and staff
assessment-consider pre-trip assessment to situation
check: ‐ Describe staff size, experience and skill
o Specific health program needs level
o Facility needs (capabilities/management) ‐ Describe equipment/consumables/costs
o Staff capability (training to local needs) ‐ Describe local products/ cost /supply
o Equipment (appropriate/biomed support) network
o Products (consistent with local supply, ‐ Provide information on local programs for
availability; for example: what is coordination with medical mission effort
prescribed can be procured /refilled ‐ Explain in-county health structure
locally) o MoH – National Health Plan
‐ Work with host to develop the needs for MM o Local Healthcare structure
trip (Determine whether the medical mission o Local Community health capabilities
assessment will be conducted virtually or in- ‐ Describe approval process of government

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 person) for volunteers -e.g. registration/medical
‐ Work with host to understand national health licenses product/equipment (e.g. local
requirements, local health system and local consumables) immigration
community health efforts requirements/custom fees etc.
‐ Assessment of available personnel and their ‐ Assessment of the medical mission and the
skill levels for the planned medical mission potential impact of the program on staff and
‐ Ensure that each volunteer position helps local community.
with the overall mission goals and objectives. ‐ Assess benefit of MM to host organization
‐ Estimate the costs and benefits of MM effort o Benefit of medical service to local
o Health services costs program
o Training costs o Benefit of skill training to local staff
o Capacity building costs o Benefit of resources/ process training
o Benefit to sending organization ‐ Protect reputation of host and local health
reputation system
o Benefit to individual volunteer (personal ‐ Note: the planned medical mission must
growth) enhance not demoralize or diminish
o Cost/benefit assessment of the entire confidence in host organization or local
MM trip health system.
‐ Assess costs of other resources required ‐ Assess overall cost and local resources
for example: required to determine if MM trip is the best
o Logistics/Accommodations/travel use of the limited resources of host
o Language translators organizations and local health system
o Volunteer orientation/prep (e.g.
vaccination)
o Contingencies e.g. In country
Emergency
o Organization, protection and liability

2) PARTNERSHIP/ALLIANCE
If the assessments indicate a medical mission would be beneficial, the next step is to
develop a formal partnership where the parties agree on the relationship and
activities. This doesn’t have to be a long complex legal document, but it is very
important that expectations, responsibilities and cost be clearly understood and
agreed upon by all involved through the joint development of a memorandum of
understanding (MOU). To be successful, medical mission partnerships must be
aligned with the overall goals of all parties.

Sending Organization Host Country Organization

‐ Present sending organization ‐ Present host organization mission/purpose
mission/purpose ‐ Discuss interest and host requirements
‐ Discuss general interest in partnership (short ‐ Discuss past history with other partners
and long-term interest) ‐ Discuss local expectations of MM trip
‐ Discuss planned medical mission trip(s) ‐ General agreement on program - local
‐ Obtain general agreement on scope of impact
program ‐ Provide program expectations
‐ Engage in collaborative goal setting with host o Specific benefits

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 o Define expected learning/teaching o Specific benefits from training
outcomes o Patient care and health benefit
o Determine expected patient outcomes ‐ Confirm duration of the mission and plans
(treatment and/or prevention) to coordinate with local program schedule.
‐ Confirm duration of the mission with host ‐ Define resources to be provided, received
‐ Define local program resources required and used (services, training,
(facilities, patient access, staff support etc.) product/equipment etc.)
‐ Do not pay for services/staff that is beyond ‐ Seek cultural understanding /seek respect
the local norms. ‐ Identify host and local individuals that would
‐ Recognize cultural differences in best fit with medical mission team
conversations ‐ Identify lead person for medical mission
‐ Selection of MM participants (select interface (support for sending organization)
participants based on certain criteria such as, ‐ Conduct government pre-approval efforts
understanding of the language, level of (in conjunction with sending organization)
awareness about the destination ‐ Agree on in-country use of finances/
country/community, cultural familiarity, resources
required specific skills, past experience, etc.) ‐ Plan for obtaining information and reporting
‐ Identify lead of MM team and HQ authority ‐ Agree on local review process for MM effort
‐ Define financial/resource allocation ‐ If MM is positive, seek further partnership
‐ Define reporting and measurements commitments (with goal of self-
‐ Agree on terms for MM partnership review sustainment)
‐ Consider further partnership and longer-term ‐ Define the level of information that will be
partnership agreement shared with sending organization – explain
‐ Define the level of information (confidential local and cultural sensitivities.
and non-confidential) that will be shared from
sending to host (financial
assessment/impact, funding prospects,
relevant personal team member information,
etc.)

3) GOVERNANCE
Prior to any joint medical mission efforts, both organizations should provide each other with
proof of due diligence and governance compliance. Due diligence proves that the
organization is properly managed and can stand up to scrutiny. Governance pertains to
compliance with national laws (both sending and receiving) and local regulations. In addition,
the organizations should show adherence to global principles and ethical practices.

The actual documentation regarding due diligence may differ based on country and
organization category. For example, organizations may differ in structure (NGOs,
churches/religious organizations, universities informal volunteer groups); however, the same
general principles of accountability and transparency apply to all organizations (both sending
and host).

Laws and regulations vary by country. This document presents North American examples
however, the global equivalent would apply for all participating HICs. It should be noted that
in some countries the government is under-resourced and may have difficulty with
enforcement and support. However medical mission volunteers and programs should comply

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 with the laws and regulations of the host country. Also, sending countries may have different
laws however, in many instances the laws are similar. Overall the spirit of due diligence and
good governance is a major element in the general principles of medical missions.

Sending Organization Host Country Organization

Due Diligence Due Diligence
Provide host with due diligence documents ‐ Agreement on governance documents
(legal entity, financials, tax status) ‐ Provide sending organization with
‐ Bylaws/List of Directors documents of host organization (viability of
‐ 501 C 3 tax status (US) entity, financials
‐ Canadian Revenue Agency (Canada) ‐ Confirm host organization is in good
‐ Audited Financial/ 990 /GAAP (US) standing with in-country government and
‐ T3010/IDE(Canada) local authorities

Legal compliance Legal compliance

Discuss with host legal requirements, including: ‐ Confirm an understanding of the
‐ Foreign Corrupt Practices Act (US) requirements of sending organization
‐ Corruption of Foreign Public Office regarding corruption and health laws and
ACT(Canada) that the host organization is in compliance
‐ Office of Foreign Assets Control (US) ‐ Provide sending organization with basic
‐ Minister of Foreign Affair (Canada) local health program practices (e.g. patient
‐ Protected Health Information HIPPA (Patient data sharing, cultural norms patient privacy
Privacy (US) expectations)
‐ Medical mission teams must know laws of the ‐ Clearly communicate local laws and also
host country and be in total compliance (not informal practices regarding these laws
just compliance with laws of sending country)
Confirmed ethical compliance
Confirmed ethical compliance ‐ Explain local cultural and ethical
Discuss with host basic expectations regarding: practices/concerns
‐ Human Rights Principles (UN) ‐ Communicate a basic understanding of the
‐ Patient Safety (WHO) expected ethical standards of sending
‐ Healthcare Compliance (US Office of organization and agreement to comply
Inspector General) ‐ Confirm that the sending organization also
‐ SPHERE – Quality Humanitarian Response understands the ethical expectation of local
(Red Cross/Red Crescent and NGOs) country and host organization.
‐ PQMD – Partnership for Quality Medical ‐ Describe local product supply network with
Donations – Product donation standards economic and social considerations
‐ THET – Tropical Health Education Trust (UK ‐ Convey ethical sensitivity and respect for
Organization – strengthening healthcare) local healthcare practitioner roles

Program Health Role Compliance Program Health Role Compliance

In addition, sending and host organizations ‐ Define and establish scope of practice for
must agree on program health role and MM volunteers both health practitioners
practices and non-health participants
‐ Define and establish scope of practice for ‐ Confirm the scope of practices is in
each category of health practitioners compliance with in-country health laws and
‐ Define and establish scope of practice for regulations
non-health participants ‐ Confirm student /trainee involvement is in

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‐ Define and establish scope of practice for compliance with local health laws
each category of health
students/residents/trainee
‐ Define required level of supervision needed
for student/trainee/resident participants

4) CODE of CONDUCT
Many problems regarding medical missions pertain to attitudinal issues. It is essential
to show humility and respect for all involved. Cultural sensitivity plays an important
part in the success of medical missions. Therefore, the following components should
be considered:

Sending Organization Host Country Organization

‐ Establish general organizational Code of ‐ Define Code of Conduct for local program,
Conduct policy for MM volunteers based on especially workers involved with the mm
WHO directives: effort
o Patient Safety ‐ Describe expected behavior for medical
o Healthcare System Strengthening mission visitors (Humility, respect, cultural
o Training/Capacity Building sensitivity)
o Patient Monitoring /Health Impact ‐ Establish group norms and awareness
o Child Protection around safe conduct
o Gender ‐ Create a forum for candid
‐ Define anti-discrimination policies (race, opinions/concerns such as safe conduct
nationality, religion, creed, political ‐ Communicate local social norms and
standpoint) religious considerations
‐ Consider factors which might affect rapport ‐ Seek to provide good experience for mm
with any team member/patient or local guests share pride in local culture
community member) ‐ Provide information on local practices
‐ Establish rules of respect for host (rationale)
organization programs and culture ‐ Explain local health structure/processes
(appearance and work attire) ‐ Make formal introductions to key local
‐ Consider sexual exploitation and abuse in health
Humanitarian Settings (IASC Task Force, ‐ Establish patient selection process around
2016). patient recruitment and respect
o Avoid paternalistic attitude ‐ Describe local health
o Comply with local health practice economics/implications
‐ Explain staffing and health system needs
o Support local health workers
‐ Discuss local financial considerations of
‐ Practicing within the scope of volunteer’s
host organization and healthcare systems
licensure and preparation and not acting
Discuss proper use of assets
beyond competence (this includes students)
‐ Convey support for local healthcare system
‐ Promote patient autonomy by obtaining
‐ Explain the major political and social
informed individual consent from patients.
situation and define sensitive topics that
(collaboration with host may be necessary to
guest should not engage or make
achieve this)
comment.
‐ Be sensitive to potential economic impacts
‐ Provide information on local environmental
o Don’t hire away local health workers
practices.
o Avoid negative impact on local

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 healthcare system (i.e. providing “free” ‐ Explain local social and humanitarian
medical services) concerns
o Avoid causing diminishing confidence in ‐ Explain local patient care and recording
local health system ‐ Explain local health reporting processes
‐ Be sensitive to level of interference with local ‐ Explain local government policies and
issues that are not medically related or requirements
medical mission related – e.g. sensitive to ‐ Assist mm team with obtaining registrations
local politics by outside organizations ‐ Assist sending organizations to deal with
‐ Consider environmental impact of medical any local government crisis
missions (litter, disposal of medicines and ‐ Explanation of local corruption and advice
other hazardous items, etc.) to maintain ethical practices
‐ Obey all ethical and global governance ‐ Clear rules should be established in both
requirements sending and receiving
‐ Human Rights countries/communities on how gifts should
o Patient monitoring /Health impact be handled
o National health rules ‐ Assist sending organization in the event of
 local medical license local safety concerns
 register as MM practitioner ‐ Assist sending organization with any local
lifesaving or emergency situation
 government directives/policies
‐ Coordinate with sending organization
‐ Code of conduct on dealing with government
regarding local communication practices
officials/military, in times of war/emergencies
‐ Have open communication with sending
‐ Code of conduct on giving bribes, kickbacks
organizations regarding any inappropriate
or other improper payments
social activities
‐ Code of conduct for accepting and offering
gifts (feeling the urge to help with money and
pay your way out of process, giveaways such
as toys or footwear, clothing etc.).
‐ Code of conduct with regards to safety and
security. Define course of action in case of
adverse event reported
‐ Consider course of action if medical
lifesaving practice are in opposition with
strongly enrooted cultural norms
‐ Code of conduct in emergency situation.
‐ Code of conduct with regards to confidential
information and privacy, conflict of interest or
social media guidelines
‐ Images, logos and other intellectual property
(taking and using photographic images)
‐ Other Considerations
o Conflict of interest
o Sexual exploitation and abuse

5) PREPARATION
Advanced planning and preparation is very important for medical missions. It is especially
important to develop plans in conjunction with the host organization

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Sending Organization Host County Organization
‐ Continued communications with host on ‐ Discuss in-country program plan (clarify
medical mission plans and objectives objectives and expectations)
including site selection and role of all partners ‐ Mutually agree on the timeline of the project
‐ Create a Memorandum of Understanding and finalize local program itinerary
(MOU) with host partner(s) ‐ Determine preferred mode of
‐ Define selection criteria for volunteers communication, work with contact person
o Credentials and identify resource
o Technical Skills for MM team prior to their arrival
o Medical mission experience ‐ Establish rules and local expectations
o Pre-departure training ‐ Prepare country/community immersion and
o Personality fit orientation programs for MM program
o Cultural attitudes/sensitivity participants (both sending and local host) or
‐ Confirm program resources required team members - possibly matching key
o Health practitioners people for better familiarization with local
skills
o Facility/Location
‐ Define nature of work and anticipated skills
o Product/Equipment
tools needed
o Technology
‐ Describe the capabilities of the
o Respectful, educational photo taking only facilities/location
(with patient consent) ‐ Confirm product needs and local
‐ Work with the host community to determine appropriateness
the issues around equity, human rights, ‐ Provide information on local tech capabilities
gender and other social determinants of ‐ Describe local social/political/economic
health. situation
‐ Coordinate logistics from departure to return - ‐ Plan for all necessary legal permissions in
with emergency contingencies. host country (legal authorization to import
‐ Plan participants safety donated medicine, medical mission practice
o Vaccination and immunization by foreign health professions)
o Security and safety measures around ‐ Prepare adequate accommodations/local
local travels logistics for teams
o Food safety (dietary, allergies) ‐ Inform team in advance of current health and
o Locate consulate/embassies safety conditions plus expected
‐ Learn destination’s national formulary and weather/floods
become familiar with local medical products ‐ Confirm the number of participants that can
and foods available locally be hosted, given food, and accommodation
‐ Understand in advance the composition of
incoming team
‐ Provide information on local staff and
perceptions
‐ Plan ahead for all local resources required to
the team (facilities, skilled health
practitioners, technology, products,
equipment, interpreters)
‐ Determine local health system interface
‐ Prepare for announcement of the arrival of
type of team for the targeted community
(especially community leaders), and make
sure of cooperation, consent and
commitment

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6) IMPLEMENTATION
The implementation of the medical mission will vary by the specific
organization/program. This includes the execution of the current medical mission
effort, but should also include planning ahead for possible future medical/health
programs and support for local healthcare system strengthening

Sending Organization Host County Organization

‐ Work with the host to implement the trip ‐ Implement the MM effort per plan and work
/program as planned within local, existing programs (when possible)
‐ If changes required, work with host on ‐ Provide support and advice if the MM plan
changes changes especially when local solution
‐ Have regular communication with host needed.
during implementation to gauge progress ‐ Provide on-going communication and local
‐ Utilize local health system feedback on MM activities during
o Don’t run parallel efforts implementation
o Avoid disrupting regular flow of service ‐ Provide local resources coordinated to best
delivery interface with existing healthcare system
o Prescribe local medicines from trusted ‐ Work with sending organization to coordinate
sources programs which “builds-off” local facility
‐ Prepare site upon arrival capacities
o Meet and get to know the local team ‐ Implement the patient process and prepare
o Determine the number of patients to patient files (patient recruitment/prep)
see per day ‐ Establish a referral system to follow up on
o Optimize patient care (take account of patients seen during the medical mission
language barriers) ‐ Organize hand-off sessions
‐ Implement medical procedures that o Patient needing follow up care
conform to accepted local standards if not, o Collect patient information sheets
international standards. o Collect comments and feedback
‐ Work to address local issues, such as: ‐ Establish inventory management
o Laboratory without Biomed equipment,
procedure to ensure appropriate use of
techs and repair service
medicines (labeling, expiry dating, etc.)
o Surgical without functional facilities
‐ Provide information on local capabilities/
/trained staff/local supplies
supplies
o Primary Care without health system
‐ Establish joint reporting on patients for follow-
interface
up purposes (especially for chronic diseases),
o Cost effective local pharmaceuticals
and carefully file patient information and
and med supplies for long-term care of
statistics
patients
‐ For monitoring and referral purposes, notify
‐ Provide/dispose of product and equipment
the local health center of the efforts of the
in accordance with PQMD Guidelines and
all other standards and directives medical mission in their areas of responsibility
‐ Conduct a final project review with host at ‐ Support cleanliness of community and local
the end of the MM trip facilities and support product network and
‐ Discuss long-term continuity disposal needs

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 o Multiple trips to same location ‐ Debrief on medical mission program activities
o If possible, and appropriate, work on a regular basis
toward establishing in-county program ‐ Reviews and critiques going “both-ways”
provide perspective from host and health
system
‐ Encourage long-term continuity to develop
local health capabilities (not dependency)

7) TRAINING /CAPACITY BUILDING

Medical missions should be viewed as “temporary” with the ultimate goal to develop
local health system to where it can take care of itself. Medical missions are “gap
fillers” however, they can help build towards the future by providing transfer of
knowledge (training and capacity building) – with the ultimate goal of having
sustainable local programs and a viable a strong healthcare system.

Sending Organization Host County Organization

‐ When possible, provide training in addition to ‐ When possible, seek opportunities to
MM clinical services including illness obtain training for local health practitioners
prevention education (By med students only and staff
when appropriate) ‐ Make introductions to local health officials
‐ Seek to coordinate health training with local medical associations, and government
workforce and officials officials
‐ Try to develop training in conjunction with ‐ Make introductions to in-country education
local educational institutions (College/medical
system government agencies and medical
organization certification)
associations
‐ Discuss expectations and responsibilities of
both host and sending institutions and agree ‐ Include local health systems and
on terms of training program implementation government
‐ Develop structured program plans that agencies in discussions regarding training
include bidirectional training and local efforts and long-term coordination
capacity building interaction ‐ Proactively provide local knowledge and
‐ Prepare a detailed outline on how the training health experience to sending
will be conducted such as clinic/hospital organizations
shadowing, specific training sessions, ‐ Achieve local awareness, understanding
simulations, etc. and buy-in for any training effort
‐ Promote transparency regarding the ‐ Seek up-front orientation of planned
motivations for using program as training training efforts and discuss impact of
opportunity and identify and address any these efforts on the community and local
conflicts of interest that may result from such health system
a program
‐ Emphasize the importance of training
‐ Clarify the level of training and experience for
methods appropriate for host country
the host institution so that appropriate
activities are assigned, and patient care and (cultural sensitivity)
community well-being is not compromised ‐ Involve all government agencies that
‐ Establish effective supervision and approve and certify health training and
mentorship of trainees with the host and education
‐ Include key local officials in training

13 
 
 including the selection of appropriate mentors development both health professionals
and supervisors and facilitate regular and community leaders
communication among them. ‐ Seek local involvement in all levels of the
‐ Assess the cost and benefits to host training aspects.
institutions, local trainees, patients, ‐ Proactively provide local knowledge and
communities, and sponsoring institutions to health experience to sending organization
assure equity. and training efforts
‐ Establish methods to solicit feedback from ‐ Work with sending organizations to
the trainees both during and on completion of develop
the training program. Ideally, follow up after appropriate local skills attainment metrics
3-6 months to see if the training has had any (in conjunction with government agencies)
impact. ‐ Determine the local assets that are
‐ Determine ways to measure transfer of available to support competency
knowledge and application to local care development and capacity building
‐ Determine the local assets that are available ‐ Seek engagement in local capacity
to assist with competency development and development planning and implementation
capacity building bringing in local health officials and
‐ Provide initial resources to help develop local individuals with support skills
capabilities (i.e. IT, medical equipment and ‐ Seek long-term partnership with health
technology) officials
‐ Develop capacity in conjunction with local ‐ Seek to obtain local funds/ partial fund
health system and medical associations, training and capacity building activities (a
government officials and WHO plan balanced partnership)
o Leadership/governance
o Health workforce skills
o Health facility and process capabilities
o Medical equipment (biomed support)
o Medical products and process
o Financing capabilities
‐ If requested, provide some on-going support
(with time limits to avoid dependency)

8) SUSTAINABILITY
Training and capacity building can help improve local health efforts, but to be
sustainable requires locally managed and properly funded health efforts. Long-term
collaborative relationships can help move towards sustainability.

Sending Organization Host County Organization

‐ Work with host to establish long-term ‐ Work with in-country authorities to support
collaborative relationships these long-term efforts
‐ Focus on prevention and development ‐ Work with the community and health
efforts - not “treat and leave” system officials to establish local
‐ Select local partner organizations that have prevention efforts
long-term presence locally and can provide ‐ Advocate to develop local capacity to
follow-up and ongoing care transform medical mission experiences into
‐ Establish short-, medium-, and long-term sustainable output across the health
measures of success (number of patients system (primary, secondary and tertiary

14 
 
 seen, prescriptions given, incidence, and local communities)
prevalence or control of a disease, to ‐ Seek to bring in partners for long-term
measure and improvement long term access collaboration (local and international
and support and strengthen the local partners)
healthcare system ‐ Work within local political environment to
‐ During the transition period (after the MM obtain support to long-term efforts
trip) carry out a responsibility transfer ‐ Seek local responsibility and resources to
create a more balanced partnership
process where medical and patient
relationship
information will be passed on to local hosts
‐ Develop programs with business logic (not
‐ If several medical missions planned, charity)
consider recurrent medical missions to the ‐ Seek to establish local joint effort for long-
same location term
‐ Seek to develop multi-partner multi-sector sustainability (e.g. merging local partners)
collaborative efforts ‐ Define revenue allocation between all
‐ Foster independence by providing training partners
and building local capacity ‐ Consider self-sustainable revenue stream
‐ Define revenue allocation between all to compensation practices and support pay
partners focusing on developing capacity for
development efforts expatriate and national (this would limit
‐ Work with host to expand mm health public-private pay inequity, strengthen
commitment – moving up One-time medical public sector, incentive for rural service)
mission trips ‐ Seek continuity (rather than only 1 trip)
o On-going trips to same location ‐ Seek formal in-country programs (in
o In-country based programs with conjunction with the MoH and local
healthcare system)
occasional HIC teams

9) MONITORING and EVALUATIONS

Finally, there must be monitoring and evaluation of medical missions and health
efforts including measurement of outcomes and health impact metrics. Measuring
activities are needed to gauge progress and, equally important, help identify areas to
be improved for long-term sustainability. While measurement methodology will differ
for individual programs, the basic measurement principles are summarized below:

Sending Organization Host County Organization

‐ Work with host to define and monitor ‐ Provide information on overall local
objectives and conduct program evaluations measurement practices and procedures
on MM trip ‐ Advise on measurement practices
‐ Create program health metrics to evaluate the currently used by local program
current MM effort ‐ Provide information on healthcare
‐ Work with host to establish criteria for overall metrics currently used by local
health performance measures healthcare system
‐ Conduct reviews of the MM program relative ‐ Coordinate and support with data
to in country health metrics collections for MM program and national
‐ Assess cost-benefit/effectiveness and health efforts
financial viability of medical mission ‐ Work with the sending organization to

15 
 
‐ Create basic metrics to help develop future provide cost and health information
MM efforts and program improvements specific to MM
‐ Utilize standard measurements such as; ‐ Assist in the assessment of future
input, output, and outcome/health impacts programs potential with health impact
and costs consideration
Inputs
o Amount of funds spent Inputs
o Number of medical volunteers o Calculate the benefit of funds to local
o Amount of product/equipment program
o Assess impact of volunteers on local
health effort
o Determine appropriateness and
Outputs practical use of product/equipment
o # Services provided/patients Outputs
o # of people trained o Impact on patients and health
o # of facilities improved program
o Impact of training on improving local
health system
Outcomes/Health Impact o Impact on improving local capacity
o % population covered building
o Health impact (morbidly/mortality) Outcomes/Health Impact
o Improvements in markers such as o Use local health impact information if
hypertension and blood glucose possible
o Economic impact o Work with sending organization to
o Patient satisfaction obtain specific health information
o Patient follow up and referral requested
o Also measure local social and
economic impact
‐ Coordinate information on local social,
‐ Create ongoing measurement regarding
health and economic measurement
ethical and health directives (WHO, UN etc.)
(when possible)
‐ Develop information and establish basic
‐ Work with local healthcare system
metrics regarding training and capacity
officials to assess training and capacity
building efforts (including baselines)
building efforts
‐ Develop specific measurements for report to
‐ Provide data and information specific to
donors to document on donations (cash and
request of sending organization/donors.
in-kind) used in the program
‐ Assist in providing pictures and
‐ Also provide qualitative personal reporting in
information to be used only with
the program review
consent, according to sending country
o Debrief – Post MM trip review
norms.
o Documentation of collaborative
‐ Debrief sending organization on MM
future plans and identified health care needs
effort from local perspective
‐ Use information/data to convey
appreciation with appropriate cultural
sensitivities
‐ Work to provide information on next
steps

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Finally, the measurement, evaluation and reports should include narrative describing how
current medical mission effort(s) will be leading towards the long-term goal of improving and
creating locally sustainable health programs. This narrative should also include how the
partnership of sending and host organizations can improve local health system including training
and capacity building efforts. It is also important that the report include attitudinal aspect
regarding mutual respect for all involved, with a special focus on the patient.

References
Bielefield & Cleveland, 2013 Faith- Based Organizations as Service Providers and Their
Relationship to Government, Non-Profit and Voluntary Sector Quarterly
https://doi.org/10.1177/0899764013485160
Caldron P., Impens, A., Pavlova, M., Groot, W. (2016) Economic assessment of US Physician
participation in short-term medical missions Globalization and Health
https://doi.org/10.1186/s12992-016-0183-7
Inter-Agency Standing Committee (IASC), 2016). Best Practice Guide Inter-Agency Community
Based Complaint Mechanism https://interagencystandingcommittee.org/accountability-
affected-populations-including-protection-sexual-exploitation-and-abuse/documents-50
Martiniuk, A et al . (2012) Voluntourism: The downside of medical missions ABC News
http://www.abc.net.au/news/2012-06-12/negin-and-martiniuk---voluntourism/4064550

Tracey, P (2015). NGOs Impact on Health Care Services in Rural Honduras: Evaluating a Short-
Term Medical Mission (STMM) Utilizing a Case Study Approach
https://tspace.library.utoronto.ca/handle/1807/71357

WHO – Documents and Directive

The PQMD Health System Strengthening/ Medical Missions Standards were developed in
accordance with the following World Health Organization Directives:
World Health Organization – Everybody’s Business
Strengthening Health Systems to Improve Health Outcomes
WHO’s Framework for Action 2007
http://www.who.int/healthsystems/strategy/everybodys_business.pdf

World Health Organization – Monitoring the Building Block of Health Systems:

A Handbook of Indicators and their Measurement Strategies 2010
http://www.who.int/healthinfo/systems/WHO_MBHSS_2010_full_web.pdf

World Health Organization – Human Resources for Health: Toolkit for Monitoring Health
Systems Strengthening (2009):
http://www.who.int/healthinfo/statistics/toolkit_hss/EN_PDF_Toolkit_HSS_HumanResourc
es_oct08.pdf

17 
 
 World Health Organization – World Alliance for Patient Safety 2005
http://www.who.int/patientsafety/en/brochure_final.pdf

World Health Organization – People-Centered Healthcare: A Policy Framework (2007)

http://www.wpro.who.int/health_services/people_at_the_centre_of_care/documents/ENG-
PCIPolicyFramework.pdf

World Health Organization – Partnership for Safer Health Service Delivery:

Evaluation of WHO African Partnerships for Patient Safety 2009-2014
http://www.who.int/patientsafety/implementation/apps/evaluation-report.pdf

World Health Organization – WHO Guidelines for Safe Surgery 2009

WHO Safe Surgery Checklist 2009
https://www.ncbi.nlm.nih.gov/books/NBK143243/pdf/Bookshelf_NBK143243.pdf
http://www.who.int/patientsafety/safesurgery/tools_resources/SSSL_Checklist_finalJun08.
pdf

World Health Organization – The World Health Report 2008 – Primary Health Care: Now
More Than Ever.
http://www.who.int/whr/2008/whr08_en.pdf

World Health Organization – Laboratory Biosafety Manual 2004 – Third Edition Primary
http://www.who.int/csr/resources/publications/biosafety/en/Biosafety7.pdf

World Health Organization – Classification and Minimum Standards for Foreign Medical
Teams in Sudden Onset Disaster
http://www.who.int/hac/global_health_cluster/fmt_guidelines_september2013.pdf?ua=1
World Health Organization – Laboratory Biosafety Manual 2004 – Third Edition Primary
http://www.who.int/csr/resources/publications/biosafety/en/Biosafety7.pdf

World Health Organization- Laboratory Assessment tools 2012

http://www.who.int/ihr/publications/laboratory_tool/en/

World Health Organization-Strengthening Laboratory Management towards Accreditation

http://www.who.int/tb/laboratory/afro-slipta-checklist-guidance.pdf

Appendix A: LIST OF DEFINITIONS

The following definitions are provided to assist in the understanding of the terminology used in
the PQMD Standards.
‐ Audited Financials - are financial statements which have been prepared in accordance
with the financial standards of a country and have been audited by a qualified
independent auditor and includes notes to state whether or not the entity is in
compliance with financial requirements.

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 o Form 990 (officially, the "Return of Organization Exempt from Income Tax”) is the
service form of United States Internal Revenue that provides the public with financial
information about a nonprofit organization.

o T3010 (officially the “Registered Charity Information Form”) is the Canadian Revenue
Agency form that provides the public with financial information about a nonprofit
organization.

o GAAP (Generally accepted accounting principles) are a collection of commonly

followed accounting rules and standards for financial reporting adopted by the US
Security and Exchange Commission.

o IFRS (International Financial Reporting Standards) are the collection of standard

accounting rules and Standards followed in Canada and many other nations.

o 501 (C) 3 is a name used for US tax-exempt organizations (charity organizations).

The name refers to the section of the United States Internal Revenue Code (26 USC
Section 501(c) which grants tax free status to charity organizations which comply with
the rules therein.

o Canadian Revenue Agency is the government department that qualifies and

regulates charity/tax exempt organizations in Canada. To be recognized a tax exempt
the organizations must be registered with the Charities Directorate of the Canada
Revenue Agency.

‐ Biomedical Equipment Technician is a trained individual, usually in electro-

mechanic, that ensures medical equipment is well-maintained, properly configured and
is functioning safely.

‐ Bylaws is a set of rules used by most charity organizations to provide governance,

structure and establishes procedures to regulate itself. Bylaws derive their authority by
being tied to some higher authority generally a legislature or some other government
body.

‐ Capacity Building (healthcare) is the process where efforts are made to strengthen the
skills, competencies and abilities of people, facilities and organizations in developing
societies so they can overcome causes of suffering. The capacity building process
begins with understanding the obstacles that inhibit entities from realizing their
development goals. Then enhancing the abilities and physical facilities that will allow
them to achieve measurable and sustainable results.

‐ Code of Conduct is a set of rules outlining the social norms and rules and
responsibilities of an organization. This includes principles, values, standards, or rules
of behavior that guide the decisions and procedures of an organization in a way that 1)
contributes to the welfare of its key stakeholders, and 2) respects the rights of all people
affected by its operations.

‐ Cultural Sensitivity Cultural sensitivity is being aware that cultural differences exist
between people without assigning them a value – positive or negative, better or worse,
right or wrong. It simply means that you are aware that people are not all the same and
that you recognize that your culture is no better than any other culture. A challenge for

19 
 
 members of dominant cultures.

‐ Due Diligence is a systematic investigation of an organization prior to entering a

relationship. Due diligence can be a legal obligation, but the term more commonly
applies to voluntary investigations. Due diligence typically leads to more informed
decisions by ensuring that the information collected in done in a complete quality
organized manner.

‐ Foreign Medical Teams: groups of health professionals (doctors, nurses, paramedics

etc.) that treat patients affected by an emergency or disaster. The WHO established the
standards for medical mission teams in the 2013 Classification and Minimal Standards
for Foreign Medical Team document. These standards also emphasize that teams be
properly trained and self-sufficient so as not to burden the national system.

‐ Ethical Standards refers to commonly accepted principles that encourage the

values of trust, fairness and benevolence. Ethical standards are broad statements,
open to interpretation and not easily enforceable. However, the ethical directives
by organizations such as the United Nations /World Health Organization (WHO)
are generally accepted worldwide. It is every health care providers obligation to
follow and adhere to the specific regulations and professional practice standards
set by their respective college or governing body by country/province/state.

‐ Faith-based organizations are charitable organizations whose values are based on

religious or spiritual beliefs and have a mission based on the social and cultural values
of their particular faith. Many faith-based organizations have health ministries and are
active on an international scale including medical missions (Bielefield & Cleveland,
2013).

‐ Foreign Corrupt Practices Act (FCPA) is a US federal law that pertains to ethical
requirements for any organization or individual involved with foreign activities. The FCPA
has two provisions, the first addresses accounting transparency requirements; the
second concerns bribery of foreign officials. Corruption of Foreign Public Officials is
the Canadian Law which pertain to ethical dealings with foreign officials.

‐ Health Information: is the data and process that provide reliable and timely knowledge
for management decisions regarding health services and the management of the
healthcare systems. Health information also provides data and knowledge to assess
health determinants and health status.

‐ Health Services: include primary, secondary, and tertiary care, ranging from promotion
and protection of health to hospital, rehabilitation and palliative care services (Stamler,
Yui & Dosani, 2015).

‐ Healthcare Systems is the organization of people, institutions, and resources that

deliver health care services to meet the health needs of the population. Each nation
designs and develops their individual health systems in accordance with their needs and
resources.

‐ Healthcare Training is any activity focused on teaching medical professionals and

support staff on methods that can be used to analyze and improve health quality. This
also include clinicians, community health workers and health managers. Healthcare

20 
 
 training is designed to improve the skills, competencies, clinical experience, required to
meet the health needs of the populations they serve.

‐ Health Workforce: are the medical practitioners and staff involved with health care
service and support. The principle for the health workforce is to work in ways that are
responsive, fair and efficient to achieve the best health outcomes possible, given
available resources and circumstances.

‐ HIPAA: is an acronym that stands for the Health Insurance Portability and
Accountability Act, a US law designed to provide privacy standards to protect patients'
medical records and other health information. HIPAA includes information that is
provided to health plans, doctors, hospitals and other health care providers. HIPAA has
been used as a reference for patient privacy policy worldwide.

‐ Host Country is the term for nations in which organizations or individuals conduct
activities such as humanitarian efforts, government intervention or other purposes. While
in the host country the guest must comply with the laws and regulations of the host
country.
.
‐ Host Organizations is the local entity in the host country that invites and support the
sending organization and volunteers. While the role of the host organization will vary
based on the specifics of a program, the responsibilities of host organizations typically
include; receiving the guests, providing facilities for the program, furnishing in-country
resources, and providing local expertise required for the successful implementation of
the in-country program.

‐ Humanitarian Organizations/NGOs are charitable entities (termed as 501 C 3

organizations in the US) which provide philanthropic programs and support to help
people in need. The primary purpose of humanitarian NGO organizations are efforts
such as; saving lives, reducing suffering and maintaining respect to human dignity and
addressing health and social economic situations.

‐ Information Technology (IT) is the development, maintenance and use of computers,

storage, networking and other physical devices. This includes the infrastructure and
processes to create, process, store, secure and exchange all forms of electronic data -
for the purpose of processing and distributing data and information.

‐ In-country NGOs (INGO) – are humanitarian charitable organizations within the host
country that create and manage philanthropic programs to support and serve people in
need. The INGOs are major partners for medical missions - along with other groups
such as churches, school, government agencies, universities etc.

‐ Laboratory (medical) is a facility established to conduct tests in order to obtain

information about the health of a patient pertaining to diagnosis, treatment, and
prevention of disease. Clinical laboratories are focused on applied science, as opposed
to research laboratories that focus on basic science.

‐ Medical Missions: Medical Missions are teams of individuals, generally including

healthcare professionals (doctors, nurses, and other medical professionals) and support
individuals traveling to a LMIC country to provide medical services, and training to help
support the health of the population.

21 
 
 Medical Mission are often classified in three time durations:
- Short-term missions - 4 weeks of less
- Medium-term missions - Five weeks to 6 months
- Long-term missions - 7 months to 2 years

‐ Medical Products, Vaccines and Technologies are elements essential for a well-
functioning health system. To be effective, the products, vaccines and technologies
must be of assured quality, safety, efficacy and cost-effectiveness and appropriate for
local needs.

‐ Ministry of Health (MoH) is the national government department responsible for issues
related to the general health of the citizenry. Health departments also compile statistics
about health issues. The head of the Ministry of Health is often called the Minister of
Health.

‐ Mission Statement is a written declaration of an organization’s core purpose and focus.

Mission statements normally remain unchanged over time. Mission statements serve as
1) filters to separate what is important to the organization from what is not 2) clearly
state which area will be served and how 3) communicate a sense of intended direction to
the entire organization.

‐ Monitor and Evaluation (M&E) is a process designed to helps improve performance

and achieve results. Monitoring is the systematic and routine collection of information
during a program to track and account for resources used to help make decisions on
program execution. Evaluation is the assessment of a project after completion, to review
and determine the relevance, effectiveness, efficiency, impact and sustainability of the
program.

‐ Office of Foreign Assets Control (OFAC) is the financial intelligence and enforcement
agency of the US Treasury Department charged with the planning and execution of
economic and trade sanctions in support of U.S national security and foreign policy
objective. OFAC carries out its activities against foreign states as well as a variety of
problematic organizations and individuals, like terrorist groups, deemed to be a threat to
U.S. national security Minister of Foreign Affairs is a Canadian governmental
department that conduct similar function for Canada

‐ Paternalistic Attitude is behavior by an individual, organization or state that limits the

liberty or autonomy of others for what is presumed to be for “their own good”.
Paternalism can imply behavior taken regardless of the will of others and expressed in
an attitude of superiority. It is usually unwelcomed as it comes with control and
condescension

‐ Patient Safety is a fundamental principle of heath care where actions are taken to
protect the patient from harm. Patient Safety is a major WHO directive. Patient safety
includes a wide range of actions including infection control, safe use of medicines,
equipment safety, safe clinical practice and safe environment of care.

‐ Partnership of Quality Medical Donations (PQMD) is a global alliance of corporations

and nongovernmental organizations. PQMD is leading the development and
championing of high standards in medical supply and service donations. PQMD seeks

22 
 
 to enhance access to health care in underserved communities and in areas affected by
disasters.

‐ PQMD Healthcare System Strengthening /Medical Mission Initiative (PQMD

HSS/MM) is a major 3-year effort to explore the shortcoming of current practices in
medical mission and work to design and develop guidelines that better connect medical
mission volunteers with the needs and priorities of national healthcare systems. In
addition, PQMD HSS/MM aims to create a coalition of organizations, experts, institutions
and individuals that will be a consultant group to continuously update information, share
knowledge and innovation and keep guidance relevance and valuable to all those
involved.

‐ Primary Care is the day-to-day healthcare given by a healthcare provider-typically the

first point of contact for the patient within the healthcare system. Patients commonly
receive primary care from professionals such as a physician or physician assistant. In
some localities the primary care professional may be a nurse, pharmacist, or a clinical
officer (as in parts of Africa), Depending on the nature of the health condition, patients
may then be referred for secondary or tertiary care facilities.

‐ Safe Surgery is the initiative by the World Health Organization (WHO) to improve the
safety of surgical care around the world by defining a core set of safety standards that
could be applied in all WHO Member States. Safe Surgery publications include the 2009
WHO “Safe Surgery Saves Lives” directive and the 2008 WHO safe surgery Checklist

‐ Surgery is the treatment of injuries or diseases by cutting open the body and removing
the damaged part. Surgical procedures are commonly categorized by urgency, type of
procedure, body system involved, degree of invasiveness, and special instrumentation.
Examples of surgical specialties include; cardiothoracic, colon and rectal, general
surgery, gynecology and obstetrics, gynecologic oncology, neurological, ophthalmic, oral
and maxillofacial, orthopedic surgery, otorhinolaryngology, pediatric, plastic, urology,
and vascular surgery.

‐ Secondary Care is medical care provided by a specialist or facility upon referral

from the primary care provider. Secondary health care providers include
cardiologists, urologists, dermatologists and other such specialists. The health care
services received in secondary care facilities include acute care, short period stay in a
hospital emergency department for brief but serious illness.
Standards are rules or principles used as a basis for judgement and may include
authoritative statements that articulate acceptable levels of performance.

‐ Sending Organizations (medical missions) are groups that send out medical mission
or medical brigades to LMIC countries. Examples of medical mission sending
organizations are; Humanitarian organizations, Faith-based NGOs,
Colleges/Universities/Medical schools. Churches/religious organizations etc. Ideally,
sending organizations are responsible for screening of volunteers, providing orientation
and preparation of volunteers for the local program, arranging for the travel and safety of
the volunteer, planning for the ethical and successful implementation of humanitarian
health program – which will be conducted in partnership with the host organizations in-
country.

23 
 
 ‐ SPHERE Project is a voluntary association of various humanitarian organizations
designed to set standards to improve the quality of assistance provided to people
affected by disasters The SPHERE project also sets standards to enhance the
accountability of the humanitarian system in disaster response. The primary publication
of the SPHERE project is the handbook, Humanitarian Charter and Minimum Standards
in Disaster Response. Members of the SPHERE project includes organizations such as
Care International, Caritas, International Federation of the Red Cross and Red Crescent,
Lutheran World Relief, Oxfam, The World Council of Churches, and Medescins Sans
Frontieres (Doctors without Borders).

‐ Tropical Health Education Trust (THET) is the UK Health support organization that
provides links between health institutions in Africa, Asia and elsewhere in the world and
their counterparts in the UK. THET identifies health priorities then links them with a
health institution in the UK that has the knowledge and skills to help them address their
health priorities. THET also provides advice and support, such as accessing funding,
evaluation and connections with Government agencies.

‐ Tertiary Care is the highly specialized medical care and healthcare facility that
provides medical service over an extended period of time. The patients are
referred to tertiary care from primary or secondary health professionals. Tertiary health
care is provided in a facility that has facilities for advanced medical investigation and
treatment. Tertiary care involves advanced and complex procedures and
treatments performed by medical specialists. Services provided include care such
as cancer management, neurosurgery, cardiac surgery and a host of complex medical
and surgical interventions.

‐ World Health Organizations (WHO) is the specialized agency of the United Nations
that is concerned with global health. The WHO currently defines its role in public health
as follows:

 providing leadership on matters critical to health

 shaping the health research and disseminating valuable knowledge;
 setting norms and standards and promoting and monitoring their
implementation;
 articulating ethical and evidence-based policies;
 providing technical support, catalyzing change, and building sustainable
institutional capacity;
 monitoring the health situation and assessing health trends.

24