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Advocating for Equitable Access to Global Health Internship Opportunities

Kaleem Hawa, Oluwaseyi Owaseye, Tara Kedia, and Ashton Barnett-Vanes comment on unequal access to global health career training opportunities and announce a fundraising campaign to help support internships at WHO Headquarters for young health professionals from low and middle income countries.

Image Credit: tup wanders, Flickr
Image Credit: tup wanders, Flickr

Global health is a field in which thousands of interns work every year. Some may undertake an internship as part of their academic programme, others as a work placement. Irrespective of an intern’s professional background, these placements afford candidates the opportunity to boost their skill sets, prepare or launch their global health careers, and develop academic or experiential global health knowledge that may be invested back into their local health systems.

Curiously, whilst equitable access to health care is a core value of global health and universal health care, equitable access to internships in this field has received far less scrutiny. A report by the UN’s Joint Inspection Unit in 2009 using 2007 data found that United Nations internships (including those offered by the World Health Organization) were inaccessible to many, with almost 60% of candidates from a high-income country. Surveys conducted in 2011 and 2013 at World Health Organization Headquarters (WHO-HQ) in Geneva, Switzerland support this finding, with only a quarter of WHO-HQ interns coming from low- or middle- income countries (LMICs). In many cases, this inaccessibility stems in part from the financial barriers and costs of living associated with an unpaid position in an expensive, global city like Geneva.

Young health professionals from high disease-burden regions have fewer international training opportunities than their peers from lower-burden regions (Figure 1). In the South-East Asia (SEARO) and Africa (AFRO) regions, 81% of countries are defined as low- or lower-middle income. The unpaid status of these internship programs likely restrain such candidates from applying without self-funding or financial support. Perniciously, these countries have the highest health burdens (Figure 1).

Supporting global health training opportunities could offer several benefits to WHO and other global health agencies. Interns from LMICs will aid research and priority-setting ongoing at WHO-HQ (each intern brings with them a wealth of experiential knowledge that can be helpful in WHO policymaking) and, upon return to their home countries, will directly build the capacity of personnel working in health systems in LMICs, where much of WHO’s work takes place. For example, one of the authors is now State Manager of the Ebola Emergency Operation Centre in Lagos, Nigeria. Meanwhile, former WHO-HQ intern Dr Bruce Aylward is now Assistant Director General and Coordinator of the Global Ebola Response.

As an organization with a diverse and global employee base, WHO should take the lead on having an equally diverse intern community. Our goal as the alumni network of former WHO Interns is to make access to international global health internships more equitable, at WHO-HQ and beyond. We have already begun mobilising the global health community on this issue through the release of our publication last year in the Lancet Global Health.

Our next step is to support two accepted LMIC interns at WHO-HQ Geneva. Alongside this, their experiences and perspectives will be featured in a documentary and report to raise public awareness on internship access. Interns will be selected by an independent panel of public health experts based on their capacity to lead and motivation to invest skills learnt back in their home country.

We’re fundraising to support these interns financially and produce the documentary through a Royal Society of Arts backed Kickstarter campaign. It is important to recognise that transformative learning experiences such as internships are a key component of health systems capacity building, and global health agencies should acknowledge the importance of strengthening the public health and policy skills of young health professionals in LMICs.

We’re live until the 9th July! This is a unique opportunity to effect real culture change towards the accessibility of global health training opportunities. Please donate and become part of this change.

Figure 1

Figure 1 - Intern Representation
Image credit: Kaleem Hawa, et al.

 

Circle size represents the percentage of interns from WHO regions, based on their described country of origin from survey data of two summer intern cohorts (2011, n=192, and 2013, n=157). 2011 data are not shown but are very similar to 2013 data. Data were granted exemption from review by the Institutional Review Board at Dartmouth College, USA on 28/01/2014. Data on the burden of disease, expressed as disability-adjusted life-years (DALYs) for all causes and both sexes, are from the GBD Data Set, Institute for Health Metrics and Evaluation, University of Washington. High-income North America denotes United States and Canada.

Acknowledgments

Much of this could not have been accomplished without the help of the other members of the Network of WHO Intern Alumni (Kyle Ragins, Jordan Jarvis, Flora Olcott, and Cai Long). Further thanks must go to former WHO interns Jim Murphy, Susan Ifeagwu, Kieren Egan, Wendy Leung, and Chris Dittrich for helping with the establishment of timeline and coordination of efforts. We thank the Royal Society of Arts for support with the Kickstarter campaign.

Declarations

We declare that we have no competing interests. AB-V and TK were former interns at WHO headquarters in 2012, KH and OO were former interns at WHO Headquarters in 2013.

Authors

Kaleem Hawa, Network of WHO Intern Alumni; Trinity College, University of Toronto, CA

Oluwaseyi Owaseye, BS.c, Network of WHO  Intern Alumni; University of Ibadan, Nigeria

Tara Kedia, B.A., Network of WHO Intern Alumni; Dartmouth Medical School, USA

Ashton Barnett-Vanes, BS.c, F.R.S.A, Network of WHO Intern Alumni; Imperial College London, UK

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