Health Systems Strengthening Through Global Service-Learning: A Mixed-methods Investigation

University of Technology Sydney. Faculty of Health.Internationalisation is a driving strategy of contemporary higher education, and one mechanism for achieving this goal has been through student exchange, using a global service-learning model, where the pedagogical approach leverages reciprocity and shared learning. While data suggest that global service-learning experiences are generally beneficial to the student, the perspectives of the host organisations are less well understood. Moreover, changing models of international development challenge current models of delivery. The aims of this study were to investigate: the delivery of global service-learning experiences in the health sciences; the impact on host communities and their health systems; and based on the study findings develop guiding principles to facilitate health systems strengthening in host countries. This study applied a cross-sectional, mixed methodology design with concurrent qualitative and quantitative data collection. An online survey (n=69) was used to measure attitudes of the three major stakeholder groups in the global service-learning programmes: students; faculty; and hosts. Semi-structured, in depth key informant interviews (n=12) were undertaken with experts in global health education, research and practice, who had experience across global regions as defined by the World Health Organization. Study findings showed that visits from high-income countries to low and middle income countries were significantly more likely to provide services at no cost to the community (p=0.001). Those participants involved in visits with stronger adherence to best practices for global service-learning were significantly more likely to positively view their impact on the local health workforce (p=0.002), and on the quality and use of medical products, vaccines and technologies (p=0.032). Finally, only 12 of the 69 online survey participants (17%) shared data with local healthcare agencies, limiting opportunities to drive improvements. Qualitative data from interviews yielded four main themes: formal opportunities for preparation and processing were important to generating the desired learning and understanding for all groups of participants; fragmented funding and limited time are a challenge in providing mutually beneficial programs; respect and understanding must underpin the building of relationships and the sharing of resources between partners; and in some situations it may be appropriate to completely reconsider international student visits. These data underscore the importance of adhering to best practices. Based on the study findings, five guiding principles for global service-learning are proposed: (1) partnership; (2) preparation; (3) impact analysis; (4) collaboration; and (5) reflection. Finally, the study proposes alternative models of global service-learning particularly considering the role of non-government organisations and leveraging digital technology