Setting the agenda in global health education

Mr Eric O’Flynn outlines how Irish doctors are supporting health workforce training in low-resource settings worldwide

It has been recognised for some time that the world has too few healthcare workers to meet the needs of its population and that the problem is worsening. The World Health Organisation estimates a shortfall of 11 million healthcare workers by 2030. While this challenge is acutely felt in Ireland, it is in low- and lower-middle income countries where the shortage is greatest. This gap results in the loss of hundreds of millions of years of life each year and hundreds of billions of dollars in economic productivity. Behind every statistic is a person: Someone who is not receiving childhood vaccinations, is at risk from preventable complications related to pregnancy and childbirth, or is not receiving the life-saving surgery they need.

International cooperation and partnerships are critical in supporting the development of the global healthcare workforce. For a small country, Ireland has been a surprisingly impactful partner to many countries facing extreme healthcare workforce challenges, with a particularly strong impact in east and southern Africa. The most effective international cooperation in medical and nursing education is an approach which supports low-resource setting training institutions to deliver training locally. While there can be value in bringing students and trainees from low-resource settings to study and train in Ireland, it is not a scalable solution and often contributes to medical migration. Similarly, while high-income country partners can provide valuable educational experiences by travelling to deliver courses in low-resource settings, it simply can never be enough. Ultimately, only empowered local training bodies can effectively develop the healthcare workforce that their own populations need. The appropriate role for partners in high-resource settings such as Ireland, is to help local training bodies achieve their goals by leveraging the training capabilities in their own country.

Challenge

To be effective partners, Irish institutions must understand the changing nature of the healthcare workforce challenge faced by low- and lower-middle income countries. As well as a desperate lack of healthcare workers in many such countries, many of the very same countries also now face the paradoxical challenge of high medical unemployment. As significant investments in medical education, particularly in undergraduate medicine, result in dramatic increases in the number of newly graduated doctors, the workforce has been unable to absorb them. This means that many new doctors face unemployment or informal employment, which understandably creates further incentives for medical migration. As a somewhat extreme example, Ethiopia increased the number of medical schools in the country from five in 2005 to 43 in 2022.

While every country and healthcare worker cadre is different, the changes seen in Ethiopia are broadly reflective of a new context for training in low-resource settings. The challenge for national governments and local and international partners is no longer to simply train more doctors and nurses, but rather to assure the quality of training and practice, align education and employment strategies, and provide better opportunities for further education, specialisation, and lifelong learning.

Symposium

These issues and more were explored at the Global Health Education Ireland Symposium 2025, which was held in the RCSI in late October. The Symposium is an annual event, organised by the global health committee of the Forum of Irish Postgraduate Medical Training Bodies and hosted in rotation by each of the Irish Postgraduate Medical Training Colleges. It brings together trainees, members, Fellows, and staff from the Irish Colleges, as well as other key global health stakeholders and international partners.

We can see reflected in the Symposium programme clear trends in the changing nature of how Irish medical training bodies, universities, NGOs, and other partners are working in global health education. Increased Irish interprofessional cooperation is evident. The RCSI, the College of Anaesthesiologists, and the Institute of Obstetricians and Gynaecologists in the RCPI all support the development of partner postgraduate training colleges in surgery, anaesthesia, and obstetrics in east, central, and southern Africa. The RCPI works with the HSE Global Health Programme to support postgraduate training in Zambia, specifically. Members of other colleges contribute to the Irish College of GPs’ programmes supporting primary care in Malawi. There are many other examples and such cooperation adds huge value to Irish colleges’ global health initiatives.

Curriculum

Bringing this learning back home, a global health curriculum for specialist medical training in Ireland has been jointly produced by all of the Irish training bodies, designed to integrate core global health competencies into all postgraduate medical training programmes in Ireland. A core part of the curriculum is an e-learning course, which is available on each college’s own e-learning platform and is also available to all Irish healthcare workers through the Irish Global Health Network (https://globalhealth.ie/emodules/).

Another clear theme is leveraging emerging technology. Examples include training in affordable point-of-care ultrasound in low-resource settings, low-cost simulation using local materials, the United Nations Global Surgery Learning Hub open-access e-learning platform, and artificial intelligence-assisted education in Sudan. It is heartening to see critical thinking about practices in Ireland that have global impact; from how we teach global health, to how humanitarian research is conducted, to tackling environmentally unsustainable practices in the delivery of healthcare in this country.

There are numerous opportunities for doctors in Ireland to contribute to healthcare education in low-resource settings. To achieve maximum impact, we must prioritise coordination, foster interprofessional cooperation, and learn from our partners in low-resource settings.

There are numerous opportunities for doctors in Ireland to contribute to healthcare education in low-resource settings

The Global Health Education Ireland Symposium 2025 was held on 22 October in the RCSI. The theme of the Symposium was ‘Ask not what global health education can do for you, but what you can do for it’.