Table 1

COVID-19 forced innovation case studies summary

CaseProject typePartnershipPre-COVID-19 structureCOVID-19 innovationsFuture plans
1High-income country:
public health response to the COVID-19 pandemic
Massachusetts General Hospital (MGH) Center for Global Health:
  • A centre which partners with diverse international communities and institutions for care delivery, training and research and offers global health education/ training to local and international health trainees.

City of Holyoke Board of Health:
  • Local Board of Health for City of Holyoke, responsible for tracking infectious disease.

MGH Center for Global Health:
  • Focused on global partnerships including clinical rotations, surgical training, research capacity building, disaster response training and global health fellowships (for local and international nurses, residents and scientists).

Holyoke Board of Health:
  • Implemented inspectional services/code enforcement for environmental health-related issues including housing, food safety, waste disposal, wastewater and drinking water (accomplished by Sanitarians).

  • Provided local infectious disease case management including follow-up, tracking and investigation (accomplished by public health nurses).

MGH Center for Global Health:
  • Embedded MGH global health trainees in local board of health operations, implemented a COVID-19 seroprevalence study and developed a bilingual COVID-19 data dashboard.

Holyoke Board of Health:
  • Expanded Sanitarian role from primarily health code enforcement to include disease surveillance activities.

  • Collaborated with MGH Center for Global Health in COVID-19-related innovation including conducting research study and creating data dashboard.

MGH Center for Global Health:
  • Continue international projects.

  • Provide ongoing support for local board of health research goals and strengthening of community-based research efforts.

Holyoke Board of Health:
  • Increase Holyoke’s local community health capacity via shared service agreements with neighbouring boards of health.

  • Modernise code enforcement by incorporating data-driven approaches used during COVID-19 research.

  • Increase the organisation’s focus on health equity by expanding direct funding of positions and programmes that advance health equity.

2Middle-income country: domestic health equity trainingPrevencasa:
  • A community health organisation in Tijuana, Mexico, which provides HIV care and harm reduction services to local underserved communities.

Mexican Medical Social Service Program (Pasantía):
  • A mandatory year of social service following health professional school designed to provide a safety net for the underserved (a licensing requirement in Mexico).

  • Hosted rotating local and international medical students, residents and other volunteer healthcare professionals, many from the USA.

  • Visiting global health trainees had variable duration of rotation time and varying degrees of Spanish fluency.

  • Applied to receive Mexican health professionals in training from different areas (medicine, nursing and nutrition) during their ‘pasantía’ year.

  • Graduates are fluent in Spanish and spend 6–12 months at a time at Prevencasa, allowing more stability for trainees, local staff and patients.

  • Prevencasa’s medical coordinator received a grant from a US-based academic partner through a Justice Border Fellow programme to allow for growth and formalisation of a Social Medicine Curriculum for social service trainees.36

  • Continue to expand the social medicine curriculum for social service trainees, incorporating exposure to health advocacy alliances and global partnerships through medical education grant.

  • Encourage international rotators to work closely in partnership with the social service doctors, fostering exchange of knowledge and skills.

  • Upcoming book chapter with detailed content on lessons learnt in ‘Voices from the Front Lines: The Pandemic and the Humanities’.42

3High-income country:
migrant health elective
Johns Hopkins Global Health Leadership Program (GHLP):
  • Interprofessional advanced clinical elective focused on training future leaders in global health through an exchange of cultural, clinical, and educational knowledge and skills.

Center for Salud/Health and Opportunities for Latinos:
  • Outreach organisation at Johns Hopkins dedicated to promoting equity in health and opportunity for Latinx community in the Baltimore metropolitan area.

  • Established international electives with longstanding relationships with organisations in India, Nepal and Peru available to third-year and fourth-year Johns Hopkins students with a comprehensive pre-departure curriculum/orientation and funding.

  • Piloted a hybrid online/in-person advanced elective in migrant health and human rights in February 2021.

  • Elective students were exposed to medical–legal partnerships through training and participation in virtual forensic evaluations of asylum seekers both locally and transnationally, in partnership with local and international legal organisations coupled with direct service supporting COVID-19-related outreach to the local undocumented Latinx population in Baltimore.

  • Developed a longitudinal patient-centred refugee health elective based on a previously established model and with migrant health and human rights elective feedback.43

  • Incorporate new community partners (for example, local organisation supporting forced migrants) and create new longitudinal client-centred experiences for students, who can sign up to partner with clients to serve as health navigators, providing education/advocacy over the course of a year.

  • Develop new leadership opportunities in the asylum clinic for students who have completed the elective, such as creating a peer coaching model where students can help others to ensure their success when initially volunteering with the clinic.

  • Continue to offer international rotations through longstanding collaborations.

4High and low middle-income countries: curriculum revision for medical/surgical subspecialty trainingUrogynecology Global Health Initiative (UGHI):
  • US-based organisation focused on expanding urogynaecology education, training and service in the Dominican Republic (DR).

Latin American Pelvic Floor Association (ALAPP):
  • International organisation supporting pelvic floor medicine education in Latin America and the Caribbean through courses, workshops, conferences and online access to scientific journals.

  • Conducted in-person urogynaecology intensive training for OB/GYN and urology residents and attendings in the DR with workshops and yearly patient evaluations/surgical trips, under supervision of US-based urogynaecologists.

  • Offered online recorded and live courses, access to international journals and an international week-long in-person urogynaecology conference with workshops and hands-on training for Latin American and Caribbean members.

  • Collaborated to create a longitudinal, year-long, free, virtual urogynaecology course available to healthcare providers in Latin America and the Caribbean, with presentations from international and multidisciplinary experts.

  • Supplemented virtual longitudinal course with hybrid model of surgical simulation and virtual journal club discussions and surgical ‘video cafés’ while elective surgeries were suspended.

  • Continue to offer longitudinal urogynaecology course with yearly improvements (eg, in the 2022 course, each topic was presented by a multidisciplinary panel instead of a single expert).

  • Offer regional urogynaecology intensive hands-on training with local and international experts and local trainees for a discounted price.44

  • Formalise and expand surgical simulation and journal club curriculum to other countries in Latin America and the Caribbean.

  • Include innovative technology, such as Tobii glasses (Tobii Pro, Reston, Virginia, USA), which enables the wearer to live stream and record video images to augment distance teaching in real-time settings for immersive learning and enable virtual consultation.45 46

  • Resume international clinical-surgical activities while maintaining new curriculum.

  • In process of writing detailed account of COVID-19-related innovations as potential model for other global surgery training programmes.