1. Principles and Practices of Global Health Engagement
Dr. Charles Beadling, FAAFP, IDHA, DMCC
Col (ret), USAF,MC, CFS

2. Learning Objectives
Understand the importance of building partnerships, building partnership capabilities and building partnership capacity
Appreciate the need for GHE activities that contribute to sustainable objectives
Recognize key challenges and methods to achieve success in GHE activities

3. Global Health Engagement
OSD Policy Cable re Global Health Engagement (May 2013)
“Health activities which the DoD conducts in support of the National Security Policy and Military Strategy of the United States. They are a means to partner with other nations to achieve security cooperation and build partner capacity through health-related activities and exchanges.”
Emphasis on:
Strategic linkages
Coordination (interagency, international, partner nation)
Capacity-building
Monitoring and evaluation/Measures of Effectiveness
Historically, military medicine has not afforded medical stability operations the same priority as combat operations/force health protection (or ‘delivering the benefit’)
OSD: Office of the Secretary of Defense for Policy
The most definitive guidance we have right now for global health

4. The Sixth Line of Effort
Define and Develop the MHS core resources and competencies to support Global Health Engagement
Ensure a coordinated federal approach with clearly defined objectives;
Identifying/establishing and aligning appropriate DoD resources and sustaining skills;
Evolving our capabilities and capacity with global partners
Sustaining skills in concert with global health requirements and threats
MHS used to have five line of effort but Dr. Woodson added the sixth one pertaining to global health

5. Stability Operations DODI 3000.05 re Stability Operations:
“It is DoD policy that: Stability operations are a core US military mission that DoD shall be prepared to conduct and support. They shall be given priority comparable to combat operations and be explicitly addressed and integrated across all DoD activities…”
Establishes requirement to “Ensure DoD medical personnel and capabilities are prepared to meet military and civilian health requirements in stability operations.”
Stability Operations: Military and civilian activities conducted across the spectrum from peace to conflict to establish or maintain order in States and regions.
DODI: DOD Instructions

6. Medical Stability Operations
DODI – re Medical Stability Operations
“Medical Stability Operations (MSOs) are a core U.S. military mission that the DoD MHS shall be prepared to conduct throughout all phases of conflict and across the range of military operations, including combat and non-combat environments.”

7. Military Health System (MHS) Responsibilities
Traditional’ Responsibilities
‘Peacetime’ Medicine – Garrison, Military Treatment Facilities, US-based, Dependent care
‘Operational’ Medicine – Force Health Protection, Deployed care, Combat Casualty Care
‘Emerging’ Responsibilities
Global Health Engagement/Medical Support to Stability Operations – medical security cooperation, mil-mil medical capacity-building, medical HA/DR, health sector stabilization, health sector reconstruction
Medical Homeland Defense

8. MHS Role in GHE ‘Garrison’ Medicine Operational Medicine
CONUS/MTF care
Dependent care
‘Deliver the Benefit’
Operational Medicine
Deployed care
Combat casualty care
Force Health Protection
CONUS/MTF: Continental United States/Military Treatment Facility
OCONUS?MTF: Overseas Continental United States/Military Treatment Facility (Alaska and Hawaii are included)
Global Health Engagement/ Medical Stability Operations
Medical Homeland Defense

9. MHS Role in GHE
The MHS has a significant role in GHE/MSO across the spectrum from peacetime through conflict:
Medical Security Cooperation
Mil-Mil Medical Capacity-building (subset of Medical Security Cooperation)
Medical aspects of humanitarian assistance/disaster relief
Health Sector Stabilization/Support to COIN
Health Sector Reconstruction

10. Military Health System Role in GHE/MSO
Medical Support to
Health Sector Reconstruction
Medical Support to
COIN/Health Sector Stabilization C O M P L E X I T Y
Medical Support to International Humanitarian
Assistance/Disaster Response
Medical Mil-Mil Capacity Building
Medical Security Cooperation
FREQUENCY
The MHS has a significant role in GHE/MSO across the spectrum from peacetime through conflict

11. MHS Role in GHE
I. Medical Security Cooperation – Component of DoD Security Cooperation Programs
Ongoing, deliberate health activities conducted around the globe to promote security/stability, build relationships with regional counterparts, and prevent/prepare for outbreaks, disasters or instability
Health/Medical capacity-building
Multiple funding sources/streams
Disease surveillance (Global Emerging Infections Program, Overseas labs – NAMRU/AFRIMS)
Direct medical care projects (MEDCAPs/MEDRETEs, US training missions)
Cooperative Threat Reduction
Health clinic construction
Disaster preparedness (medical)
Int’l Avian Influenza/Pandemic Influenza preparedness

12. MHS Role in GHE
II. Mil-Mil Medical Capacity-Building (subset of Medical Security Cooperation)
Military-to-Military efforts to increase capacity in allied militaries to provide health/medical care to their forces and to contribute to medical aspects of stability operations
Military medical training and exercises
Mil-to-Mil subject matter health exchanges/meetings
Global mil-mil medical capacity-building efforts
IMET; Train and Equip
DoD HIV-AIDS Prevention Program (DHAPP)
Defense Institute for Medical Operations (DIMO)
Medical component of Afghan National Army
Medical component of Iraqi Security Forces
NOTE: Significant expansion of DoD mil-mil capacity-building responsibilities underway – with significant implications for MHS
IMET: International Military Education and Training (These international medical personnel receive funding from US to participate in education or training occurs in the US facilities.

13. MHS Role in GHE
(Medical) Humanitarian Assistance/Disaster Relief – Component of DoD HADR efforts
DoD/MHS contributions to health/medical component of international humanitarian/disaster relief efforts
Asian Tsunami
Pakistan earthquake
USUHS/Center for Global Health Engagement (CGHE)
Center of Excellence – Disaster Management/Humanitarian Assistance (USPACOM/Hawaii)

14. MHS Role in GHE
Medical Support to COIN/Health Sector Stabilization – Component of DoD COIN/Stability Operations
DoD/MHS efforts to stabilize a host nation health sector as a component of stability operations
Operation Enduring Freedom/Afghanistan
Commander’s Emergency Response Program (CERP) funds
Provincial Reconstruction Teams (PRTs)
Other civilian health sector support efforts – capacity-building

15. MHS Role in GHE
Health Sector Reconstruction – Component of DoD Reconstruction Operations
DoD/MHS efforts to support host nation health sector reconstruction as a component of reconstruction operations
Operation Iraqi Freedom/Iraq
Coalition Provisional Authority (CPA) Ministry of Health Advisory team – national-level health sector efforts
Need Health Attaché/Deputy Health Attaché billets filled at USEMBASSY
Commander’s Emergency Response Program (CERP) funds
Provincial Reconstruction Teams (PRTs)
New developments re health/medical
Other civilian health sector support efforts – capacity-building

16. Core Principles in GHE Consider Unintended Consequences Do No Harm!
Context matters
Understand Heath (and broader) Context
Culture and Communication considerations
Coordination is essential
Identify stakeholders/ensure proper coordination
Capacity-building approach
Pursue SUSTAINABLE capacity-building

17. Best Practices in GHE Mitigate Unintended Consequences
Do No Harm! (Ethics Presentation)
Coordinate/Coordinate/Coordinate
Identify and engage key stakeholders
DoD, USG, International/non- governmental, partner nation (Stakeholders/Coordination presentation)
Assess and apply health context
Geo-Political, Socio-cultural, health culture, determinants of health, health systems (Health Context Presentation)
Capacity-building approach
Ensure sustained capacity-building

18. Best Practices in GHE – Cont’d
Consider and apply ethical considerations (Ethics brief)
Beneficence, Non-Maleficence, Justice, Autonomy
Assessment driven (needs-based) (HNA brief)
Compile/conduct assessments – gap analysis
‘Strategic’ Planning (Strategic Planning brief)
Vision/Mission/Goals/Objectives
Ends/Ways/Means
Functional/Operational Planning (Functional Planning brief)
Ensure proper execution (Security Assistance Manual)
Monitoring and Evaluation (M&E brief)
Incorporated into strategic planning/program planning/execution

19. Best Practices in GHE – Cont’d
Communication (Strat Comm brief)
Ensure Strategic Communication Plan
Communication Strategy
Standards
SPHERE Standards
Competency
Engage appropriate SMEs
Ensure education/training for personnel

20. Sustainability What is sustainability in relation to GHE?
The ability to be sustained, supported, upheld, or confirmed?
The quality of not being harmful to the environment or depleting natural resources?
Planning and executing activities that contribute to a partner nation’s objectives which either they or their long-term partners can continue once you have left?
To be sustainable, an activity needs to:
Focus on capability or capacity gaps identified by an accurate assessment
Prioritize partner nation objectives (while maintaining US objectives)
Include a transition plan for long-term support, developed from the initial planning stages (preferably)

21. Sustainable Engagement
Builds capacity and self reliance
Maximizes participation / partnership / ownership
Links to other programs
Past and future
Cross sector – ‘Whole of Government’ in US / PN
Other agencies / donors
Sustainable with local culture / religion/ supply chain
Seeks ways to positively impact or foster local employment
Whether mil-mil or mil-civ, if we want savvy, coordinated stability foster engagement, we need to have the discipline to build in these criteria. This makes it harder. These prevent the quick knee jerk, photo op, quick impact project.
But, by following these criteria, we dramatically increase our chance of success in laying the foundation for stability.

22. DoD GHE Areas for focus: Policy/Leadership/Oversight
Education/Training
Career-tracking/professional qualifications
Doctrine, Tactics, Techniques, Procedures
Integration of medical intelligence
Interagency coordination
International coordination
After-Action Reporting/Lessons Learned
Joint/intraservice coordination
Coordination/cooperation between Civil Affairs and Medical
Foreign language/intercultural skills
Monitoring and Evaluation (Measures of Effectiveness)

23. Core Competencies for DoD Health Engagement
Security Cooperation
Cultural Aptitude & Competence
Joint Operations
Joint Operational Planning
Foreign Language Proficiency
Global Health & Health Systems
Civil-Military Operations
Health Diplomacy
Monitoring and Evaluation
Strategic Communication
We must develop and train to the joint skillset and complimentary skillsets to meet the requirements for efficient, cost-effective, and enduring health engagement

24. Mil-Mil Building Partner Health Capacity Activities
Building PN Military Health Capacity
Leadership
Recruit selection, retention
Military Public Health
Aerospace Med
Undersea Med
Trauma care
Military mental health
Amputee care
TBI care
Support to Civ Disaster Resp
Human Rights

25. Thank You! Questions/Comments?