Volunteers are an integral part of the International Red Cross and Red Crescent (RCRC) Movement, with over 16 million people actively contributing to humanitarian action worldwide. Academic volunteerism within the Movement includes contributions from students, volunteers and professionals from academic institutions who offer their time and expertise. In this study we aimed to understand the process of embedding academic volunteers in humanitarian organizations such as the Canadian Red Cross (CRC) and assess the impact of their activities within the realm of public health education. We used a qualitative case study design with an instrumental approach. All documents related to academic volunteers within the CRC database from September 2018 to August 2023 were gathered and reviewed. Data related to the processes around engaging with volunteers, timelines, outcomes and feedback surveys from students and staff members were extracted and a content analysis was conducted. A return-on-investment analysis (ROI) was conducted to assess the financial impact of engaging academic volunteers. A total of 68 academic volunteers were engaged with CRC, including unpaid or partially paid master’s students, doctoral and postdoctoral fellows, and student volunteers. The collaboration between CRC and academic volunteers contributed to educational enrichment, professional development, knowledge transfer, operational efficiency, and talent pool expansion. Results from a survey on academic volunteerism further highlighted benefits such as maintaining project schedules, promoting diversity, and amplifying the Movement’s voice on important matters. The return on investment for unpaid academic volunteers and Masters students was 70

Universal Health Coverage (UHC) will not be achieved if health care worker shortages, estimated to increase to 18 million by 2030, are not addressed rapidly. Community-based health systems, which pivot to effective engagement of community health workers (CHW), may have an essential role in linking communities with health care facilities and reducing unmet health services needs caused by these shortages. The Canadian Red Cross (CRC) has partnered with different National Red Cross/Red Crescent Societies and Ministries of Health in Africa in the implementation of programs where CHWs contributed to the provision of various health services. This study reports on key findings (i.e., beneficiaries reached, CHWs engaged, programs implemented, intervention outcomes) and lessons learned from CRC supported CHW programs in Africa over the last 15 years (2007-2022). Qualitative methodology was employed to conduct document analysis on 17 sets of reports from each CRC-supported community health worker project in Africa over the past 15 years. Focus was on identifying challenges, facilitators, and lessons learned. CRC supported projects have trained over 9000 CHWs, benefiting nearly 7.5 million people across Africa. Key success factors include adaptability and agility in programming and project management, and considering contextual factors (political, social, and cultural systems). Investing in essential training for CHWs, staff, and volunteers is crucial, alongside employing an evidence-based approach to inform all aspects of programming and implementation. Additionally, projects prioritizing protection, gender and inclusion (PGI) while leveraging existing community structures and partnerships important for successful implementation. Despite challenges (i.e., weak health systems, lack of political commitment, insufficient funding, inadequate training) CHWs are recognized as crucial in promoting community-based health, improving access to care, addressing disparities, and contributing to achieving (UHC). Their unique position within communities enables them to provide culturally appropriate and localized primary health care- particularly in remote, resource limited and poverty-stricken regions.

BACKGROUND:The delivery of quality healthcare for women and children in conflict-affected settings remains a challenge that cannot be mitigated unless global health policymakers and implementers find an effective modality in these contexts. The International Committee of the Red Cross (ICRC) and the Canadian Red Cross (CRC) used an integrated public health approach to pilot a program for delivering community-based health services in the Central African Republic (CAR) and South Sudan in partnership with National Red Cross Societies in both countries. This study explored the feasibility, barriers, and strategies for context-specific agile programming in armed conflict affected settings.METHODS:A qualitative study design with key informant interviews and focus group discussions using purposive sampling was used for this study. Focus groups with community health workers/volunteers, community elders, men, women, and adolescents in the community and key informant interviews with program implementers were conducted in CAR and South Sudan. Data were analyzed by two independent researchers using a content analysis approach.RESULTS:In total, 15 focus groups and 16 key informant interviews were conducted, and a total of 169 people participated in the study. The feasibility of service delivery in armed conflict settings depends on well-defined and clear messaging, community inclusiveness and a localized plan for delivery of services. Security and knowledge gaps, including language barriers and gaps in literacy negatively impacted service delivery. Empowering women and adolescents and providing context-specific resources can mitigate some barriers. Community engagement, collaboration and negotiating safe passage, comprehensive delivery of services and continued training were key strategies identified for agile programming in conflict settings.CONCLUSION:Using an integrative community-based approach to health service delivery in CAR and South Sudan is feasible for humanitarian organizations operating in conflict-affected areas. For agile, and responsive implementation of health services in conflict-affected settings, decision-makers should focus on effectively engaging communities, bridge inequities through the engagement of vulnerable groups, collaborate and negotiate for safe passage for delivery of services, keep logistical and resource constraints in consideration and contextualize service delivery with the support of local actors.

We thank the authors of the Letter to the Editor (Kassam et al. 2023) for raising excellent points about our scoping review (Hamza et al. 2023). Our goal with this work was to offer a synthesis and mapping of literary conversations about CBME since 1978 as both a resource and a prompt for further conversations about multiple aspects of competency-based medical education (CBME). The letter authors share that in their own program, ‘those who identified as men felt much better prepared for the transition to CBME than those who identified as women.’ We suggest that gender differences in perception of preparedness are likely more related to persistent findings regarding to confidence gaps between men and women (Ehrlinger and Dunning 2003) than to actual preparation or issues specifically related to CBME. However, the authors do raise an important point about observed risks of gender inequity in assessment. This issue highlights the critically important need for ongoing monitoring for bias in assessment related to gender or other learner characteristics to inform strategies to counteract inequity in all learner assessment, including CBME programs (Klein et al. 2019). We agree with the letter authors’ concerns about the risks of reductionism and implementation issues overshadowing the larger goals of CBME to ensure desired outcomes of training. Attention to assessing and monitoring the progress of all learners, not just those in difficulty, is a core feature of CBME design (van Melle et al. 2019). The letter authors also identify ‘a significant omission regarding the individual and societal impacts of CBME.’ We have analyzed and mapped the societal and individual impact of CBME in the article, with more details included in Supplementary Appendix C (Hamza et al. 2023), and we believe this content draws important focus to the larger goals of CBME to balance with the attention to implementation concerns. We agree with the letter authors about the unfortunate lack of sufficient research into the societal impacts of CBME to date. We propose a challenge to leaders across disciplines to balance vision and strategy with tactics and management as they implement and/or evaluate CBME in their contexts.

BACKGROUND:Competency-based medical education (CBME) received increased attention in the early 2000s by educators, clinicians, and policy makers as a way to address concerns about physician preparedness and patient safety in a rapidly changing healthcare environment. Opinions and perspectives around this shift in medical education vary and, to date, a systematic search and synthesis of the literature has yet to be undertaken. The aim of this scoping review is to present a comprehensive map of the literary conversations surrounding CBME. METHODS:Twelve different databases were searched from database inception up until 29 April 2020. Literary conversations were extracted into the following categories: perceived advantages, perceived disadvantages, challenges/uncertainties/skepticism, and recommendations related to CBME. RESULTS:Of the 5757 identified records, 387 were included in this review. Through thematic analysis, eight themes were identified in the literary conversations about CBME: credibility, application, community influence, learner impact, assessment, educational developments, organizational structures, and societal impacts of CBME. Content analysis supported the development of a heat map that provides a visual illustration of the frequency of these literary conversations over time. CONCLUSIONS:This review serves two purposes for the medical education research community. First, this review acts as a comprehensive historical record of the shifting perceptions of CBME as the construct was introduced and adopted by many groups in the medical education global community over time. Second, this review consolidates the many literary conversations about CBME that followed the initial proposal for this approach. These findings can facilitate understanding of CBME for multiple audiences both within and outside of the medical education research community.

Abstract Background The delivery of quality healthcare for women and children in conflict-affected settings remains a challenge that cannot be mitigated unless global health policymakers and implementers find an effective modality in these contexts. CRC and ICRC used an integrated public health approach to pilot a program for delivering community-based health services in the Central African Republic (CAR) and South Sudan in partnership with National Red Cross Societies in both countries. This study explored the feasibility, barriers, and strategies for context-specific agile programming in armed conflict affected settings. Methods A mixed-methods study design was used for this study. Focus groups with community health workers/volunteers, community elders, men, women, and adolescents in the community and key informant interviews with program implementers were conducted in CAR and South Sudan. Additional data related to program activities and qualitative data to validate findings from focal group discussions and key informant interviews were extracted from program implementation reports. Data were analyzed using a content analysis approach and triangulated during the study analysis and inference. Results In total, 15 focus groups and 16 key informant interviews were conducted, and 169 people participated in the study. Engaging community elders emerged as an overarching theme underpinning the importance of gaining community trust. The feasibility of service delivery in armed conflict settings depends on well-defined and clear messaging, community inclusiveness and a localized plan for delivery of services. Security and knowledge gaps, including language barriers and gaps in literacy, impacted service delivery. Empowering women and adolescents and providing context-specific resources can mitigate some barriers. Community engagement, collaboration and negotiating safe passage, comprehensive delivery of services and continued training were key strategies identified for agile programming in conflict settings. Conclusion Using an integrative community-based approach to health service delivery in CAR and South Sudan is an effective approach for humanitarian organizations operating in conflict-affected areas. To achieve successful, agile, and responsive implementation of health services in a conflict-affected setting, decision-makers should focus on effectively engaging communities, bridge inequities through the engagement of vulnerable groups, and contextualize service delivery with the support of local actors.