There has long been a notion that military and development operations are completely unique. While it is true that both have different priorities, needs, and methods, there are lessons to be learned between the two communities. At the Association of the United States Army 2017 Medical Symposium, I heard firsthand how the military is modernizing medical care delivery to soldiers and their families. Listening to these new approaches, I considered how these changes could translate to a global health setting. Despite the obvious differences, I believe that many health systems can learn from military health care.
In both military and global health,
- the health system has to deal with treating patients in austere settings, often a day’s journey—or more—from a major hospital,
- there are limits on the availability of doctors on the front line, causing reliance on medics or clinicians with limited training and resources, and
- the focus is on delivering care that promotes the productivity of patients.
Given these similarities, the global health community can learn several practices from military operations.
Treatment vs. Evacuation
When patients are far from the advanced medical care a full hospital can deliver, transportation (what the military calls evacuation) becomes a challenge. Transporting sick or injured patients can be difficult because it not only involves delivering the patient safely, but maintaining a level of medical care along the way.
The military has in place, and continues to refine, practices that clearly identify what treatments can be administered in the field by a medic, what can be administered in a temporary field hospital, and what situations require evacuation. By changing the levels of care, like giving medics different training and resources, the military can balance which patients will need to be transported. More importantly, there is clear criteria for clinicians to make these decisions. While most global health systems have levels of care similar to the military system (community clinics, regional clinics or hospitals, and national or major hospitals), the guidance on what level of need demands transportation to a higher level of care is often informal and at the patient’s discretion rather than in accordance with set guidelines. Formalizing a system of care and identifying what medical needs trigger movement to the next level of care can help all levels of the health system better focus on the specific care delivered and help patients navigate the system. In turn, this can lead to decisions that improve care at the community level and prevent patients from making unnecessary and costly journeys to major hospitals.
Using Technology to Cover Distance
In both settings, clinicians in the field often encounter patients requiring treatment beyond the clinician’s training, yet can’t wait for transport to the next level of care (or require stabilization before transportation). The military is exploring ways to use technology to close this gap. Mobile communication, even in most developing countries, has advanced to allow for easy sharing of voice, text, and visual media. This allows clinicians and medics in the field to communicate with more highly trained medical personnel to deliver care to the patient in need. It also allows clinicians in the field to deliver lifesaving care, regardless of prior patient or situational training. Successfully accomplishing this requires having defined technology tools for clinicians to use for communicating and a formalized organizational structure so clinicians know who to call for what situation and are guaranteed a response every time.
Empowering Communities to Lead in Healthcare
The military continues to refine the way it communicates the importance of healthcare to the community with an understanding that people who take responsibility for their healthcare are healthier and better patients. Beyond just delivering reminders about regular check-ups and the importance of preventative care, such as vaccines and healthy lifestyles, the military emphasizes the importance of health to the outcomes of the individual and community. The military also tracks patient behavior and looks for ways to engage patients who are not getting the preventative care they should. While the military has a level of control over its patients that most clinicians don’t, improved patient engagement is still a path to better community health. In many countries, HIV/AIDS programs are achieving good levels of patient engagement by communicating healthy lifestyles to patients while emphasizing self-care and pharmaceutical adherence. These programs can be expanded to other patient communities to continue that success. Empowered patients receive more preventative care, reducing community health risks and improving economic outcomes.
There will always be differences between military and community health delivery. However, by understanding how military medical organizations address delivering high levels of care in difficult environments, health systems can find ways to deliver better care within their resource constraints.
LMI will be hosting its second annual Global Health 2030 Symposium on October 4, 2017, at the United States Institute of Peace. We invite you to join us to learn more about global health systems and the impact technology has on global health and epidemics.
“Having served for over 40 years in the federal space, I have a deep appreciation of the pressures and challenges federal managers face. My background provides an extensive array of practical solutions and alternatives that I draw on in my support of federal clients. It’s a privilege to continue to be involved in public service.”