Discussion

Even though in recent years the demand for skilled humanitarian health workers has rapidly grown due to the rising number of humanitarian emergencies, there is to date an evident lack of skilled and expert humanitarian personnel. ^{Reference Amat Camacho, Hughes and Burkle7,Reference Colombo and Pavignani8,Reference Niescierenko, Fischer, Prager and Nilles22} Indeed, it is well-established that the effectiveness of the humanitarian response strictly depends on the competencies developed by humanitarian workers through education and training programs. ^{Reference Jacquet, Obi, Chang and Bayram23}

The findings of this comprehensive web-based analysis of currently available education and training programs in humanitarian health may be used by key stakeholders, such as health care providers, employers, sponsors, and educational institutions, to foster the professionalization of humanitarian responders, especially in under-served geographical areas where it is needed the most.

This study was able to identify and characterize 142 humanitarian health training programs world-wide: 18 (12.7%) of them were OOC training programs, while the remaining 124 (87.3%) were based in 30 countries. In this regard, it is important to stress how only a few humanitarian health training programs are currently available to people living in regions affected by humanitarian emergencies, while the vast majority of training programs are based in a limited number of developed countries, a trend consistent with the distribution of other humanitarian training programs world-wide. ^{Reference Rainhorn, Smailbegovic and Jiekak24} Furthermore, besides geographical constraints, high tuition costs appear to constitute an additional barrier to access accredited training programs by local humanitarian health responders from the global South. ^{1,Reference James4} These access barriers are then likely to further widen the gap between the global North and the global South in terms of political power and leadership in humanitarian operations. ^{Reference Roth25} A solution to this problem may be represented by the implementation of online training programs, which would allow health care professionals and students from all over the world to access affordable and high-quality humanitarian health training. ^{Reference Della Corte, La Mura and Petrino26} This solution would be particularly attractive during periods of humanitarian crisis and pandemics, when face-to-face training and traveling are often banned despite the urgent need for such activities. A limitation to this approach is due to the fact that most of the identified online training programs are OOCs, which may pose a challenge for training recognition.

One-hundred twenty (84.5%) of the identified training programs specify credit numbers and system. This facilitates training recognition and credit transfer between different academic institutions, thus improving the trainees’ options for training selection based on their specific needs. Also shown is the existence of different types of training programs ranging from short-term, focused on specific skills, to long-term, providing a comprehensive specialization in humanitarian health, which allows humanitarian health workers to choose the training course that best suits their needs. ^{Reference Ingrassia, Foletti and Djalali21}

Most of the training and assessment methods identified in this study were theory-based, with only a minor emphasis on learning skills. This lack of hands-on learning may be overcome by the implementation of online-based simulations, which would ensure greater accessibility ^{Reference Della Corte, La Mura and Petrino26} while providing effective and efficient training and assessment methods for cognitive skills and decision making. ^{Reference Cook and Hatala27–Reference Burkle, Kushner, Giannou, Paterson, Wren and Burnham29}

In a humanitarian health worker survey, the respondents rated “needs assessment” and “public health” as essential knowledge for all humanitarian workers. ^{Reference Burkle, Walls and Heck17} Fittingly, this study found that public health was the most frequently addressed topic in the identified humanitarian health training programs. This is particularly relevant if one were to consider that to Niescierenko, et al, the gaps in global health competencies have been associated with poor knowledge about specific public health areas, such as humanitarian principles and architecture, outbreak investigation, and surveillance. ^{Reference Niescierenko, Fischer, Prager and Nilles22} Although being generally addressed in public health courses, these topics are often disregarded in short, specific courses.

Another important issue is that humanitarian responders also lack operational skills, such as management and leadership, or are unable to transfer their skills into the humanitarian context. ^{Reference Briscoe19} Consistently, the analysis reveals that management is at a low level of consideration (n = 7; 4.9%). Importantly, most of the identified humanitarian health training programs are courses taught in the context of public health, international health, and/or global health master’s programs, while a fewer number of these courses are present in humanitarian aid master’s programs. Thus, explaining why trainees are often unable to transfer their skills into the humanitarian field. Also, few identified training programs have competency-based curricula, although this study was unable to ascertain whether these competencies were related to the humanitarian sector or to other fields.

The identified training programs tended to have a high rate of missing data available online. For instance, missing information on the target audience (n = 104; 73.2%) and curriculum (n = 113; 79.6%) were high. This indicates insufficient clear communication and dissemination of information and may indicate a lack of standard competencies and requirements among humanitarian health professionals.