Expanding Orthopaedic Care Across the Pacific: A Global Health Model Translated Into the Pacific Islands Orthopaedic Association.

Abstract

Pacific Island countries face persistent and profound gaps in access to essential orthopaedic care driven by geographic dispersion, fragile infrastructure, and workforce shortages. Reliance on overseas medical referral schemes, often politically influenced and consuming substantial portions of limited health budgets, can improve access for individual patients but fails to build local capacity or ensure timely intervention for trauma and infection. Evidence from low- and middle-income settings demonstrates that "train-in-place" education models can expand the workforce, improve care processes, and reduce preventable disability. The Pacific Islands Orthopaedic Association exemplifies a regionally tailored approach through a tuition-free curriculum that retains trainees within their home health systems, reintegrates graduates as educators, and progressively reduces dependence on expatriate teams. To translate this model into durable system-level gains, parallel investments in procurement, supply chains, biomedical maintenance, and enabling policy are essential. Standardized capacity assessments encompassing workforce, case mix, infrastructure, readiness, and overseas medical referral utilization, coupled with regional train-in-place orthopaedic education, offer a scalable pathway to timely, high-quality care across the Pacific. The purpose of this article was to evaluate the current literature on strategies to increase access to musculoskeletal care in the Pacific, with a focus on home-training programs in the Pacific and their cost effectiveness.