Bringing Sustainable Healthcare to Under-Resourced Populations: Field Experiences from OneWorld Health


Global health is a rapidly growing field, and the need to improve access to high-quality care in developing countries has become increasingly apparent. Various charitable organizations, missionaries, and NGOs have attempted to supplement the health care provided by the government with short-term relief efforts. However, there is still a desperate need for everyday, ongoing care for patients in the developing world. OneWorld Health (OWH) was developed with the goal of decreasing that gap by providing long-term, sustainable health care in the communities that need it most. The organization’s vision is to see impoverished communities take ownership in a sustainable healthcare model and empower them to bring about long-term change and tangible improvements in their health and quality of life. OWH has developed a model that provides affordable healthcare to the communities that need it most and does not require ongoing support to keep the doors open. Furthermore, local people in the community staff each medical center, which encourages community engagement. Each OneWorld Health medical center offers a full scope of healthcare services to the community, delivered by trained nationals and offered at a price point that is affordable to the overwhelming majority of the population. Patient fees offset the costs of running the clinic, eventually meeting or exceeding the total monthly operating costs. This model has proven extremely successful, and this year more clinics will be opened and more staff will be trained in advanced medical procedures. So what is it like to be a part of this organization? Three key members of the leadership team explain their experiences and perspectives on working in the field.

Aaron Stroud-Romero, Vice President of Field Operations

The site of OneWorld Health’s Clinica Integral-Sebaco, which opened in Nicaragua in July 2015. Source: OneWorld Health.

OneWorld Health’s innovative social enterprise model places it squarely between the overwhelmed and understaffed public health system and the expensive private health system. Though there are a few others working within this niche market, they are often charity hospitals that require continual financial support. By contrast OneWorld Health aims to provide high quality, affordable care, without ongoing financial support for operations.

When I first heard about OneWorld Health in 2013, it all sounded too good to be true. Their first medical facility in Masindi, Uganda, had managed to become operationally sustainable in its first year. With such success, they built an inpatient department, which also became sustainable in about a year. The maternity ward, labor and delivery suite, and operating theatre were just over a year old and were on their way to sustainability. At this point, I had spent nearly four and a half years working in the health sector in Sub-Saharan Africa and had never heard of such a thing.

I spent two and a half years working for OWH as the Regional Director in Uganda. In that role, I worked with our national leadership staff at each facility to ensure that our business model was sound and that the quality of care met the highest standards. The previous Regional Directors were always based at the facility in Masindi, but my position was to be based in the capital, three hours away. This transition was done intentionally to allow the national leadership team to take even greater ownership of the project. We certainly faced challenges, but our team has shown incredible perseverance in the midst of struggles. Their growth in both hard and soft skills is the kind of leadership that we at OneWorld Health seek to foster with our national teams everywhere. In my current role as Vice President of Field Operations, I have the privilege to work with our Regional Directors in both Uganda and Nicaragua to develop and implement our growth plans, while also ensuring that our business model is working in each facility.

In my last three years of working with OneWorld Health, I have been amazed at how much can be done, with relatively little financial input. By working with the community, rather than for them, we have empowered community members to see the value in their health. Community members recognize the difference in the quality of care, our consistency and accountability to them as patients, and the hospitality and patient care that each of our staff provides.

To be clear, despite six successful years of operation and growth, we continue to face challenges. There are a whole host of cultural challenges that we face–reliability and timeliness, honesty and transparency, and customer service. Leadership at each of our facilities sets an incredibly high bar and holds their teams accountable. This is not always an easy task, but the community has certainly come to appreciate and expect it. I remember sitting in a community meeting before we built our second facility about an hour from Masindi. The community leaders and local church members were so excited about the medical facility we were going to build. While I was obviously encouraged by their enthusiasm, I began to worry that they thought we were going to be a free medical care provider. I hesitantly broached the subject and waited for their response. The community members let out a little laugh, and one of the leaders stood and said that they were well aware of the financial obligation, saying “if you are bringing the kind of care that we have seen in Masindi, we are prepared to pay.” Our hope is that these expectations will start to become normal, that private and public facilities will begin to hold their staff accountable, improve their patient care, and create real value for patients, generating an impact far beyond the number of facilities we can build or patients we can treat.

TJ McCloud, Regional Director of Central America

A staff worker examines a patient in the waiting room at OneWorld Health’s Bulima Ktara Medical Center in Uganda, which opened in February 2016. Source: OneWorld Health.

Whenever I get the chance, I take a few minutes and just sit down in the lobby of OneWorld Health’s clinics here in Nicaragua. On a normal day, I sit next to young mothers with feverish babies, older ladies with swollen feet checking their blood sugar, teenage soon-to-be mothers anxious about their first ultrasound, and day laborers who come in for a quick stitching-up before carrying their machetes back out to the sugar cane fields. I’m not there as a patient (usually, at least), but as a learner. Hearing their stories, I am amazed at the challenges they bravely face every day, and am humbled by the opportunity to be part of their story. Afterwards, I’m always left with the same question: “How did I end up here?” I’ve found it’s a common sentiment from expat and development communities; we all arrived at wherever it is we find ourselves from the strangest places, it seems.

As for me, a Midwestern boy, I didn’t grow up speaking other languages or traveling to faraway places. My world was pretty small, with international events and peoples meriting a quick glance at the news or a prayer at the dinner table, but not much more. Nor was I interested in medicine at the time, and while I cared deeply about serving others, I figured that local church and charity work was about as far as that passion would go. I definitely never imagined my life and work would one day be dedicated to global health.

So what happened? Well, I discovered Jimmy Buffett. I know, I know, it’s silly—this hokey niche artist singing poorly-written songs about Latin tourist traps and Caribbean beach bums, but the music was, for me, a window into a world I had never experienced before. I had to see it with my own eyes. In college, I signed up for a summer internship with a development organization in the Dominican Republic, mainly because it was near the ocean (which I had never seen before) and sounded exotic, but manageable.

In those rolling green mountains and pastel-colored palm houses, I very quickly got the education of a lifetime. Suddenly, I realized that Latin America and the Caribbean were so much more than the clichés that drew me to them. They were, instead, places of vast riches and poverty, joy and suffering, and were made up of a myriad of fascinating cultures and compelling histories that I couldn’t even scratch the surface of in just one summer. I was forever hooked.

Soon, I was successfully coaxing my Oklahoma drawl into Spanish conversations with people I never imagined I would befriend or work alongside. I learned of the struggle that is daily life for most of the world, and suddenly found new appreciation for how access to even basic health care saves lives and helps communities and local economies develop and become more productive for the people who live there.

For me, working in global health is the best way I’ve found to blend my love of people and culture, history and development. When I was unsure about what discipline to focus on in development work, a mentor pointed me towards global health and said “people who die from easily treatable illnesses don’t ever get a chance to develop their communities”.

OneWorld Health also supports U.S. volunteer groups who participate in medical service trips to sites in Nicaragua and Uganda. This group completed a ten-day trip to Nicaragua in September 2016. Source: OneWorld Health.

So, here I am, Regional Director for OneWorld Health’s Central American projects. My family and I live in Managua. I spend most of my time here in the capital at our central office, coordinating OneWorld Health’s legal, financial, and operational challenges (there’s always a new hurdle in this business). I love being in a position to develop and nurture our service-oriented organizational culture, and our quickly-growing list of projects and programs. More than anything, however, I relish the opportunity to visit a project each week to experience, learn from, and assist in the important work our staff does, day in and day out. I travel regularly in the shadow of volcanoes and lakes, through cane fields and banana plantations, sometimes spotting howler monkeys or sloths in the trees as I visit our three fixed clinic sites and our mobile clinic, all of which function primarily in rural areas. At the time of this writing, we have a staff of 25 full-time and 30 part-time healthcare and support professionals, of which I am the only North American. Sitting in that clinic lobby, I often wish I had the medical skills to personally treat these “stakeholders” next to me, but I’m proud to have a team of local professionals that I can rely on and learn from.

I confess, I still kind of like Jimmy Buffett, and every once in a while you might find me on a Nicaraguan beach, but my heart and hands love this work and people so much more than I ever would have imagined in my previous life. I am constantly grateful to be able to support OneWorld Health’s local providers as together we build high-quality, low-cost, sustainable healthcare for generations to come.

Michael O’Neal, Executive Director

As I begin to formulate a response to the statement, “Tell me about your experience working in global health,” I am tempted to reply with a myriad of numbers. I am tempted to rattle off statistics that are, and have been, at the forefront of my mind for years, such as the under-five mortality rate of 54.6 per 1,000 live births in Uganda.1 Or the fact that public health expenditure in the same country is a dismal 1.8% of GDP.2 Or the sad reality that in Burundi, there is only 1 physician for every 35,000 people.3

My temptation to respond with this data is spawned from an altruistic place. It is an attempt to quickly and succinctly communicate the salient need for the world to concentrate on responding to healthcare needs in the developing world. It is an attempt to create a framework for the listener to relate to the harshness of life that is the reality for the roughly 1 billion people living under the international poverty line ($1.90/day) around the globe.4

However, as I try to get a bigger perspective, I recognize that my knee-jerk reaction to respond with statistics is a synthetic attempt to convey my message. I recognize that I am not doing the listener, my East African and Central American friends, or myself justice by responding quantitatively and focusing only on the despair that exists in these contexts. Because the one thing that all of those numbers have in common is that they represent a person: a beautiful life with a name and a story, with real tears, real smiles, real hopes, real dreams and most of all, real life. The lives of so many of these individuals have shaped me into the man I am today and continue to shape my future and the future of my family.

Since opening their first medical center in January 2011, OneWorld Health has provided medical care to nearly 150,000 patients. Source: OneWorld Health.

I currently have the privilege to serve as the Executive Director for OneWorld Health, a global health organization that exists to provide quality, affordable care to those in need. My role with OWH provides me with an opportunity to bridge the gap between my family, friends and colleagues in the United States to my family, friends and colleagues in East Africa and Central America. I have the privilege of working with our host country staff to navigate the complex healthcare infrastructure and work alongside them to develop long-term strategies. I work collectively with our team to develop culturally-relevant and sustainable projects that seek to empower individuals and communities through quality healthcare. As I have had the privilege to interact with people from Nicaragua to Burundi, each interaction has tinted the lens through which I see the world. I have discovered a common thread in all my experiences: we are all more similar than we are different.

Over the years, I have developed deep friendships with folks that I have nothing in common with. We were born and raised on opposite ends of the earth, in different cultures and with different life experiences. Even so, these friends have become family. We have shared in one another’s pains and joys. We have tirelessly worked to see small changes take hold in the health of the community. We have worked together to take the next baby step in improving health for their families. And in all of it, I have learned that we are more alike than we are different.

Many people who are represented by the statistics above have less than a second grade education but have challenged me intellectually, spiritually and philosophically in ways that could only happen by stepping out of my comfort zone and experiencing the harsh realities of life. We have shed tears over the heart-wrenching loss of life. We have shared countless frustrations about the brokenness of our world that leads to the systematic dysfunction that plagues the majority of healthcare systems around the globe. We have rallied together around late night calls or knocks on the door of mothers pleading for help to ease the suffering of their children. And in each of those moments, I have learned that we are more alike than different.

I have shared in joy where life has been given a second chance and communities have been transformed. This transformation was not the result of Western innovation or ingenuity, but the simple provision of a space for the community to share their vision for their community and respond to their needs. I have learned that we are more alike than different.

One patient’s story that is still emblazoned on my mind and heart to this day is that of a 6-year-old boy named Eddie from the Uganda bush, who, by all accounts, had no chance of survival. But through the unwavering efforts of our Ugandan clinical staff that worked tirelessly day and night and fought for him, he beat all odds and is now a healthy 11-year-old boy. And, undoubtedly, also a hero of mine. And as I share in the joy of his life and celebrate the brilliant and dedicated clinicians that saved it, I have learned that we are more alike than different.

In my story, one that was prompted by a deep calling to serve the least advantaged of the world, it has turned out that the “least advantaged” have given me exponentially more than I have left behind.

My hope is twofold. First is that, as OneWorld Health continues to invest in the communities where we work, a greater impact can be made and each medical center will exist long after we are gone. And second, I hope that our partner communities will continue to allow me to learn and grow from our partnership, as I am forever grateful for the lessons I have learned from my friends around the world. Being at the forefront of global health crises has given me the perspective and humility to continue to do this work, and I am optimistic about what we can achieve in the future.

OneWorld Health currently has four permanent clinics and one mobile clinic in Nicaragua and Uganda. For more information please visit



  1. World Bank. (2015). Mortality rate, under-5 (per 1,000 live births). Retrieved from http://data/
  2. World Bank. (2014). Health expenditure, public (% of GDP). Retrieved from
  3. World Bank. (2004). Physicians (per 1,000 people). Retrieved from
  4. World Bank. (2013). Poverty headcount ratio at $1.90 a day (2011 PPP) (% of population). Retrieved from

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