The crossroad of global justice and domestic benefits: rethinking public financing of the Medical Doctor Global Health training programme

Written by

Global Health Physician in training; Master of Law
jvandenbergsci@outlook.com
Masters’ Degree in Global Development and Planning and Organisation Science

Published in October 2026

Editorial

Recent changes to the Dutch training curriculum for Medical Doctors Global Health (MDGH) have brought an end to the subsidy that trainees relied on to cover the costs of their training abroad and the mandatory Global Health core course. The consequences are far-reaching. Doctors already enrolled now face unexpected expenses, while those considering the specialisation must think carefully about whether they can afford the additional costs.

The decision also raises a fundamental question: does the Dutch government still recognise the value that MDGH specialists bring to the Dutch healthcare system? Having worked in resource-limited settings, these doctors return with broad clinical experience, adaptability and a practical understanding of global health challenges that increasingly affect healthcare at home.

In this two-part series, two doctors currently in MDGH training share their experiences and reflect on the implications of these changes for their training, their future careers and the place of Global Health within Dutch healthcare.

Main content

Politics can be seen as the bridge between an idealistic and the practical world. On the one hand, there is the idealistic world, in which political visions shape what politicians believe to be the best possible societal model. On the other hand, there is the practical world, characterised by imperfect implementation, competing opinions, and — perhaps most importantly — limited resources. Politics is fundamentally about these limitations and the balancing of interests that arises from it. In this process of selecting and assigning the limited resource, against the background of a certain vision on an ideal world, there are winners and losers. Currently, one of the losers is the Dutch Medical Doctors Global Health (MDGHs) in training. Their personal subsidy, intended to cover costs for training abroad, is expected to end in 2028.[1] In this paper, we hope to further nuance and broaden the view of the public financing of the MDGH training programme, while taking into consideration the scarcity of resources and weighing of interests. In doing so, we aim to add a new perspective to the current discussion on public financing of the MDGH training programme.

Background

The decision to stop the subsidy caused a (re-)activation of the lobby for financing the training of Medical Doctors Global Health (MDGH) programme. The lobby focuses on the benefits of the programme for the Netherlands, a strategy that fits the present right-wing dominated political climate. Yet this pragmatic framing obscures a deeper tension, as the personal motivations of most GHP residents themselves is primarily idealistic, and not focused on domestic benefits.[2] Medical doctors choose the GHP trajectory because of values such as social justice, equity, and global solidarity. Their intention is to work in low- and middle-income countries (LMICs), not primarily to strengthen Dutch healthcare.

Against that backdrop, it becomes relevant to consider the underlying motivations of MD-GH trainees. Their idealistic motivation aligns more closely with international development primarily, rather than with a role in the Dutch healthcare system. Such values of social justice are not only strong drivers for MDGHs, but also a primary driver for international development.

International development revisited

Some critical notes from an international development perspective can also be made. The short stay abroad of MDGHs after their training appears to have followed a downward trend over the last 30 years.[3] The most recent publication reported an average stay abroad of 13 months after the training, which is less than half the total training programme.[4] It is generally accepted that long-term, equal partnerships are required in order to achieve sustainable results.[5] This raises questions about how these short-term foreign deployment periods of MDGHs contribute to sustainable international development, equitable partnerships, genuine capacity strengthening programmes, and sustainable progress.

Reflection is also needed on their positioning and role in the Dutch health landscape on returning to the Netherlands. One could argue that a short stay in LMICs limits the opportunity to deeply understand local systems and develop context-specific competencies. This may arguably result in a lesser yield of the competences contributing to the Dutch health landscape.[4] However, others could argue that a three-year-long training programme is not actually needed to obtain such competences at all. Might there be other ways to obtain them? In our opinion, it would be good to critically reflect on both the constrained development impact and learning yield of these short stays.

Currently, many of the trained MDGHs leave to work in a low-middle-income country (LMIC), de facto as an international development worker. International development is also complex due to the huge differences between (and within) countries in terms of power, resources, health care services, societal systems and burden of diseases.[5-6] To support sustainable international development, we are proposing a potential strategy to address these huge differences by introducing collaboration with smaller steps. These steps create a model where HICs in their support systems and partnerships would focus on MICs, whereas MICs can play a more prominent role in building partnerships with LICs. This model challenges the historic focus of HICs on LICs, dating from colonial times. As a Brazilian doctor reflected on the description of a MDGH: “All Brazilian doctors are global health physicians. We are part of global health and are equipped to handle tropical diseases and their societal implications”. Her remark brings up an underlying, provocative, question. Why should the Netherlands invest public funds in a specialised training programme when many LMICs already have physicians who are accustomed to working in such environments (e.g. the Cuban strategy)?[7]

From a health equity and social justice perspective and in line with efforts to decolonise global health, localisation is becoming increasingly important. Localisation is defined as “shifting power between actors, including who makes strategic decisions and who controls resources”.[8-9] These developments ask for a critical review of the role of and need for a trained clinical MDGH in international development, a review that is not new and asks for continuous critical assessment of the real demands inherent in the MDGH profession[10], particularly in the light of public financing. Such a review should also consider that many LMICs still face a severe shortage of medical doctors.[11] MDGHs can play a role in reducing this shortage and supporting knowledge of health systems in LMICs. On the other hand, in line with the phrase “the Master’s tools will never dismantle the Master’s house”, should a former colonial power publicly finance the bridging of this gap? In other words, does the public financing of MDGHs in its current state still fit in a changing global health context, marked by a prominent debate on decolonising global health? Or is it mainly self-serving in relation to Dutch identity, personal values and perhaps even a last echo of the (colonial) past? This review might assess whether the long-term benefits outweigh the risks of continuing a traditional, hierarchical system of international development.

Rethinking, redefining, acting

The debate about financing the Medical Doctors Global Health (MDGH) training programme unfolds precisely at the crossroads of idealism, pragmatic policymaking, and the political reality of scarce resources. The current lobby emphasises the domestic benefits of the MDGH for the Netherlands. However, we hope that this article presents additional perspectives, recognising that such a narrow, utilitarian framing does not fully capture the motivations of MDGH trainees nor the broader ethical and geopolitical context in which global health work takes place. The MDGH programme is rooted in values of justice, solidarity, and equity – values that align more naturally with international development than with the Dutch healthcare system. In line with this logic, we would argue for a possible financing of the training programme through the international development budget, linked, for example, to an obligation for a longer stay to obtain financing. This can then be framed as international development spending, ultimately delivering benefits to the Dutch healthcare system. The return in terms of domestic benefits does not leave the money abroad but gives the “home base” clear advantages. This is a marketable message in the current right-wing dominated political climate.

Honest assessment

Ultimately, we believe that the future of the MDGH training programme cannot be determined solely by pragmatic arguments about national benefit, nor solely by idealistic commitments to global justice. It requires an honest assessment of what the programme aims to achieve, whom it is meant to serve, and how it fits within a rapidly evolving global health landscape. Rather than arguing for or against financing, this paper calls for a broader, more reflective political discussion, one that acknowledges both the idealistic foundations of the MDGH and the practical realities of international development and the Dutch healthcare system. Such a discussion may not only clarify the role of the MDGH but also strengthen the current lobby by grounding it in a more coherent and future-oriented vision.

References

Kamerstukken II, 2025-2026, 29282, nr. 625.
Dienst Uitvoering Subsidies aan Instellingen, Twee tropenartsen, één missie: zorg voor wie het het hardst nodig heeft, 1 June 2026, https://www.dus-i.nl/actueel/nieuws/2026/06/01/twee-tropenartsen-een-missie-zorg-voor-wie-het-het-hardst-nodig-heeft, consulted 20 July 2026.
Visser, J.(2013) Veel tropenartsen worden later gynaecoloog, Medisch Contact, 22 februari 2013.
Özcan, H, et al. (2023) Applicability of working abroad for physicians with a specialization in Global Health and Tropical Medicine, Globalization and Health, 19:28.
Chambers, R. (1997). Whose reality counts? Putting the first last. Intermediate Technology Publications.
United Nations. (2025). The Sustainable Development Goals Report 2025. United Nations Department of Economic and Social Affairs. un.org
Albornoz, S.C. de (2006), On a mission: how Cuba uses its doctors abroad, BMJ Sep 2;233(7566):464.
Geoffroy, V., & Grünewald, F. (2017). More than the money: Localisation in practice. Groupe URD; Trócaire. alnap.org
Wanner, M. S. T., & Miljand, M. (2025). Unlocking the transformative potential of multi-stakeholder partnerships for sustainable development: Assessing perceived effectiveness and contributions to systemic change, World Development, 191;107007.
Spanjer, J. M. (1992). Medisch werk onder barre omstandigheden. Het Directoraat-Generaal Internationale Samenwerking. Nederlands Tijdschrift voor Geneeskd, 136(2)
Boniol M, Kunjumen T, Nair TS, Siyam A, Campbell J, Diallo K. The global health workforce stock and distribution in 2020 and 2030: a threat to equity and ‘universal’ health coverage? BMJ Glob Health. 2022 Jun;7(6):e009316.