Long-Term Bidirectional Global Health Workforce Exchange: Coordination, Continuity, and Financing

Background: International health workforce exchanges are widely used to support training and institutional collaboration, yet many remain dependent on individual relationships, short‑term funding, and episodic activities. Evidence regarding the organizational structures, continuity measures, and financing arrangements required for long‑term bidirectional exchange remains limited. Objective: To describe the long‑term implementation of a bidirectional international health workforce exchange platform and examine its organizational coordination, partnership continuity, financing evolution, and formal institutional development. Methods: We conducted a descriptive implementation study (April 2015–March 2026) on a bidirectional exchange platform coordinated at Kyushu University Hospital in Japan. Inbound training included 587 trainee participations from 54 countries. Outbound outreach visits were summarized per annual trends, professional composition, destinations, and financing mix (internal university funds, program‑based external funding, and other/mixed sources). Continuity was quantified using institution‑ and country‑level repeat indicators. Formal partnership development was assessed using memoranda of understanding (MoUs). Findings: Institution‑level continuity was substantial: 31.1% of sending institutions contributed ≥2 inbound trainee participations (100/322, 95% CI: 26.3%–36.3%) and 27.6% contributed trainee participations in ≥2 calendar years (89/322, 95% CI: 23.0%–32.8%); repeat intensity showed a long‑tail pattern (≥10 inbound trainee participations in 5.3%). Country‑level continuity was high (country repeat rate: 72.2% [39/54, 95% CI: 59.1%–82.4%]; multiyear country repeat rate: 70.4% [38/54, 95% CI: 57.2%–80.9%]). Outbound activities comprised 109 visits involving 405 participants, 39 countries, and 139 facilities, with diversification in professional composition and destinations over time. Financing evolved from internal expansion to increased external funding following the COVID‑19 disruption. Eight platform‑related MoUs were concluded. Conclusions: Centralized coordination, routine continuity monitoring, and progressive financing diversification may contribute to the long‑term institutionalization of bidirectional international health workforce exchange in university hospital settings.