Thursday, 6 April 2017

Brexit: Self harm or a shot in the arm?


At the recent Global Health Exchange: Improving Global Learning conference in Manchester, Ben Simms, THET’s CEO, gave a stirring keynote speech on the need to go beyond media headlines and act together to promote both a stronger NHS and a fortified global health environment.

Joining speakers and delegates from across the UK and international health sector, from Public Health England, Royal Colleges and NHS overseas volunteers, the day was a fantastic moment in the health partnership movement reflecting the vital energy the Global Health Exchange is bringing to the global health and development space. This blog reflects on the key points of Ben’s speech.



The Choice


I believe we now face a fundamental choice as a country. Whether we are to be “a kind and generous” country, as Theresa May phrased it in her speech to staff at the Department for International development last week; open to the world, mindful of our mutual dependence. Or whether we are to be an insular country, holding our sovereignty close to our chest, suspiciously eyeing our neighbours, both near and far.

Nowhere is this choice more clearly expressed than in the debate around the UK’s commitment to spend 0.7% of GNI on overseas aid.

The UK is now one of just six wealthier countries to be meeting this long-standing UN target. In 2015, the UK provided a total of £12.13 billion in overseas aid. This coming Wednesday, the UK will announce that our contribution increased by an additional £1 billion in 2016. And next week, the OECD will publish their global comparison figures, which will show that the UK has seen the largest increase in overseas aid spending the world over.

It is a profound and impressive contribution. It is both kind and generous.

The Chicken

This 0.7% investment is of course, underpinned by a searing logic, which speaks of our national interest. If a chicken sneezed thirty years ago, so the joke goes, it would have been bad news for the chicken and its relatives, but nobody else would have taken much notice. Today, our increased understanding that human, animal and ecosystem health are inextricably linked combined with our ease of travel, means that such a sneeze will be heard in every capital of the world.
Ebola is often cited as the wake-up call which taught us that the health of one country is dependent on the health of another. Arguably, it’s not the first wake-up call. HIV and AIDS was such a call, as the 33 million people who died from AIDS-related illnesses can testify. Hopefully, Ebola will be the last such call:
The world is awake. It is time to put together a new landscape that will deliver universal health coverage to all its citizens. And UK overseas aid has a crucial role to play in this. It is in our national interest.

The Media

However logical this sounds, it cannot be taken for granted. The 0.7% commitment is under unprecedented attack. Just in January, the Mail on Sunday persisted in its campaign for overseas aid to be re-directed to support the NHS. And it’s not just the Mail. It’s The Times and the Express. In fact, it’s many of the papers that campaigned vigorously for Brexit.
For THET, the choice the Daily Mail gives is one that speaks very poignantly to our vision of a world where everyone has access to healthcare. The decision between investing in ODA or the NHS, is not an either or, they can and should go hand in hand.

The Future

We need to fight for an internationally-focused NHS. At the heart of this is the challenge of ensuring that, as we learn to identify the benefits we can derive from an internationally-minded NHS, to too we must think carefully about how these align with the benefit derived from host countries.
All this means asking and answering difficult questions: not just around how we balance the interests of the NHS with those of overseas health services. But how, for example, we transition from aid dependency to grasping the opportunities for commercial activity overseas which could produce valuable income for the NHS.
To travel on this journey involves making a choice. The choice I talked about at the beginning: about what country we want to be a part of.
Theresa May’s speech last week set the standard by which we can now judge our government’s promises, exemplified by our commitment to spend 0.7% of our national income on overseas aid.
We too need to express this choice, individually and organisationally, to grapple with this complexity to produce an outward facing NHS, one that brings benefit both to countries overseas and to its own patients. In Our Mutual Interest.


Ben Simms

CEO,
THET

Tuesday, 4 April 2017

Strengthening Global Mental Health partnerships - #LetsTalk Depression

A new mental health collaborative was inspired to come together after the Health Partnership Symposium, Petty and Randy explain why sharing knowledge and practice across country borders is so crucial in the battle to improve mental health care. 


Seeing mental health and substance misuse patients suffering, neglected by the community, families and other healthcare workers; motivated me to work with mental health. Working as a health Administrator and a Project Coordinator at a Tanzania National Mental Health Hospital, I found I could help these individuals so that they can be provided with an environment that will allow them to recover from their illnesses, reduce relapses and lead a normal life.
Perpetua Mwambingu- Tanzania Link Project Coordinator

In Ghana mental illness is often attributed to spiritual causes and people who suffer from mental illness do not get the help that they need. Stigma and discrimination is high and people who suffer from mental illness lose their dignity, respect and self-worth. My passion for awareness creation and advocacy and my belief that someday Ghana will appreciate the importance of mental health motivates me even during moments of burnout
Randy Agbodo- Project Lead for Ghana - Zambia - NHS Highlands Partnership

The Story Remains the Same

According to the World Health Organization, for every four people, one will be affected by a mental or neurological disorder in their lifetime. The magnitude of mental health burden is not matched by the size and effectiveness of the response it demands. Currently, more than 33% of countries allocate less than 1% of their total health budget to mental health[1].

Sadly, in Tanzania and Ghana where Randy and I are working, the story remains the same, mental health services are underfunded, and most of the donor funded programs go to communicable diseases. There is inadequate human resource and insufficient supply of medications. Stigma and discrimination towards persons with mental disorders is still prominent and effective mental health prevention and promotion programs are woefully inadequate.

 No Health without Mental Health

Depression is ranked first in the list of top ten leading causes of years lived with disability (YLDs)[2]. Globally, an estimated 350 million people of all ages suffer from depression[3]. At its worst depression can lead to suicide and close to 800,000 people die due to suicide every year[4].

This is why it is so vital that World Health Day this year is addressing depression, bringing it to the fore of global health discussions. It gives health managers and policy advisers the opportunity to appreciate that depression affects productivity and therefore prioritizing and investing heavily in mental health would, in the long run, culminate in populations with healthy outcomes, respect for human rights and stronger economies.

The Health Partnership Symposium ‘effect’

In order to make this a reality, we believe that collaboration and the sharing of approaches is key and at the recent Health Partnership Symposium, organized by THET, we found we were not alone in this thinking.

Our passion for working in mental health was further cemented at the event where a certain chemistry brought colleagues from Ghana, India, Kenya, Nepal, Scotland, Tanzania, Uganda and Zambia together to form the ‘Mental Health group’.

We all wanted to come together to tackle and develop our learning on different mental health issues.  Ultimately we wanted LMIC’s to start collaborating and to share experiences which can strengthen the partnerships we work in. That’s when a luncheon ‘chat’ was called, then a dinner ‘talk’ happened and then we came to form a WhatsApp group, a way for us to easily reach out to each other.

The world is facing many challenges; political unrest, war, economic hardship, unemployment, etc., all are contributing factors to depression. This must be a wake-up call for the global community, the need to re-think, and re-act to this global crises, now is the time to re-set our priorities with regards to mental health and to act together through partnerships and shared learning. After all there is no health without mental health.


Perpetua Mwambingu
Tanzania Link Project Coordinator,
Tanzania

Randy Agbodo
Project Lead for Ghana - Zambia - NHS Highlands Partnership,
Ghana




Together We Can Overcome - #LetsTalk Depression

The grief and grievances for those suffering from mental health problems are largely overlooked by both health and social sectors.


In every street, in every corner, we find those suffering from neuropsychiatric disorders. They are silent victims of neglect and abuse experiencing human rights violations across the globe. Those we called our friends, fathers, mothers, sisters, brothers, sons and daughters in the past, today have become our enemies without committing any crime.

Depression is the most commonly diagnosed mental illness in Zambia[1], alongside other neuropsychiatric disorders such as those relating to drug and alcohol abuse. Stigma attached to mental illness, the prevalence of HIV, high unemployment and socio-economic difficulties all significantly increase the risk of mortality[2]. At a global level, over 300 million people are estimated to suffer from depression, equivalent to 4.4% of the world’s population[3].

Although mental health constitutes a large number of disease burdens in developing countries, it is largely overlooked and given inadequate attention.

It is in this context that THET is working hard to help those facing mental health challenges, among other global health issues. As part of their work they have provided funding for the Mental Health Literacy and Improved Patients Safety Empowering Communities Project run by the NHS Highlands – Chipata General Hospital Partnership.

Located in the eastern part of Zambia is Chipata Central Hospital. The hospital is the biggest referral Centre in the province and is well known for its specialized treatment of mental health services. Like any other hospital in low income countries, Chipata Central Hospital suffers from huge medical demand with limited financial resources that put mental health in the periphery of priorities.

People can recover from mental illness but traditional beliefs and cultural practices have led to a persistent belief that mental conditions are untreatable, and this in turn has led to the marginalization of the issue in the public domain. The stigma and limited public knowledge diminishes grassroots demands for mental health policy and service developments which are weak and poorly implemented. As a result traditional medicine and spiritual management are the most common forms of treatment. Thus the need for the project is apparent.

The main aim of our partnership is to empower communities and patients to take action for better and safer mental health by creating positive change in:

  • Perception, attitudes and understanding of mental illness,
  • Improving levels of safety and support by health institutions and local communities
  • Providing relevant mental health educational materials delivered appropriately and creatively to communities deprived of contemporary communication channels

We also acquired bicycles to be used by community volunteers and as a social enterprise, to provide greater access to creative Arts, explaining mental health and helping to disseminate more accurate information to communities regarding mental health.

I have met so many people through the partnership and have seen the positive impact that reaching out and empowering communities on mental health literacy can have. It is increasingly clear that supporting such projects in any way possible can help overcome the challenges mental health is facing.

People with mental health problems, deserve your attention. Together we can overcome.


Pearson Moyo
Project Coordinator - Zambia
Mental Health Literacy and Patient Safety: Empowering communities.



Tuesday, 7 March 2017

#BeBoldForChange

THET needs to become more conscious about how, if at all, our work is advancing gender equality. 2017 is the year we will achieve this.


Our approach is centred on the Key Performance Indicators (KPIs) we have developed for THET this year. Alongside the necessary data we gather to track the performance of our programme, grants-making and policy work, we will ask ourselves one overarching impact question: how is our work accelerating gender equality? 

We will use this question to drive individual and organisational learning across our six offices, commissioning external evaluations, gathering case studies and data and, by the end of the year, publishing our findings publicly. This will be an honest and critical assessment of how well we are faring, and how we can become still more systematic going forward. Collaborating with our partners across the health partnership community will be critical in achieving this.

We already have a certain awareness of how gender influences who delivers health services and who benefits from them. In a recent staff meeting on this theme examples were plentiful and various: from an obstetrician who ran clinical training on reproductive and maternal and neonatal health, to women who needed consent from their male relatives to undergo surgical procedures. 
But this focus is perhaps made even more urgent in 2017 given the position being taken by the US under the leadership of President Trump, and especially his gagging order concerning funding for abortion or post-abortion care. Never has the phrase ‘one step forward, two steps back’ seemed so applicable.

It is also an area highlighted for greater consideration in the recent DFID-commissioned evaluation of the Health Partnerships Scheme and of course, we cannot talk about the Sustainable Development Goals without thinking about gender equality, the phrase ‘No one gets left behind’, alongside health.
This process is being championed across THET by one of our Trustees, Professor Irene Leigh. A Gender Equality Working Group has been established to steer our progress. Written guidance to help us consider gender equality in programme planning and monitoring is being developed by our Monitoring, Evaluation and Learning Team and we have  commissioned two studies into how partnerships’ approach gender equality and an analysis of the populations who use the health services and facilities partnerships work to strengthen. 

This is an exciting and vital area of consideration for THET. If you would like to stay in touch or contribute to this process, please get in touch: info@thet.org

Ben Simms
CEO,
THET

Raising the Profile of Family Planning in Uganda

Clare Goodhart, USHAPE Clinical Lead, reflects on the progress made in the partnership between the Royal College of General Practitioners and Bwindi Community Hospital, Uganda. Over the last two years they have been working to strengthen the capacity of the health-system in South-West Uganda to promote sexual and reproductive health. 


The World Health Organization (WHO) states that family planning and the use of contraception have led to a reduction in the transmission of HIV/AIDS, reduces the need for unsafe abortion and prevents the deaths of mothers and children.

'Promotion of family planning – and ensuring access to preferred contraceptive methods for women and couples – is essential to securing the well-being and autonomy of women, while supporting the health and development of communities.' WHO, 2016

In sub-Saharan Africa, their remains an acute need to raise the profile of family planning, not least in rural Uganda.

USHAPE (Uganda Sexual Health and Pastoral Education) is a THET funded project which has been addressing local misconceptions that act as barriers to women controlling their fertility.

‘We have been using a novel ‘whole institution approach’ to raise the profile of family planning which is taken for granted in most continents of the world. Through the ‘Training of Trainers’ model we are able to provide Ugandan health workers with the knowledge to go on and teach more nurses and midwives, both pre-service and in-service, as family planning providers and advocates. This approach is currently being adopted by three rural nursing schools in south-west Uganda. Staff and students develop their confidence by training community health workers and teachers who are then able to take messages directly out into the community.

Babrah, a young midwife is one of twelve USHAPE trainers, and 150 new providers in south-west Uganda. Her contagious enthusiasm for USHAPE is ensuring that all women who pass through the maternity wards are given a clear idea about how to nurture their new baby, by spacing the next pregnancy. She goes further than this by volunteering to teach at youth outreach events in remote villages, and is now personally supporting a thirteen year girl in her ambition to return to education.

Babrah is part of the USHAPE ambition to scale up training across south-west Uganda, but also the ambition to benefit specific individuals.’

Clare Goodhart, 
USHAPE Clinical Lead,
Lensfield Medical Practice, UK


Somaliland: Health After War

In 2000, THET and Kings College Hospital (UK) began working with health training Institutions in Somaliland to improve the skills and knowledge of health care providers. THET works in partnership with health training Institutions, health professional associations and the Ministry of Health by harnessing invaluable experience of UK partners to improve the health care system.

Louise McGrath, Head of Programmes and Development at THET, travelled to Somaliland in January to discuss a new programme to strengthen health worker training in the region. Here follows her account.


I don’t cease to be amazed at what people can achieve,
even when faced with such adversity.

It had been well over a year since I was last in Somaliland, so I was very glad to touch down in Hargeisa at the end of January. I was arriving alongside a number of colleagues from Kings College London and Medicine Africa to hold discussions with national partners; three Somaliland Universities (Hargeisa, Amoud and Edna Adan), to agree the initial plans for the Kings led  Prepared for Practice programme. It is one of the first projects awarded under the DFID funded Strategic Partnerships Higher Education Innovation and Reform (SPHEIR) programme, managed by the British Council.

The project aims to strengthen the training of doctors, nurses and midwives to ensure they are prepared for practice once they qualify. Running over five years it will focus on strengthening undergraduate education and faculties.

THET will support national partners to identify and develop any additional policies and regulations that need to be in place to guide effective oversight of health worker training. We will also be responsible for the security and logistics associated with the trips of the project team and volunteers.
During the course of the meetings, it was brilliant to see how much progress the Somaliland partners had already made and to see the commitment and energy that was invested in achieving the shared goals. I was particularly pleased to see the number of women amongst the faculty and students and hear how dedicated they were to contributing to their countries progress.

One thing the trip also served to highlight is just how far Somaliland has come in the short period since the war ended.  A number of people reminded us of the destruction that the war caused to institutions and to the population. I don’t cease to be amazed at what people can achieve, even when faced with such adversity.

The trip was also a valuable opportunity to spend time with our country team and agree what steps need to be taken in the coming months. All in all a very exciting time for our country team and our partners...

Louise McGrath
Head of Partnerships and Development,
THET, UK

Tuesday, 14 February 2017

Medical Equipment in Top Condition

Since 2011, THET with support from the UK Government’s Department for International Development (DFID) has been working with the Northern Technical College (NORTEC) to develop the first pre-service training course for Biomedical Engineering Technologists (BMETs).

In this blog, Chris Mol, a lecturer in Biomedical Engineering at NORTEC, celebrates the projects most recent successes and comments on the complexity of the tasks ahead.


At the end of 2016, our first cohort of Biomedical engineering technologists (BMET’s) in Zambia completed their final examinations. 

Every year from now on, some thirty new technologists will become available to improve the poor maintenance situation of the medical equipment in the country. We have also trained enough local BME lecturers to make this teaching program sustainable! Good reasons to be proud! Surely this will have a major impact on the availability of working medical equipment for patient diagnosis and treatment!

Well…maybe not. Whereas the presence of well-trained BMETs is a necessary condition, it may not be sufficient. When you think about it, what good can a BMET do in a hospital where a workshop or tools are extremely limited? Or where there is no substantial budget to purchase spare parts for repair? Or where spare parts purchasing procedures are so cumbersome that it may take up to one year to acquire these, even if a budget is allocated? Or where service and user manuals are available only in the Chinese language because they came as part of a business package and there are no regulations on local language documents? Or where donated equipment comes without adequate documentation and spare part provisions? Or where the local culture is to wait with repairing a piece of equipment until it is really broken, rather than doing preventive maintenance? Or where the status of the BMET is such that (s)he is supposed to sit in the cellar of the hospital, waiting for a phone call to come and fix a unit, rather than pro-actively managing the installed base of equipment in the hospital?

When you come close, the issue of good medical equipment appears to grow in complexity. Such is life! This is not a reason to despair and give up, but rather to remove our blinders and consider the total complexity (‘eco-system’) of the task at hand. 

Let’s appreciate the potentially limited but still crucial importance of our contributions and diligently hammer away at the next roadblock.  

Considering the crucial position of the Ministry of Health in managing local healthcare, support of local policy generation will be one of the focal points of our follow up actions. Another one will be to support process improvement activities in local hospitals and the support of a national BME Association to advance the profession. Only a broad and integral approach will, in the not too long  term, deliver bottom line value to the Zambian patients. Let’s do it!

Chris Mol
Lecturer in Biomedical Engineering
NORTEC, Zambia 

Tuesday, 24 January 2017

Engineering a future for global health


Linnet, one of our Grants Officers, travelled to Uganda to attend the first National Biomedical Conference. Here follows an account of her time there. 


‘Without Heath Technology Management mortality rates go up.’

Priscilla Kemigisha, Biomedical tutor at ECUREI, asserted the fundamental importance of biomedical engineering at the inaugural National Biomedical Conference held in Kampala, Uganda in January 2017.

I represented THET at the two-day conference, which brought together a truly multi-disciplinary audience, from university lecturers to biomedical engineers, doctors to private companies, and members of local government and donors from Uganda, the UK, US and Kenya. The programme was rich and covered a number of topics including, medical equipment donation, innovation and intellectual property rights as well as the roles different attendees could play.

Priscilla's statement  points out a reality that is all too often overlooked within hospitals and by Ministries of Health and is still fighting for recognition from international organisations. Biomedical engineering remains a little known global health crisis. It is only this year that biomedical engineers have been recognised as forming a separate occupation by the ILO. There also remains no Sustainable Development Goal that centres on medical equipment or biomedical engineering.

For THET, the knowledge that donation of medical equipment is not always a help has become increasingly clear, as a recent survey we conducted showed. Throughout the conference, stories of badly donated equipment abounded, including equipment arriving with only French or Chinese manuals that no one could read, or a CT scanner that spent fifteen years outside in a compound as it was too large to move into the hospital.

While it can be easy to think of biomedical engineering just in terms of the machines you see in a hospital or the broken ones sitting outside in a junk pile or cluttering up a store cupboard, for an unconscious patient in the ICU or a labouring mother the difference between life and death often depends on whether a machine is working or broken.

Beyond patients, it is also evident that healthcare workers in low and middle income countries are dealing with crises every day whilst faced with tight or non-existent budgets, pressures from donors and their governments and targets to be met. In this environment preventative maintenance and careful assessment of potential donations can seem like low priority activities for hospital administrations who struggle with stock-outs, power cuts and water shortages.

Whilst this all paints a rather murky picture of the lack of importance accorded to biomedical engineering, the focus of the conference was on how to move forward, to create a national environment receptive to engineers and the equipment we take for granted in the UK. Discussions centred on what innovations could be implemented and how students from the universities were conducting outreach in high schools and working together with the private sector to turn final year projects into reality.

Solutions do not have to come from outside, while we, including those from donor countries, can all work together, Uganda is making strides and taking responsibility for its own ecosystem. From innovations such as a low field MRI being designed by a lecturer at Mbarara University of Science and Technology, to Fort Portal Regional Referral Hospital ensuring that each piece of equipment in the hospital has a service card, and demand that the direction taken should be dictated by those in Uganda is mounting.

For me, the key message of the event was collaboration, from donors to government and clinicians to technicians. With training, budgeting and responsible funding Uganda, and other nations, can move towards the sweeping reform required to improve the state of biomedical equipment and the training for technicians that is most keenly needed.

At THET, the importance of biomedical engineering is one championed by our biomedical consultant Anna Worm, and the team continue create guidance and tools for the donation of medical equipment and the positive impact that training engineers can have on an entire health centre. Since 2011, our work in Zambia has focused on creating the first pre-service training course for Biomedical Engineering Technologists, a country-led initiative which aims at changing the huge percentages, 35 and 50%, of medical equipment that is currently out of service.

Linnet Griffith-Jones
Grants Officer
THET

Tuesday, 17 January 2017

Digital tools building the future of global health?

Digital tools building the future of global health?


In December, Marta our Senior Partnerships Manager, travelled to Maryland to attend the third annual Global Digital Health Forum, a platform focusing on digital and connected health in low and middle income countries, sharing lessons on what works and what doesn’t in technology for development. Here follows an account of her time there.


The potential of digital tools are proving not only crucial to the provision of health services but also to the wider health system, allowing strong systems to be built before crisis occurs. Digital data, for example, helped bring an end to Ebola in West Africa. The global usage of digital tools has also led to a surge in popularity for supporting the growth of digital health globally, it has become trendy. It is coming to be seen as a key part of a complete health package, which needs to be fully integrated into the health system, with countries such as Tanzania and Nigeria having developed national health data strategies.

Over 400 people beat the cold, in Maryland, to attend the third annual Global Digital Health Forum, a platform focusing on digital and connected health in LMICs, sharing lessons on what works and what doesn’t in technology for development. Over two days in December, it seemed that everyone that mattered in the global digital health field, including newcomers such as myself, came together to discuss the future of digital health. A number of shiny, new solutions to global health challenges were shared. From Facebook to Google new innovations such as the use of drones and balloons to bring Wi-Fi to those in remote and rural areas were debated, while others spoke of using apps to ensure healthier babies and mothers. Most discussions, however, revolved around sustainability and collaboration. How can one ensure that technology solutions live beyond the funding period? Digital tools are after all useless if citizens themselves do not use them.

Most of the tools developed for gathering data are, however, disease specific. The donor community are partly to blame for this as most funding mechanisms tend to favour linear health responses.  Partnerships between government, private and civil society actors offer a solution to health information challenges. Yet, collaboration may suffer in the current country-focused political environment. In these times, it is important to remember the nine principles for digital development, which were written by and for international development donors and their implementing partners. These principles emphasise the importance of human-centred design, context-specific solutions, re-use and improve existing technology and tools and being inclusive and collaborative. If we can get these principles right, we’ve come a long way in ensuring sustainable health information systems and better health responses as a result in the future.

With so many new digital avenues and innovations forming in the global health arena, there is certainly much to think over. For THET, we must now ask how we can use this technology to complement our partnership work and apply digital solutions to the strengthening of global health systems.

Marta Roxberg
Senior Partnerships Manager
THET