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

[1] http://www.who.int/whr/2001/media_centre/press_release/en/

[2] http://www.who.int/mediacentre/factsheets/fs369/en/

[3] Ibid

[4] Ibid

Maximising the potential for further funding in Mozambique.

We asked Sarah Cavanagh, Pharmacist and Peter Donaldson, Consultant Surgeon, to reflect on what they did to increase the chances of their project lasting beyond Health Partnership Scheme funding; by forging links with the Rotary Club they have secured potential funding for the future. Their project aims to develop patient safety programmes at the Central Hospital of Beira, Mozambique.

Tell us more about how you started to engage with the Rotary Club and where you are at now.

We began to engage with the Rotary club fairly early on in our partnership. We attended the 2014 THET conference which provided inspiration in the form of a workshop that covered fundraising strategies, as well as local stakeholder engagement. 

What was the issue?

The main issue was that our partnership did not have a very high profile locally, either within our hospital or in our local community. We also had no certainty that we would secure funding after the project end which is set for February 2017.

Who said or did what, and when?
We presented to Ipswich-Orwell Rotary Club in December 2014, October 2015, July and September 2016. In October 2015 we also presented to Woodbridge Rotary Club. In March 2016 we were invited to attend a drinks reception with local business leaders and our local MP and former Health Secretary, Ben Gummer, who has over many years been very supportive of both Ipswich Hospital and The Rotary Club. We also met with MP Ben Gummer separately, in his constituency office.

Ipswich-Orwell Rotary Club greet Health Professionals from Mozambique

Photograph taken by Eleanor Bull in Ipswich Hospital, April 2016.

What were the immediate reactions and results? What challenges did you face?

Immediately our profile was raised because we had spoken to these influential people. We also had increased press coverage, specifically in The East Anglian Daily Times and the Ipswich Star, through a Rotary-Orwell contact.

We did face some challenges however, as the vision to involve the Rotary Club and seek wider support, as well as additional funding was not universally shared within the team. This led to some debate and delay, but eventually it was seen to be a good idea for the future of the partnership.

What were the longer-term results?

After presenting twice, and without asking for any money, Rotary-Orwell asked whether they could support us financially. They organised a fundraising event in July 2016 and prior to that held a raffle; the two events raised over £700 for the project! As the July fundraising event (Rotary Mastermind Competition) was held in collaboration with the other three Ipswich Rotary Clubs, it has led to friendly contact with these clubs as well as Ipswich-Orwell. The partnership’s involvement has also helped raise awareness of the great work of the Rotary Club and Rotary International.

Sarah Cavanagh presenting the Rotary Ipswich-Orwell banner to Dr Wingi Olivier in Beira 2016

Photograph taken by Eleanor Bull in Ipswich Hospital, April 2016.

Have you solved the problem of sustainability? What will you do next?

We feel that we have to a certain extent solved this problem. There is a much greater understanding and awareness of our partnership both within our hospital and our community, and we have established good links with five of the local Rotary Clubs. After our next visit, in November 2016, we will have a clearer idea of the next steps with the partnership. We will be maintaining our established links with Rotary, with a view to maintaining or even increasing their involvement in the future.

What have you learnt, and what advice could you give to other partnerships?

One of the most important lessons we learned was that asking for money straight away is not necessarily the best way to maximise fundraising, neither is it the best way to forge longer term relationships with potential funders and local opinion leaders. These things take time and it is important to nurture the relationships.

Orwell Rotary Club presenting a cheque for £703 to our partnership in September 2016 for medical and maintenance equipment for Beira Hospital.

Photograph taken by David Vincent, 2016.

Rotary Club and Rotary International consist of 1.2 million neighbours, friends, and community leaders who come together to create positive, lasting change in local communities and around the world. Differing occupations, cultures, and countries give Rotary a unique perspective. Rotary support a variety of causes both at home and abroad. They are specifically identified and targeted to maximize local and global impact. Rotary uses its network of resources and partners to focus service efforts in promoting peace, fighting disease, providing clean water, saving mothers and children, supporting education, and growing local economies. As such this ethos ties in very nicely with Health Partnerships.

If you would like more information on the work of the Rotary Club and  Rotary International, please visit https://www.rotary.org/en/about-rotary

BMET training in Zambia: the money

As described in a previous blog, I am supported by THET to work at a Technical College in Zambia to train local students to become hospital equipment maintenance professionals. In this blog I want to share with you some of my experiences on what it means to be in what the ‘International Development’ world calls a ‘low resourced country’.

Training to become a Biomedical Technician is quite an expensive undertaking. The college is over 90% funded by the fees from students. The main fee is about 300 USD per term (900 USD/year).  On top of that come examination fees (100 USD/year) and housing fees (60 USD/term), for which you have a bed in a small room with two-four co-students plus some facilities. Altogether, that is quite a lot of money in a country where 60% of the population lives below the poverty line and 42% are considered to be in extreme poverty.

Chris Mol lecturing to BMET students.

Our BMET students are usually funded by their family. This includes not only parents, but also uncles, aunts and older brothers and sisters. It is very difficult for ‘older brothers’ with a reasonable income to save money or purchase a house while their (many) younger siblings still require education. These contributions are not considered a loan and won’t be paid back. Money is spent in the family where it is needed.

On top of family funding, many of our students have to work to earn money during their school terms as well as in between terms. The work they do is what they call piece work: washing cars, helping in building works, and whatever else they can find. The salary for this, as for gardeners and house maids, is in the order of 40 cents/hour, if you can find the work!

Students take notes during a lecture.

In this context it is not surprising that many students have little money left for anything that is not an absolute must. Most students do not have a computer and if they do, are dependent on the overloaded network at the college to get internet access. However, most of them do have a mobile phone which is frequently used. The cost of talking is about 10 cents per minute, but many schemes give cheaper access under certain conditions. Also, special offers for ongoing Facebook access are popular. 

Coming from a high resource country, it at first appears to be a good idea to help students by offering them loans to finance their studies or a computer, something that is currently not done by the government. But this becomes less attractive considering the near certainty that such loans will not be paid back, simply because students would not feel this as a strong moral obligation.  And a problem of gifts is to define where to begin and where to end and how to do this in a way that appears fair and does enable you to continue to be related to your environment in a ‘normal’ way.  The advice I am currently following is not to interfere in these matters and consider my teaching of the BMET course and the long-term improvements to healthcare graduates will make as the best contribution I can make.

Your comments are welcome at: chrisr.mol@gmail.com

Sending our professionals overseas is one of the best things the NHS can do

Sending NHS staff overseas is as vital to the NHS as 0.7 per cent aid contribution is to UK plc.

Pulling up the drawbridge and looking after one’s own is a debate that’s gaining pace within the certain media, spurred on by calls that the straitened NHS needs every last penny.

Such reporters would thirst for the story that along with our hard earned cash, the Department for International Development invests in programmes that send our much needed and short on supply doctors, midwives and nurses overseas, too. Fuel on theDaily Mail’s pyre that directly instigated a parliamentary debate on the UK’s spend of 0.7 per cent on overseas aid last Monday.

But sending our UK trained health professionals overseas is one of the best thing the NHS can do right now. There’s no amount of efficiency awareness training that quite cuts through as a stint in an impoverished sub-Saharan hospital.

Comfort zone

Speaking of his time as chair of the first hospital in the country to be rated “Outstanding” by the Care Quality Commission, Mike Aaranson attests that sending his doctors to Zambia encouraged a more innovative and imaginative approach from those used to working in a more comfortable environment.

Speaking on the foreign aid expenditure debate, Conservative MP Steve Double said: “The truth is that this country gets great value for money from the aid”.

There are strong parallels with this argument to why more NHS trusts should send their staff abroad.

Independently audited data and feedback we have from NHS leaders, who invest their resources in our overseas clinician exchange programs, show improvements in skills, leadership and motivation that would be harder won elsewhere.

With the aim of creating a cadre of skilled leaders who will apply their skills on return the UK, one of our programs has led 150 NHS healthcare professionals to swap their UK role for six months of the working in Cambodia, Kenya, Nairobi or South Africa.

Since 2008, a steady stream of NHS professionals on this programe have worked on system-strengthening projects in partnership with local health care workers, contributing to improving healthcare in the local area in a sustainable way rather than providing direct clinical care.

Independently audited data and feedback we have from NHS leaders, who invest their resources in our overseas clinician exchange programs, show improvements in skills, leadership and motivation that would be harder won elsewhere

NHS Thames Valley and Wessex Leadership Academy has carried out an independent longitudinal analysis of the impact of this overseas experience on NHS professionals careers. The findings of which show an impact as long lasting and deep routed as the personal story MP Pauline Latham shared in the House on Monday, living with two abandoned Rwandan girls sharing one bowl between four in a mud floored hut for several days.

Desire for change

From retaining clinicians to stay in the NHS, to continuing to improve their clinical and leadership skills, the results attest to a seismic shift in how clinicians view their place in the healthcare system. When interviewed prior to taking their overseas placement 33 per cent said they ‘felt they were leaders’. On returning, this increased to 82 per cent.

In a questionnaire responded to by 107 of the 150 attendees, 91 per cent of respondents said the programme changed how they approached their current role. One detailed “[I am] less frustrated by system inefficiencies and [have] more desire to change them”, another “My self-awareness of my leadership and management skills has greatly increased and I am much more effective as a doctor on the ward.”

Newly qualified GP Charlie Gardiner shared with us directly about the programme that “I’ve learnt more in five months about leadership and service development, and all these really key skills, than I’ve learnt in five years in the UK.”

Health Partnership Scheme

In a detailed analysis of the skill sets improved by taking health professionals overseas, leadership is reported to be most strengthened. On questioning a representative sample of the 2,072 UK health workers who volunteered in a different exchange programme, the Health Partnership Scheme, 76 per cent reported improvements in developing leadership skills.

By opening up our minds, hearts and practice to our health professional peers overseas we are improving outcomes for patients at home

In this current global health climate, we are moving away from traditional forms of development and leaving behind old paternalistic models. To support this move, DfID has turbo charged a new model called health partnership.

These are a model for improving health and health services based on ideas of co-development between actors and institutions from different countries. The partnerships are long-term but not permanent and are based on ideas of reciprocal learning and mutual benefits

Working in this partnership-style has huge and varied impacts on the NHS back home. From the surprising finding shown by preliminary research conducted by Imperial that the imperative of need and dearth of procedures in middle to low income health economies is creating test beds of tech innovative.

To perhaps the more expected, that professionals saying time and time again, that the parred back environment brings about a crystalline focus on the power of their core clinical skills. By opening up our minds, hearts and practice to our health professional peers overseas we are improving outcomes for patients at home.

Ben Simms is CEO of Tropical Health and Education Trust.

Originally appeared on Health Service Journal.