Global Health: The Northern Irish Approach

90% of blindness occurs in Low and Middle Income Countries (LMICs), the places that are least prepared to deal with this burden, but about 90% of the research funding goes to High Income Countries (HICs).

At Queens University Belfast, as part of a rapidly evolving global health scene, there is much to celebrate and be excited for in terms of the progress being made to change this statistic. As an ophthalmologist, who has spent over ten years in China developing appropriate approaches to vision impairments and diseases, it is an exciting time to be in Northern Ireland and to be part of pioneering global vision programmes which are affecting real change both here and throughout the rest of the world.  

As part of this, we have a number of projects underway including; a new Global Health MPH to ensure that there is improved training in global health and our Global Health Symposium, now in its third year, which continues to bring in diverse participants from all over the world, including the Republic of Ireland. The Global Challenge Research Fund has also enabled colleagues at the Queen’s Centre for Public Health to apply for ‘research aid’ to develop models for Cervical Cancer screening in Vietnam and look into new approaches to diabetic eye disease in China.

Collaboration on these projects has gone beyond Queen’s and has brought together experts from all over the globe, to ensure that the programmes are both clinically focused and needs-driven.

A global model

As the Sustainable Development Goals (SDGs) illustrate, so many global issues from health to education interconnect and create valuable synergies. In this vein, the implications of poor eye health are far reaching. Diabetic eye disease, for example, is the leading cause of global blindness for those in their working years and is a fast-growing problem in LMICs where the loss of the main breadwinner in a family can plunge them into extreme poverty.  

The NHS is an acknowledged global leader in universal health coverage and as seen in numerous schemes can contribute to the furthering of the SDGs. More specifically the NHS’ work on screening for diabetic eye disease is a leading example of excellent practice. The models and techniques employed by the NHS screening program are widely available on the internet, allowing anybody in any country to understand and learn from the practices employed in the UK. At the same time, through working with our counterparts overseas on eye health programmes, we continue to learn new insights in areas such as school vision screening, which can further improve the quality of care in Northern Ireland and the rest of the UK.

Our collaborations incorporate many different actors. Currently, with Orbis International, we are developing and scaling-up models of diabetic screening based on NHS practice and modified for low-resource settings. The first of these will be rolling out soon in Vietnam, and we expect more later in Africa, Latin America and Asia.

We have also been working on incorporating NHS software. Working with Health Intelligence, a provider of NHS image grading software, we are implementing a model for the Vietnam programme through the creation of a version of the software specifically designed for use in LMICs. Thus, there are so many ways and opportunities in which we can apply through an adaptive approach these NHS models in ways that are appropriate for low resource settings.

The need: global and local 

It has become apparent that to think of ‘global health’ doesn’t mean to exclude underserved areas that happen to be in higher income countries. At Queen’s, we also realise the need at home and are working to combat the disparities in care. We continue to work to understand the problems within Northern Ireland, especially as some of the postcodes in the country are among the poorest and most deprived in the UK.

As a response to this we have been working with a group of over a dozen institutions, as part of the Developing Eyecare Partnerships (DEP) project, a programme developed by the NHS with the goal of developing partnerships to create more efficient models of care We are using research to try to further improve the quality, efficiency and equity of care in Northern Ireland for diabetic eye disease, cataract surgery and school vision screening.

NHS as a driving force

There is no question then that the leading NHS institutions have been important drivers in our thinking, both here in Northern Ireland and globally. My work continues to focus on bringing equity of access not just for eye care but also as a result for communities more widely. Improved eyesight also brings wider world of educational and work opportunities in low-resource settings.

It is truly inspiring to be a part of the growing global health arena in Northern Ireland. There is a huge sense of momentum, driving forward programmes both in LMICs and in deprived areas of our own country. Being part of initiatives which use our own NHS models to improve care across the globe, whilst highlighting improvements and new initiatives which we can use to improve care throughout the whole of the UK, is extremely exciting and I am looking forward to what is to come. 

Professor Nathan Congdon, 

• School of Medicine, Dentistry and Biomedical Sciences
• Centre for Public Health
• Queens University Belfast 

Global Health: From National Beginnings to International Partnerships

At the end of June we reached a milestone in the Health Partnership Scheme (HPS) which entered into its seventh year implementation. After six years of global health partnerships it is clear that the model has really come of age. The stats speak for themselves.

In 2011, at the inception of the programme the target was to train 13,000 overseas health workers by 2015. In those four years over 38,000 had been trained and by June this year, following a two year extension over 84,000 health workers had been trained through projects in 31 countries. Impressive HPS figures abound but perhaps the next one to stagger me is that over 90,000 days were spent by UK health workers volunteering.  

This is the true legacy of the HPS and it is sure to be one which only continues to go from strength to strength. There is more engagement from UK institutions than ever before. During the programme over 130 NHS and Health and Academic Institutions from across England, Scotland, Wales and Northern Ireland formed partnerships with their counterparts in low- and middle-income countries, not only delivering invaluable training but also bringing improved skill sets, clinical knowledge and management experience back to an  NHS system facing many challenges.

Health Partnerships beyond the Health Partnership Scheme

The partnership model has also spread well beyond its original parameters with more funding approaches taking up the method than ever before. From Hub Cymru Africa to the Royal College of Physicians and Surgeons of Glasgow, several initiatives are strengthening and furthering the development of UK country and regional approaches to global health development. But it is not just the health partnership community which continues to expand the model, other DFID funding mechanisms are also incorporating the shared value element, and even further afield beyond the UK, organisations in the USA and in Europe are employing these methods.

The NHS - A global force

It is clear that health partnerships are contributing to the NHS’ positioning as a global force, providing a blueprint for other activity, including commercial opportunities which could see the NHS derive an income from engaging overseas. With such a wealth of knowledge harboured in the NHS, one such opportunity could, in the future, come from the deployment of UK health workers to middle and high income countries to assist with paid health system strengthening programmes.

Where once the development community was sceptical of ideas of ‘aid to trade’, it becoming increasingly clear that ODA spending can work to serve the interests of all, both overseas development aims and the wider interests of the UK. 

In Myanmar for example, as the nation continues to move forward with its own complex evolution, new and exciting opportunities are springing up for the UK health care sector to share knowledge and expertise with their local counterparts. From growing private sector investment particularly in the provision of medicines and equipment, to the development of training schemes and curricula o meet the depleted medical education system within the country. I am following with excitement our own expanding in-country presence with Health Education England.

A motor for innovation

A feature of this coming of age are the very diverse approaches that are emerging in the UK. From the dedicated global health policies in Wales to the specialised and thematic programmes within Northern Ireland, each nation is demonstrating innovation and impetus in their devolved states.

In England alone, regional actors are playing catalytic roles in fostering greater engagement. From the East of England where just a few weeks ago Anglia Ruskin University held a Sustainable Health Symposium bolstering the growing body of NHS Trusts and Universities taking up global health programmes, to the North West  where the Universities of Manchester and Salford together with the Global Health Exchange continue to forge new learning and volunteer engagement programmes, to Wessex where the Improving Global Health Leadership Development Programme is recruiting NHS volunteers to work with their counterparts in low-resource settings.

In this newsletter we start the task of ‘spotlighting’ this diversity. From the blog, interview and article captured in this month’s edition it is clear that this is an exciting time for the UK and its global health contribution and one that all countries and regions can continue to collaborate on. It is truly an admirable environment taking shape across the UK and one that collectively amounts to a distinctive and profoundly impressive UK offering to the goal of UHC for all.

THET is proud to be playing a modest role in enabling this to happen.

Ben Simms

CEO

THET

Addressing Child and Adolescent Mental Health (CAMH) in Uganda

Mental health nurse Emma Gilbert has spent nine months volunteering in Kampala, Uganda, within the Child and Adolescent Mental Health (CAHM) project implemented by the East London NHS Foundation and the Butabika Hospital. What follows is the account of her experience in Uganda. 

With a background in anthropology and a career in radio, my interest for global health only developed at a later stage of my life. I qualified as a mental health nurse and from the beginning I found the idea of working in global health very appealing. When, in 2015, the East London NHS Foundation was looking for a mental health nurse for their health partnership in Uganda, I jumped at the opportunity.

Understandably, the first question that my family and friends asked was: Why are you going?

The answer was pretty easy: when the project was launched there were, I think, only five child psychiatrists in Uganda, a country where 60% of the population is under 16. The lack of specialised human resources was appalling, so in implementing a training course for CAMH the partnership was trying to address a very obvious need.

The training course was designed by Dr Allison Hall, from East London, in collaboration with Dr Godfred Jokundo and Dr Joyce Naluja, the two psychiatrists from Butabika Hospital who run the course in Kampala. The programme promotes a multidisciplinary approach, to foster better integration of services, a real problem in a country where child healthcare often falls under primary care and there is a lack of specialist services. Therefore the training attracted a really interesting mix of health professionals, not only psychiatric clinical officers, but also paediatricians, nurses, social workers, psychiatrists and medical doctors. The enthusiasm of the people I was teaching was probably one of the best things of the job. They took time out of their formative jobs, and travelled from all over the country to take part in incredibly long teaching days. At the end of these, at 6 or 7 pm, we usually had a question session. I did not expect anybody to have the energy to keep going. I was wrong. The dedication - the interest was great. And because CAMH is a relatively new area, you could really feel their hunger for leadership, for pioneering the field.

At the hospital we saw the broad spectrum of mental health disorders. Sometimes that would also include severe learning disabilities or episodes of psychosis and issues linked to trauma or abuse. If a person had emotional behaviour difficulties, which wouldn’t necessarily be classified with a mental health diagnosis, they would still come to Butabika. There were all these factors in play which meant that diagnosis, although important, wasn’t always the first thing that we addressed. In many cases we were operating almost like a children’s home

The majority of our cases, however, were epilepsy. The child’s family often believed that epilepsy was contagious or that the child was bewitched. In many instances we saw evidence of violence on epileptic children. They were often brought to traditional healers and went through all sorts of ceremonies.

There is still stigma attached to mental health in general and by extension to the Butabika hospital, which means that the hospital is often the last resource. I saw a lot of brain injuries that could have being avoided if they had come to us sooner. The work that has been done with the trainees is also helping to overcome and challenge the wrong beliefs, but it is a slow process.

The training has been instrumental in developing CAMH services. It has generated the interest of the Ministry of Health, which we have tried to engage from Day 1. We also have university accreditation which was extremely important in order to attract new students. Before the very few CAMH specialists were operating individually with lack of support, supervision or platforms to share any kind of clinical knowledge, a network for collaboration and discussion has been established. Finally, we collaborated with the Ministry to write policy guidelines on CAMH services. I feel very proud of what the course achieved.

On a more personal level, I also learnt a lot, being forced out of my comfort zone and in the end almost running a clinic where you see fifty patients a day. In the UK, you’d be seeing maybe four patients daily, here it’s more 30 to 40, so my clinical knowledge improved significantly. I 100% feel that I am a better nurse after this experience. The ability I developed to work with different people, and to be open and flexible is extremely valuable back in London where I work with patients from diverse backgrounds.

I now consider myself a strong advocate for health partnerships. I have already encouraged other colleagues within the NHS who want to work overseas that this is the best way to do it. A lot of nurses feel the appeal of working with organisations like MSF, which is of course a very valuable frontline aid service. But health partnerships are amazing because they enable sustainable service transformation.

Emma Gilbert 

Mental Health Nurse

East London NHS 

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

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

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

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

A New Generation Takes On Chronic Malnutrition

THET’s Communications Officer, Timur Bekir, traveled to Lusaka, Zambia, to document the activity of two ground breaking training courses in nutrition.  

100 acutely malnourished children. That’s how many cases University Teaching Hospital (UTH) in Lusaka has in the severe acute malnutrition ward at any one time during its peak season. It’s a shocking number for a country edging towards middle income status.

It’s a number that becomes more overwhelming when you’re told that the whole hospital only has four Nutritionists. Just four to deal with the multitude of nutrition related cases such as under-nutrition, diabetes, obesity, renal failure, the list goes on.

Mr Zimba, one of UTH’s valuable Nutritionists, is showing me around the children’s ward. He explains that the peak season is from April to September, this is before harvest time when food stores are low:  

‘Malnutrition is about bad nutrition so there is over nutrition and under nutrition, so on this ward we are dealing with under nutrition. Nutrition intervention is not a remedy but it is a supplement to whatever doctors are doing.’

60% of the population lives below the poverty line and 42% are considered to be in extreme poverty, with much of the population surviving on subsistence farming. Chronic malnutrition, or stunting, is a serious concern in Zambia. With a prevalence of 45% among children under five years of age, substantially higher than the average of 38% for sub-Saharan Africa and the eighth highest prevalence among the 123 countries for which data exist.[1]

Mr Zimba takes me to another ward where the role of the Nutritionist is crucial. At the Renal Unit he explains the tests he does on patients to find out if they are deficient in nutrients or electrolytes or minerals like iron, potassium, sodium. Those tests allow him to see where the deficiencies are, do calculations and know the amount of nutrients needed in the fluid. This is a specialised role but the hospital does not have any specialists in the field of nutrition:

‘Right now in Zambia we do not have Nutritionists who are specialised in treating all these outlying cases, and with only four Nutritionists we are struggling in the field of nutrition.’

THET responded to the lack of Nutritionists and the problem of chronic malnutrition by working in partnership with the University of Zambia (UNZA) to develop the first BSc and MSc in Human Nutrition. This level of teaching in Nutrition has never existed in Zambia before and will go a long way to supporting the Zambian government’s commitment to improving the nutritional situation of its population.

The country’s National Food and Nutrition Strategy and the First 1000 Most Critical Days Programme were launched in 2013.  Central to the Government’s strategy are the objectives to significantly reduce chronic malnutrition in young children and increase investment in nutrition and nutrition-sensitive interventions.  The Government of Zambia acknowledges that achievement of their objectives is constrained by the shortfall of adequately qualified nutritionists and dieticians in Zambia.

Five volunteer lecturers from the UK, east and southern Africa are delivering the programme until UNZA has enough qualified lecturers to run the programme themselves.  Lecturers like Tonderai Matsungo from Zimbabwe:

‘The skills that the students are going to get from the programme are very crucial in terms of improving the quality of care that patients receive at the different health institutions, either government or private. An integral part of any nutrition training, besides the clinical part, is an emphasis on preventing and prevention is the one that covers public health and community aspects of nutrition so that is very important and those components are well covered in the BSc and MSc nutrition programme.’

Lecturer Tonderai Matsungo teaching in class at UTH. (Photo: Timur Bekir)

22 students graduated from the BSc on the 8th of December 2015 and there are nine students currently enrolled in the MSc Programme. Adana has one more year left of training, after which she hopes to go back to her local community and carry on her work as a Nutritionist. But, as she states, if the course wasn’t there she may have chosen a different career path altogether due to the lack of career development:

 ‘If this course was not there, probably I would have been doing other courses in other fields and I’m sure by now I would have gone to do another profession or career. But now that there’s this course I will continue as a nutritionist and I will go back to my province to make sure malnutrition levels are low.’

Adana, BSc Nutrition student. (Photo: Timur Bekir)

Back in the acute ward at UTH a mother is feeding her child, who was brought in with severe malnutrition. Talking to the mother was a stark reminder of how important the role of Nutritionist is, not only to cure nutrition related problems but to improve public knowledge of what good nutrition is. By training a new generation of Nutritionists THET is ensuring that the causes of malnutrition are addressed. Education and training is not a quick fix to health problems, it’s a long-term approach, but one that means a health service, with skilled health workers on the frontline, can offer quality care to patients not just in the short-term but well into the future. 

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Mother with under nourished child receiving treatment at UTH. (Photo: Timur Bekir)

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[1] UNICEF (2014) State of the World’s Children