Getting senior leaders' support for your health partnership

How health partnerships get active support from senior leaders in their partner institutions and beyond

Photo: Anne Jennings

All health partnerships work with the approval of institution leaders, but some go further and win active support from senior leaders in their institutions and beyond. We recently asked some HPS-funded health partnerships to explain how they’ve been able to do that. Here’s what they told us.

• Getting the active involvement of senior leaders in a health partnership project can take time but makes a partnership stronger in the long term. Senior leaders are in a position to delegate partnership work to other staff, embedding it in an institution, while retaining responsibility.

• Health partnerships that make an effort to keep senior managers informed of their work are more likely to get support from those managers when they need it, for granting leave requests for volunteers or helping a partnership team get cooperation from other teams in a hospital. One engaged senior manager can share updates with senior colleagues and networks through formal reporting channels such as management meetings. If there are changes in a senior leadership team, it is important for a partnership to engage early on with new managers who can influence their work.

• LMIC partners may visit the UK, or other LMIC countries (in the case of partnerships with more than one LMIC), for training or planning. Sometimes they are accompanied by government staff or other health sector leaders. These visits are a great opportunity for the leaders of the visited institution to meet health workers and leaders from overseas, and for the partnership to raise the profile of its work.

• Looking beyond the partner institutions, some health partnerships have made an effort to engage the MoH in the LMIC country, by keeping them informed about their project or inviting them to join a project steering committee. Others have aimed to influence the health agenda at a governmental level. They have found success through aligning with existing advocacy networks and opportunities, and using all their contacts to make connections with supportive individuals in Ministries of Health.

“Support from senior leadership,” as described here by health partnerships, includes a diversity of activity by various individuals. If there is a common theme, it is the importance of investing time and effort to build relationships as early as possible – rather than waiting until you need the support of a senior manager or leader.

Thanks to all the health partnerships that have contributed to this list.

Do you have other lessons to share? Please add them in the comments below. 

Dan Ritman - @danonuke
Evaluation & Learning Manager - THET

New Partnerships Essential for Global Health Success

THET CEO, Ben Simms, highlights how health partnerships are best placed to help realise the health focused SDGs, specifically the hope for Universal Health Coverage. 

Photo: James Dowling

The Overseas Development Institute described the newly adopted Sustainable Development Goals as being an architectural marvel, soaring and visionary in their ambition. And so they need to be if they are to do justice to the scale and complexity of the challenges this world faces.

One in 7 people across the world today will never see a qualified health worker. According to the World Health Organization, the worldwide crisis of health worker shortages is set to grow to 12.9 million by 2035.

Without a major effort to recruit and educate health workers, how can the commitment to achieve universal health coverage be realized?

Greater emphasis needs to be placed on supporting and training health workers, building preventative capacity — as highlighted by the devastation of the recent Ebola outbreak — and ensuring that countries have a health workforce that is fit for purpose. One way to do this is to effectively harness the medical and managerial expertise available in high-resource settings.

There is a broad range of ways in which health professionals voluntarily engage in overseas work. The scale and contribution of overseas volunteering has been explored in detail in the report by the U.K. All-Party Parliamentary Group on Global Health. The report recognizes the increasing number of links between NHS Hospitals, Royal Colleges, U.K. universities and their counterparts in low- and middle-income countries.

Over the past four years the Tropical Health and Education Trust has partnered with the U.K.Department for International Development to create and support the development of such partnerships so that they are more effective, as well as to award grants that provide for a diverse range of size, reach and theme. Since the Health Partnership Scheme was launched in 2011, more than 1,500 NHS professionals have volunteered to train over 40,000 health workers across 29 countries, helping to improve training structures and fill knowledge and skills gaps.

The results of this training can be seen in the day-to-day practice of health professionals, in the development of new cadres of health workers, and the broader policy and regulatory environment they are working in. Over 500 improved clinical guidelines, policies or curricula have been generated in the past four years.

Improving the quality of mutually beneficial health partnerships

Alongside greater activity, HPS represents an important opportunity to share information and to gather evidence on what works well and what does not in partnerships and international volunteering. As part of THET’s ongoing approach to quality improvement, we have developed Principles of Partnership to accelerate the quality and effectiveness of how U.K. health care institutions engage in low and middle-income countries. We’ve defined our principles through consultation with the wider health partnership community and we plan to further develop tools and practical resources over time to highlight the most important factors for successful partnership.

A vision of ‘co-development’

At the heart of the health partnership model is the idea of reciprocity, the idea that all who engage in training health workers overseas, benefit from the kind of professional growth that brings great benefits to our working lives back in the U.K. This is what Lord Crisp terms in his seminal book “Turning the World Upside Down” as a vision of “co-development.” These partnerships are in keeping with the framing of the SDGs as global goals rather than for goals set exclusively to benefit the global poor.

Health Education England and the Academy of Medical Royal Colleges recognize the educational and learning opportunities of allowing U.K. health workers to engage in global health. Despite this, across the U.K., contributors to Improving Health at Home and Abroad commonly reported having to keep international volunteering through partnership activity “under the radar.” As a result, the scale of health partnerships remains modest, a fact recognized by the International Development Committee report on health systems strengthening in 2014, which commended volunteering schemes for health professionals but noted that the U.K. has “one of the best health systems in the world ... DfID makes only limited use of it.”

The adoption of the new SDGs is a turning point in the history of how the we live together on this planet. If that was a moment to be soaring and visionary, now is the moment to work out how we are going to deliver on our promises. We must seize this moment to direct the energy and dynamism of health professional volunteers towards the even greater challenge of building health systems fit to deliver universal health coverage to every citizen in this world.

Mutually Reinforcing Strategies

Mutually reinforcing strategies to improve blood sugar monitoring

Global Links is working with nurses at Ola During Children's Hospital, Freetown, Sierra Leone. 

Health partnerships often find that multiple, mutually reinforcing strategies are more effective than any single approach to changing health worker behaviour.

The HPS-funded Global Links Volunteer Programme sends UK paediatricians on 6–12 month placements in East and West Africa, and facilitates African doctors to undertake placements in the UK. The programme aims to improve paediatric care in hospitals and communities, improve paediatricians’ leadership skills and strengthen institutional links.

Volunteer UK paediatricians work on priorities agreed with their host institutions. One reports from Karatina General Hospital in Kenya on ways to encourage consistent neonatal blood sugar monitoring:

It can be difficult to change behaviours sometimes. In our neonatal nursery in Kenya, blood sugar monitoring was poor. By attacking this from several angles we were able to improve this. This consisted of:

1.       Teaching sessions with the nursing staff and the medical officers on the importance of blood sugar monitoring in neonates.

2.       Positive reinforcement when it was done appropriately.

3.       Use of a white board to facilitate the nursing staff to remember to check blood sugars.

4.       Asking about blood sugars for every baby on the ward round.

5.       Reviewing blood sugar monitoring at mortality meetings attended by neonatal nurses and medical officers.

 Global Links is run by the Royal College of Paediatrics and Child Health, the Kenyan Paediatric Association (KPA), the Ugandan Paediatric Association (UPA) and the West African College of Physicians (WACP), Faculty of Paediatrics. 

A Life-line for Rural Communities: Training Community Health Workers in Somaliland

In this blog, THET's Communications Officer, Timur Bekir, describes his visit to a rural village in Somaliland to see how a newly trained group of Community Health Workers are improving healthcare for the local population.

We’re driving along one of Somaliland’s main roads, an artery that cuts across the Sahil Region linking the capital Hargeisa with the coastal city of Berbera, when our driver, Abdi, makes a sharp right turn, leaving the relative comfort of the pot holed tarmac and embracing the undulating and unforgiving terra incognita of the Somaliland desert. As we hit the earth, we’re thrown about in all directions and I make use of any and all handles to support myself. A couple of minutes in and I’m starting to feel nauseous. ‘How long till we’re there?’ I enquire. ‘Two hours,’ comes the reply, ‘maybe three.’ It’s at this point that I realise the herculean task of getting an ambulance to a remote village like the one we’re visiting today, and how truly awful it must be for any sick patient taking that journey.

60% of the population in Somaliland is nomadic and many settlements and villages sit in isolated rural parts of the country. These remote communities have little or no access to healthcare and often only seek treatment when conditions take a turn for the worse. I’m visiting one such village today, Hulqaboobe, to see how THET’s Community Health Worker (CHW) programme is bringing essential healthcare to the local population.

I’m traveling with Amina Abdi, the lead tutor for the Community Health Worker programme. The programme has been developed by THET in collaboration with the Somaliland Ministry of Health and the UK Department for International Development, and takes a three tired approach: train CHWs, update the existing CHW curriculum and training manual, and deliver training to trainers who can continue to deliver the course in the future.

CHW lead tutor Amina Abdi. Photo: Timur Bekir

One of the fundamentals of the CHW programme is that students must be selected by their local community and then return back to that same community to work and provide healthcare, as Amina explains:

One of the criteria was that trainees should be selected by the health committees in their village. The person living there knows the rules and what the situation is in the community. We wanted to make sure the candidate can help their own community.

Hulqaboobe Village. Photo: Timur Bekir

The car slows and Abdi tells me we’re in Hulqaboobe. The village is flanked by mountains on two sides and looks about as remote as you can get.  Up ahead sits a large tree surrounded by huts and a Primary Healthcare Unit, built recently by one of THET’s partners Health Poverty Action. The village elders greet us and I’m introduced to the three CHWs who will be serving the local population. I speak to one, Asiya Awiye Muhumed, about her experience on the course:

When I was selected by my society that was the first time they trusted me, and during my first visit to the village after initial training we organised a community gathering and explained about our objectives. We told them that with the knowledge we are gaining from the training we want to serve them better.

Newly trained CHW, Asiya Awiye Muhumed. Photo: Timur Bekir

Health indicators in Somaliland are extremely poor. According to UNICEF one in every 14 children die before reaching age one while one in every 11 children does not survive to their fifth birthday; the maternal mortality ratio is 1044/100,000; and less than 50% of births are attended by a skilled attendant.*

CHWs embark on a nine month course that is broken down into six week blocks. This includes three weeks of class based study, a week working in their local health facility, and a community placement for a week, which is followed by a week of leave. Amina highlights the scope of the training:

The topics they are learning are really a lot. I can say some of the things they are learning are how to take care of pregnant mothers, how to take care of sick children, how to recognise the danger signs during pregnancy, after pregnancy, or during delivery. The healthy environment is also one of the things we are teaching them so they understand what health means and why we need to have a healthy environment, a simple example being handwashing.

The rugged beauty of Hulqaboobe village is quite stunning. The unexpectedly green landscape is broken up by orange rock and dusty earth, punctuated by the bright, vibrant colours of the Hijabs worn by local women. There is a huge crowd in Hulqaboobe today and Hersi Ahmed, one of the other CHWs selected from the village, explains that this is usual. People come from all around the area to be seen by the health workers:

Every day is like this and there are lots of sick people who need help, that is why I wanted to work for my people.

Hersi describes the impact of the training so far:

The training is going very well. We’re learning a lot of good things and Amina is supporting us to learn many things which we did not know before. We did not know how to measure BP and first aid, we knew none of these! But now we know many things.

CHW Hersi Ahmed. Photo: Timur Bekir

As our time in Hulqaboobe draws to an end I grab a quick word with the village elder. I ask him what impact the CHWs will have on the community:

Before this health facility was built we used to hire a lorry to take pregnant mothers to hospital, but now we get access to ambulances, and when someone gets ill in the village we get medicine from the health centre. Initially, there was only one health worker in the facility, but now we are expecting it to be more efficient because we are going to have the Community Health Workers who are very active in the health centre. So that is huge benefit to the village people, and we are very grateful to those whose support has made this happen and all those who participated in their training. We want to continue from there and improve upon it, I hope that we continue receiving support.

Village elder, Muse Hussein. Photo: Timur Bekir

The engine of our car rumbles into life behind me, signalling that it really is time to go. It’s clear from the people I’ve met today that the appetite for healthcare development is strong in Hulqaboobe. The CHWs are providing a much needed life-line to neglected communities and I look forward to returning again when the CHWs have graduated and are in their posts to see the impact they are having on patient’s lives.

*Summary Preliminary Results Multiple Indicator Cluster Survey, 2011, UNICEF.  

Developing village-based community mental health care in southern Malawi

In the blog, project Co-ordinator, Jerome Wright, charts the development of partnership project work between  the Department of Health Sciences at the University of York in the UK and Zomba Mental Health Services in Zomba, southern Malawi. 

The origin of the Mental Health in Zomba (MHiZ) Project stems from work on a 2005-6 British Medical Association (BMA) Humanitarian grant funded project to pilot the teaching of mental health care to staff posted at health centres around Zomba in southern Malawi.  These health professionals – nurses, clinical officers, medical assistants - were updating their mental healthcare skills, skills they rarely utilised in the midst of challenges besetting the low resourced and overstretched health centres, compounded by the priority afforded to physical health problems of communicable disease and mother and infant health.  The evidence of mental health problems contributing to the global burden of disability, and how the physically unwell and their carers are among the most vulnerable to mental health problems, was only beginning to emerge.  Two things were challenging – HOW to design and deliver mental health training that would be effective and accommodate the social and cultural context of rural Malawi and secondly, WHERE best to target these efforts.

Health Surveillance Assistants (HSAs) are a group of Malawian health workers closest to the communities they serve.  While based at a health centre, they attend there only once or twice a week but spend most of their time promoting health in the villages – directing efforts to providing vaccinations, monitoring children and mothers’ health, supporting the treatment of malaria, TB and HIV, monitoring and promoting community efforts at water and sanitation facilities and tracing outbreaks of infectious disease. Mental health was not included in their training to become an HSA and yet at the teachings HSAs would describe ‘people experiencing madness’ (“anthu a misala”) and other mental health and development difficulties such as learning disability, epilepsy, low mood and suicide.  Though previously untested, the accessibility of HSAs within the communities made them the ideal staff group to be supported to promote mental healthcare for people closest to their homes.   

HSAs from Matiya health centre. 

However, what type of assessment and intervention should be promoted? In the past, initiatives in low income countries have tended to focus on enhancing the often sparse psychiatric service, with the intention that the ‘expert’ knowledge of mental illness from institutions filtering through the interventions and provision of effective care to the public.  The knowledge espoused too would be based upon that evidenced from other (usually high resourced) countries – with the assumption of universal applicability and appropriateness.  While there appears to be an agreement that throughout the world people experience mental distress, the way that these experiences are understood, lived, and ‘treated’ differ according to cultural context.  A decade of experience working with colleagues in rural Malawi – where there are rich traditional African and other religious responses to what might be described as mental health problems, together with its mixed picture of effectiveness and an absence of western psychiatric thought – meant we wanted to tread carefully by introducing a determinedly ‘healthcare’ response to people suffering distress that was also conducive to Malawian social and cultural mores. 

MHiZ Project manager Chikayiko Chiwandira and Nurse Jane Mlumbe providing supervision to HSAs.

To develop such a mental health curriculum that would assist HSAs in recognising and responding to the range of mental health problems they witness in their communities, a mixed group of Malawian and UK health professionals, academics, users of mental health services and HSAs themselves was convened.  Through a series of workshops and deliberations a three day training programme was designed and prepared. The curriculum acknowledged multi-factorial pathways to experiencing mental health problems, accepting the personal value and significance of people’s own attribution beliefs (stress, the use of drugs, bewitchment, the ‘will’ of God etc.) and offering a ‘health model’ as a way of responding to the distress.  Although, within the community, ‘bewitchment’ was the most common attribution for a person experiencing what may be termed a mental health problem, so too was ‘stress’ which provided HSAs with an ideal opportunity to pose a ‘stress-vulnerability’ model to understand the psychological ‘distress’ as a health problem.   Instead of identifying psychiatric diagnoses, a client- and HSA-assessed adjudication of ‘psychological distress’ and ‘risk to self or others’ was sought, together with a  Human Rights framework utilised to determine prioritisation and acceptability of an intervention against a person’s consent.  The response and interventions from HSAs too emphasised the mobilisation of support locally from within the family or wider community, with the health centre available for the most severely disturbed people.

The curriculum was successfully piloted in 12 health centres between 2010 and 2012 and involved training 271 HSAs and the current MHiZ Project is now scaling–up that programme to the whole of Zomba District which includes 32 health centres and serves a population of 550,000.  In a development from the pilot project, to support the integration and sustainability of mental health within the role of HSAs further, a one day training course on mental health using the same model was also provided to 240 health professionals based at the 32 health centres in order to acquaint them with the HSAs new role and enlist their support managing mental health problems at health centres. 

In 2013, once a ‘training of trainers’ programme was completed, nine Malawian trainers delivered ten three day training programmes to more than 450 HSAs.  The third day was delivered six to nine months following the first 2 days to incorporate an opportunity for HSAs to review and discuss their new mental health roles.  A pre- and post-training assessment of each individual HSA’s knowledge and confidence in tackling mental health issues was also undertaken, with increases in both recorded on follow-up. 

In the 18 months since the trainings, the small MHiZ team have provided monthly supervision to HSAs at their health centres, reviewing their interventions with individuals and families and also the huge number of mental health promotion activities the HSAs have facilitated.  A record of both HSAs’ mental health care activity with individuals and their families and their mental health promotion activity is being collated.  Records show people are presenting to HSAs with a range of life-problems: bereavement, abuse, marital problems, epilepsy. Carers attend to see the HSA describing clients ‘abnormal’ behaviours such as ‘wandering’, not eating, not sleeping, dizzy, talking to self and smoking ‘chamba’ (marijuana).  The HSAs describe people challenged by difficult social contexts including death of loved ones, abuse, physical illness and relationship problems, with more than 1 in 10 people feeling suicidal.  HSA interventions range from providing information, emotional support and reassurance, communicating with extended family or community to mobilise support, advice on medication or referral onto the health centre.

To date, records of over 800 mental health promotion activities have been collected, with over 40,000 persons attending these events – including public meetings, meetings of village health committees, consultations and support groups for patients and carers.   This demonstrates the huge reach HSAs have within their communities and the potential this has for public mental health promotion and sensitization.

As the project nears its end in March 2015, we look towards sustainability and summative evaluation.  In September last year the Project financed and hosted an Award Ceremony at Matiya Health Centre, Zomba District, to celebrate their efforts as the top performing health centre and the mental health work of individual HSAs.  The event, attended by local stakeholders and national press, has helped to draw attention to the potential of HSAs and to generate interest within the Malawi Ministry of Health and more widely in developing this or similar initiatives. To inform this too, the MHiZ Project team is currently analysing data to determine both successes and ongoing challenges in developing this innovative approach to community mental health care. 

MHiZ Project manager Chikayiko Chiwandira and Assistant DHO Mr Mlotha presenting HSA Shadreck Chinsima with his award of bicycle for his excellent and sustained contribution to mental health promotion and care.

In the coming weeks, we are looking forward to testing the degree to which the MHiZ Project has developed a way of increasing primary mental healthcare that is responsive to local understandings and experiences of distress and provides humane and effective care for some of the most vulnerable people in society.

MHiZ Project Lead Jerome Wright congratulating top HSA Shadreck Chinsima on his award.

Improving health outcomes for women in Uganda

Sarah Muwanguzi is a Senior Midwife at the Mulago Hospital in Uganda working with the THET funded Liverpool-Mulago Partnership to train health workers and improve health outcomes for patients. As she prepares to visit the UK and speak at THET’s 25^th anniversary event in Salford on the 25^th November, we asked Sarah to reflect on her experiences of health partnerships, the improvements that have been made in her hospital and the challenges now faced by her team.

It all began when I was deployed as a Deputy Sister in charge of the High Dependency Unit (HDU) in July 2011. My major role was to team up with the then in charge, Prosy Namukwaya, to improve the quality of care for women with critical conditions in the department of Obstetrics and Gynaecology.

Maternal mortality rates in Uganda are very high, at 438 deaths per 100,000 live births, with a still birth rate of 30 deaths per 1,000 total births. Mulago Hospital is a national referral hospital which carries out approximately 70 deliveries per day, with neonatal and maternal mortality rates also very high.

The idea to start a High Dependency Unit (HDU) came up after Dr. Muyingo Mark and Dr. Nakubulwa visited Liverpool Women’s Hospital in the UK with the Liverpool-Mulago Health Partnership. With funding from The Eleanor Bradley Fellowship Trust, the Obstetric HDU Project was initiated in October 2010, with the aim of improving the hospital’s ability to render improved services to the large female population.

We were a group of twelve midwives newly deployed from other wards to work in the HDU and were not conversant in managing critically ill patients. Thus, a training workshop was organized by the UK team, Professor Andrew Weeks and Dr. Sarah Hoyle, to build capacity for all the HDU staff. The knowledge gained from this workshop, plus continuous mentorship and supervision, meant the HDU midwives were able to use their new knowledge and skills to assess and manage acutely ill adults.

I will never forget a woman who was returned from theatre immediately post-surgery. The midwife had not carried out her post-operative observations and had hurried her out of theatre to go off duty. She wheeled her to the HDU and left without handing over to the HDU team. The woman was sitting in a pool of blood, very pale, and with an African Maternal Early Warning Score (AMEWS) of 8. (It is now mandatory for all women admitted in the HDU to be scored and intervention carried out based on the AMEWS score.) UK volunteer, Dr. Emily Lewis, was summoned for help and immediately put up a normal saline 0.9%, which was run very fast and also established a second line to resuscitate for adequate fluids. With that promptness the collapsed woman was revived and returned to theatre for further interventions. She was a near miss!

Learning from Dr. Emily the importance of a good team and promptness in managing emergencies, I was motivated to train, guide, and support the HDU team, and other midwives, to strengthen their knowledge and skills in managing obstetric emergencies. Together with Dr. Jo Sinclair and other UK trainers, we conducted a training workshop at Kansagati HCIV in preparation for the proposed re-opening of the operating theatre, where emphasis was on post-operative observations and infection control measures.

We have also successfully developed a unit culture to review all maternal deaths and near misses (Maternal and Perinatal Death Review, MPDR), so as to generate next steps in improving care. The HDU is now a model ward, where prescribed drugs are administered on time and with good record keeping. The challenge now faced is the high staff turnover due to frequent change over. This calls for more funds and time to conduct more training for newly deployed staff.

Meeting in the HDU.

Training at Mulgao Hospital.

Infection prevention project in the Obstetric HDU

My trip to Liverpool in 2012 was very interesting and informative. I saw and admired how things are done differently and greatly desired to bring about a change at my unit. I recalled the situation back home, where there were inappropriate hand hygiene practices carried out by the doctors and midwives while making ward rounds. The unit had many faulty hand washing sinks; we lacked infection control protocols and basic reminders when going in to the main labour ward; the shower rooms were not functional and women went in to labour in a very unhygienic state. Waste disposal methods within the labour ward were inexcusable, with very old broken waste bins, without lids, predisposing new mothers to postpartum infections. The exposure I got while on my exchange visit at Liverpool Women’s Hospital, prompted me to lay down strategies to improve infection control measures at my hospital. Among these was to conduct mandatory trainings in infection control, establish a link system, and to carry out clinical infection control audits for each unit in the department.  We managed to conduct a number of trainings and also identified link staffs on all obstetric wards. However, due to limited funding, we were not able to conduct training on clinical audits.

New bins on the ward.

There is generally a new outlook to the entire hospital, which the HDU has painted. There are now alcohol rubbing facilities mounted near entry points for the HDU and labour ward. More thanks to Mulago Hospital’s top management and the Deputy Director, Dr. Birabwa Male, who lobbied for funding to roll out the hand hygiene project to all of the hospital’s wards. Twelve pedal bins were bought and placed within the labour ward and surrounding units, to improve waste management within the labour ward.

I’m grateful to the UK volunteers for the contribution they made towards strengthening our midwives capacity to implement simple, routine procedures. I have continued to guide midwives to put into practice what they had learnt from the UK volunteers. Such as triaging in the admission area of the labour ward, newborn resuscitation skills, labour monitoring using a Partograph, infection control measures and using the AMEWS.

You can find out more about the Liverpool-Mulago Partnership here.

If you'd like to attend the event in Salford, you can register for free here. 

NHS expertise, how to reach its full potential

The International Development Committee (IDC) recently published a report on the findings of an inquiry into DFID’s work on strengthening developing country health systems. Graeme Chisholm, THET’s Volunteer Engagement Manager talks about its recommendations and what it might mean for the future of volunteering from the NHS. 

In my previous blog, Voluntary Engagement in Global Health, I asked, partly rhetorically, whether a leap of faith was required for us to believe that engaging in global health can be good for everyone. I didn’t expect an answer so quickly and certainly not one as resounding as the one I read in the recently published report Strengthening Health Systems in Developing Countries from the House of Commons International Development Committee. In this report the highly influential Committee states in no uncertain terms their firm belief that volunteering overseas can indeed be of great benefit to the NHS as well as to developing country health systems.

The report calls for volunteering schemes to be well coordinated, structured and of sufficient scale to achieve lasting change. Engaging in global health comes in all forms but let’s not forget that there are a number of wonderful examples of volunteering schemes funded by the Health Partnership Scheme (HPS) that display all the qualities called for in the report. Take Global Links, managed by the Royal College of Paediatrics and Child Health, for example. Since it started in the spring of 2012 36 paediatricians, trainees as well as consultants, have volunteered for periods of six months in some of the toughest conditions in East and West Africa. A number of Global Links paediatricians have been working, for example, in Ola During Hospital, the only children’s hospital in Sierra Leone, alongside Sierra Leonean doctors and nurses. What they’re achieving is summed-up by Timur Bekir in Giving Children a Chance: Reducing Child Mortality in Sierra Leone below. One other thing to celebrate about Global Links though is how the RCPCH have worked hard to ensure that paediatricians from west and east Africa get the chance to come to the UK, 17 so far, to learn and share knowledge with us before returning to their countries to help lead their health services. And I know that all this hard work has helped greatly to counter the Ebola threat currently faced by the people of Sierra Leone.

So what else does the report say? At its heart is a call for us all, however we engage in global health, to make better use of NHS expertise. The report recommends that NHS staff should be supported in seeking to apply their skills where need is greatest. It rightly points out that the new guidance, Engaging in Global Health, from the Department of Health, Department for International Development and the NHS, should lead the way. But it’s worth pointing out that Engaging in Global Health is simply that, guidance rather than policy. So how do we take the next steps and create ‘formal structures to facilitate the participation of many more’ to engage in global health as the report goes on to recommend?

There are two things that can make this happen. One is more money and the other is policy change. But where can we find the money in these austere times and what needs to change in terms of policy? Here are some ideas.

When it comes to engaging in global health through partnerships, a patchwork of charitable donations and support from philanthropic and commercial sources all provide vital funding. But the lion share of funding is currently provided by DFID through the Health Partnership Scheme. The report commends HPS but it also says that its level of funding is but ‘a drop in the ocean’. There is clearly an appetite for more partnerships that can demonstrate value so shouldn’t we be lobbying DFID right now for a higher level of funding to allow partnerships to flourish beyond 2017 when HPS is currently due to end?

These are exciting times we live in as Healthcare UK and UK Trade and Industry look to markets overseas to export the UK’s healthcare knowledge and expertise. And as profits from these commercial partnerships begin to flow and we continue to understand more and more the value to the UK’s health sector of voluntarily engaging in global health isn’t the time now right for us to explore the relationship between commercial partnerships and voluntary health partnerships and how they can mutually support one another?

As for policy change where to begin? In terms of direction from the top, there has been some progress. Even though Engaging in GlobalHealth is guidance rather than policy it does provide solid foundations to work from. And earlier this year a new clause supporting voluntary engagement in global health by the UK workforce was included in the refreshed Mandate from the Department of Health to Health Education England. But what is notable is the absence of anything similar in the government’s Mandate to NHS England. This is worrying. Shouldn’t we be calling for support for engaging in global health from NHS England? I think we should for if the de facto system manager of our health service has nothing to say on the matter then doesn’t this legitimise inaction and insularity?

But what about more practical measures? I’m delighted to report that Health Education England and NHS Employers are working on a Continuing Professional Development toolkit that will help all those who volunteer overseas to reflect on and evidence the competencies they gain whilst volunteering. And we at THET are keen to study how this is received at appraisals when NHS employees return to the UK. We know, anecdotally at least, that lots of good comes from volunteering but we also really want hard evidence to put to bed once and for all the concern that the NHS is losing vital skills and gaining nothing in return. This is a big task so wouldn’t it be great if Local Education and Training Boards helped to roll this initiative out to help to really embed it across the health service?

A final thought. Model policy examples aren’t always necessarily eye catching but my gaze keeps drifting back to the one developed by NHS Employers in conjunction with the Ministry of Defence for NHS employees who are also members of the reserve forces. This particular Model Policy Example manages to tackle the many issues as well as offer solutions and it packages it all up neatly in the one document. I wonder whether we should be pushing for something similar for international volunteering?