Now more than ever: in defence of aid

Ben Simms, THET CEO, reflects on the challenges we face as individuals engaging in the health partnership approach as we live through this tumultuous period in UK political history.

UK Volunteer in South Sudan with the Winchester-Yei Partnership

We are living in profoundly troubled and even toxic times, an age when our optimism and idealism is being tested to the hilt.

There is no escaping the fact that the vote to leave the European Union and the appointment of a new Secretary of State for International Development piles on new degrees of uncertainty about the future of the UK’s commitment to spend 0.7% of our Gross National Income on overseas development aid.

Britain is now one of just six wealthier countries to meet this long-standing UN target. In 2015, the UK donated £13.21 billion in overseas aid. It is a profound and impressive contribution, and I believe we are in a fight to ensure this commitment is kept.

Under this government I believe our chances are good. It is, after all, a 2015 Manifesto pledge. But there are others, joined by The Daily Mail, who would wish it away.

And what level of funding will 0.7% deliver if our economy contracts and the value of sterling falls? THET, a medium-sized charity, and our partners, are already feeling the effects of unfavourable exchange rates. It is deeply troubling.

The EU referendum and cabinet reshuffle has also delayed decision-making in DFID. 14 months in to the life of the current UK government we are still unclear about their intentions in relation to most aspects of their development expenditure – multilateral, bilateral and in relation to civil society.

One way of defending the aid commitment is to seize the opportunity provided with the adoption of the Sustainable Development Goals.

The SDGs are a useful communication tool. They are universal. It is just as important to address poverty in Caerphilly as we do in Mbale. It is not one or the other, either/or, over there or over here, it is simply, unequivocally, a fight to end poverty and improve health everywhere.

The SDGs point to the inter-connectedness of our world. As does the health partnership approach, with its emphasis on reciprocity and mutual benefit: 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.

However, a new rhetoric is emerging around ‘mutual benefit’ which risks distorting the purpose of aid. I am thinking in particular about the November 2015 publication 'UK aid: tackling global challenges in the national interest'. Here, poverty alleviation is listed as the fourth goal.

I am an enthusiast for the idea of recognising mutual benefit. THET’s new strategy places the concept of co-development at its heart. However, there is a risk, that in embracing the universality of the SDGs and defending the benefit we derive here in the UK from working overseas, aid priorities will be defined too much in terms of our own national interest, and not enough in favour of the governments and people of lower and middle-income countries.

A risk, in other words, that in defending aid from the attacks by the Daily Mail we’ll begin to think and sound too much like the Daily Mail.

It is therefore vital that those involved in health partnerships must be expert in striking the right balance. Alongside our clinical expertise we must be applying good international development practice. 

That is why THET has embarked on a journey of producing a policy paper which will articulate what the appropriate balance between UK national interest and benefit to aid-recipient countries should look like. This paper is being put together in collaboration with leading thinkers from the north and south, such as Lord Crisp, Professor Myles Wickstead, Jim Campbell at the World Health Organisation, and Dr Mliga from Tanzania.

The paper will be launched at our conference this October which will also throw light on striking the right balance through a series of peer-reviewed presentations.

The world is at a crossroads.

As individuals and institutions involved in the health partnership approach, we must:

• Defend our historic 0.7% commitment to aid.
• Promote the universality of the Sustainable Development Goals.
• Strike the right balance between what we expect to give and what we hope to receive; I am unashamed in applying a mutual benefit lens to our work in global health, recognising the enormous benefit we derive as individuals and as UK institutions, but our work must be grounded in an analysis of what our host countries ask of us.

Now more than ever we must work with idealism to promote the value of aid, and to articulate a vision through health partnerships of how we all benefit from being part of a world bent on ending poverty.

This blog is based on a speech given at the Wales for Africa conference, which you can read on the THET website.

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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. 

Collaborating to change behaviour in Mozambique

In this blog, Eleanor Bull, Health Psychologist, and Corina Mason, Trainee Health Psychologist, reflect on their recent experience working in partnership to change health worker practice at Beira Central Hospital, Mozambique. 

In 2016, as part of a new THET funded programme called the Change Exchange, health psychologists joined existing partnerships to help understand and change healthcare staff practice, helping to strengthen THET partnerships. As health psychology practitioners employed in NHS Grampian, we are fortunate to have broad roles in offering expertise in the complex task of changing health behaviour. Our practice includes patient interventions and research and training of professionals across prevention and self-management initiatives in public health and the acute sector.

Both of us had previously volunteered in Uganda, and were inspired by this fascinating programme. The cultural and personal learning opportunities from previous experience in Uganda had influenced our professional development. Following an article in ‘The Psychologist’ (the British Psychological Society monthly publication), we rushed to register our interest in working with a network of multi-disciplined professionals to improve the local health needs in a low income country.  The partnership approach particularly appealed to us as we observe in our daily practice the benefits of working in collaboration with our multi-disciplined colleagues.

From the outset, we were warmly welcomed into the partnership with great enthusiasm and interest from the fantastic team of health professionals at Ipswich Hospital and Beira Central hospital.  The partnership’s current aim is to improve patient safety through projects related to two key strands of work: medical equipment maintenance and medication safety. The Medical Director at Beira Central Hospital states, ‘this is important for us because hospital changes start in the mind of staff.’

Our role predominantly focuses on the complex strand of medication safety because the ideas being implemented by Beira Hospital professionals depend on changes in staff practice. Some initiatives include:

· adaptations to in-patient medication charts
· development and delivery of drug dosage calculation training
· availability of emergency drug boxes on each ward

During our visit to Beira Central hospital in June this year, we collected information from health professionals by conducting interviews, discussion groups and questionnaires with staff involved in implementing the new medication safety procedures. We observed drug dosage calculation training to understand its active ingredients, presented to Beira healthcare staff on the role of Health Psychology and the importance of behaviour in healthcare, and worked with our Ipswich partners to deliver training on antibiotic resistance.

Following data collection, we presented findings and recommendations based on health psychology to help the partners implement their excellent work. We were really pleased that health professionals in the partnership suggested our input to date has been valuable, as the Head of Nursing states,  ‘this is very good for all situations here (at the hospital) and is good that you made these observations as we are too busy to do this.’

This was an amazing and inspiring opportunity to develop our health psychology skills within a brilliant UK-African partnership. We are both incredibly grateful for this opportunity and particularly the invaluable help of our UK and Mozambican translators, as unfortunately our Portuguese still doesn’t stretch far beyond ‘Obrigado!’ We are now engaged in meetings on Skype and producing a report outlining our recommendations before a second planned visit in November to offer further help in changing staff practice.