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 

Medical device challenges and global priorities

Linnet, one of our Country Programmes Coordinators, travelled to the WHO in Geneva to attend the third Global Forum on Medical Devices. Here follows an account of her time there. 

The successful 3^rd World Health Organisation’s Global Forum on Medical Devices was held over three days in Geneva. It brought together over 600 delegates from around the world, including three THET representatives (Andrew Jones, Anna Worm and myself). The great thing about the forum is the variety of people who attend from Beninese biomedical engineers to representatives of UN agencies and the private sector all exploring how to improve the medical equipment ecosystem.

Anna ran an interactive workshop (Gradian Health and THET collaboration) on the role of BMETs in the Healthcare Technology Management lifecycle and presented new data that suggest the status of medical equipment in sub-Saharan Africa is more positive than most publications indicate. It was great to see so many backgrounds coming together to look at not just problems but solutions. The outcome of the workshop will be shared with the participants, and the presentation on African data is now available; click here to get a copy.

On Thursday, Andrew co-chaired two sessions, one on Human Resources and Medical Devices, where six abstracts were presented by LMIC representatives on collaboration and their experiences as BMETS in low resource settings and a plenary session with international partners sharing ideas and views.

Throughout the three days there were plenary sessions showing how the issue of medical devices is an intrinsic part of so many global health priorities from NCDs to Reproductive, Maternal Neonatal Child and Adolescent Health and looking at how medical device challenges effect these global priorities.

The collaborative feeling of the conference was reinforced by the messages from all corners of the world emphasising how we must all work together, from funders to government representatives, supranational organisations to the engineers on the ground, we all have a part to play. As one delegate from IFMBE (International Federation of Biological and Medical Engineers) said “partnerships are vital.” With so many challenges to overcome we need to all work together.

The global forum was a great chance to share experiences and lessons learnt from all over the world, and while each context faces its own challenges and different stakeholders have different priorities, there were great examples of innovations being showcased and it was clear that we could all take something from each other’s experiences. 

Linnet Griffith-Jones

Country Programmes Coordinator

THET 

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

Together We Can Overcome - #LetsTalk Depression

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

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

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

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

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

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

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

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

• Perception, attitudes and understanding of mental illness,

• Improving levels of safety and support by health institutions and local communities

• Providing relevant mental health educational materials delivered appropriately and creatively to communities deprived of contemporary communication channels

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

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

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

Pearson Moyo

Project Coordinator - Zambia

Mental Health Literacy and Patient Safety: Empowering communities.

[1] http://www.commonwealthhealth.org/africa/zambia/mental_health_in_zambia/

[2] Ibid

[3] http://apps.who.int/iris/bitstream/10665/254610/1/WHO-MSD-MER-2017.2-eng.pdf?ua=1

#BeBoldForChange

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

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

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

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

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

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

Ben Simms
CEO,
THET

Raising the Profile of Family Planning in Uganda

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

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

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

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

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

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

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

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

Clare Goodhart, 

USHAPE Clinical Lead,

Lensfield Medical Practice, UK

Somaliland: Health After War

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

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

I don’t cease to be amazed at what people can achieve,

even when faced with such adversity.

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

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

THET will support national partners to identify and develop any additional policies and regulations that need to be in place to guide effective oversight of health worker training. We will also be responsible for the security and logistics associated with the trips of the project team and volunteers.

During the course of the meetings, it was brilliant to see how much progress the Somaliland partners had already made and to see the commitment and energy that was invested in achieving the shared goals. I was particularly pleased to see the number of women amongst the faculty and students and hear how dedicated they were to contributing to their countries progress.

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

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

Louise McGrath
Head of Partnerships and Development,
THET, UK

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

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

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.