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

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

Strengthening Global Mental Health partnerships - #LetsTalk Depression

A new mental health collaborative was inspired to come together after the Health Partnership Symposium, Petty and Randy explain why sharing knowledge and practice across country borders is so crucial in the battle to improve mental health care. 

“Seeing mental health and substance misuse patients suffering, neglected by the community, families and other healthcare workers; motivated me to work with mental health. Working as a health Administrator and a Project Coordinator at a Tanzania National Mental Health Hospital, I found I could help these individuals so that they can be provided with an environment that will allow them to recover from their illnesses, reduce relapses and lead a normal life.”

Perpetua Mwambingu- Tanzania Link Project Coordinator

“In Ghana mental illness is often attributed to spiritual causes and people who suffer from mental illness do not get the help that they need. Stigma and discrimination is high and people who suffer from mental illness lose their dignity, respect and self-worth. My passion for awareness creation and advocacy and my belief that someday Ghana will appreciate the importance of mental health motivates me even during moments of burnout”

Randy Agbodo- Project Lead for Ghana - Zambia - NHS Highlands Partnership

The Story Remains the Same

According to the World Health Organization, for every four people, one will be affected by a mental or neurological disorder in their lifetime. The magnitude of mental health burden is not matched by the size and effectiveness of the response it demands. Currently, more than 33% of countries allocate less than 1% of their total health budget to mental health[1].

Sadly, in Tanzania and Ghana where Randy and I are working, the story remains the same, mental health services are underfunded, and most of the donor funded programs go to communicable diseases. There is inadequate human resource and insufficient supply of medications. Stigma and discrimination towards persons with mental disorders is still prominent and effective mental health prevention and promotion programs are woefully inadequate.

 No Health without Mental Health

Depression is ranked first in the list of top ten leading causes of years lived with disability (YLDs)[2]. Globally, an estimated 350 million people of all ages suffer from depression[3]. At its worst depression can lead to suicide and close to 800,000 people die due to suicide every year[4].

This is why it is so vital that World Health Day this year is addressing depression, bringing it to the fore of global health discussions. It gives health managers and policy advisers the opportunity to appreciate that depression affects productivity and therefore prioritizing and investing heavily in mental health would, in the long run, culminate in populations with healthy outcomes, respect for human rights and stronger economies.

The Health Partnership Symposium ‘effect’

In order to make this a reality, we believe that collaboration and the sharing of approaches is key and at the recent Health Partnership Symposium, organized by THET, we found we were not alone in this thinking.

Our passion for working in mental health was further cemented at the event where a certain chemistry brought colleagues from Ghana, India, Kenya, Nepal, Scotland, Tanzania, Uganda and Zambia together to form the ‘Mental Health group’.

We all wanted to come together to tackle and develop our learning on different mental health issues.  Ultimately we wanted LMIC’s to start collaborating and to share experiences which can strengthen the partnerships we work in. That’s when a luncheon ‘chat’ was called, then a dinner ‘talk’ happened and then we came to form a WhatsApp group, a way for us to easily reach out to each other.

The world is facing many challenges; political unrest, war, economic hardship, unemployment, etc., all are contributing factors to depression. This must be a wake-up call for the global community, the need to re-think, and re-act to this global crises, now is the time to re-set our priorities with regards to mental health and to act together through partnerships and shared learning. After all there is no health without mental health.

Perpetua Mwambingu

Tanzania Link Project Coordinator,

Tanzania

Randy Agbodo

Project Lead for Ghana - Zambia - NHS Highlands Partnership,

Ghana

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

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

[3] Ibid

[4] Ibid

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

Medical Equipment in Top Condition

Since 2011, THET with support from the UK Government’s Department for International Development (DFID) has been working with the Northern Technical College (NORTEC) to develop the first pre-service training course for Biomedical Engineering Technologists (BMETs).

In this blog, Chris Mol, a lecturer in Biomedical Engineering at NORTEC, celebrates the projects most recent successes and comments on the complexity of the tasks ahead.

At the end of 2016, our first cohort of Biomedical engineering technologists (BMET’s) in Zambia completed their final examinations. 

Every year from now on, some thirty new technologists will become available to improve the poor maintenance situation of the medical equipment in the country. We have also trained enough local BME lecturers to make this teaching program sustainable! Good reasons to be proud! Surely this will have a major impact on the availability of working medical equipment for patient diagnosis and treatment!

Well…maybe not. Whereas the presence of well-trained BMETs is a necessary condition, it may not be sufficient. When you think about it, what good can a BMET do in a hospital where a workshop or tools are extremely limited? Or where there is no substantial budget to purchase spare parts for repair? Or where spare parts purchasing procedures are so cumbersome that it may take up to one year to acquire these, even if a budget is allocated? Or where service and user manuals are available only in the Chinese language because they came as part of a business package and there are no regulations on local language documents? Or where donated equipment comes without adequate documentation and spare part provisions? Or where the local culture is to wait with repairing a piece of equipment until it is really broken, rather than doing preventive maintenance? Or where the status of the BMET is such that (s)he is supposed to sit in the cellar of the hospital, waiting for a phone call to come and fix a unit, rather than pro-actively managing the installed base of equipment in the hospital?

When you come close, the issue of good medical equipment appears to grow in complexity. Such is life! This is not a reason to despair and give up, but rather to remove our blinders and consider the total complexity (‘eco-system’) of the task at hand. 

Let’s appreciate the potentially limited but still crucial importance of our contributions and diligently hammer away at the next roadblock.  

Considering the crucial position of the Ministry of Health in managing local healthcare, support of local policy generation will be one of the focal points of our follow up actions. Another one will be to support process improvement activities in local hospitals and the support of a national BME Association to advance the profession. Only a broad and integral approach will, in the not too long  term, deliver bottom line value to the Zambian patients. Let’s do it!

Chris Mol
Lecturer in Biomedical Engineering
NORTEC, Zambia 

Health Partnerships: An Effective Response to the Global Health Agenda

ABOUT THE SERIES 

THET is very pleased to announce the release of the first publications in our special series in the academic journal, Globalization and Health, ‘Health Partnerships: an effective response to the global health agenda’.  The series sets out to explore the concept of international ‘twinning’ relationships between healthcare delivery or training institutions in high-income countries and counterparts in low or middle-income countries.  Health partnerships build the expertise and capacity of an institution’s health workforce not only in clinical areas, but also leadership, management, patient safety, research, and monitoring and evaluation.  Partnerships may also work on the implementation of standards and protocols, develop curricula, or influence health policy.

Health partnerships frequently publish in journals specific to their clinical specialism  but this is the first time that a journal has published a collection of articles dedicated to health partnerships’ work.  So this series is a milestone for health partnerships, which shows how far we have come; it is the product of a movement that puts partnership at the heart of strengthening health systems.

ORIGINS OF THE SERIES

It was at THET’s annual conference that the idea for a special series on health partnerships was born, with support and encouragement from Greg Martin, editor-in-chief of Globalization and Health, who was one of our speakers (see also Greg’s YouTube series on Global Health).  The time was right for a series: THET had funded a significant number of projects across multiple grant programmes (International Health Links Funding Scheme, Health Partnership Scheme, Strengthening Surgical Capacity, our country programmes in Zambia and Somaliland) so we knew that there were experiences and results out there that would be valuable not only to the health partnership community, but the partnership movement more broadly.  With the call for evidence ever-present from donors and other stakeholders, a series in a peer-reviewed journal was an exciting opportunity to bring together evidence, insights, critiques, and lessons learned, and to explore health partnerships in detail.  The Sustainable Development Goals, with their many health related objectives, provide the broader context for this series.  Notably, SDG 3 ‘ensure healthy lives and promote well-being for all at all ages’ sets out the vision for universal health coverage and THET believes that health partnerships have a significant  contribution to make to achieving UCH, as described in our UHC Discussion Paper. 

Overall, we were delighted by the number of responses to the call for papers as well as by the breadth of countries, specialisms, and institutions represented; authors hail from Africa, Europe, North America, and South America. The editorial by Andrew Jones – Envisioning a Global Health Partnership Movement –  introduces many of the papers featured in this first issue and these are just the start; with the level of interest shown to date, there will be more issues released in 2016 and we hope well into 2017 too.  Full information on the series and how to submit a paper is available here.

THET’s COMMITMENT TO EVIDENCE

THET is in a privileged position: we give training, advice, and grants to health worker training projects; and we run capacity development programmes in Somaliland and Zambia. We provide a flexible framework for people to work together effectively and responsively for the longer term.  Our wealth of knowledge about health partnerships and partnership working is down to the practitioners whose rich experiences inform our approach and develop our understanding of how best to support them.  We provide training and advice in monitoring, evaluation and learning because partnerships face challenges in tracking the difference they make, such as poor data and limited resources.  We develop resources to improve the quality of health partnerships, from case studies, to guidelines, manuals, and webinars that bring practitioners together in real-time.  In 2016, in addition to continuing this special series in Globalization and Health, THET will bring together researchers interested in the mechanisms, efficiency, and effectiveness of health partnerships, to agree a research agenda and explore opportunities for multidisciplinary work.  This is the next step in our commitment to developing the rigorous evidence base for health partnerships as an effective response to global health needs.

To find out more about THET’s work visit our website www.thet.org, read the special series in Globalization and Health or contact a member of the team – info@thet.org.  You can submit a paper to the journal at any time as this is a rolling, on-going series.  For more information about how you can submit a paper to the series, visit the Globalization and Health website: http://globalizationandhealth.biomedcentral.com/