The reciprocal benefits of sustained partnerships between health professionals in developed countries and their counterparts in poorer countries are considerable, a conference in London last week was told. Such partnerships may also help stem the migration of health professionals from poor countries—sub-Saharan Africa in particular, where a shortage of health workers is contributing to the crisis in health.
The conference, which was held at the Royal Society of Medicine and which followed the simultaneous launch in London and Lusaka of the World Health Organization’s 2006 report Working Together for Health (BMJ 2006;332:809, 8 Apr), explored these claims and discussed the links fostered by the Tropical Health and Education Trust (THET) International.
THET was set up in 1988 to support the training of health professionals in the poorest African states. As an umbrella organisation it facilitates and guides twinning projects between individual NHS hospitals and primary care trusts and partners overseas.
The organisation’s role, said Eldryd Parry, THET’s chairman, is to be responsive to needs expressed by overseas partners, not to be prescriptive. “Our aim is to augment skills, sustain professionalism, and buttress motivation. As a country which poaches human resources from the world’s poorest countries, there is a moral imperative for the United Kingdom to foster international partnerships to promote development.”
The King’s College Hospital THET Somaliland partnership was started in 1998 by Andy Leather, a general surgeon. The catalyst, he said, was his meeting with the former medical director of Somaliland, who came to work in his unit as a refugee doctor.
“Armed conflict had all but destroyed the health infrastructure in Somaliland,” Mr Leather said. “It remains a desperately poor country with a population of 3.5 million and a health budget of only $200 000 [£115 000; €165 000]. Our partnership started modestly in a single hospital, where we helped draw up protocols for obstetric, medical, and surgical care.”
King’s now works with several hospitals in Somaliland and has supported curriculum development in the medical school at Amoud University and the country’s only nursing school. It has also been involved in training health officers (who undertake an 18 month course) and arranging exchanges between pharmacists from the two countries as well as health managers. “We have now been asked to provide an analysis of the human resources needed for health in the whole country,” Mr Leather said.
Evaluation of the impact of THET’s links initiatives is scant, but the meeting provided anecdotal evidence of mutual benefit. “King’s staff have made around 60 visits to Somaliland over the past few years, and they have had a galvanising effect,” said Mr Leather.
Working in a poor country promotes cultural awareness and provides lessons in adaptability and resourcefulness, he said. “Staff return energised and empowered to adopt leadership positions and instigate change at home, as well as garnering support for their African partners. A week in Africa achieves a lot more for staff than sending them on one of the [obligatory] UK based ‘diversity and motivation courses.’”
Benefits at the Somaliland end have been considerable, said Said Ahmed Walhad, dean of Amoud University Medical School. “We have had to build our medical school from scratch, and King’s staff have helped us review and fill the gaps in the undergraduate medical curriculum and informed our approach to assessing students’ competence.”
“The links we have established with King’s have done more for us than donor aid,” added Suleiman Ahmed Guled, president of Amoud University.
Different ways of organising and financing links were discussed by several speakers at the conference. Geoff Lloyd, a GP in Pontypridd, has financed the PONT (Pontypridd Overseas Networking Trust)-Mbale initiative (www.pont-mbale.org.uk) by harnessing the goodwill of his local community with the help of colleagues in the primary care trust, schools, and churches. Strong collaborative links have now been established with parallel institutions in Umbali, a town of 760 000 people in Uganda.
“We have supplied bed nets and helped train a cadre of community health volunteers,” Dr Lloyd said. “Our aim is to expand to support secondary care services. We hope that in the future DFID [the UK government’s Department for International Development] will provide financial support, but we know that we must show health gain if we are to be successful in attracting substantial donor money.”
“Twinning of institutions and health workers needs to be set within the wider debate on migration and development,” said Mary Robinson, president of the new global initiative Realizing Rights (www.realizingrights.org) and former president of the Irish Republic.
“Policy makers must recognise that health workers are central to development and have a right to decent working conditions and salaries. The pilot that has been established in Malawi [in which the Global Fund to Fight AIDS, Tuberculosis, and Malaria and the DFID have financed the doubling of health workers’ salaries] should be replicated throughout Africa.”
Training health workers so that they have an appropriate mix of skills should be an integral part of health reform, said Joseph Figueras, head of the European Observatory on Health. “Reforms tend to focus on structure, financing, and organisation. Five years later the focus moves to education and training. Donors must recognise that well supported, motivated health workers are the most effective agents of change.”
The Links Manual , a guide to establishing long term overseas partnerships, is available at www.thet.org.