Tuesday, 7 March 2017

#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

Tuesday, 14 February 2017

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 

Tuesday, 24 January 2017

Engineering a future for global health


Linnet, one of our Grants Officers, travelled to Uganda to attend the first National Biomedical Conference. Here follows an account of her time there. 


‘Without Heath Technology Management mortality rates go up.’

Priscilla Kemigisha, Biomedical tutor at ECUREI, asserted the fundamental importance of biomedical engineering at the inaugural National Biomedical Conference held in Kampala, Uganda in January 2017.

I represented THET at the two-day conference, which brought together a truly multi-disciplinary audience, from university lecturers to biomedical engineers, doctors to private companies, and members of local government and donors from Uganda, the UK, US and Kenya. The programme was rich and covered a number of topics including, medical equipment donation, innovation and intellectual property rights as well as the roles different attendees could play.

Priscilla's statement  points out a reality that is all too often overlooked within hospitals and by Ministries of Health and is still fighting for recognition from international organisations. Biomedical engineering remains a little known global health crisis. It is only this year that biomedical engineers have been recognised as forming a separate occupation by the ILO. There also remains no Sustainable Development Goal that centres on medical equipment or biomedical engineering.

For THET, the knowledge that donation of medical equipment is not always a help has become increasingly clear, as a recent survey we conducted showed. Throughout the conference, stories of badly donated equipment abounded, including equipment arriving with only French or Chinese manuals that no one could read, or a CT scanner that spent fifteen years outside in a compound as it was too large to move into the hospital.

While it can be easy to think of biomedical engineering just in terms of the machines you see in a hospital or the broken ones sitting outside in a junk pile or cluttering up a store cupboard, for an unconscious patient in the ICU or a labouring mother the difference between life and death often depends on whether a machine is working or broken.

Beyond patients, it is also evident that healthcare workers in low and middle income countries are dealing with crises every day whilst faced with tight or non-existent budgets, pressures from donors and their governments and targets to be met. In this environment preventative maintenance and careful assessment of potential donations can seem like low priority activities for hospital administrations who struggle with stock-outs, power cuts and water shortages.

Whilst this all paints a rather murky picture of the lack of importance accorded to biomedical engineering, the focus of the conference was on how to move forward, to create a national environment receptive to engineers and the equipment we take for granted in the UK. Discussions centred on what innovations could be implemented and how students from the universities were conducting outreach in high schools and working together with the private sector to turn final year projects into reality.

Solutions do not have to come from outside, while we, including those from donor countries, can all work together, Uganda is making strides and taking responsibility for its own ecosystem. From innovations such as a low field MRI being designed by a lecturer at Mbarara University of Science and Technology, to Fort Portal Regional Referral Hospital ensuring that each piece of equipment in the hospital has a service card, and demand that the direction taken should be dictated by those in Uganda is mounting.

For me, the key message of the event was collaboration, from donors to government and clinicians to technicians. With training, budgeting and responsible funding Uganda, and other nations, can move towards the sweeping reform required to improve the state of biomedical equipment and the training for technicians that is most keenly needed.

At THET, the importance of biomedical engineering is one championed by our biomedical consultant Anna Worm, and the team continue create guidance and tools for the donation of medical equipment and the positive impact that training engineers can have on an entire health centre. Since 2011, our work in Zambia has focused on creating the first pre-service training course for Biomedical Engineering Technologists, a country-led initiative which aims at changing the huge percentages, 35 and 50%, of medical equipment that is currently out of service.

Linnet Griffith-Jones
Grants Officer
THET

Tuesday, 17 January 2017

Digital tools building the future of global health?

Digital tools building the future of global health?


In December, Marta our Senior Partnerships Manager, travelled to Maryland to attend the third annual Global Digital Health Forum, a platform focusing on digital and connected health in low and middle income countries, sharing lessons on what works and what doesn’t in technology for development. Here follows an account of her time there.


The potential of digital tools are proving not only crucial to the provision of health services but also to the wider health system, allowing strong systems to be built before crisis occurs. Digital data, for example, helped bring an end to Ebola in West Africa. The global usage of digital tools has also led to a surge in popularity for supporting the growth of digital health globally, it has become trendy. It is coming to be seen as a key part of a complete health package, which needs to be fully integrated into the health system, with countries such as Tanzania and Nigeria having developed national health data strategies.

Over 400 people beat the cold, in Maryland, to attend the third annual Global Digital Health Forum, a platform focusing on digital and connected health in LMICs, sharing lessons on what works and what doesn’t in technology for development. Over two days in December, it seemed that everyone that mattered in the global digital health field, including newcomers such as myself, came together to discuss the future of digital health. A number of shiny, new solutions to global health challenges were shared. From Facebook to Google new innovations such as the use of drones and balloons to bring Wi-Fi to those in remote and rural areas were debated, while others spoke of using apps to ensure healthier babies and mothers. Most discussions, however, revolved around sustainability and collaboration. How can one ensure that technology solutions live beyond the funding period? Digital tools are after all useless if citizens themselves do not use them.

Most of the tools developed for gathering data are, however, disease specific. The donor community are partly to blame for this as most funding mechanisms tend to favour linear health responses.  Partnerships between government, private and civil society actors offer a solution to health information challenges. Yet, collaboration may suffer in the current country-focused political environment. In these times, it is important to remember the nine principles for digital development, which were written by and for international development donors and their implementing partners. These principles emphasise the importance of human-centred design, context-specific solutions, re-use and improve existing technology and tools and being inclusive and collaborative. If we can get these principles right, we’ve come a long way in ensuring sustainable health information systems and better health responses as a result in the future.

With so many new digital avenues and innovations forming in the global health arena, there is certainly much to think over. For THET, we must now ask how we can use this technology to complement our partnership work and apply digital solutions to the strengthening of global health systems.

Marta Roxberg
Senior Partnerships Manager
THET



Monday, 14 November 2016

Characterizing partnerships and measuring their impacts, both intended and unintended

On Day 1 of THET Annual Conference 2016, ‘Evidence, Effectiveness & Impact’, Lawrence Loh chaired the breakout session entitled ‘Network for collaboration: partnership communities and volunteers contributions’. Here the highlights of the session. 


I recently had the pleasure of attending the 2016 Tropical Health and Education Trust conference held 20-21 October at Resource for London and chairing the breakout session titled “Networks for collaboration: partnership communities and volunteer contributions.” 

In keeping with the conference theme of Evidence, Effectiveness and Impact and focus on health partnerships, the presented valuable abstracts covered the full range of tools and topics around partnerships. These included tools to measure and visualise partnerships and networks; frameworks to assess a partnership or coalition’s development phase; strategies to tangibly measure the outcomes of partnerships; and of course, broad descriptions of how partnerships might better support sustainable, positive development impacts on communities worldwide.  

The first presentation, from Kristy Yiu of McMaster University, reviewed the results of a network mapping analysis conducted on a novel community health partnership in the Dominican Republic. The specific aim of this coalition is to bring visiting short-term volunteer groups into the fold of established development efforts identified by the communities, thus eliminating the “parallel system” of programming created by foreign visitors. To move the partnership forward, Yiu and her co-authors analysed the range of connections between coalition partners and evaluated their perceptions around the coalition’s strengths and weaknesses. By doing so, Yiu’s work aimed to show the value of network analysis in planning and developing global health partnerships. 

Dr. Oliver Johnson of Africa Health Placements (AHP) then shared a summary of post-experience survey evaluations from their participants. The studied population was largely junior doctors placed by AHP in Africa based rural hospitals for year-long placements to support health human resource gaps. In doing so, African-based partners were described as having a notable role in leading the recruitment and assignments in question. The surveys found that partnerships with a local facility meant greater engagement between parties, and interestingly, a commitment from participant junior doctors to undertake quality improvement projects while on the ground there – perhaps reflective of an unintended shift in volunteer mindset towards capacity building rather than strict service provision. 

The next talk from Dr. Katie Mageean also emerged from an African project that focused on the evaluation results arising from a partnership-led paediatric triage intervention in Uganda. Dr. Mageean’s work helped demonstrate the substantive outcome of health partnerships. In her specific example, local partner leadership and buy-in was essential to facilitating training and support for local staff, which in turn supported the success of the intervention in changing process outcomes. Her presentation closed by highlighting additional ongoing research work that is targeted at documenting improved patient outcomes from this capacity building partnership effort.

The last and final presentation by Dr. Annalee Yassi presented a “North-South-South” partnership model based on the development of partnerships between a Canadian institution and its South African counterpart. In this specific model, technical expertise around health challenges was sought through an initial international partnership (North-South) that then was distributed through a national network of peers (South-South). Dr. Yassi shared lessons learned and opportunities that such a model might provide, highlighting the need for a strong, respected southern partner to act as the key modulator between the two relationships and bring information and identified needs from their South-South “community of practice” as part of the conversation within the North-South partnership. In turn, that same partner would be expected to bring and disseminate international inputs within the South-South partnership.

The session ended with a panel discussion featuring the presenters that drew out common themes among their work. Questions focused on tools to understand and measure the outcomes of partnerships to show their value, and the importance of flexibility in developing and tweaking differing partnership models depending on context and priorities. The perspective of trust and openness from local partners was also highlighted as one potential area to explore that had not been touched on. 

In all, the session was extremely fruitful and provided a lot of food for thought around how we understand and evaluate the nature of health partnerships in global health work. As with all good sessions, many left with more ideas and questions than they started with!

Lawrence C. Loh, MD, MPH, CCFP, FRCPC, FACPM
Associate Medical Officer of Health, Peel Public Health Director of Programs at The 53rd Week Ltd., Brooklyn, NY

See pages 23-26 of the Abstract Booklet for more information about the work of the partnerships featured in this blog.