Meeting with Lord Crisp 27 July 2006 at UKOWLA Office, the Dutch Barn, Elm Tree Park, Manton
Meeting with Lord Crisp 27 July 2006 at UKOWLA Office, The Dutch Barn, Elm Tree Park, Manton
Michael Carmel, Partnerships in Health Information
Richard Collins, Medical Superintendent in Tanzania
Lord (Nigel) Crisp,
Martin Drewry, Director, Health Unlimited
Geoffrey Findlay, Marlborough Brandt Group
Lady Ruth Hawley, Medical Support in Romania
Avril Jackson, Help the Hospices
Prof Denise Lievesley, Information Centre for Health and Social Care, Leeds
Nick Maurice, UKOWLA/BUILD
Pepi O’Neill, UKOWLA/BUILD
Raul Pardinaz-Solis, Skillshare International
Karen Peachey, Tropical Health & Education Trust
Dr Barney Rosedale, one time director and trustee, British Nepal Medical Trust
Joe Sang, Friends of Gaa
Jurgen Schmidt, Health Partners International
Sir Nigel Thompson, Chair of BUILD, Adviser to Arup
Leena Vadher, VSO
John Whitaker, ex Oxfam, Special Advisor to BUILD
John Wood, Hereford / Muheza (Tanzania) hospital link
Nick Maurice
Gave background to the meeting. BUILD (Building Understanding through International Links for Development) formed 2002. A coalition of some 50 agencies committed to the ideal of community based international partnerships for development, understanding and peace, including towns, schools, HEIs, health care institutions, faith and BEM groups, social, sporting and cultural groups. Recently published of DFID White Paper includes and recognises the importance of international links.
Nigel Crisp
Here to listen. In the DFID White Paper the notion of linking is becoming stronger and seen as a Strategic Action within government.
As Chief Executive of the NHS became aware of the work that individuals and organisations were doing with partners in the developing world. Conscious that people linking with different hospitals in different countries, people came back refreshed and revitalised. Seemed a good activity, some felt wasteful and not always as effective as it should be.
Met Eldred Parry at THET and seconded David Percy to THET, 100 links in NHS to Southern institutions.
What more could the NHS be doing, in a spirit of mutuality and interdependence. Reporting to PM on how can we use the resources of the NHS and its partners better in development.
Wants to know what to say, welcomes all advice.
Already many discussions and visited South Africa and Malawi, met 10 ministers of health at World Health Assembly to discuss their issues.
Three themes developing :
§ How do we help the NHS to be a better “global citizen”. If nurse goes to work for 1 year abroad they lose pension etc. Nothing systematic about the way NHS thinks about their business plans, great potential for linking.
§ Human resources and staffing crises. Good stuff happening on vertical basis eg HIV / AIDs but need to get the health systems to work. Crisis of staff leaving Africa and working in UK and elsewhere, healthcare workers dying of AIDS in Africa. Supporting education and training for health workers in developing world. Global health force alliance.
§ Technology: lots of mobile phones but no electricity. How do you get communication information to support the health worker.
In summary
What are the opportunities?
What could the PM do?
Raul Pardíñaz-Solis, Skillshare International:
§ During the training of health staff, use global education in the medical curriculum (undergraduate and graduate), if we want the health services in UK to be active in development, eg global health SSM, international health BsC and international foundation year (FY2).
§ Best practice foster curriculum development in partnership between academic institution and international NGOs, NHS Links inform teaching and research, electives opportunities and mutual learning with southern partners.
§ Professional development link to global health. Must recognise the career development of the many volunteers who have worked in health services internationally when they return to UK. Currently it is not taken into account.
§ Ensure sustainability of NHS support to developing countries, undergraduate, graduate and continues professional development (CPD) need to include a global health training opportunities.
Karen Peachey, THET:
§ Endorse what is starting to happen, needs cross-Whitehall coordination.
§ Action needs to be long term and with strategic commitments,
§ Recognise the benefits of institutional links, can bring flexibility and long term nature
§ There is need for support for individual links, to have access to the same support that schools have, not to be government funded, but given support.
Denise Lievesley, Information Centre for Health and Social Care:
§ Promote the cause of good information systems.
§ What can we do to support and improve the information systems.
§ Shocked about poor quality of information in UN.
§ High level performance indicators at national level are not what drives improvement within countries.
§ Need to have relevant info at local levels.
§ Statistics give a voice to the poor and can recognise inequalities within societies.
§ Build on initiatives, Paris 21, UK founded member of through DFID, “Partnership and statistics for development for the 21 century” ensure statistics are not distorted through “safari research” and “interested governments”.
§ Opportunity to twin with 1 or 2 countries that have poor information systems in the their health area and work together to build international collaboration centre
§ Big agenda in UK, give staff opportunities to develop skills, and be challenged by different environments.
Michael Carmel, Partnerships in Health Information
§ Fosters partnerships and joint working between medical library in UK and developing countries.
§ Aim is to reciprocal learning within the partnerships.
§ Need for long term commitment.
§ Broaden it out as quickly as possible to avoid being simply an institutional commitment.
§ Need to get senior staff involved, and embedded in organisation.
§ Got to be respect-based partnership, work together on problems, the longer the partnership the more respect there is.
§ Sharing of commitment to solving problems, not gift-based.
§ Aid is important but partnership shouldn’t get too involved in aid.
§ Transferring systems and skills through courses and working together.
§ Broaden the partnerships. Make them inclusive
National Electronic Library of Health – David Hall and Muriel Grey, the UK has the means to make the intellectual property available to othersa but in developing countries this doesn’t happen due to poor resources.
Martin Drewy, Health Unlimited
§ Develop quantity and quality of health care in developing counties.
§ Targeting the support in a strategic longer term sustainable way
§ Project to project links can be a mixed bag, needs to be strategic
§ Need to be confident as a country that we are more than compensating our supply of health staff by what’s given back
§ Target those that no one else are targeting, most deaths in developing world are preventable by primary health care. Mainly they are the marginalised in the country
§ Range of things the NHS can supply, work as interface between communities with poor access to health care and try to link the health system in that countries, Try to identify the needs of the communities.
§ For all the NHS’ vast technical and professional resources the best thing the NHS can provide is access to the public.
§ Link with UK charities as well, for education, shows the health service as caring and would be good PR.
Jurgen Schmidt, Health Partners International
§ When working in developing countries DANGER we export a model, eg NHS or market economies, doesn’t mean it will work in other countries.
§ Logistics – people catapulted into countries with almost no briefing, no decent overlap and short shelf life of projects. Need to guarantee long term presence on the ground
§ Need to address the fact that there are more Malawian nurses in Birmingham than in Malawi; they should be paid a decent salary in their own country to encourage them to stay.
§ Hilary Benn has started to rethink the wisdom of giving money to governments.
§ DFID and Dept of Health must communicate
John Whitaker:
§ To make more of a difference and to have more impact; look to wider communities not just the NHS.
§ The most valuable links are those that are multi-faceted, the mutual growth on both sides are profound.
§ Recommendation in terms of using the best practices for linking, those motivations from the grass roots are encouraged to think outside the hospital walls and see what is already happening in the wider community, if there are links, talk to them.
Leena Vadhar, VSO:
§ Provide enabling solutions so that small links can grow,
§ Act as catalyst for development awareness.
§ There is an increasingly positive political climate around school partnerships.
§ Provide funding to enable development education to take place.
§ Over the last year 130 RVs returned from health postings, need to enable them to help with developing health care links in the way we know are sustainable and will help developing countries and UK.
Ruth Hawley, Medical Support in Romania:
§ Medical exams can be bought in Romania.
§ Have sent 300 specialists to Romaina and have bought medics to UK from Romania, seen benefits on personal development.
§ Gifts, supplies and medics go out together.
§ Have built up trust over the years and are running a pilot project that will roll out to other hospitals
§ Been given “Gifts” from World Bank, which are unusable as the doctors and staff don’t have the training.
§ Do an assessment of what is needed and then supply it.
Geoffrey Findlay, Marlborough Brandt Group:
§ Linking brings mutual understanding and benefits to both communities.
§ Risk of explicitly or implicitly of imposing a model on a different country.
§ Listen.
§ Inclusivity of community very important.
§ Value to UK – everyone comes back changed
§ Health isn’t about giving people medicines it’s also about literacy, civil engineering, bring water to communities,
§ Must be an integrated approach to health.
Joe Sang, Friends of Gaa:
§ Involve and engage the diaspora groups in UK in creation of links.
§ Be cautious of the transfer of skills and expertise, – consultants sent to hospital, nothing happened but lots of money pumped into hospital.
Richard Collins:
§ Working in Muheza hospital in Tanzania, £300,00/yr budget.
§ Link running for 20 years with Hospital in Hereford.
§ A diploma in tropical health and medicine costs £1,200 for UK citizens for expatriates it costs £2k.
§ Enthusiasm from medical students, some get grants to go abroad on elective periods but need more help.
John Wood, Muheza/Hereford Link:
§ Core activity is that any health worker in Herefordshire of hospital or Muheza can apply for 6 week visit.
§ Link has grown out of the hospital into the wider community
§ Access for visitors to get experience has become more difficult over the years.
§ Would like to see health care visitors treated as ‘medical students’ so that under supervision they can get the experience that would be useful for them.
§ More difficult for health workers from Hereford to take time off to work in Tanzania as they cannot get released from their departments.
§ Need seed corn funding to start up links
Avril Jackson, Help the Hospices:
§ UK charity of hospices and palliative care.
§ Big international strategy. Want every country to have palliative care.
§ Networking, building links in UK and across the world to support palliative care.
§ Give small grants to poor countries for education and training, and e.g. buy a vehicle to provide home care
§ Advocacy: provide the secretariat for world hospice day.
§ Have help line, most focused on international palliative care
§ Encourage linking, 19 good examples of UK hospices linked overseas
§ Try to facilitate volunteer placements, huge willingness in hospice movement to go abroad and work, but pension problems
§ Could government use its influence to provide advocacy for palliative care - needs to be written into national policies.
Barney Rosedale:
§ Emergency response and disaster relief, needs different funding / approach
§ Struck by the divisiveness, wastefulness of disaster relief. Range of circumstances can be very different. Could NHS work with for example MSF and not restrict itself to UK organisations.
§ Take on coordinating role. Could be tremendous contribution that could have enormous effect.
Points raised during general discussion
§ There is good and bad practice.
§ Need to set standards of Good Practice
§ Don’t forget primary care
§ There is and should be a diversity of links
§ Government could legitimise these links
§ NHS could have strategic role
§ What is the business case?
§ Potential for using the model that has been adopted in educational (school) partnerships using consortium of civil society organisations supported by Government to deliver health care partnerships
§ Exchange information with other European Countries
§ Potential role of WHO but beware bureaucracy
§ Don’t control but provide the framework
§ Share good practice in country
§ Encourage don’t mandate
§ DFID/FCO to be involved
i) Government to government arrangements and strategic plans
ii) Civil society – government playing facilitating role
§ Support coordinating post within governments (mapping)
§ Don’t forget professional associations
§ Aid money is never enough - think about trade
§ How do we work in partnership with the people who need it
§ Make it easier for health care workers to take time off to work abroad and recognise and accredit on return.
§ Enable partnerships to exist between countries in the South.