International Health Links: an investigation into health partnerships between Wales and Africa.

1. International Health Links: an investigation into health partnerships between Wales and Africa. Network of Development Researchers, May 2011 Dr Kathrin Thomas MRCGP FFPH Jasmin Chowdhury BA Hons Dr Hugo Van Woerden MRCGP FFPH

2. Aims and Objectives Aim • To provide an overview of activities of Health Links between Wales and sub-Saharan Africa. Objectives • To identify and describe Health Links partnerships between Wales and sub Saharan Africa • To assess whether Welsh participants believe that there has been personal and organizational benefit to health services in Wales • Undertake an assessment of current practice in Links’ working and their perceived support needs for: • Monitoring and Evaluation skills • Teaching and training skills • Fundraising skills • Communication skills • Develop an evaluation proforma for each Link to include in the annual Health Links Network report. • Produce a public Report for theWales for Africa Health Links Group.

3. Definition • Long history of health links: • “….. long-term partnerships between UK health institutions and their counterparts in developing countries. The aim of Links is to improve health services in developing countries through the reciprocal exchange of skills, knowledge and experience between partners in the UK and those overseas.” Tropical Health and Education Trust

4. Background • Health Links are low cost and small scale • Rooted in volunteerism • Heterogeneous • Few published evaluations, even fewer looking at outcomes and impact. • Most evaluations focus on benefits to UK partner

5. Methods • Included any bilateral link between institutions or organisations in Wales and a sub Saharan African country that focussed primarily on health. • An email invitation to electronic questionnaire • A sample was also interviewed in more depth by telephone.

6. Questionnaire • multi choice tick boxes with a free text option • questions grouped: • About your link • Activities • Processes • Benefits • Challenges • Support

7. Analysis • Questionnaire - quantitative • Interviews – written notes combined with free text comments from questionnaire and analysed for emerging themes by second researcher. • Correlation of selected characteristics sought.

8. Results • Identified 20 Links, 17 Links gave at least one response. • 76 people in Wales were identified who had a connection with at least one Health Link. • 37 (49%) responded to an initial email • The questionnaire analysis is based on responses from 45 people: • 36 Welsh Link members (some of whom did not answer every question) • 9 African Link members (of whom one person did not answer every question). • 7 Welsh and 3 African Link members were also interviewed by telephone

9. Beginnings • 13 of 17 Links (75%) are less than 5 years old. • Most developed through a Welsh member who had returned from working or visiting in a sub Saharan African country, or an approach from a Welsh partner to a potential African partner. Years since Link was established(Welsh respondents)

10. Activities • All Welsh and African respondents gave training as the most common activity. • Training was primarily focused on maternal health and mostly delivered during visits by Welsh members to their African partner. • Distance learning is not common. Training the trainers: midwife tutors, Southern Ethiopia/Gwent Link

11. Benefits (1) • For Welsh and African respondents two of the top three choices: • Experience of different cultures • Support and friendship with your overseas partner. • Then Putting UK problems in perspective for Welsh and Sustainability of services for African. • The majority agreed or strongly agreed that their problem solving, leadership/ management and educational skills had improved.

12. Benefits (2) • Positive comments throughout about their personal satisfaction and benefits from involvement in a Health Link • All were committed to continuing the work in the future. • Welsh respondents felt that the benefits to the Welsh partner were clear but should be secondary to that of the African partner as the aim of their work was to improve health in the African setting.

13. Agreement with statements on benefits, Welsh respondents

14. Communication • Two distinct patterns: • active communicators (7 Links) and • infrequent communicators (5 Links). Glan Clwyd/ Hossana link Strong personal relationships were felt to be a very good facilitator of effective partnership working while the lack of them led to frustration and lack of action.

16. Processes • A third of Welsh respondents were not aware that they had a Memorandum of Understanding with their African partner • Half did not know if there was a monitoring system. • One third of Welsh respondents were not aware of the Strategies and Priorities of their African partner’s Ministry of Health • all African respondents believed that their individual Welsh Link was aware.

17. Gender • Many respondents brought up the fact that there was a relatively high participation of women in many Health Links, both in Wales and in Africa. Medical students from Gambia and Swansea

18. Challenges • Top choices for Welsh respondents. : • dependence on too few key individuals, • communication difficulties • visa problems • Top choices for African respondents : • visa problems • communication difficulties • Top choices for support needs: • advice on applying for grants, • fundraising • opportunities to network with other Links

19. Conclusion • There is strong evidence that those who are involved in Health Links, both in Wales and in Africa, believe that they gain personal and professional benefit. Swansea Gambia Link: medical students

20. Recommendations

21. For Health Links • Increase good practice in partnership working and governance. • Invest in communication between partners • Ensure plans are in place for sustainability, • Make the most of available support to capture long term, quantitative and qualitative information for outcome evaluation and impact assessment. • Consider modern, distance based, sustainable methods of shared learning to reduce reliance on one-off short visits between partners for delivery of training.

22. For support organisations (e.g. Wales for Africa Health Links Network, THET, SMIDOS, WACL and others) • Provide opportunities for networking and shared learning • Support good practice and good governance in partnership working • Support good practice, particularly delivery of training and education and provision of equipment. • Support the development of modern, distance based, sustainable methods of shared learning • Support Health Links in needs assessments, monitoring and evaluation. • Support research into how to measure the impact of Health Links’ activity

23. For Government, Health Boards and Universities • Ensure grant schemes include evaluation and impact assessments • Encourage the sustainability and scaling up • Recognise the skills and experience gained by professionals involved in Health Links as integral to their continuing professional development. • Use Health Links as an alternative to current spending on organisational development and leadership and management training. • Provide administrative support to Health Links. • Have policy on study leave/ professional leave • Integrate research to increase impact. • Develop a Charter Mark scheme

24. Contacts • Full report is at: • http://www.wales.nhs.uk/sites3/news.cfm?orgid=834&contentid=19006 • Kathrinthomas@hotmail.com

25. Acknowledgements • Many thanks to the many people from Health Links in Wales and in Africa who willingly gave us their time. • The investigation was commissioned and funded by the Welsh Assembly Government Wales for Africa Program. • Jenny Allen and Jon Townley from the International Sustainable Development and Wales for Africa Team. • The Welsh Assembly Government Department of Public Health and Health Professionals. • The members of the steering group : Cath Taylor, Sue Bowker, George Karani, Ed Howarth and Robyn Phillips. • Lynne Elliot for help in designing the questionnaire.