‘How do we support peer-to-peer networks as the bedrock of a sustainable global health system?’, ask Thomas Hughes, Head of Development Partnerships and Ged Byrne, Director of Global Health Partnerships, Health Education England.
Following the global pandemic, we need to consider how to support the front-line staff of the NHS to continue and enhance their engagement in global health work. Future pandemic ‘preparedness’ and global health security more generally, is dependent on the ability of health workers everywhere to collaborate providing the world’s populations with a more equitable and safe access to lifelong health and wellbeing.
Shared experience, peer-to-peer and institutional partnership can be built through participation in such work. Health Alliances can foster the individual and institutional links which can provide the solidarity to enable us to ‘build back better’, but current enthusiasm to build new and enhance existing Alliances need political and financial support to do so.
Health Education England, with the help of the Tropical Health and Education Trust (THET) hosts two such alliances (Uganda and Myanmar) which continue to promote and support health partnerships, and we are currently brokering the development of several more. HEE is fully supportive of these Alliances because, as the education, training and workforce development arm of the NHS, we know that there are few better learning environments for our staff to develop the critical skills necessary (resilience, leadership, adaptability, cultural intelligence) to maintain the NHS’s ability to deliver the highest quality Healthcare to the UK population.
We also know that through these Alliances we can equitably contribute to global sustainable health system strengthening efforts. Now more than ever we see the importance of a truly global approach to global health.
There have always been strong ties between the NHS, the quintessential internationalised organisation, and the rest of the world. Professional and personal ties between the UK and a plethora of countries exist at all levels, not least due to migration from overseas, with at-least one in seven NHS staff being born and qualified outside the UK1. There is a strengthening desire, from the boardroom to the ward, in the NHS to support global health work. The previous UK ODA funded Partnerships for Health Scheme trained more than 100,000 health workers in LMICs using NHS volunteers from over 130 NHS organisations.
HEE and new ways of working
Early in the pandemic HEE made all NHS COVID related e-learning materials available for free online. Online educational materials have the potential to be a global good – but the evidence suggests that behaviour change and sustainable impact comes from blended educational programmes and peer to peer role modelling which cannot be delivered by technologically enhanced learning alone, but requires real conversations between peers, educators and system leaders.
HEE have developed a series of pilot programmes to promote the development of these relationships but are eager to increase partnership participation. An example of such an HEE-led programme is the ‘Improving Global Health Fellowship Scheme’. Initially this scheme, following a period of intense training, placed young health workers from the UK as part of teams delivering Quality Improvement Programmes in LMICs. Travel restrictions brought about by COVID-19 have led to the evolution of virtual fellowships delivering the same high quality QI programmes but through technology-brokered partnerships and relationships.
Alliances
At a recent Healthcare World panel on the future of healthcare in Africa post-aid, it was striking how a discussion which might once have used the language of aid-to-trade had moved to a space of peer-learning and a dialect of mutual interest and mutual commercial gains.
Well-managed healthcare alliances work to bring together NHS and UK-based partner organisations (Higher Education Institutions, charities, commercial entities) with their peers overseas to work in partnership under a Government-to-Government agreement. This aligns health workers’ desires to work and learn alongside their peers tackling pressing global health issues with the requirements of ministries of health, as well as commercial interests in both countries providing a seamless ‘top down and bottom up’ approach to bilateral partnerships.
These Alliances also facilitate an economy of scale for those working within partner countries by creating a consortium/collaborative approach to capacity building and shared learning. Within the Uganda-UK Alliance there are several consortia, whose members have used their shared interests and collaboration to produce a scaled-up approach to capacity building through sharing logistic support, providing sustainable presence and preventing duplication.
One such consortium working in West Nile has brought together an extraordinary breadth of partners ranging from Everton in the Community and the English Premier league through the African and International Red Cross to several secondary care trusts based in the UK. This consortium has focused, to date, on improving the mental health of refugees through sport and wellbeing coaching.
The way forward?
COVID-19 has not simply reminded us that healthcare is all about people and that we can use technology to develop and maintain high quality relationships, it has also demonstrated that we can only be globally prepared for any future global force majeure if we recognise that cross border, organised, robust peer-to-peer networks are the building blocks of health security.
We would suggest the following three lessons from the pandemic should be acted upon by us all:
1. We must recognise that health workers are at the centre of the new world of global health. However, security must come not just from increasing their numbers but from empowering them as agents and of change and catalysts for improvement.
2. We must explore new mechanisms for funding overseas volunteering programmes and alliances through public private partnership and rely less on traditional governmental funding mechanisms. This can be achieved by the first, second and third sector organisations in every bilateral partnerships recognising that there is much to be gained from such investment.
3. We must support NHS Volunteering programmes and recognise the role such programmes can play in development of individuals skills, improving mental health, and driving improvements in the NHS.
If, in 2019 there was a desire to link NHS organisations and health workers with their peers in LMICs, in 2021 there is a requirement to do so.
HEE Global Engagement: ge@hee.nhs.uk