1Newcastle
upon Tyne Hospitals NHS Foundation Trust & Newcastle University, UK; Guy’s and St Thomas NHS Foundation Trust, UK; 3King’s Centre for Global Health, King’s College London, UK; 4Northumbria Healthcare NHS Foundation Trust & Newcastle University, UK
Poster presented by Dr Felicity Knights (neé Jones) – now Academic Foundation Doctor at Newcastle Hospitals NHS Trust: felicityaeknights@gmail.com
Background Health partnerships between institutions in the UK and Low or Lower-Middle Income Countries are an increasingly important model of development [1]. These partnerships typically engage in sharing of resources and expertise, training and capacity-development programmes. It has been proposed that such links promote genuine understanding and respect for different societies and cultures [2], offer a more sustainable, locally-led model of development, build capacity and strengthen health systems in developing countries [3]. We conducted two literature reviews to examine the evidence on benefits and costs of health partnerships to individuals, institutions & the healthcare system and sought to understand how partnerships might impact on workforce development and service delivery.
Methods Systematic reviews of both published literature and grey literature were conducted. Literature was found using a combination of published literature databases; systematic google searching; citation mapping; and consulting with experts in the field. Studies were included if: (1) links were between (only) 2 locations with one in the UK and one in a lower income / LMIC country; (2) links extended beyond a single event; (3) activities had a health focus; (4) UK participants were volunteers (unpaid); (5) studies referred to at least one level of cost or benefit. Content relating to costs or benefits to the UK / lower income country partner at an individual, institutional or system level was extracted and analysed by thematic synthesis.
Results: UK Partner
Results: LIC/LMIC Partner
The 40 benefits codes were grouped into 7 key domains. A high degree of concordance was shown between benefits cited and professional development indicators within 5 UK workforce development frameworks, including the Knowledge & skills framework (KSF) & The NHS Leadership framework.
12 benefits for individuals were elicited which fell into four domains: skills acquisition, professional support, personal benefits and experience of other cultures.
Educational/Individual Benefit Domains: UK Partner Domain Clinical skills
Original Codes Tropical Diseases Clinical Skills Innovation in healthcare and use of resources Leadership and Management Skills Ability to Cope in Different Environments Prioritisation of Limited Resources Self–Understanding Leadership and Management Communication and Improved skills of negotiation Team-working, Languages Teamwork Increased appreciation of/skills in relationships Appreciation of factors influencing health Patient experience Increased knowledge/appreciation of cultures and dignity Policy Understanding of other health systems Perspective on UK problems Education, Training and Research Academic skills New Ideas Personal satisfaction Lifelong Interest in Global Health & Development Personal Satisfaction and interest
Educational / Individual Benefit Domains: Overseas Partner Domain Original Codes Clinical Skills Skills Educational/Teaching Skills Acquisition Leadership/Management Skills Research Skills Administrative Skills Coaching Professional Mentorship Support Reduction in Professional Isolation Refreshment / Growth Personal Inspiration / Motivation Benefits Support / Friendship Experience of Other Cultures Experience of Other Cultures
The most benefits were found at the institutional level. These were mapped to the WHO 6 pillars of a health system, with benefits cited for every pillar. The most benefits were found within Human Resources (most pertinent to education), with codes including: provision of educational infrastructure / equipment; improved educational systems; specialist gap filling; attraction of high quality educators; increased staff competencies; and improved staff retention.
Conclusion There is little published or unpublished literature on the educational impact of health partnerships – both on the UK partner and on the LIC / LMIC partner. The existing evidence base is mainly descriptive and does not reach the highest levels of quality of evidence. Benefits to the UK partner were most commonly cited at the individual level whereas Benefits to Individuals and Workforce Conclusions benefits to the LIC/ LMIC partner were most commonly institutional. This suggests the Model of Transferring Benefits - The 40value individual benefits codes grouped into 7 keyfor UK partners, with There is little published or unpublished literature on the impact educational of links is being morewere effectively embedded domains: clinical skills; management skills; communication & of volunteering within health partnerships. The existing evidence benefits closely mapping to professional development frameworks. This is surprising teamwork; patient experience & dignity; policy; academic base is descriptive and focuses on the benefits. when many links would describe training as their core activity in the LIC/ LMIC partner. skills; and personal satisfaction & interest. More work is required to quantify the costs and benefits of More work is needed to elicit and embed the individual benefits to lower income volunteering within health partnerships for individuals and - A high degree of concordance was shown between benefits country colleagues and the institutional benefits to the UK. Newer links are focussing institutions, and the associated challenges and barriers. cited and professional development indicators within UK on mentorship of colleagues in lower income settings. These require further support workforce development frameworks, including the Knowledge and evaluation. Our theoretical model [right] shows a way to translate individualDespite these limitations our analysis suggests that skills acquired & skills framework (KSF), The NHS Leadership framework and through volunteering map closely to workforce development benefits into improved patient care and outcomes in the UK. continuing professional development competencies. frameworks and can be theoretical linked to improved service Only a minority of studies cited costs at any level. Increasing rigorous internal and delivery within the NHS. Benefits could be maximised by formally - A theoretical trajectory from volunteer experience to UK external evaluation of health partnerships is required to identify and minimise costs embedding volunteering within health partnerships within service delivery outcomes was demonstrated in most areas, but and maximise benefits and thus maximise the impact of health partnerships. continuing professional development processes. not all (see Model of Transferring Benefits).
References: [1] Crisp N: Global health partnerships: the UK contribution to health in developing countries [2] The Royal College of Physicians and the Academy of Medical Sciences: Building institutions through equitable partnerships in global health [3] NHS and Department of Health: The Framework for NHS Involvement in International Development
Acknowledgements: We thank Andy Leather, Hannah Franklin and the King’s Centre for Global Health for the support and oversight and support of the UK literature project. We thank Lord Nigel Crisp KCB and Graeme Chisholm (on behalf of THET) for their support, advice and recommendation of literature for the UK review.