by Amaran Cumarasamy – CORBIS Co-Founder.
One of the most ubiquitous thematic evolutions regarding the adoption of development strategies as part of the SDG framework, has been the acknowledgement of the interconnection of agendas and their ambitious targets across all areas including health, education to name a few. Interwoven into the DNA of such ambitions is the recurring theme of partnerships, central to the success of the SDGs according to development practitioners and academics across the sector.
Within international health, partnerships and collaboratives in all their shapes and sizes have existed for decades, often the product of inter-continental friendships, good intentions and the belief that Western medicine has the power to transform livelihoods and communities around the world. Many of the health partnership schemes (HPS) are formally monitored and supported by the Tropical Health Education Trust (THET).
The Health Partnership Scheme was a 6-year £30 million funding programme underpinning the financial viability of the 80 UK health partnerships; NHS hospitals and health institutions twinned with contemporaries in low to middle-income countries. Since 2011 over 157 partnerships in 31 countries have been supported, with projects ranging from maternal health and family planning interventions to patient safety improvement and health worker training schemes. Administrative and technical support come secondary to grants management, undertaken on behalf of funders, DfID, allocating funding based on planning and needs to the numerous projects within the HPS framework.
The funding was extended to the end of April of this year, and the scheme is currently undergoing review in light of an independent report commissioned by DfID to evaluate the impact, benefits and potential for the continuity of the HPS. The initial signs are promising for the future of the scheme. This is particularly significant at a time when many aid and development groups are uncertain over the longevity of their contracts with government, and where cultural shifts towards ODA priorities signal a change in how the UK may contribute towards meeting global development goals.
Despite its progress and potential, the partnership scheme is not perfect and as a global health community it is both our responsibility and in our inherent interest to challenge how the frameworks we put in place can be improved, and to better understand and mitigate arising negative externalities. Much is described of the benefit to partners in the global south, but beyond a renewed sense of purpose and a demonstrable growth in leadership skills for UK healthcare workers (HCWs), the evidence describing the benefit of these schemes in the UK can appear superficial, ungrounded and expensive.
Furthermore, little has been discussed regarding how projects falling under the HPS umbrella may affect satellite health systems which form part of the wider domestic healthcare services provided by the state. Familiar to many, in the field of international development, are the clear ethical considerations involved which may go unnoticed. In recognition of one of the central tenets of evidence based medicine: ‘do no harm’, we must be mindful of the intrinsic limitations that medical personnel face when engaging in the complex socio-political matrix of sustainable development, an area where few from medical backgrounds have received formal training.
Despite these concerns, as a member of two health partnership schemes operating in Uganda and Mozambique, I have seen first-hand the plethora of benefits for under-resourced health systems, and what substantial improvements to healthcare provision can be made. We must nonetheless be mindful of the risks that come with misaligned policies, both disconnected from wider domestic strategies and influenced by the agendas and limited perspectives of those making the decisions within the partnership schemes themselves. A more objective and impartial culture must continue be promoted to help ensure a robust and consistent approach towards achieving best practice, as part of our contribution towards achieving universal health coverage and the broader sustainable health goals.