Presenting the initiative ‘Hospital Partnerships – Partners Strengthen Health’ on the world stage
‘Institutional capacity development is the single most important challenge that hospitals in low- and middle-income countries face today,’ states Andrew Likaka, Director of Quality Management and E-Health at Malawi’s Ministry of Health. This challenge was the focus of a panel discussion on October 15 2018 at the World Health Summit in Berlin entitled ‘Hospital partnerships for improved service delivery – strengthening competencies of medical personnel’, which attracted over 150 international participants. Moderated by Oliver Haas, Head of GIZ Section Health, Education and Social Development, the panel of five included international experts and hospital partners in Germany’s most recent initiative for promoting clinical partnerships.
A dynamic initiative for peer-to-peer learning
A member of the ESTHER Alliance of Global Health Partnerships, the initiative ‘Hospital Partnerships – Partners Strengthen Health’ was launched in 2016 by the German Federal Ministry for Economic Cooperation and Development (BMZ) together with the Else Kröner-Fresenius Foundation (EKFS) in order to support hospital partnerships between German medical and health institutions and their colleagues in low- and middle-income countries in Africa, Latin America, Asia and Eastern Europe. Implementation and knowledge transfer are coordinated by the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH. GIZ is responsible for publishing calls for project proposals, for managing financial support and for delivering expert advice. To date the Initiative is accompanying 113 projects in 37 countries. Eighty-six of these projects are on the African continent. It is now launching its fifth round of funding.
Getting the big picture on benefits, potentials, challenges and opportunities in partnerships
The session kicked off with a screening of the short movie ‘Hospital Partnerships – Partners Strengthen Health’, in which protagonists of existing partnerships in Malawi, the Republic of Moldova and Germany share their most inspiring moments and the goals of their work based on the SDGs 3 and 17 as well as on the ESTHER Alliance quality principles.
In his opening remarks Prof. Madeja of the EKFS Board underlined the Initiative’s mission: ‘We believe in the importance of Hospital Partnerships, because the foundation has a global responsibility for those who have no access to healthcare systems.’
Intercultural cooperation in the Ethiopian-German hospital partnership ‘Strengthening knowledge improves medical care’
Prof. Yadeta Dessie of Ethiopia’s Haramaya University and Dr Annegret Kiefer of Eichsfeld Clinic in Germany have been cooperating since 2009 on improving quality of care in gynaecology, obstetrics and anaesthesia at the Haramaya University Hospital. Both panellists emphasised the importance of trust and equality in establishing this relationship. Dessie stressed the time factor in developing a deep relationship: ‘You sometimes need years to get to know each other and identify the main requirements and supportive possibilities for sustainability.’
Kiefer shared what in her experience are the key factors for a partnership between two culturally different parties: ’Never compromise on knowledge, be patient and conserving, respect the higher officials and regularly repeat trainings.’ She cautioned against one-time training and then leaving the personnel without further support and follow-up: ‘This would just end up as a unique experience but without any sustainability in the future for the hospital and its staff.’ Both Dessie and Kiefer are convinced that in the institutionalisation of a partnership, collaboration with other institutions and organisations is essential. ’Knowledge must be shared”, said Kiefer, adding that partner mapping and strategic communication are needed.
‘Bottom-up’ communication and face-to-face sharing are key
Dr Gisela Schneider of the German Missionary Medical Institute (DIFÄM) is in a partnership with three referral hospitals in the Liberia-Guinea cross-border area on the topic ‘Safe Pregnancy and Childbirth – Improving Obstetric Care’. She shared her experience from the Ebola outbreak in 2014: ’We asked the communities and citizens, “If you were to rebuild your local healthcare system – what would you need?” It is essential to involve the local population in the planning of interventions, their knowledge, resources and expectations are indispensable for the partnerships. Schneider stressed that south-north cooperation and triangle partnerships, e.g. between two African and one German hospital, are becoming more and more meaningful, ’because African doctors know more about their own situation and diseases than the German doctors do.’ The meaning of sustainability must go beyond a hospital partnership according to Schneider: ‘It is about a healthcare system change which starts in people’s heads.’ In her experience she has found that face-to-face sharing is sometimes more efficient for knowledge sharing than e-learning.
The importance of a functional monitoring system for hospital partnerships
Dr Shamsuzzoha Babar Syed of WHO, in charge of Quality of Care in Twinning Projects, is an advisor to the Initiative. He agreed with Schneider that ‘asking the most disadvantaged can provide the best orientation.’ He also contributed that a key factor of partnerships lies in a functional monitoring system. This should be created by all parties with a strong involvement of the countries’ ministries of health for the most outcome and impact. The risks within joined projects (e.g. dominance by the European partner) can be minimised when measurements are clearly defined and agreed upon by all parties. Shamsuzzoha concluded: ‘For the quality of hospital partnerships, the local understanding is paramount – the beauty of partnerships will then drive the improvement. A hospital partnership can be a positive model for change and impact.’
Time and mutual trust are essential for sustainability
Like the other panelists, Andrew Likaka of Malawi’s Ministry of Health emphasised the importance of time when it comes to building a functioning and productive partnership. ‘The time factor is essential when it comes to a partnership. Without good planning, an intensive knowing of each other and working together on eye-level, cooperation would be useless.’ When asked if hospital partnerships are recognised as a vehicle to contribute to national health goals, Likaka remarked that in concert with other national and international efforts hospital partnerships have a great potential to strengthen national health institutions in order to improve quality of care, retain medical personnel and prevent brain drain.
The session came to an end with the closing remarks of Annegret al-Janabi, Senior Policy Officer from BMZ, who reminisced about the road travelled since launching the initiative. ‘When we started planning the Hospital Partnerships, we had the hope that this initiative would come to life. Now I can see that it is not only alive – it is thriving!’
Liva Haensel and Mary White-Kaba