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Partnerships for better patient care

How ESTHER Germany supports the twinning of African and German hospitals

This publication describes how ESTHER Germany supports partnerships between hospitals in Africa and Germany, allowing the partners to learn from one another and to join forces in addressing HIV and other health challenges.

Ruth Evans

Peer reviewers
  • Dr Henning Mothes (Consultant at the Department of General, Visceral and Vascular Surgery at University Hospital, Jena, Germany)
  • Dr David Weakliam (Programme Lead, Global Health Programme, Health Service Executive, Ireland)

Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, October 2015

1 Title Page

Key Learnings

Situation. ESTHER Germany supports partnerships between hospitals in Germany and African countries.

Approach. In contrast to many other approaches to capacity development, these partnerships aim to generate a two-way flow of ideas and expertise, based on mutual professional respect between equals. They focus on jointly agreed local challenges and work through regular reciprocal visits, on-the-job training in both the German and African hospitals and via continuous joint monitoring of progress.

Results. Tanga Regional Referral Hospital in Tanzania has markedly improved the quality of care and a culture of quality has been firmly established at the hospital, which now shares its quality competence with other Tanzanian hospitals and in a South-South partnership with a hospital in Cameroon.
Enhanced laboratory, medical and nursing capacity has led to better HIV care and treatment at Limbe Hospital in Cameroon, which has become a regional centre of excellence.

Lessons learned. Hospital partnerships can strengthen health systems by empowering hospital staff in resource poor settings to develop small-scale, tailor-made solutions, which sometimes plant the seeds for larger improvements. The partnerships inevitably depend on key individuals, but they must also be firmly grounded in institutional commitment to lead to sustainable changes.


ESTHER Germany is a member of the Ensemble pour une Solidarité Thérapeutique Hospitalière En Réseau, a European initiative to improve health outcomes in low- and middleincome countries through a series of twinning arrangements between European and African, Asian and Latin-American hospitals and academic and research institutions. The initial aim of most of these partnerships was to enhance North-South collaboration on hospital diagnosis and treatment of HIV and AIDS, but it soon became apparent that this approach could also be very effective in addressing other health challenges, such as the management of infectious diseases and fast and effective responses to epidemic outbreaks, a topic high on the international political agenda following the Ebola outbreak.


ESTHER Germany twins hospitals in Germany and Africa and, more recently, has begun to support a South-South partnership between hospitals in Tanzania and Cameroon. These peer-to-peer partnerships are based on mutual professional respect and understanding, and are built up over a period of time, with both sides benefitting from the two-way learning experience. Interventions are carefully planned after a joint assessment of the African partners’ specific needs and the corresponding expertise and experience which professionals working in similar fields in the German partner hospitals can provide. The partners agree upon plans of action to be implemented over a specific period, mostly by means of knowledge transfer through reciprocal exchange visits, training on the job in the German and African hospitals and regular joint monitoring of progress.

This case study describes two partnerships supported by ESTHER Germany. The first is between Tanga Regional Referral Hospital in Tanzania and Charité University Hospital in Berlin and focuses on a quality improvement approach for strengthening healthcare outcomes. A five-year relationship has given the hospitals time to work through the stages of quality improvement, from initial quality assessment to establishing quality management.

The second partnership is between Limbe Regional Hospital in Cameroon and Rostock University Hospital and aims to improve diagnosis and care of HIV patients through strengthening laboratory, medical and nursing capacities.

The case study also details the establishment of an innovative South-South partnership between Tanga Regional Hospital in Tanzania and Bamenda Hospital in Cameroon, extending the quality management approach to Cameroon.


Both ESTHER Germany supported hospital partnerships have generated important results. For the Tanga-Berlin partnership they include the following:

  • The quality of care at Tanga Hospital has markedly improved. Regular hospital self-assessments conducted over a five-year period from 2009 to 2014 show that clinical practices have continuously improved, and that the partnership has helped to improve the quality of health care.
  • A culture of quality has been established at Tanga Hospital, with hospital and departmental quality teams in operation, regular assessments conducted, action plans drawn up to address problems identified and a fulltime quality focal point appointed to coordinate efforts. Health workers in Tanga are now keen to improve the quality of care and their working conditions with the resources they have at their disposal instead of waiting for assistance from outside.
  • The quality improvements have led to better health outcomes (including a reduction in the percentage of maternal deaths) and an increased number of patients.

Similarly, the Limbe-Rostock partnership produced the following outcomes:

  • The capacities of laboratory, medical and nursing staff have been significantly enhanced through training of key staff in Rostock and on the job in Limbe with regular visits from German partners.
  • The health outcomes for HIV patients show marked improvements, with more patients seen, fewer lost to follow-up treatment and fewer known deaths.

Some positive results are shared between both partnerships:

  • In the course of their partnerships, both Tanga and Limbe Hospitals have become regional (or even national) reference points for their competencies in the field of quality management and HIV diagnostics and care, respectively.
  • Both partnerships have produced a number of peer-reviewed research articles to which both the African and the German partners contributed.
  • Health workers from both Germany and Africa have found the partnership to be an invaluable learning opportunity and mutually beneficial relationship.

Lessons Learned

Peer-to-peer partnerships can be an innovative, valid and complementary approach for development and health systems strengthening in low-income countries. The examples described in this report illustrate that:

  • Partnerships can develop, implement and continuously adapt tailor-made local solutions to local problems, whether related to HIV and AIDS care and treatment, or to wider issues of quality improvements.
  • Partnerships help staff involved to keep a focus on what CAN be done. Even in resource-poor settings, such partnerships can empower health workers to address local challenges and achieve improved outcomes in an effective and sustained way.
  • Partnerships inevitably depend on key individuals, but they must also be firmly grounded in institutional commitment to lead to sustainable changes.
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