NHS International Health Links – what difference can we make? (the Lusaka-Brighton Link)
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NHS International Health Links – what difference can we make? (the Lusaka-Brighton Link)



Dr Melanie Newport, Brighton and Sussex Medical School, m.j.newport@bsms.ac.uk

Dr Melanie Newport, Brighton and Sussex Medical School, m.j.newport@bsms.ac.uk



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  • Thanks for invitation to speak
  • We live in an unjust world Born in UK I could live another 40 years; born in Zambia I would have been dead for 10 years Many factors contribute to inequities but for today I wish to concentrate on health
  • However…. people are still required to make these effective tools
  • There are many ways of looking at the problem one is worker density rates
  • Worker density makes an important impact on effectivness of interventions such as vaccination and perinatal mortality
  • Maldistribution of HCWs in 186 countries Mobilisation and strengthening of human resources for health is central to combating health crises in the worlds poorest countries and for building sustainable health systems in all countries More that just about survival – health, development and security in an increasingly interdependent world
  • short fall of 4 million workers globally
  • Interlinked – e.g. migration driven by chronic underinvestment
  • Push and pull factors
  • Started as amateur pastimes by enthusiastic individuals Tony Blair – improving global health is in the UK’s interests – commissioned this report
  • THET is the UK support organisation for Health Links between health institutions in Africa, Asia and elsewhere in the world, and their counterparts in the UK. THET is committed to improving access to and the quality of health services in developing countries. We believe that the most effective way of doing this is to work in partnership with those delivering and running health care, helping to strengthen and extend existing services.
  • 3 times the size of UK 9 provinces, ~10 districts in each province
  • The country
  • employment
  • Man of 25
  • The patients
  • The provision of long-term educational links between Higher Education Institutions in the UK and their counterparts in Zambia strengthens health worker morale and competencies in Zambia.
  • Reasons for Lusaka and tertiary vs primary
  • Tertiary refereal centre
  • Mercy Nachalwe Dr Veronica Sycheza
  • Like all Sub-Saharan African countries high rates of HIV HIV effects disadvantaged societies poverty/poor health care/poor education/gender inequalities Because of population movement cities have higher prevelance WHO disease staging describes stage 3 & 4 requiring ARV’s Since availability of ARV’s and more universal access many more people on ARV’s so presents different challenges Testing Treatment Adherence Monitoring
  • A detailed questionnaire was completed by 30 randomly selected nurses. This questionnaire provided an enormous amount of information on the nurses’ level of knowledge and experience, their current concerns and their individual needs and requirements related to the care and treatment of patients with HIV. In Brighton, focus group discussions were established with the BSUH Black and Ethnic Minorities Group at which nurses who worked in sub-Saharan African countries joined the Brighton Nurse trainers to explore culturally appropriate means of teaching, engaging and motivating nurses
  • Sustainable training for mid to high level immunization programme managers

NHS International Health Links – what difference can we make? (the Lusaka-Brighton Link) NHS International Health Links – what difference can we make? (the Lusaka-Brighton Link) Presentation Transcript

  • NHS International Health Links – what difference can we make? Dr Melanie Newport Brighton and Sussex Medical School [email_address]
  • Inequities are killing people on a "grand scale" Life expectancy and health continue to increase in some parts of the world yet fail to improve in others
  • Positive developments:
    • Millennium development goals set the agenda for change
    • Increasing commitment from industrialised societies
    • New vaccines, drugs and technologies are increasingly available at reducing cost
  • Chen et al 2004 Lancet; 364:1984-1990 Association between worker density and mortality rates
  • Chen et al 2004 Lancet; 364:1984-1990 Worker density and service coverage
  • Chen et al 2004 Lancet; 364:1984-1990 Child mortality (under 5) per 1000 live births Density (workers per 1000)
  • Challenges
    • Global shortage
    • Skills imbalance
    • Maldistribution and migration
    • Poor work environments
    • Weak knowledge base
    • HIV/AIDS
      • Increase work loads
      • Exposure to infection
      • Weakened morale
    • Migration
    • Chronic underinvestment in human resources
    Specific drivers
  • Migration of health care workers
    • Health systems in a number of industrialized countries depend heavily on doctors and nurses who have been trained abroad
    • one in four doctors and one nurse in 20 trained in Africa are working in developed countries
    • 29% of Ghana’s physicians are working abroad
    • 34% of Zimbabwean nurses are working abroad
  • Global health partnerships: the UK contribution to health in developing countries (Lord Crisp 2007)
    • The NHS has benefited greatly from the “brain drain” of health workers from poor countries. Health Links are a highly cost-effective way of putting something back.
    • “ By developing stronger global health partnerships that link individuals and communities – hospitals, nursing schools, primary care facilities and universities, for example – we will be able to use UK expertise and experience in health to help make an even greater difference.”
  • How can health workers in the UK contribute?
    • Health Links  allow reciprocal transfer of knowledge and skills between partner institutions
    • Links help improve the basic health services of the poorest countries, building long-term capacity through training and support
    Professor Eldryd Parry
  • Benefits of links
    • Clinical education and training
    • Build institutional capacity
    • Material benefits
    • Encourages sustainability
    • Support and friendship
  • Benefits of links
    • Increase in global awareness
    • Development of clinical skills
    • Personal satisfaction/new perspectives
    • Puts NHS challenges in perspective
    • Support and friendship
  • Population ~ 12 million
  • ~50% of population under 15 years old GNI $630 per capita Per capita income ~ $490 p.a.
  • >50% unemployment 68% literacy rate Ranked 165 out of 177 countries in the Human Development Index
  • Life expectancy: 41 years Infant mortality: 100 per 1000 live births Under 5 mortality 182 per 1000 live births
  • HIV prevalence in adults: 16% 48% of under 5’s are stunted 25% are underweight
  • Health expenditure per capita: $63 ($6096 in USA) 1 doctor per 18000 1 nurse per 2000 1 pharmacist per 475,000 1 dentist per 800,000
    • To develop opportunities for:
      • Multi-professional education and training
      • Exchange of faculty members, research scholars and students
      • Joint research activities
      • Systems and service improvements
    Aims of the Lusaka Brighton Link
    • Many partners have become involved in addition to UTH and BSUHT
      • Medical schools in Brighton and Lusaka and parent Universities
      • Non-governmental organisations
      • Primary Care Trust
      • BME Network
    • A memorandum of understanding has been signed
    • Steering Committees exist at both ends to direct activities
  • 1656 beds 250 cots Full range of primary, secondary, and tertiary services
    • Accident and
    • Emergency
    • Paediatrics
    • Ophthalmology
    • Oncology
    • Radiology
    Clinical Activities
  • Educational activities
    • Medical education
      • - external examiners
      • - curriculum development
      • - Medical student electives
      • - Mentoring/distance learning modules
    • HIV nurse education programme
    • Link between Schools of Nursing and Midwifery in Lusaka and the University of Brighton – clinical mentorship and supervision, critical care curriculum
  • HIV Nurse Education Programme Lashida Mwaba, Evelyn Mwamba, Mary Jalamba and Universe Mulenga, University Teaching Hospital Lusaka Eileen Nixon, HIV Nurse Consultant BSUHT Sian Edwards, Senior Lecturer, SNAM, University of Brighton Brighton-Lusaka Link
  • Background
    • HIV Prevalence in Zambia 16% (2007)
    • 25-35% in Lusaka
    • 1,482,228 people HIV +ve
    • 298,398 in need of ARV’s
    • In 2005 39,351 on ARV’s, now 149,199 (end 2007)
    • Sustainable HIV programme
    • Train the ‘trainers’
    • Holistic skills development
    • Develop nurses’ role
    • Motivate nurses so they can make a difference
    Mercy Mbewe, Director of Nursing HIV Nurse Education Needs
  • HIV Nurse Education Programme Day 1 Introduction Nursing Contribution to HIV/AIDS Overview of HIV/AIDS Day 2 Transmission Nursing Role in Prevention Nursing patients with opportunistic infections Day 3 Antiretroviral therapy (ART) HIV in Pregnancy Monitoring and managing ART Day 4 Resistance to ART Barriers to Adherence Adherence workshop Day 5 Stigma and Discrimination Workshop Day 6 Caring for the carers Complex case scenarios Identifying the way forward Course Evaluation
  • I know you are not only interested in what you are doing - a lot of lives will be saved. Every aspect of the course has been valuable. I have appreciated the different modes of teaching. It really helped and enhanced my understanding. The whole course was well presented with a lot of interesting methodologies e.g. role plays It was very valuable. I have learnt a lot. It will really have an impact on both my nursing practice and teaching. OVERALL EVALUATION Poor............................................................................Excellent 1 - 0 2 – 0 3 – 0 4 – 0 5 – 5 6 - 22
  • Placement of all student nurses in HIV clinic Involvement of male partners in antenatal care Fathers also HIV counselled and tested when children sick Stigma workshops for all nurses Facilitation of another HIV education course In pregnancy: syphilis test 36/40 CD4 at 26 weeks Achieved Achieved Sept ‘06 60 men tested May ‘07 282 men tested Sept 06: NO male partner at ANC May 07 1:20 male partner at ANC 82 nurses attended workshops Significant impact on +ve nurses Facilitated in May 2007.....
  • Delivered by Zambian tutors……
  • Progress with HIV Nurse Education Project
    • core Zambian trainers trained
    • >200 Nurses trained in HIV Skills
      • 7 courses so far
      • Matrons/senior nurses and tutors
      • Sisters and Ward Managers
      • Enrolled nurses
    • Project laptop and printer
    • Funders (British Council) have attended workshop
  • ZAMBIAN HIV NURSE EDUCATION CO-ORDINATOR Oversee Action Plan activities Roll out HIV education to nurses in surrounding district clinics Support nurses with teaching and facilitating educational courses research the impact of educational programme on nursing practice Nurse exchange programmes between Brighton and Lusaka
  • Funding
    • THET seedcorn grant
    • Payroll giving
    • Fund raising by students and junior doctors
    • University of Brighton Students’ Union
      • Southern African Scholars fund
    • Grants for specific projects
      • NHIVNA
      • DELPHE (British Council/DFID)
      • Merck vaccine initiative
      • Sightsavers/VISION 20:20
  • Next steps
  • Acknowledgements
    • Our colleagues in Lusaka and Brighton whose enthusiasm and support make the link work
    • Medical students and junior doctors
    • British Council/DFID
    • NHIVNA
    • THET
    • International HIV/AIDS Alliance
    • University of Brighton Student Union
  • I’m grateful that I was afforded this opportunity to attend this workshop. I have learnt a lot, that HIV and AIDS is a worldwide problem, but it has a solution. Now we’ve seen that we can do something about it and we can improve the quality of health for those who are infected. Especially in my department, there is hope for the babies who are born. Now we know that there are antiretroviral drugs, even in syrup form, for the babies to take and they will be able to enjoy a good life for some time. I’m so happy.