NHS International Health Links – what difference can we make?

Dr Melanie NewportBrighton and Sussex Medical School

m.j.newport@bsms.ac.uk

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

Den

sity

(wor

kers

per

100

0)

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 populationunder 15 years old

GNI $630 per capita

Per capita income ~ $490 p.a.

>50% unemployment

68% literacy rate

Ranked 165 out of177 countries in theHuman Development Index

Life expectancy: 41 yearsInfant mortality: 100 per 1000 live birthsUnder 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 cotsFull range of primary, secondary, and tertiary

services

Accident andEmergency

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 BSUHTSian 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 differenceMercy 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 ANCMay 07 1:20 male partner at ANC

82 nurses attended workshopsSignificant 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.