rcog global health strategy · impact on women’s health worldwide and it must consider a wider...

RCOGGlobal Health Strategy2013 - 2017

Introduction ..................................................................................3

Our aims ..........................................................................................4

What the College can offer .................................................5

Key themes in delivering global health ......................14

Contents

“ Women are not dying because of diseases we cannot treat. They are dying because societies have yet to make the decision that their lives are worth saving.” Professor Mahmoud Fathalla, Egypt, Honorary Fellow of the Royal College of Obstetricians & Gynaecologists

RCOG Global Health Strategy 2013-2017

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The College is a worldwide organisation. We have Fellows and Members in 106 countries, all of whom are committed to delivering the best in women’s health care. The quality of our education and training is renowned and RCOG examinations and courses are run in more than 20 countries. Our clinical standards and guidelines are respected the world over.

Our goal is to raise awareness around the world of what the College has to offer in terms of improving care quality and life chances for women and newborns.

We know we have much more to offer but to do so we must focus our expertise and our resources. We want the College to have a clear strategy for global health now and into the future, using our resources in areas where we can be most effective and to evidence our impact on women’s health.

We will build on our expertise to offer a range of activities and projects which are quality assured and which can be adapted for almost any country. Our aim is that the same high standards will apply wherever the College is engaged.

We are actively working with a range of organisations and we want to increase our partnerships over the next five years. Our collaboration with VSO and the Ugandan Maternal & Newborn Hub will be developed and we aim to support more volunteers to work around the world. We are increasingly working with other Royal Colleges and with international O&G organisations. We can, and will do more, including securing additional funding to support our work.

We hope that, like us, you see our global health strategy as ambitious but achievable and will work alongside us to make a lasting improvement to women’s health across the world.

Introduction

Dr Paul Fogarty FRCOG Senior Vice President, Global Health 2013-2016

Professor James Walker FRCOGSenior Vice President, Global Health 2010-2013

Our aims

1

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The Royal College of Obstetricians and Gynaecologists is a world leader in women’s reproductive health, setting standards on the clinical practice of obstetrics and gynaecology in the UK and across the world.

We have worked internationally to support the Millennium Development Goals (MDGs) 4 and 5. There is much work to do: each year, there are still an estimated 2.6 million stillbirths, 3.1 million neonatal deaths, 360,000 maternal deaths and 275,000 deaths from cervical cancer occurring globally. Many of these deaths are avoidable and are a major unmet need in women’s health.

The College’s overarching strategy 2012-15 has six aims that drive our global health strategy:

To ensure outstanding professionalism in all matters affecting the provision of quality health care for women

To promote global advocacy for women’s health and childbirth

To establish access to trained specialists ensuring high-quality care for women at all times

To enhance evidence-based practice to ensure the highest quality of care

To keep standard-setting and education provision at the core of all RCOG work

To develop leadership, both managerial and clinical, within all aspects of the profession


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The College’s key strengths are in standard-setting and education/training. We want to ensure that the College’s investment in global health has a profound and lasting impact on women’s health worldwide and it must consider a wider range of activity.

The College will transform its global health activity from a largely reactive, uncoordinated approach, to one in which the College takes the lead, works collaboratively, advocates on behalf of women’s reproductive health and gathers robust evidence. We will do this strategically by focusing clearly on our areas of expertise and developing a distinct global health package of services which can be adapted to suit almost any country.

This package of services will include:

• Guideline development and adaptation

• Curriculum development

• Service reviews and audits

• Training for health care workers

We will also phase additional services and activities over the course of the strategy period. Our work will be underpinned by health and training needs-assessments and a robust programme-management approach.

We will balance the College’s ‘core’ income-generating activities (education and training of clinicians; developing standards) and global social action. The two are not mutually exclusive and we will explore ways to bring these strands together where doing so would lead to improved health outcomes for women.

What the College can offer

Our map shows the breadth of work across the world, with long-established work in education and training. While there will be changes over the next few years (particularly as a result of the work that the College is doing with some of the Gulf states, and with China), the key areas of current activity reflect the highest level of global need: Africa, South Asia and Eastern Europe.

Where we currently work


MAP KEY:

RCOG EXAMINATIONS

COURSES AND TRAINING SUPPORT

MTI TRAINEES LIAISON GROUP ACTIVITY

INTERNATIONAL REPRESENTATIVE COMMITTEE

VOLUNTEERING LIFE SAVING SKILLS

EVENTS

RCOG in Africa

Examinations and franchised courses are held in Egypt, Sudan and Nigeria. The College has placed volunteers in Uganda (in collaboration with the Ugandan Maternal and Newborn Hub - UMNH) and in Ethiopia, Gambia, Kenya and Sierra Leone (with VSO).

The RCOG’s Lifesaving Skills course, developed with the Liverpool School of Tropical Medicine (LSTM), has been delivered in Ghana, Kenya, Malawi, Nigeria, Sierra Leone, South Africa, Tanzania and Zimbabwe.

We have International Representative Committees and/or Liaison Groups in Egypt, Ghana, Kenya, Libya, Nigeria, South Africa, Sudan and Zimbabwe.

The health risks to women and girls in sub-Saharan Africa continue to be a challenge.

We will:

• Work with O&G societies in Africa who want to work with us, to raise standards in women’s health care and engage other organisations across sub-Saharan Africa to gauge interest in collaborating to achieve this aim

• Seek sources of external funding to enable RCOG to expand its work in Africa

• Work with women’s community organisations to empower women and girls through health education.

Fellows and Members in Africa

• More than 350,000 women die annually from complications during pregnancy or childbirth, almost all of them — 99 per cent — in developing countries

• In sub-Saharan Africa, a woman’s maternal mortality risk is 1 in 30, compared to 1 in 5,600 in developed regions.

(source: UN)

BotswanaCameroonEgyptEthiopiaGambiaGhanaKenyaLibyaMalawiMauritiusNamibia

NigeriaRepublic of ChadSierra LeoneSouth AfricaSudanTanzaniaTunisiaUgandaZambiaZimbabwe

Photo: William Ranieri http://williamranieri.wordpress.com

36 of the 40 countries with the highest maternal mortality rates are in Africa. (WHO figures, 2010)


RCOG in South Asia

The College currently holds examinations and courses in Bangladesh, China, India (four centres), Malaysia, Myanmar, Nepal, Pakistan and Singapore. The Lifesaving Skills course has been held in Bangladesh, India, Nepal and Pakistan (by LSTM). We have a Memorandum of Understanding with the Sri Lankan College of Obstetricians and Gynaecologists (SLCOG) to improve standards of clinical care in Sri Lanka through facilitating the placement of trainees in the UK.

We have International Representative Committees and/or Liaison Groups for Bangladesh, India, Malaysia, Myanmar, Nepal, Pakistan, Singapore and Sri Lanka. Some of these have undertaken a range of proactive developmental work but others are less well-developed.

Fellows and Members in South Asia

We will:

• With our International Representative Committees and Liaison Groups, develop closer links with key decision-makers to identify ways to improve women’s access to good quality health care and health education

• Build good relationships with the key NGOs and aid agencies working in the region.

RCOG in Eastern Europe and Central Asia

The College has collaborated with other organisations, including the UNFPA, to provide specialist training workshops and courses in several Eastern European and central Asian countries. We developed a comprehensive training course on evidence-based guidelines and a training of trainers master class, as well as overseeing the course in Romania.

We also undertook a workshop and keynote speaker-based initiative (called ‘Eurovision’) involving engagement with a local obstetric & gynaecological society at their national meeting. It has been delivered in Albania, Kosovo, Latvia, Lithuania, Romania and Turkey.

We will:

• Review the College’s activities and involvement within Eastern Europe and Central Asia (as part of an overall review of global activity) to ensure that our work in that region adds value and leads to lasting change

• Explore the opportunities for creating Liaison Groups in parts of the region where we have been invited to work.

While the WHO data indicate that the Maternal Mortality Ratio is highest in sub-Saharan Africa, the MMR and risk in parts of South Asia are also high.

BangladeshBruneiCambodiaChinaHong KongIndiaIndonesia Laos

MalaysiaMyanmarNepalPakistanPhilippinesSingaporeSri LankaThailand

BahrainIraqIranIsraelJordanKuwaitLebanon

OmanPalestineQatarSaudi ArabiaSyriaUAE

RCOG in the Middle East

We have International Representative Committees in Kuwait, Iraq, Jordan, Saudi Arabia and the United Arab Emirates and a Liaison Group for Iraq.

The Gulf Development Project is to build a strategic relationship with governments, regulators and leading service providers, positioning the RCOG as a high-level partner able to support step change improvements in women’s health care.

Fellows and Members in the Middle East

We will:

• RaisetheprofileoftheRCOGbydevelopingcloserrelationships with O&G societies, governments and academic institutions in the region

• Explore the opportunities for more Liaison Groups in the region.

Focusing our resources

As a charity, the College needs to raise funds from its Members and other donors to undertake social action. Often, we rely on the goodwill of our Fellows and Members to volunteer, to donate funds, and to be champions for global health. While we will continue to ask these things of them, it is not a strategic approach, nor is it sustainable.

We will:

• Be proactive in marketing the College’s expertise and income generating opportunities

• Develop a clear case for support for external funding

• Increase the number of RCOG experts available to undertake international work

• Offer a standard range of activities and services that can be adapted to local needs.

The College has excellent links with countries in the Gulf and especially in Iraq, Jordan, Lebanon, Oman, Saudi Arabia, and the UAE (Abu Dhabi and Dubai).


Being clear about what we will and will not do

We want a clear approach to what we do, where we do it and, just as importantly, what we will not do.

This means:

• Having an open and robust approach to global health project development, using good programme management and governance arrangements

• De-commissioning activity which has little or no focus, or does not meet our strategic aims

• Prioritising regions and countries for needs-assessment and gap-analysis, to make or reinforce local connections

• Managing expectations (both internally and externally) about our capacity to engage in non-priority areas

• Resisting the temptation to scale-up activities or initiatives prematurely before they have been properly piloted and assessed

• Resisting ‘scope creep’ – the temptation to take on projects and pursue initiatives which are not specificallylinkedtoachievingourstrategy.

In deciding where we should be working, the College must identify:

• whether we are welcomed by a country’s government and local health care professionals

• health and training needs and gaps

• what we can do to add value and help meet those needs in a sustainable way

• which organisations are a good ‘fit’ for partnership

• where we might attract any additional funding requirement.

We must also bear in mind the safety of our Members, staff and volunteers, and we will not send them to areas where we assess that risk of harm is high (although we may collaborate with organisations that do work in high risk areas by providing training and support).

Developing a global health package

The College already has a significant international profile through its Membership, its examination programme and providing a range of courses for health care workers but, until now, there has not been a cohesive approach to its global health activity.

We will develop a distinct ‘global health package’ for the College – a set of products, services, partnerships and support that can be mobilised in almost any country according to identified need.

This will include:

• developing a standard range of expert services which can be amended to suit local need

• using available technology and working with other organisations to provide free clinical or educational materials for under-resourced countries

• developing clinical standards

• advocacy (women’s and girls’ health, women’s and girls’ human rights, ethics)

• fostering formal and informal collaboration with other organisations to support the work.

Additionally, we have a strategy to increase the College’s influence via consultancy services to deliver systemic improvement in women’s health care and medical training and standards. The focus for this effort will be the Gulf, India and China.

There will also be flexibility to develop new products, as the need arises. This will enable the College to work with local partners to create tailored programmes that are already proven to be effective.

The same standard. The same quality. Everywhere.

RCOG Global Health

Modular training package

Advocacy

Developing standards

Equipment & supplies

Health needs assessements

Using technology

Supporting volunteers

Working collaboratively

We will

• Ensure that our global health package provides the same standard, with the same quality, everywhere.


Volunteering programmes

Volunteering is an essential part of the College’s global health ‘package’. The College has been co-ordinating volunteers for a number of years, however, it is small scale and largely reactive, with little infrastructure in place to support volunteers.

With the development of comprehensive and targeted programmes, we can call for volunteers and align with NGOs to provide improved support for those volunteers in-country. Volunteers can also assist with increasing our knowledge base, including undertaking needs-assessments, which can be during short-term placements and which may attract a wider range of people including trainees, students and retired consultants.

We will

• Develop a new package of support for volunteers, with logistical and organisational expertise from other organisations (e.g. obtaining visas, and providing a local contact for non-clinical support)

• Expand opportunities for our Members to volunteer overseas.

NHS placements for international doctors

The Medical Training Initiative (MTI) scheme was established to provide training opportunities to International Medical Graduates (IMGs) in the form of the International Doctors’ Training Programme (IDTP).

We want to attract suitably qualified applicants from a wider range of countries and we will explore ways of raising the profile of the scheme in sub-Saharan Africa and other under-represented areas.

We will

• Make the MTI application process electronic for 2014 which will ensure that only completed applicationsfromsuitablyqualifieddoctorscanbe submitted. This will provide a faster and more responsive service for applicants

• Investigate opportunities for sub-speciality training and non-clinical internships, sponsored by a doctor’s home country and the RCOG.

We encourage doctors to volunteer as it has huge benefits for the receiving country but can also greatly enhance a range of skills that the doctor can bring back to the NHS.

Towards an outcomes focus

The College needs to know that our involvement brings positive and lasting changes to the lives of women, girls and their families. To that end, we need to develop a suite of outcome measures which will demonstrate our impact and:

• develop a clear evidence-base

• demonstrate value for money

• evidence the learning from our experience

• apply that learning to improve our work

• check that what we are doing remains strategically relevant.

Introducing principles used in good practice strategic commissioning will enable the College to implement the strategy by first establishing need, designing a service to meet that need, rolling it out and assessing the outcomes.

Maternity Mortality Ratio (MMR)

• There were 342,900 maternal deaths worldwide in 2008, down from 526,300 in 1980

• Global MMR decreased from 422 in 1980 to 320 in 1990, and was 251 per 100,000 live births in 2008

• The yearly rate of decline of the global MMR since 1990 was 1.3%

• More than 50% of all maternal deaths were only in six countries in 2008:

(Hogan, M, et al, 2010 published in The Lancet)

Understanding need

Much of the work of the College requires a training needs-assessment to be undertaken, as well as a health needs-assessment. A needs-assessment ‘toolkit’ is being introduced to support this strategy to (a) gather needs information in countries where we are already working and (b) undertake needs-assessment in new territories.

A phased approach will be taken, based on the Global Health Board’s development priorities, and assessments can be undertaken in a variety of ways. The ‘toolkit’ can be given to volunteers, to complete during a placement. It could also become a function of Liaison Groups and International Representative Committees.

Global health development process

A standardised procedure for assessment is being introduced with this strategy. All current activity and all new proposals will undergo this process, which will enable the Global Health Board and its committees to identify whether a project or proposal meets the strategic aims of the College.

We will:

• Develop a knowledge base of all countries (using published data from WHO and UNICEF, for example). This will help the College to focus its attention and availableresourcesonspecificareas

• Develop health and training needs-assessment tools for use in any country in which we are asked to work. This will enable us to work with local organisationstodesign‘fitforpurpose’services with measurable outcomes

• When resources allow, we will develop an interactive web-based world map, showing where we are working and providing information for each country in the world about women’s health outcomes.

Key themes in delivering global health

Afghanistan

Democratic Republic of Congo

Ethiopia

India

Nigeria

Pakistan


Monitoring, evaluation and review

The College currently lacks robust information about its altruistic international activities. We must change if we are to attract external funding and work in partnership with organisations that already have robust performance management methodology in place.

Linked to an outcomes-based approach to project development, we will develop monitoring procedures, learning from good practice in other organisations. We will also be undertaking a stepped programme of ‘story gathering’ in a number of countries, which will help build a qualitative evidence base and demonstrate our effectiveness to current and potential donors.

Story Gathering

In its simplest form, story gathering is a means for charities to engage donors by telling the stories of the lives they have changed and the impact they have had.

It is the stories of people that inspire supporters to give, whether it is their time or money, which is one reason why more charities are investing in story gathering. The use of the recipient’s voice and their views on how the College has changed their lives makes for a much more powerful case for donors to support our work than the charity explaining what they have achieved.

Every charity wants to connect with their donors and bring them closer to their work. Story gathering and storytelling helps to achieve this in a powerful way. Once we have our stories catalogued, we can use them on the website, in fundraising and marketing materials, in applications for support, in our policy work, PR and press stories. Story gathering is a resource for the College to use to help explain how we make a difference to women’s health.

By monitoring and reviewing our approach we can ensure best practice; delivering the best possible service to meet the identified need of the country.

Photo: © Ben Langdon

Working collaboratively

While the RCOG is a world leader in women’s reproductive health care, we want to collaborate more with other organisations to achieve better outcomes and meet the wider needs of women and girls.

A key work-stream during the period of the strategy will be to formalise the College’s relationship with other national colleges and particularly the American College of Obstetricians & Gynaecologists (ACOG), bringing together our expertise. There are opportunities for strengthening the relationship with the Canadian and Australian/New Zealand Colleges, and with our counterparts across the European Union. We will also become more involved in the work of the International Federation of Gynaecology and Obstetrics (FIGO), to ensure that the College has a strong voice in post-2015 discussions.

The Royal Colleges are working together increasingly to share learning and align their operations. There are a number of organisations which might be termed ‘natural partners’ for the RCOG: the Royal College of Paediatrics & Child Health; the Royal College of Midwives; the Royal College of Surgeons, and the Royal College of Anaesthetists, for example. We will work closely with our Faculty of Sexual and Reproductive Healthcare in areas of shared interest. We also need to foster relationships with other charitable organisations with an international health ‘mission’ and particularly women’s and children’s health.

Developing our fundraising and relationships with donors

Fundraising is a key consideration, and we will identify suitable projects which could be packaged for a donor/funder. We are producing a fundraising business case which will include global health social action as a key offering.

We will improve our monitoring and performance management procedures to evidence how we are using the funding effectively.

The College will also explore opportunities to partner with other organisations to bid for government grants and contracts, and to grant-awarding bodies.

Advocating for women’s health

The College has a strategic objective to advocate for women’s health, in the UK and globally. We have responded to consultations (through written and oral submissions) on child marriage; reducing maternal mortality and female genital mutilation (FGM) and we have raised awareness of key issues in women’s health through special events such as International Women’s Day. With our international Membership base and as global experts in women’s health, we can and must do more.

“ 27% of girls aged 15-19 in sub-Saharan Africa have been married and 28% have given birth by age 18. The lack of women’s role in decision-making in community affairs and local institutions, remains a challenge but is a necessary step towards improving political representation. Women in Africa are generally excluded from decision-making in the home, communities and society, and they represent only a 17% share of parliamentary seats across Africa.”

(Comic Relief; Women and Girls Programme Strategy 2009-12)


Promoting women’s health and well-being

There is clear evidence that countries with higher levels of women’s education have lower maternal and infant mortality rates. Not only is women’s health and well-being directly linked to education and life chances, it also increases economic development. The worldwide effort to achieve the UN Millennium Development Goals 4 and 5 (focused on reducing child (5 yrs and under) and maternal mortality) has had significant impact in a number of countries but in countries such as Afghanistan the maternal mortality rate has increased.

There is still much work to do. The College is already playing a role in influencing the post-2015 environment: as a member of the Partnership for Maternal, Newborn and Child Health (PMNCH) which brings together organisations focused on improving the health of women and children in the UK; as a member of FIGO; and working with other international colleges. We will actively pursue opportunities to make the College’s voice heard and to influence decision-makers in the UK and internationally and to carve our position as the world leader in women’s health.

Raising ethical standards

We have a key role to play in raising awareness of good medical ethics as well – not only from a clinical governance perspective but from a human rights perspective. Fellows and Members of the RCOG are expected to practise the highest levels of ethical behaviour and to treat patients with respect, compassion and dignity, involving them in decisions affecting their health. Fellows and Members are expected to encourage the same high standards from their colleagues and to challenge others’ behaviour when it falls below expectation. We also have a strategic role, globally, to raise ethical issues that affect women and to challenge behaviour that harms women and girls, such as the medicalisation of female genital mutilation (FGM), access to contraception and abortion, and violence against women.

Reducing cervical cancer

The MDGs have raised awareness of and funding for reducing maternal mortality but there is another killer that deserves the world’s attention. Cervical cancer remains a preventable cause of death of young women, causing around 270,000 deaths a year globally. Much of the burden of the disease exists in the developing world.

The RCOG will work with its international partners to develop a global approach to cervical cancer prevention through HPV vaccination and screening programmes.

High level advocacy is required to highlight the un-heard stories of women with cervical cancer involving a variety of stakeholders from women’s groups, politicians and medical bodies including the RCOG.

Photo: © Ben Langdon


Together, we can be part of the solution

Partners Funders and Donors

Members and Staff

And finally...

This global health strategy is a means of focusing the College’s attention and resources on the areas (geographical and thematic) in which our expertise and our voice can be most effective in improving health outcomes for women, girls and their families. Our ability to achieve this ambition depends on the actions of three groups of people: our Members and staff; our partners; and our funders and donors.

Statistics compiled by WHO: Cousens S, et al. National, regional, and worldwide estimates of stillbirth rates in 2009 with trends since 1995: a systematic analysis. The Lancet, published online April 14, 2011, The United Nations (maternal death statistic)

http://globocan.iarc.fr/factsheets/populations/factsheet.asp?uno=900 Cervical Cancer

Global Health Unit

Royal College of Obstetricians and Gynaecologists

27, Sussex Place, Regent’s Park, London NW1 4RG

Tel: +44 (0) 207 772 6285 Fax: +44(0) 207 227 6359

Email: [email protected] Web: www.rcog.org.uk/internationalRegistered charity number: 213280

Photographs courtesy of:

William Ranieri http://williamranieri.wordpress.com

Ben Langdon (including photograph on front cover of baby in blanket)

Professor Alison Fiander FRCOG, Dr Sonia Barnfield MRCOG, Eurovision: Lithuania 2009; Life Saving Skills Programme, RCOG Liaison group Chairs.

Loraine Rossati, Dr Rose Anorlu and RCOG International Meeting in Abu Dhabi, 2009

rcog global health strategy · impact on women’s health worldwide and it must consider a wider...

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