How Health Partnerships Can Help Prepare Health Systems for Pandemics
By Lucy Gilder
Abstract: This second post in our COVID-19 blog series examines how health partnership work can help prepare staff working in both low and high resourced health systems for dealing with public health crises.
Glancing at the latest map of the COVID-19 outbreak, there is no mistaking where the epicentre of the outbreak now lies. If someone looked at that map a mere two months ago and again now, they would no doubt be surprised by the speed at which the disease, initially confined to China, became centred in Europe and the US. While cases have dropped dramatically in China, in countries such as Italy, Spain and the UK, infection rates continue to rise, as is the case across other continents. Although at the time of writing COVID-19 has seemingly spread slowly across Africa, as it begins to take hold it is not difficult to foresee the devastation that could be unleashed upon its under resourced and overburdened healthcare systems. 
Despite this, or more likely because of this, several African nations are taking strict measures to delay the spread of the virus as best they can. In Lagos, the government ordered all schools to close after only 8 cases emerged. In Uganda large religious gatherings have been banned and entry for foreigners was restricted as far back as 3 weeks ago. For West Africa in particular, it is a preparedness triggered by memories of the Ebola epidemic in 2014, applying what they have learned from this most recent epidemiological crisis.
In an interview with Devex last week, Gyude Moore, senior adviser to the President of Liberia during the Ebola epidemic, remarked that ‘what we learned is that you have to over prepare so that you don’t overreact’. Moore also reflected on how West Africa came to understand the importance of behaviour change in the public, and the vital role individual hygiene can play in combating diseases on the scale of Ebola and COVID-19.
The health partnership model of sustainable development, whereby knowledge and skills are exchanged by healthcare institutions in low, middle and high income countries, contributes to the development of skills which will assist in dealing with global challenges. The Kampala Cambridge Antimicrobial Stewardship and Infection Prevention Control Partnership, facilitated by CGHP, aims to reduce maternal mortality in obstetrics and neonatal wards. Workshops and interactive training sessions are co-delivered to staff at both Mulago Specialised Women and Neonatal Hospital and Kawempe National Referral Hospital.
Increasing hand hygiene awareness and facilities, has been a key project objective, including the onsite production of alcohol gel. With remote assistance from UK partners, alcohol gel production began in Kampala last month and the gel is now readily available across both hospitals. In light of the unexpected COVID-19 pandemic, this is a timely and important development. Prior to the production of alcohol gel, hand hygiene facilities were limited which would have certainly worsened the outbreak. Access to locally produced gel demonstrates the value of health partnerships in assisting partners to prepare for a variety of global health challenges.
Whilst this example portrays the win for low- and middle-income country (LMIC) partners, high-income countries reap equal benefit from such partnerships. Health partnership engagement can equip staff with the necessary skills to handle high pressure situations, such as pandemics. For instance, high-income countries like the UK can learn from the Global South’s approach to resource management. Though highly experienced and adept at working under pressure, it cannot be stressed enough that at this moment NHS staff are delivering unprecedented levels of care to an unprecedented number of critically ill patients, leading to a huge strain on resources.
Out of the vast NHS workforce, the health workers who have previous experience working in global health are now in a position to apply some of the lessons they learned abroad. It is these individuals who have developed the skills needed to cope in a high-pressured, resource-scarce environment such as the one created by COVID-19. As the two CGHP Members recall below, working in a low-resource healthcare system can develop skills associated with problem-solving, adaptability and resourcefulness.
“I’ve learned about looking more broadly at a problem. It’s the idea that you’re short of something and then having to think ‘so, what’s the next step? Is there another way around it?’ [I learned] to try and problem-solve rather than accept the shortages as a default. I learned a lot from an area I didn’t know.”
Colin Hamilton, Physiotherapist, Gaza
“You realise that there’s quite a lot you can do with a couple of people and an empty bed space. Sometimes great is the enemy of good and you can make some real progress without having to go straight away for this very hi-tech singing-dancing-talking mannequin in the simulation room.”
Livi Rees, ICU Nurse, Myanmar
The COVID-19 outbreak has reinforced the importance of health partnerships in stimulating co-development of health systems around the world, as well as the need for international cooperation. This principle of co-development has become firmly embedded in health partnership work, at CGHP as well as other organisations around the world. Whether it is the support provided to low-income countries to improve hand hygiene practices, or the training of UK staff to manage resources, the cases outlined throughout this blog present timely reminders of the value partnership work can bring in helping resolve global health crises.
 Africa so far has over 3400 confirmed cases across 39 countries. (Source: https://www.afro.who.int/health-topics/coronavirus-covid-19#sitrep)
Beaubien, J. ‘African Countries Respond Quickly to Spread of COVID-19’ https://www.npr.org/sections/goatsandsoda/2020/03/21/818894991/african-countries-respond-quickly-to-spread-of-covid-19?t=1585560884503
Malik, N. ‘This virus is ravaging rich countries. What happens when it hits the poor ones.’ https://www.theguardian.com/world/commentisfree/2020/mar/23/coronavirus-rich-countries-poor-west-covid-19-developing-world
Saldinger, A. ‘An Ebola Veteran Shares Lessons for COVID-19.’ https://www.devex.com/news/an-ebola-veteran-shares-lessons-for-covid-19-96805
PREVIEW: In the third instalment of this blog series, CGHP Development Lead Kristijan will assess the effect of COVID-19 on funding streams.