What COVID-19 Can Teach us About Sustainable Health Partnerships

An Investigation into e-Learning

By Lucy Gilder

Normally a hive of activity, the CGHP office in Cambridge, UK has gone quiet: no project visits, no incoming delegations, no conference. Each colleague works inside their own home and all communication has become electronic. This is the work of a single virus doing its utmost to unsettle human sociability. 

As UK government policy gradually submerges the country beneath a tidal wave of isolationism, CGHP wants to use this opportunity to investigate how we can strengthen international collaboration during pandemics. In particular, we want to consider how global health partnerships can capitalise on e-learning platforms when partnership visits and related activity cannot take place. 

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If the virus outbreak has resulted in anything, it is making home workers everywhere more appreciative of technology and its connective power, whether arranging team calls or keeping in touch with loved ones. It is this power that global health organisations should galvanise in order to maintain and strengthen their relationships internationally. It is vital that the global health community develop contingency measures for when visits to partner countries are not possible. In the longer term, e-learning tools should also be deployed as a means to decrease the extent of international travel between partner countries and also make learning accessible to greater audiences. 

Many health partnerships including those managed by CGHP, have members who frequently engage using Skype, WhatsApp and other social media platforms  for consultations with partners, and have already integrated e-learning within their partnership work, as discussed below. Although these case studies highlight how e-health partnerships are already in operation, it also demonstrates the need to take this development model further, building partnerships that are sustainable in every sense of the word.

Case Study: The King’s Centre for Global Health and Health Partnerships (KGHP)

Based at King’s College London, KGHP aims to help governments improve health care delivery by empowering people, organisations and systems. Having successfully cultivated a partnership with Somaliland for almost two decades, King’s uses a delivery model that combines real time teaching, training, mentoring, project collaboration and supervision. 

Aqoon, meaning ‘knowledge’ in Somali, is one of many online programmes established by the partnership. The aim of the programme is to share King’s teaching on global mental health with medical students at Hargeisa and Amoud Universities in Somaliland. This peer-led e-learning programme offers professional development for both UK and Somaliland participants, as Roxanne Keynejad writes in her evaluation of the scheme, ‘qualitative findings identified more gains in factual knowledge for Somaliland students, whereas UK students reported more cross-cultural learning.’ Despite the overall success of the programme the evaluation highlighted several logistical challenges, such as time zone disparity and poor internet connections. 

Case Study: MedicineAfrica 

Specialising in ‘mobile-first’ partnerships with low bandwidth, MedicineAfrica’s innovative vision is to help educate future healthcare leaders through online case-based tutorials. While also supporting King’s Somaliland partnership, MedicineAfrica also facilitates an e-health partnership between medical students in Oxford and Palestine, known as OxPal Medlink. The partnership originated in an effort to overcome the geopolitical barriers faced by Palestinian medical students when accessing learning resources. 

Using the e-learning platform ‘WizIQ’, OxPal students participate in a multimedia ‘virtual classroom’, complete with both audio and text discussions as well as an interactive whiteboard. An evaluation of the OxPal Medlink partnership stressed how e-learning platforms like WizIQ remain underexploited by global health organisations, despite their capacity for low bandwidth connectivity and range of interactive tools. 

What can be gained?

Aside from the benefit of being able to continue health partnerships when political, economical and epidemiological instability make in-person visits impossible, online learning is also environmentally sustainable. Flights between partner countries needn’t be so frequent where online training programmes have been put in place. The connection between global health and the environment is the key premise of the evolving discipline of planetary health, which explores the close ties between the health of the planet and human wellbeing. As illustrated by a recent Guardian article, pathogens like COVID-19 will become increasingly commonplace the more humans continue to destroy habitats and biodiversity. 

Moving more health partnership activity online could further help charitable organisations by decreasing the often significant sums of money spent each year on travel and accommodation expenses. Subscriptions to online learning platforms may be costly, but cutting down on international travel means that a proportion of budgets could be redirected for this purpose. CGHP now budgets for carbon offsetting when project planning, in addition to actively seeking solutions to undertake partnership work remotely. Still, much more can be done and the current crisis offers an opportunity to accelerate this work.  

In accordance with THET’s Principles of Partnerships, online learning platforms would also ensure that online partnerships are ‘effective and sustainable’ by storing world-wide learning resources in a safe and secure digital location. In this way learning materials can be shared easily with future training participants, and become accessible equally to both sides of the partnership rather than belonging exclusively to the Northern partner. Working towards this goal, CGHP in collaboration with Makerere University College of Health Sciences and the Infectious Diseases Institute (IDI) in Kampala, are developing materials for the IDI online learning platforms from our joint antimicrobial stewardship and infection prevention and control project, making learning materials more widely available for partners in Uganda and beyond. In addition, the implementation of mobile apps such as CwPAMS Microguide, allows healthcare professionals on wards in Kampala or Cambridge to access information on the go.  

What is there to lose?

It goes without saying that it is not always straightforward for partners to get involved with e-learning. Global health partnerships need to plan around the likelihood that many still lack access to necessary technology and a stable internet connection. As part of a study into this, Kenyan-based organisation AMPATH (Academic Model Providing Access to Healthcare) identified ‘lack of consistent, basic services such as electricity and internet connectivity’ as one of the main barriers to effective e-health partnerships. 

Alternatively and additionally, global health organisations should increase exploration of the potential of smart phone learning, as social network usage continues to rise exponentially across the world and particularly in LMICs. Indeed, Facebook and other social media are becoming increasingly adept at diversifying their platforms to encompass a range of in-build technologies, such as Facebook Live. Trainers could use this feature to broadcast lectures, seminars and workshops live across the international health partnership. A live chat function would facilitate partner participation, questions and feedback on the session. 

Finally, it is certainly worth considering the perceptions partners might have about the growing use of e-learning, which can never truly replace the value of face-to-face interaction. There is a risk that less frequent visits might compromise activity and the achievement of partnership and project targets. Yet it is also important to think about how online tools can be used to bind health partnerships together at times when they might otherwise be weakened. These past few weeks have illuminated more than ever the need to continue strengthening health partnerships. Here, e-learning might just be the answer.  

Further reading

Berners-Lee, M. There Is No Planet B: A Handbook for the Make Or Break Years. Cambridge: CUP. 2019.

Keynejad, R.C. ‘Global health partnership for student peer-to-peer psychiatry e-learning: Lessons learned.’ Global Health 12, 82 (2016). https://doi.org/10.1186/s12992-016-0221-5

Penfold, R.S. ‘Evaluation of the first year of the Oxpal Medlink: A web-based partnership designed to address specific challenges facing medical education in the occupied Palestinian territories’ JRSM Open. 2014 Feb; 5(2) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4012652/

Vidal, J. ‘Tip of the iceberg’: is our destruction of nature responsible for COVID-19’. The Guardian. 18th March 2020. https://www.theguardian.com/environment/2020/mar/18/tip-of-the-iceberg-is-our-destruction-of-nature-responsible-for-covid-19-aoe

Lucy is an Intern at Cambridge Global Health Partnerships. She has an MPhil degree in Social Anthropology from the University of Cambridge.