Building Sustainable Partnerships to Strengthen Pediatric Capacity at a Government Hospital in Malawi

Abstract

IntroductionTo achieve sustained reductions in child mortality in low- and middle-income countries, increased local capacity is necessary. One approach to capacity building is support offered via partnerships with institutions in high-income countries. However, lack of cooperation between institutions can create barriers to successful implementation of programs and may inadvertently weaken the health system they are striving to improve. A coordinated approach is necessary.BackgroundThree U.S.-based institutions have separately supported various aspects of pediatric care at Kamuzu Central Hospital (KCH), the main government referral hospital in the central region of Malawi, for several years. Within each institution’s experience, common themes were recognized, which required attention in order to sustain improvements in care. Each recognized that support of clinical care is a necessary cornerstone before initiating educational or training efforts. In particular, the support of emergency and acute care is paramount in order to decrease in-hospital mortality. Through the combined efforts of Malawian partners and the US-based institutions, the pediatric mortality rate has decreased from >10 to <4% since 2011, yet critical gaps remain. To achieve further improvements, representatives with expertise in pediatric emergency medicine (PEM) from each US-based institution hypothesized that coordinated efforts would be most effective, decrease duplication, improve communication, and ensure that investments in education and training are aligned with local priorities.Call to actionTogether with local stakeholders, the three US-based partners created a multi-institutional partnership, Pediatric Alliance for Child Health Improvement in Malawi at Kamuzu Central Hospital and Environs (PACHIMAKE). Representatives from each institution gathered in Malawi late 2016 and sought input and support from local partners at all levels to prioritize interventions, which could be collectively undertaken by this consortium. Long- and short-term goals were identified and approved by local partners and will be implemented through a phased approach.ConclusionThe development of a novel partnership between relevant stakeholders in Malawi and US-based partners with expertise in PEM should help to further decrease pediatric mortality through the coordinated provision of acute care expertise and training as well as investment in the development of educational, research, and clinical efforts in PEM at KCH.

Managing health research capacity strengthening consortia: a systematised review of the published literature

“…The most cited platforms for coordinating activities and monitoring progress were consortium meetings, management meetings and partner visits, as well as telephone and electronic communication. Factors reported to foster coordination and monitoring included regular communication, jointly determined goals and processes, previous working relationships, and the use of codes of conduct and guidelines 60 66 67. Lack of clarity about roles and guidelines,43 50 and difficulties in organising meetings due to physical distances, time differences, conflicting partner priorities, and poor internet connectivity were reported as barriers particularly in large-sized consortia 60 68 69.…”

“…Partner relationships were fostered by principles such as openness, trust, mutual respect, transparency, shared commitment and recognition42 66 73 74; and practices such as establishing guiding principles and norms, joint planning and implementation processes and regular communication 49 59. The importance of recognising and leveraging on differences in partner needs, strengths, interests, objectives, expectations, contexts and culture to nurture effective relationships was also noted 49 74–76.…”

“I Need to Be the First One With a Different Approach and to Make a Difference to the People” - Transforming Pediatric Training for Non-physician Clinicians in Malawi: A Mixed-method Study

“…Will the project have lasting effects on students and local institutions? First, this partnership projecthad built on an existing BSc PCH training program, developed through local resources, implemented by local staff, and addressing local needs.It expanded and complemented through careful analysis of the existing training program by shared decision-making ensuring national ownership, and in an atmosphere of mutual trust [22,23]. Second,the project was designed to improve students' autonomy and to enablelocal partners to determine their needs and priorities-pre-requisites for local ownership and sustainability [18,22,24].…”

Increasing Impact: Evaluation in Global Child Health Education, Clinical Practice, and Research

“…9 Although outcomes data may not be easy to collect, particularly for shorter-term programs, longer-term partnerships have demonstrated it is possible to collect needed data, including on intermediate outcomes, such as enrollments in treatments or services provided through partnerships, 16 and on patient outcomes. 17…”