30 Years of Leveraging International Partnerships to Strengthen Health Worker Capacity
Co-authored by April Pinner and Nancy A. Kelly
‘Partnership’ is very much in vogue, with the growing recognition that to address the most pressing problems of our time, sustained collaboration is required. The United Nations acknowledged it as such by making it the 17th Sustainable Development Goal. But it’s not new to Health Volunteers Overseas (HVO), a nonprofit with more than 30 years of on-the-ground experience, working with more than 80 institutions around the world to build and strengthen the health workforce in resource-constrained countries and improving lives around the world.
Their research-backed lessons learned include the predictable ‘mutual goal setting,’ ‘honest and open communication,’ ‘engagement,’ and ‘flexibility.’ These are all easy to understand, although difficult to put into practice. More interesting is their insight into the critical importance of equitable work, mutual benefit, defined leadership roles, and true local champions.
The following is a condensed version of an article that appeared in the open access online journal Frontiers in Public Health Education and Promotion, 04 July 2017. The article is part of a special research topic titled International Partnerships for Strengthening Health Care Workforce Capacity: Models of Collaborative Education.
A central component of HVO’s educational model is the organization’s reliance on international partnerships to achieve its mission. The justification for adopting the partnership approach relies on the belief that intra and cross-sector collaboration can maximize impact and promote sustainability when attempting to address complex global health issues. HVO has found that the most successful model of partnership relies on a “collaborative relationship between two or more parties based on trust, equality, and mutual understanding for the achievement of a specific goal. Partnerships involve risks as well as benefits, making shared accountability critical” (World Health Organization, 2009). For over 30 years, HVO has relied on this collaborative model of partnership to ensure the success of individual projects and sustainability of interventions.
Lessons Learned/Key Indicators of a Successful Partnership
Three decades of experience has also enabled HVO to refine the key indicators of a successful partnership:
- Mutual goal setting (Wildridge et al., 2004; Leffers and Mitchell, 2011). When host institutions actively engage in defining project goals, objectives, and activities, both partners are invested in realizing project outcomes. This applies not only in the project design phase but is necessary throughout the project life-cycle as goals and objectives may evolve over time. Ongoing collaboration on project goal setting helps ensure project activities and interventions continuously align with host institution priorities and instill a sense of project ownership and responsibility on the part of the host institution, thereby increasing the likelihood of sustainable change.
- Honest and open communication (Tennyson, 2003; Wildridge et al., 2004). Establishing and maintaining effective communication instills confidence that partners are moving toward the same goals. Language and cultural barriers can often present communication challenges, especially when working with international partners. HVO has found that partners may be hesitant to provide honest or constructive feedback on the project due to concerns it may negatively impact the relationship or project status. It is important to acknowledge these challenges exist and integrate strategies to mitigate potential misunderstandings and facilitate honest communication. In this regard, HVO has developed orientation materials and provides guidance to volunteers and leadership to address cross-cultural communication challenges and enhance their oral and written communication. Further, HVO works with the host institution to encourage constructive feedback through ongoing project monitoring and evaluation. Facilitating honest and open feedback relies on HVO framing the discussion appropriately and demonstrating that constructive feedback is welcomed, non-threatening and critical to the success of the project.
- Equity (Tennyson, 2003). Initiating and sustaining a partnership requires a dedication of time, staff, and resources. HVO recognizes that each partner will provide different types of resources to a project based on their unique capacities and available resources. While resource contributions often cannot be calculated or equated in financial terms, each partner’s contributions are essential to project success. During the project design phase, each partner’s commitments and projected contributions are outlined and, then, included in the Letter of Agreement (LOA), which requires annual reassessment as external variables may influence available resources. Ultimately, seeking equity within a partnership recognizes each partner’s right to be “at the table,” regardless of an imbalance in resource contribution.
- Mutual benefit (Tennyson, 2003). Often, partners are independently accountable to stakeholders external to the immediate partnership. In addition to institutional/organizational benefits, mutual benefit is realized at the level of the individual trainee and volunteer. The benefits to the trainees are outlined in the project objectives and result in changes in knowledge, skills, and attitudes as a result of the teaching and training provided. HVO has also documented a positive personal and professional impact on volunteers as reported in post-trip surveys, including broadened professional perspectives, increased cross-cultural competency, strengthened professional networks, and increased clinical confidence.
- Active partner engagement throughout the project lifecycle (Afsana et al., 2009). While one partner may be responsible for a larger percentage of project oversight and ongoing management, each partner must be kept up to date on project activities and engaged in decision-making. It is important that expectations and roles are strategically and realistically mapped out during the project development phase and solidified in the LOA. Ultimately, HVO is a guest within the host country and institution where each project operates. This perspective is foundational to our approach and active engagement of our partners throughout the project life-cycle reflects this philosophy.
- Flexibility (Wildridge et al., 2004). Partnerships require flexibility to evolve and transform over time. This is especially true in global health where priorities and needs may shift as a result of changing health demographics, donor trends, local resources, leadership, or the strategic mission or capacities of one or both partners. Through mutual and ongoing project monitoring, evaluation, and effective communication, HVO is able to work with our partners to continuously re-assess if the nature of the partnership and/or the goals of a project need to be updated.
- Clearly defined leadership roles (Wildridge et al., 2004). As mentioned previously, HVO’s model relies on volunteers at all levels of the organization, including leadership. HVO has defined a broad set of roles and responsibilities for all PDs and OSCs. However, HVO has learned that each partner has a unique set of capacities and, therefore, the exact roles and responsibilities for the volunteer on-site coordinator (OSC) (and partner institution more broadly) are defined during the project design phase and stated in the LOA for each project.
- Local champion. Identifying a local champion at a host institution helps maintain project momentum and often guides the evolution of the partnership (Leffers and Mitchell, 2011). HVO has found a local champion may or may not have an official leadership role within the HVO project or the host institution. However, they have a demonstrated ability and willingness to leverage their personal or professional power and go beyond task related deliverables that may be defined in a formal leadership role. Common skills and traits of a local champion include the ability to motivate, inspire, negotiate, be resourceful and liaise with all parties to effectively and efficiently move the project forward.
Over 30 years, HVO has been able to identify key indicators of a successful international partnership and integrate strategies into our internal structure and processes that promote these key principles. However, it is important for organizations such as HVO to recognize each partnership is unique and as the global health environment and priorities of our partners evolve, models of international partnership must adapt to stay relevant. HVO remains committed to learning and refining our philosophy and internal processes around equitable international partnerships to promote integrated and sustainable contributions to strengthening health worker capacity.
Health Volunteers Overseas (HVO) is a United States-based nonprofit that collaborates with more than 80 universities and health institutions around the world to send volunteer health professionals to provide continuing education, train the trainer courses, professional support, and consultation on academic programs and curricula development. By establishing mutually beneficial partnerships, HVO is able to deliver effective models of collaborative education that contribute sustainable solutions to strengthen health workforce capacity in resource-scarce countries—ultimately improving health outcomes and the quality of life for millions throughout the world.
Co-Author Nancy A. Kelly, MHS
Nancy has served as Executive Director of Health Volunteers Overseas for more than 30 years. Prior to joining HVO, she worked for the National Council for International Health and was a Peace Corps volunteer in the Republic of Korea. She holds a Master of Health Science degree from Johns Hopkins Bloomberg School of Public Health. She serves on several boards including the US section of Handicap International, Global Impact, and Friends of Korea.
Afsana, K., Habte, D., Hatfield, J., Murphy, J., and Neufeld, V. (2009). Partnership Assessment Toolkit. Ottawa: Canadian Coalition for Global Health Research. http://www.ccghr.ca/wp-content/uploads/2013/05/PAT_web_e.pdf
Leffers, J., and Mitchell, E. (2011). Conceptual model for partnership and sustainability in global health. Public Health Nurs. 28, 91–102. doi:10.1111/j.1525-1446.2010.00892.x http://onlinelibrary.wiley.com/doi/10.1111/j.1525-1446.2010.00892.x/full
Tennyson, R. (2003). “The partnering toolbook,” in International Business Leaders Forum (IBLF), the Global Alliance for Improved Nutrition (GAIN), International Atomic Energy Association, UNDP, ed. E. Wood (New York: UNDP), 1–55. https://thepartneringinitiative.org/wp-content/uploads/2014/08/Partnering-Toolbook-en-20113.pdf
Wildridge, V., Childs, S., Cawthra, L., and Madge, B. (2004). How to create successful partnerships – a review of the literature. Health Info. Libr. J. 21, 3–19. doi:10.1111/j.1740-3324.2004.00497.x http://onlinelibrary.wiley.com/doi/10.1111/j.1740-3324.2004.00497.x/full
World Health Organization. (2009). Building a Working Definition of Partnership: African Partnerships for Patient Safety (APPS). Available at: http://www.who.int/patientsafety/implementation/apps/definition/en/; http://www.who.int/patientsafety/implementation/apps/resources/defining_partnerships-apps.pdf