UK-PHRST South Africa Learning Review 2022 Event Highlights from LSHTM TV on Vimeo.

Reflective report showcases the importance of partnerships and mutual learning to the UK-PHRST’s mission and highlights areas of further improvement.

The UK-PHRST and its international partners came together to review their previous work, evaluating its strengths and weaknesses as part of a three-day Learning Review Session in Cape Town, South Africa. The discussions, in September 2022, acknowledged the ongoing success and enthusiasm for the UK-PHRST’s partnership working approach and also pointed to key issues that potentially affect the work of the UK-PHRST and international partners. These included strengthening public health leadership, narrowing the North-South technological gap, ensuring deployments create impact for host countries and embedding greater levels of equity across all working relationships.

The newly published UK-PHRST and Partners Learning Review Post Review Reflections & Actions Report highlights case studies from the discussions, and provides 35 recommendations for improved ways of working. The UK-PHRST senior leadership responded to 20 of the recommendations which the attendees felt were priority areas.

Learning and improvement are fundamental to the UK-PHRST’s international activities. The Learning Review and associated report will help the UK-PHRST to better understand our partners, their opportunities and challenges, and empower us to collectively address partner identified problems - a sentiment emphasised by UK-PHRST’s Director Ed Newman.

He said: “By giving a voice to our staff and partners to capture and share some of the lessons we identified, and by being candid about the difficulties we encountered - as well as highlighting our many successes - we can continue to work well with our partners, but also learn from those lessons and grow stronger in our collaboration and in the activities we jointly undertake.”

Establishing a continental lead for public health in Africa

Dr Radjabu Bigirimana from the African Volunteers Health Corps (AVoHC) spoke of the importance of establishing a continental lead for public health, citing the success of AvoHC on the African continent as “an essential resource, providing an African solution to African problems”. He also highlighted how the organisation will achieve its future vision of building a roster of over 2500 Rapid Responders with the capacity to support response efforts for at least 10 public health emergencies/events across different African countries at any given time.

The learning review attendees felt this approach could be expanded and promoted if the UK-PHRST actively engaged local capacity by utilising centres of excellence/expertise in Africa (as well as other countries and regions of collaboration) to deliver capacity strengthening and support activities.

As such, the UK-PHRST committed to embedding local ownership into the heart of future capacity strengthening proposals, continuing to develop strong personal relationships with external partners to leverage local expertise and continuing to work with regional, national and subnational organisations moving forward.

Closing the Global North-South technological gap

Dr Issiaka Soulama from the Institut de Recherche en Science de la Santé (IRSS) in Burkina Faso highlighted the current Global North-South divide with regards to scientific training and technology availability. He argued that this stifles the ability for countries to support health services in making evidence-based decisions.

To solve this, he stated: “North-South collaboration is a definite opportunity and an important springboard for reducing the technological gap and facilitating access to the most advanced diagnostic technologies in the South”.

There are several ways this could be achieved:

• By promoting face-to-face training with Southern partners

• Focusing on group training to enable multiple individuals from different countries to gain expertise which they can transfer back to local specialists in their home countries

• Delivering sustainable training that empowers the recipients to continue to benefit in the long-term

• Supporting Southern partners to access funding sources and financial assistance for research

• Advocating for stakeholder investment in scientific research and in-country scientific capacity strengthening and mentoring

In light of these and further recommendations by the attendees, the UK-PHRST committed to continuing to work hand-in-hand with partners to ensure that the needs of partners are centre stage when designing capacity strengthening activities, prioritising sustainability and encouraging co-development of training and other proposals at every opportunity.

Introducing more effective deployments

To determine the effectiveness of deployments in strengthening in-country national outbreak response activities, Farhana Haque from the UK-PHRST gathered views and experiences from the workshop attendees.

She found that although there are already mechanisms in place to gather feedback from deployees via surveys and de-briefs, the lack of clear terms of reference and necessary information pre-deployment hampered the effectiveness of in-country deployments. Similarly, partners pointed to a lack of systematic mechanisms to collect data and poor continuity of engagement with the countries of deployment at the end of deployments as barriers to effective deployments. For instance, the deploying agency often did not communicate with the recipient nations post deployment, and so did not take forward their voices when preparing future deployments.

Dr Nafiisah Chotun, Programme Lead at Africa CDC summed up the discussion: “A key message that came out was the need for communication, […] to find out what the local capacity is before we look externally. So, looking internally before we move externally.”

The UK-PHRST committed to standardising pre-deployment discussions to include clear terms of reference pre-deployment and focus on supporting capacity strengthening and local training opportunities to shift the deployee role to “less of a doing role for “Global North”. In addition, to listen to the needs of partner countries, the team committed to regularly evaluating the impact of deployments through the UK-PHRST’s monitoring and evaluation team and supporting and investing in regional/south-south conferences after deployments.

As part of this work, the UK-PHRST is currently undertaking a joint partnership research study with Africa CDC to examine the impact of international public health deployments on national outbreak preparedness and response in partner countries. This will help the researchers understand the nature of the impacts of rapid deployments on a country’s disease outbreak preparedness, readiness and response capacities – ultimately helping to build more sustainable and effective future deployments.

Gender equality in public health

Elaborating on the Transforming Employability for Social Change (TESCEA) model they had developed with colleagues in four partner universities in East Africa and other Kenyan and UK-based organisations, Flora Fabian and Albert Luswata from Tanzania and Uganda respectively, provided a roadmap for how the UK-PHRST could achieve gender equality in its work.

They recommended that the UK-PHRST apply gender responsive pedagogy when developing its training courses as well as implementing deliberate actions to correct the gender imbalances and promote parity. They argued this should be done by challenging the underlying structural conditions that perpetuate gender inequality through policy change, practices, recruitment, resource allocation, appraisals, and promotion.

Reflecting ongender equality , Dr Kapona Olridah, Head of Zambia National Public Health Institutenoted: “ […] highlights for me have been issues around gender equality and responsiveness, but also how do we better build sustainable partnerships in the work that we do?” There are a lot of lessons that I will carry back home and see what we can incorporate in our response as we better serve our populations.”

In response, the UK-PHRST committed to exploring ways to ensure the centrality of women in leadership in all aspects of outbreaks and across the professional spectrum. Similarly, the team will develop standard questions on social equity to apply across all aspects of the UK-PHRST’s work, as well as focusing on co-developing social equity research studies as standalone pieces of work.

Equitable research partnerships

The gaps in research evidence in low- and middle-income countries and the current Global North-South divide in research partnership working were highlighted by Dr Adbul Karim Sesay, Professor Gwenda Hughes, Professor Miles Carroll and Dr Chinwe Lucia Ochu. Collectively, the group called for the building of South-South relationships and collaborations to share skills and knowledge as well as for a shift towards equitable North-South research partnerships based on “mutual trust, respect and reciprocity”.

Based on these experiences, the attendees recommended that the UK-PHRST propose research projects that slot into existing expertise networks and organisational systems while also facilitating further expansion of these resources by encouraging funding and secondments of MSc, PhD and post-doc researchers. With regards to improving partnership equity, the attendees recommended that the UK-PHRST co-develop and publish equitable partnership principles and guidance and ensure equitable co-authorship as part of their research projects.

The UK-PHRST acknowledged that it is already trying to address these issues and is committed to publishing its equitability guidelines and further deepen its focus on embedding into existing local research systems and promoting gender equity at publication level. As such, the team is now examining how it can strengthen community engagement through a joint study with the University of Brasília. The researchers aim to develop a novel early warning system involving local community leaders for early detection of events indicative of outbreaks in Cape Verde & Brazil. The work is built upon harnessing the existing expertise in outbreak response research at the University of Brasília and directly involves other global South partners in Cape Verde.

The importance of mental health in outbreak response

Finally, the UK-PHRST committed to continuing to explore the best ways to promote context specific mental health actions and to continue developing mental health training alongside Africa CDC colleagues, including it in future Field Deployment Training sessions.

This followed Dr Radjabu Bigirimana from the Africa CDC and Mr Nkwan Jacob Gobte, an IPC Nurse at Cameroon Baptist Convention Health Services, sharing their views on the importance of embedding mental health training and personal support for deployees when responding to public health emergencies. They argued that every health situation has a mental health component, a fact that has been largely ignored globally when responding to public health crises. Adding further support to their argument, the workshop attendees recommended that the UK-PHRST promote country-level measures to address mental health and wellbeing pre, during, and post deployment and provide training for leadership and management to enable them to actively embed and address mental health as part of pandemic responses.

“Unless you try to do something beyond what you have already mastered, you will never grow.” - Ronald E. Osborn, 1945

Not only was the Learning Review an opportunity for the UK-PHRST and its partners to reflect on their previous work and achievements, but it also provided a vital space for mutual and multi-directional learning and capacity strengthening outside of an emergency infectious disease outbreak situation.

Dr Maryirene Ibeto and Dr Femi Nzegwu from the UK-PHRST emphasised that: “The review highlights how by having these continuous conversations, low- and middle- income countries and support agencies like the UK-PHRST can share best practice and learn from each other constantly. This will mean that they can more effectively deal with a crisis when it hits – ultimately creating a safer and more secure global health situation for everyone.”

Read the full UK-PHRST and Partners Learning Review Post Review Reflections & Actions Report

The UK Public Health Rapid Support Team is funded by UK Aid from the Department of Health and Social Care and is jointly run by UK Health Security Agency and the London School of Hygiene & Tropical Medicine. The views expressed in this publication are those of the author(s) and not necessarily those of the Department of Health and Social Care.