Contribution to international development report: 2018-2019

Chapter Nine: Global Citizenship In NHS Scotland

9.1 Introduction

To support the Scottish Government’s international vision, under the auspice of the Chief Medical Officer for Scotland (CMO), the Scottish Global Health Collaborative commissioned the Royal College of Surgeons and Physicians of Glasgow (RCPSG) to consider matters related to how NHS Scotland staff provide support around the work, and the impact of such work. The RCPSG launched their Report “Global Citizenship in the Scottish Health Service” in May 2017.

This Report contained eight recommendations, describing how NHS Scotland engagement in global health could be enhanced in a way that maximises the reciprocal benefits of global health work and recognises the realities of “home” service pressures. The Report included evidence that this valuable work not only helps to reduce common challenges such as disease epidemics but also provides mutual learning opportunities which bring proven benefits for our NHS Scotland staff and healthcare system through a refreshed and reinvigorated workforce.

Scottish Government Ministers for International Development and for Mental Health jointly welcomed the RCPSG Report and its findings, and committed to work closely with partners across NHS Scotland to implement the Recommendations including establishing a Scottish Global Health Co-ordination Unit.

9.2 NHS Scotland Global Citizenship Programme

3 Good Health and Well-Being

4 Quality Education

5 Gender Equality

10 Reduced Inequalities

17 Partnerships for the Goals

9.2.1. Background

In NHS Scotland, staff from across all work groups already make a significant personal and professional contribution to global health work in low and middle income countries. Global health work, traditionally has been considered through the lens of overseas volunteering. However, staff from across the NHS contribute to global health in multiple (and often innovative) ways including:

• mentoring healthcare staff from low and middle income countries who come to work in NHS Scotland to develop new skills and learning;
• providing remote support including, virtual learning, clinical networks, coaching and mentoring using a wide range of technology from Scotland to staff in low and middle income countries;
• providing additional cover and support when a team member is volunteering overseas;
• fundraising to support local and global health initiatives;
• voluntary work within Scotland to support refugees/asylum seekers; and
• supporting healthcare system development in a low and middle income country with skills, experience and tools in areas such as project management, financial management and quality improvement.

9.2.2. The Programme

The NHS Scotland Global Citizenship Programme’s key aims are:

• to reflect and support the Scottish Government’s existing international development commitments to our partner countries, as set out, and in alignment with, our International Development Strategy, in particular our commitment to support capacity strengthening in those countries in the area of health; and
• make it easier for all NHS Scotland staff to participate in global citizenship both here in Scotland and abroad by ensuring better guidance, co-ordination and support. The approach builds on best practice in global health work by drawing examples from existing relationships including from NHS Borders 20 years twinning arrangement with St Francis Hospital, Zambia.

This Scottish Government led global health work – and in particular the development of the NHS Scotland Global Citizenship Programme – is a key example of the Beyond Aid agenda to which the Scottish Government committed in its 2016 International Development Strategy – where we continue to work across Ministerial portfolios such as Health to support international aims and identify other policies which can contribute positively to development outcomes.

Chris Faldon, Nurse from NHS Borders, Logie Legacy, with the ‘Zambikes’ for TB treatment volunteers and the repair workshop they ran.

9.2.3. Contribution to Development

The Scottish Global Health Co-ordination Unit, launched as part of the NHS Scotland Global Citizenship Programme, has a facilitating role in the co-ordination of health partnership work in NHS Scotland, including helping to identify opportunities, volunteers and sharing and gathering best practice, intelligence and information (www.scottishglobalhealth.org).

Each of the 22 NHS Boards in Scotland now has a Lead Global Citizenship Champion who supports local engagement and networking and also an active Global Citizenship Champions Network linking across Scotland. In addition, there are a growing number of NHS Scotland staff with a range of health experience, skills and expertise who are part of a skills bank (People Register). Building a community of champions and staff interested in getting involved in global citizenship has been an important key step in beginning to understand the contribution of NHS Scotland staff and Boards in order to better support and strengthen the capability and capacity of the NHS in Scotland to participate in global citizenship at home and overseas.

In November 2018, the Minister for Europe, Migration and International Development opened the first NHS Scotland Global Citizenship Conference which brought the NHS Scotland Global Citizenship community together to share in best practice and education and training. Planning for the second annual Conference in November 2019 is underway.

Another key achievement has been the development of a health partnership mapping tool, aligned with the SDGs which is now available online at www.scottishglobalhealth.org. NHS Scotland staff, partners and stakeholders can now search and find health partnership work by specialty, hospital and country. This mapping is now being extended to other sectors including academia that impact on health in order to support further joining up, networking and learning.

NHS Scotland Global Citizenship HR Guidance, developed in partnership with NHS Boards and staffside representatives has now been issued to all NHS Boards. This Guidance provides a structured and co-ordinated approach that NHS employees can use to access current HR policies to support their global citizenship participation with local monitoring being put in place to measure the uptake.

Scottish Ambulance Service Emergency Medical Scoping Study: as a direct result of the co-ordination and capacity building by the Scottish Global Health Co-ordination Unit, the Scottish Government International Development Team has been able to respond to a direct ask from the Minister for Health in the Zambian Government for support in developing their emergency medical service through partnership working with the Scottish Ambulance Service. This work is at an early stage but it shows what can be achieved through the sharing of NHS knowledge and expertise in partnership with our colleagues in country and their identified need. Furthermore, as a result of improved co-ordination, the Scottish Government funded Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP RU) at the University of Stirling have linked in with this work and are currently planning research into longer term work needed to address wider road traffic collisions. We will report on the next stages of this work in future reports.

IDF Case Study 15: Support for Detailed Needs Assessment: SAS By Nalukui Siame, Project Manager, First Aid Africa Limited

“Over the last few years, a sharp rise in road traffic collisions and related road traffic deaths in the central and Lusaka regions of Zambia was identified. Following a request from the Zambian Ministry of Health (made via the Scottish Government), the Scottish Ambulance Service scoped out initial interventions to assist the Zambian Government with the development of their Emergency Care System.

Following a detailed needs assessment, the Scottish Government and the Scottish Ambulance Service sent a small contingent to Zambia, to establish the foundations of a new pre-hospital care response model. This model was designed to include the current resources available in-country, and new resource developments that are planned for the future.

This pre-hospital care response model was developed in close partnership with local agencies:, e.g. Road Traffic Safety Agency, the Zambian Police force, and Ministry of Health.

The first phase of the project included developing a bespoke and territorially relevant advanced first aid and incident management course.

This course was then delivered for a sample group of police officers, with the intention to roll it out to all road traffic police operatives, via the three main Zambian police academies

In addition, a ‘train-the-trainer’ system was created by the Scottish Ambulance Service and the Scottish Government, in partnership with First Aid Africa. This system is designed to train people to become community first responder instructors. These instructors will then deliver courses in the local villages most affected by severe Road Traffic Collisions.

Over the course of the next two years, FAA will seek to monitor and evaluate these community courses to ensure the right content is being delivered. We also plan to facilitate the introduction of the advanced first-aid and incident management course in to the national police training curriculum.

As part of our 2nd and 3rd interventions, we would like to send experts to develop and deliver bespoke training courses within local hospitals, and to medical professionals and military personal who might find themselves involved in treating casualties in a pre-hospital setting.”

Scottish Ambulance Service: Dan Costigliola, Paramedic:

“International engagement visits enable peer-to-peer interaction as a means of promoting participatory knowledge and skills exchange that empower participants to improve their trainer capacity. It has created a path to help forge and strengthen networks linking people with shared concerns and ideas.

Such visits have proven to be mutually beneficial because unlike meetings organised by pressurised agendas born of organisational hierarchies and politics, these engagements have created a platform where new ideas and actionable resolutions for collaborations in research and training were explored with diverse groups.”

Other NHS Scotland Global Health Work

In the first year of the NHS Scotland Global Citizenship Programme, significant progress has been made at institutional level by NHS Scotland Boards to support our international development partner countries.

NHS Education for Scotland (NES) have made their wide range of education and training resources in Quality Improvement available supported by coaching and mentoring, The State Hospital are supporting health partnership work with partners in Pakistan to deliver forensic psychiatry education and training and NHS Grampian is developing an international health office to provide co-ordination and guidance in the North of Scotland. All of these developments will play a critical role in contributing to increasing the capacity and capability of global citizenship participation from NHS Scotland.

Global Health Case Study: NHS Scotland Collaboration to provide services to understand, promote & implement the Mental Health Act of Sindh, Pakistan

The State Hospital in Scotland and the Pakistan Psychiatric Society are collaborating to provide services to understand, promote and implement the Mental Health Act of Sindh to reduce the gap between law and mental health in Pakistan, and to develop and provide forensic psychiatric services which is one of the emerging sub specialty in Psychiatry in Pakistan.

According to current provisional law “The Sindh Mental Health Act 2013”, the Sindh Mental Health authority (Government of Sindh) has to approve psychiatrists in order to fulfil and implement the law throughout province, to ensure proper care and services which will help in safeguarding the rights of Psychiatric patients and Psychiatrists. The two day training course being developed, aims to make the understanding of the Mental Health Act easier not only for psychiatrists but also to other relevant authorities such as the police department and judicial system etc. and lay down a path to smoothen the provided services.

Professor Dr Muhammad Iqbal Afridi on the impact of collaborative partnership working:

“Our partnership working gives us a chance to understand the current effective systems of forensic psychiatry in Scotland and United Kingdom, which will in turn be an enormous help in future for developing forensic psychiatric services in Pakistan.”

From left to right: Dr. Muzamil Hyder, Prof. M. Iqbal Afridi and Dr. fariha Iqbal