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GHF 2014 – LS01 – Integrated Solutions or What Does Health System Strenghtening Mean in Fragile Settings?

12:15
13:45
LS01 TUESDAY, 15 APRIL 2014 ROOM: 2
LUNCH
SESSION
Integrated Solutions or What Does Health System Strenghtening Mean in Fragile Settings?
MODERATOR:
Dr. Anne-Claude Cavin
Conflict Prevention Advisor, Swiss Agency for Development and Cooperation, Switzerland
SPEAKERS:
Dr. Marina Madeo
Senior Advisor for SDC Regional Office Horn of Africa
Ms. Bernadette Peterhans
Deputy Head of the Teaching & Training unit, Swiss Tropical and Public Health Institute, Basel, Switzerland
Dr. Mark van Ommeren
Scientist, Department of Mental Health and Substance Adbuse, World Health Organization, Switzerland
OUTLINE:

In this session we will discuss challenges and promising approaches to rehabilitating / strengthening of health systems in fragile contexts where humanitarian aid is not yet, or no longer an appropriate tool.
In such contexts the health system strengthening approach reaches often its limits, as the political will or capacity of the State is lacking for providing essential services to the population. Where to start and how to work when all the building blocks of the health system are in disarray? How to respond efficiently to the acute lack of qualified staff, medicine, equipment and funding; weak leadership and governance; absence of information and management systems?

SDC would like to use the fishbowl format of launching a transparent discussion and experience exchange on particular challenges, successful approaches and empirical evidence on effective interventions in fragile settings.

PROFILES:

Dr. Anne-Claude Cavin

Anne-Claude Cavin has a PHD in law and is mediator, with a specialization on international mediation.

She works for SDC as specialist in governance, mediation and conflict prevention and coaches SDC employees in conflict management, mediation and CSPM (conflict sensitive programme management) in Africa, Central Asia and the Balkans.

She has further a long experience in facilitation national and international conferences and events.

In parallel to SDC, she is co-founder of “Intermédiations” and has mandates for juvenile courts.

 

LS01_Marina_MadeoDr. Marina Madeo

Dr. Marina Madeo is Senior Health Advisor for SDC Regional Office Horn of Africa and has a long standing working experience in the Somali contexts.

Before joining SDC she worked for other multi- and bilateral health programmes. She has a deep understanding of the New Deal in practical terms and a strong personal interest on fragile states.

 

LS01_Bernadetter Peterhans_squareMs. Bernadette Peterhans

Bernadette Peterhans, RN, MPH is Deputy Head of the Teaching & Training unit at the Swiss Tropical and Public Health Institute in Basel.

Bernadette taught already on PHC in fragile contexts at different universities (Geneva, Copenhagen, Edingburgh) as well as at the ICRC. She works further as specialist consultant for PHC in different fragile contexts, as for instance South Sudan (since 94), Horn of Africa or Afghanistan.

 

LS01_MarkVan_OmmerenDr. Mark van Ommeren

Dr. Mark van Ommeren is Scientist at the World Health Organization (WHO) in the Department of Mental Health and Substance Abuse in Geneva.

He is focal point with WHO for mental health during and after emergencies.

He has a particular interest in building back better, that is to convert short-term emergency-related interest in mental health into momentum for long-term improvement, as described in Building Back Better: Sustainable Mental Health Care after Emergencies (WHO, 2013).

 

 

 

Dr. Anne Golaz

Golaz-AnneDr. Anne Golaz

Lecturer and Researcher at CERAH, Switzerland

She obtained her Medical Doctor degree and Doctorate in Medicine at the University of Geneva, and a MPH at the University of Washington. She’s Board Certified in Public Health and General Preventive Medicine. She has over 20 years of field experience in humanitarian work and graduate and post-graduate education in public health. She’s worked as a medical epidemiologist for the US Centers for Disease Control and Prevention; as a senior advisor for UNICEF Regional Office for South Asia in Kathmandu and Geneva Office, and for WHO HQ and Regional Offices in Cairo and New Dehli.

Role at the CERAH:

  • Member of the Scientific Committees of the CAS Health in Humanitarian Emergencies and CAS Disaster Management
  • Coordinator CAS Health in Humanitarian Emergencies
  • Coordinator of the Research Methodology course (MAS-DAS)
  • Co-leader of the course Health Interventions in Humanitarian Crises (MAS-DAS week)
  • Co-leader TS Advocacy for Humanitarian Projects in Health

Fields of interest:

  • Public health and epidemiology
  • Reproductive health in humanitarian emergencies
  • Mental health in humanitarian emergencies
  • Genocide prevention
  • Community capacity building
  • Research and evidence generation in humanitarian contexts

Dr. Nicholas Banatvala

Nick Banatvala_squareDr. Nick Banatvala

Senior Adviser to the Assistant Director General, Noncommunicable Diseases and Mental Health, World Health Organization, Switzerland.

Dr. Nick Banatvala is currently Senior Adviser to the Assistant Director General (Noncommunicable Diseases and Mental Health) at WHO in Geneva. Current responsibilities include leading development of a global coordination mechanism for the prevention and control of  NCDs, spearheading a newly set up UN NCD Taskforce and leading WHO’s global training programme to build capacity on NCDs for senior policy makers in middle and low-income countries.

Prior to this, Nick was Head of Global Affairs at the Department of Health in England where he led the development and implementation of the UK Government's first-ever global health strategy, its strategy for working with WHO and DH’s bilateral engagement with emerging economies. Before that, he headed up DFID’s work on global health initiatives and scaling up health services. This included leading on the health inputs for the 2005 G8 Gleneagles communiqué. He has represented the UK on a number of international initiatives, including the Global Fund to Fight AIDS, TB and Malaria and GAVI. Prior to this, Nick worked for DFID on health programmes in Pakistan, Afghanistan and the Middle East. Nick has experience of the NGO sector, having worked with the UK aid agency Merlin on development and humanitarian programmes.

Nick trained in paediatrics and infectious diseases and then did public health and epidemiologic research in the UK and at CDC, Atlanta. Nick has also held senior posts in UK public health. Nick has sat on government, non-government and academic boards, as well as national and international committees. He has undertaken consultancies for a number of agencies including the World Bank.

GHF2014 – PS21 – Political Analysis of Global Health Policy Making: A Recipe

16:00
17:30
PS21 WEDNESDAY, 16 APRIL 2014 ROOM: 2
WORKSHOP
Political Analysis of Global Health Policy Making: A Recipe
MODERATOR:
Prof. Ronald Labonté
Professor and Canada Research Chair, Institute of Population Health, University of Ottawa, Canada
SPEAKERS:
An Exploration of How Health is Positioned in Canadian Foreign Policy
Prof. Ronald Labonté
Professor and Canada Research Chair, Institute of Population Health, University of Ottawa, Canada
The Integration of Health into Foreign Policy: Health is Global
Dr. Michelle Gagnon
Vice President, Adjunct Professor, Norlien Foundation and University of Calgary, Canada
Ms. Miriam Faid
Visiting Professor, CAPES-Fiocruz/CDTS, Centre for Technological Development in Health (CDTS), Oswaldo Cruz Foundation (Fiocruz), Brazil
Mr. Mohsin Ali
United Kingdom
Ms. Sarah Rostom
McMaster University, Hamliton, Ontario, Canada
OUTLINE:
PROFILES:

Ronald_LabontéProf. Ronald Labonté

Prof. Labonté is Canada Research Chair in Globalization and Health Equity at the Institute of Population Health, and Professor in the Faculty of Medicine, University of Ottawa. His current research interests include globalization as a ‘determinant of determinants’ (he chaired the Globalization Knowledge Network for the WHO Commission on Social Determinants of Health); ethics, human rights and global health development; global migration of health workers; revitalization of comprehensive primary health care; global health diplomacy.

He recently reviewed the various policy frames (security, development, global public goods, trade, human rights and ethical/moral reasoning) for health in foreign policy that inform global health diplomacy.

Gagnon PhotoDr. Michelle Gagnon

I began my career as a health professional and after working in a variety of health care settings pursued management studies and spent about a decade working for the Canadian Institutes of Health Research (CIHR). My work focused on health services and policy research and population and public health and in particular on how to support and promote the application of knowledge in policy and practice. Given I was working in a health research organization and was very interested in interdisciplinary knowledge and approaches to finding solutions to major health issues through research, I decided to pursue a doctorate in population health from the University of Ottawa. I focused on global health diplomacy and the integration of health into foreign policy under Professor Ronald Labonté. I am interested in policy relevant research and global health issues at the macro level such as governance and the role that actors from public, private and civil sectors play in the global health policy making process.

In addition to my academic and research interest, I continue to pursue an eclectic professional career aligned with my interests and experience in population health and knowledge translation. I am currently Vice President of a private foundation located in Alberta, Canada that Mobilizes knowledge about early childhood development and its link to lifelong health (lifecourse model), in particular addiction and mental health, by engaging with and brokering relationships across science, policy and practice.

Miriam.Faid_pictureMs. Miriam Faid

With parents coming from two countries that could probably not be any more different in terms of their socio-economic and political liberties and development stages – Norway and Eritrea - Miriam’s personal and professional perspective has always been shaped and guided by this particular background. Having grown up in Germany where she pursued her graduate studies in Political Sciences and with stints in Portugal, Brazil, Belgium and Norway, her more recent professional journey was significantly shaped by a 6-year long stay in Geneva, where she completed a master’s and PhD degree in International Studies. With Geneva being the world’s global health hub, there was no other way but to get involved academically and professionally in this complex but fascinating governance realm. With emerging countries taking up new identities, roles and responsibilities in global health, she is particularly interested in the Global South, most specifically on South-South health cooperation initiatives. Most recently she started a Visiting Professorship at the Centre for Technological Development in Health (CDTS), Oswaldo Cruz Foundation (Fiocruz) in Rio de Janeiro, Brazil. In this function, she identifies and initiates opportunities for cooperation between Fiocruz/CDTS and public, private and philanthropic institutions worldwide, aiming to promote scientific and technological development and innovation with a focus on neglected diseases.

PS21_Sarah_Roston_squareMs. Sarah Rostom

Sarah Rostom is currently interning at the World Health Organization in the Department of Service Delivery and Safety, focusing on the Safe Childbirth Checklist Collaboration initiative. She is also working part-time as a research associate for a project commissioned by the Canadian government on essential medicines procurement. Her research experiences and interests lie at the nexus of global health, law, and policy—which she hopes to continue as a lawyer, researcher and advocate in the future. Sarah holds a Bachelors of Arts & Science (Hons) from McMaster University in Hamilton, Ontario, Canada.

GHF2014 – PS06 – Integrated Management of NCDs at the Primary Health Care Level : a World View

14:00
15:30
PS06 TUESDAY, 15 APRIL 2014 ROOM: MOTTA
ICON_Fishbowl
Integrated Management of NCDs at the Primary Health Care Level:
a World View

MODERATOR:
Dr. Nicholas Banatvala
Senior Adviser to the Assistant Director General, Noncommunicable Diseases and Mental Health, World Health Organization, Switzerland
SPEAKERS:
An Integrated Approach to Management of Diabetes and Hypertension in Western Kenya
Dr. Simon Manyara, Pharmacist, Academic Model Providing Access To Healthcare (AMPATH), Kenya
Introducing a Model of Cardiovascular Prevention in Slums of Nairobi
Dr. Steven van de Vijver, Senior Research Officer, African Population and Health Research Center, Kenya
Clinical Audit on Diabetes Care in UNRWA Health Centres
Dr. Yousef Shahin, Chief Disease Prevention and Control, Health Department, United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), Jordan
Identifying the Barriers to Care and Medicines for Diabetes and Hypertension: A pilot study in Lima-Peru
Mrs. Maria Kathia Cardenas, Investigator, CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Peru
OUTLINE:
PROFILES:

Nick Banatvala_squareDr. Nick Banatvala

Dr. Nick Banatvala is currently Senior Adviser to the Assistant Director General (Noncommunicable Diseases and Mental Health) at WHO in Geneva. Current responsibilities include leading development of a global coordination mechanism for the prevention and control of NCDs, spearheading a newly set up UN NCD Taskforce and leading WHO’s global training programme to build capacity on NCDs for senior policy makers in middle and low-income countries.

Prior to this, Nick was Head of Global Affairs at the Department of Health in England where he led the development and implementation of the UK Government's first-ever global health strategy, its strategy for working with WHO and DH’s bilateral engagement with emerging economies. (Read more)

PS06_ManyaraDr. Simon Manyara

Dr. Simon Manyara is a pharmacist working in Eldoret, western Kenya. He also studies Global Health (masters) at the University of Edinburgh, Scotland. His two key areas of interest are non communicable diseases and access to medicines. He works in rural western Kenya to provide care for patients with diabetes and hypertension using a model that combines both peer groups and microfinance. Additionally, he implements community revolving fund pharmacies which ensure accessible and affordable supplies of essential commodities in government facilities within the same catchment area.

PS06_VijverDr. Steven van de Vijver

During his studies he worked in Ethiopia, India, Australia and the United States and published articles on this in various magazines. After specializing as a tropical doctor he worked for Doctors without Borders in the Democratic Republic of Congo. There he discovered the need for care of chronic diseases, and specifically cardiovascular diseases, in low resource countries. In order to obtain this expertise he went back to The Netherlands to finish his specialization in Family Medicine and Masters in International Health in order to focus on primary health care in slums. He obtained the position of Director of Urban Health, at the Amsterdam Institute of Global Health and Development (AIGHD) and moved with his family to Kenya to work on prevention of cardiovascular diseases in slums. Currently he works as a Senior Research Officer at the African Population Health Research Center (APHRC) on the SCALE UP project. The aim of the SCALE UP study is to design an effective and efficient intervention to prevent cardiovascular diseases in the slums of Nairobi that is sustainable and scalable to other settings in Sub Saharan Africa.

PS06_Yousef_Shahin_squareDr. Yousef Shahin

After graduating in Medicine and General Surgery at Zaprozyha Medical University in the Former USSR in 1985, he joined Jordan University of Science and Technology where he completed Master degree in Public Health in 1995.

Joined UNRWA in 1992 as Medical Officer in charge of health centers till 2005, when he was promoted to a senior position at UNRWA headquarters. He has more than 8 years’ experience in disease prevention and control programme, and responsible for the development, monitoring and evaluation of the UNRWA’s progrmme for disease prevention and control by preparing technical instructions, clinical guidelines, periodic assessment and supervision of related activities.

Dr. Shahin was designated to World Health Organization/ Eastern Mediterranean Region from July-December 2011 as Technical Officer on non- communicable diseases.

He has publications in medical journals including the Lancet on different health topics mainly diabetes care among Palestine Refugees. Participated in many international conferences and workshops addressing public health related topics.

PS06_Maria Kathia CardenasMrs. Maria Kathia Cardenas

Mrs. Cardenas is a Peruvian investigator at CRONICAS Center of Excellence in Chronic Diseases at Universidad Peruana Cayetano Heredia (UPCH) based in Lima. She graduated from Economics and studied a Master in Epidemiological Research at UPCH through a Fellowship supported by The National Heart, Lung and Blood Institute.

Prior to her move to CRONICAS, she worked in areas devoted to Economic Evaluation of Projects and Public Policy in Social Development at two larger economic and development Think Tanks in Peru: Centro de Investigación de la Universidad del Pacífico and Instituto de Estudios Peruanos. Her area of main interest is Health economics applied to chronic diseases. Her desire and main motivation is to help improving the quality of people's lives of Peruvian population through better health status, especially of the most deprived.

Case Management in Mental Health Settings in Bosnia and Herzegovina.

Author(s) Darko Paranos1, Biljana Lakić2, Tatjana Popović3, Dženita Hrelja Hasečić 4.
Affiliation(s) 1Mental Health Project in Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina, 2Mental Health Project in Bosnia and Herzegovina, Mental Health Project in Bosnia and Herzegovina, Banja Luka, Bosnia and Herzegovina, 3Mental Health Project in Bosnia and Herzegovina, Mental Health Project in Bosnia and Herzegovina, Banja Luka, Bosnia and Herzegovina, 4Mental Health Project in Bosnia and Herzegovina, Mental Health Project in Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina.
Country - ies of focus Bosnia and Herzegovina
Relevant to the conference tracks Chronic Diseases
Summary Within scope of the Mental Health Project in Bosnia and Herzegovina (BIH) the Case Management in Mental Health was introduced across the country with the aim of improving the quality of provided care focusing on increasing access to a range of complementary health, social, educational and other public services for service users with severe mental health disorders and multiple needs. In order to achieve planned objectives an integrated set of activities was conducted compromising of teaching materials development, continuous education activities targeting Community Mental Health Centres multidisciplinary teams and psychiatric hospitals/clinics/departments representatives and (Peer) Support to Mental Health institutions in applying Case Management. Initial findings indicate the significant increase in the number of CMHCs which successfully started with the application of the Case Management in their institutions.
Background Activities were conducted within the scope of the Mental Health Project (MHP) in Bosnia and Herzegovina (BIH). The Mental Health Project in BIH is a result of continuous commitment of the health ministries to continue the mental health reform in BIH. The mental health reform was launched in 1996 focusing on community-based care as a contrast to the traditional model that was mainly oriented towards hospital treatment of persons with mental disorders. The overall goal of the Mental Health Project in BIH, in the period June 2010 - December 2013, was to improve the general mental health of the population and enhance the capacities of policy makers and competent institutions for complying with European standards in mental health care in BIH. Since 2011 the Mental Health Project in Bosnia and Herzegovina was involved in trainings of Community Mental Health Centres staff in the field of Case Management with the aim to improve the quality of provided care focusing on increasing access to a range of complementary health, social, educational and other public services for service users with severe mental health disorders and multiple needs.
Objectives The objectives of the Mental Health in BiH Project in the period June 2010 to December 2013 were as follows: 1. Improved administrative and legislative frameworks to enable efficient operations and processes in mental health care in both BiH entities, Federation of Bosnia and Herzegovina and Republika Srpska.
2. Persons with mental problems to have access to improved and better quality services of mental health care at the community level.
3. Provision of high-quality mental health services at the community level is supported as a priority of the reform process by the management structures in Community Health Centres.
4. Capacities to fight against stigmatisation and discrimination related to mental disorders are strengthened. Within the objective 2, the specific objectives include: a) Competencies and skills of the multidisciplinary teams of the Community Centres for Mental Health to be enhanced, b) Independence and responsibility of the nurses in provision of the mental health services and direct work with clients to be enhanced.In order to achieve planned objectives the integrated set of activities were conducted:
• Teaching materials development -
o The Case Management continuing education Curriculum and Manual development
• The continuous education -
o A Training of Trainers (ToT) course in Case Management
o The health professionals continuous education of Community Mental Health Centres multidisciplinary teams and
psychiatric hospitals/clinics/departments representatives
• (Peer) Support to Mental Health institutions in applying Case Management -
o Mentoring and support to Community Mental Health Centres and psychiatric
hospitals/clinics/departments in applying Case Management.
Methodology The case management is a collaborative process which connects users with services and available resources aimed at ensuring provision of optimal care. The approach involves the service users with complex, multiple needs, which are at high risk and / or suffering from severe mental disorders, and often reluctant to come into contact with mental health services. It is activated by establishing contact with customers in the community, a comprehensive needs assessment, developing individual "tailored" packages of care and effective coordination of services and treatments in a variety of services which increases the user's potential for recovery. The process of introducing the Case Management principles across Mental Health Settings in Bosnia and Herzegovina is based on a set of integrated activities. The Development of Teaching materials sets the fundamentals for the continuous education of multidisciplinary teams employed by Community Mental Health Centres and psychiatric hospitals/clinics/departments representatives. The core materials are the Case Management in Mental Health Curriculum and Manual which are organised into seven modules: I - Introduction to Case Management - concepts, principles, practices and theories; II – User Involvement and needs assessment; III - Assessment and Risk Management; IV - Planning of care, implementation of treatment and use of resources in the community; V - The Case Management at the first psychotic episode, early intervention and prevention of relapse; VI - Team Approach to Mental Health; VII - Gender and Mental Health. The Mental Health Professional continuous education was organised in two phases. The first step was to identify, recruit and train group of mental health professionals as a part of Case Management Training of Trainers course. The next step was to deploy trainers in training of Community Mental Health Centres multidisciplinary teams and psychiatric hospitals/clinics/departments representatives.Applying the Care Coordination model across the country began after the completion of the trainings. The Peer support to Mental Health Institutions across the country is organised Systematic (peer) support to application principles in Mental Health Settings will be conducted in between September- December 2013 with aim of ensuring increased access to a range of complementary health, social, educational and other public services for service users with severe mental health disorders and multiple needs is secured.
Results The Mental Health Case Management Curriculum and Manual were developed setting the basis for continuous education of Mental Health Professionals in Bosnia and Herzegovina. Training for trainers was completed in 4 training cycles with total duration of 9 days. As an education result, 21 mental health professionals have been certificated and formally appointed as future trainers by entity MoHs. Training of CMHC multidisciplinary teams was organised involving 625 mental health professionals from 67 CMHCs and 15 psychiatric hospitals/clinics/departments. 565 professionals (or 90%) passed the final exam, and successfully completed the training. After completion of the trainings the application of Case Management across the Mental Health care institutions started. Initial findings indicate that the 54% CMHCs (37 out of 69) successfully started the application of the Case Management in their institutions. As such this data indicates the significant increase in number of institutions applying the Case Management compared with 4 CMHCs from the baseline conducted in 2008. (Peer) Support to Mental Health institutions will provide not only support to the institutions in applying Case Management in standardised manner, but will provide insight in terms of effectiveness in changing the practice of those institutions. The key indicators to measure success of the process (in the short term) are the percentage of CMHCs appointing the Case Managers, number of appointed Case managers per CMHC (segregated by profession, particular focus on nurses) and percentage of service users involved in care plan development. A particular focus will be on measuring the service users involved in Case Management satisfaction.
Conclusion CMHCs capacities to involve the service users with complex, multiple needs, which are at high risk and / or suffering from severe mental disorders are improved when compared to the initial survey. The significant increase in the number of CMHCs applying Case Management in their institutions is observed. The Case Management is recognised by the revised service nomenclature, an organised and officially recognised classification/ registry of the health services endorsed by entity/cantonal Health Insurance Funds. As only those services officially recognised in the nomenclature can be performed by health institutions and charged to HIFs, a long term sustainability of Case Management is supported. Initial findings emphasise the issues of a large number of patients covered by the coordinated care, lack of staff and other resources required for adequate Case Management application in their institutions. In addition, another obstacle in the implementation of the Case Management observed is weak cooperation among agencies and institutions involved in the Case Management process.

Strengthening the competencies and skills of nurses in mental health: Experiences from Bosnia and Herzegovina

Author(s) Selma Kukic1, Zvjezdana Stjepanovic2.
Affiliation(s) Mental health, Mental health Project in BH, Sarajevo, Bosnia and Herzegovina, Mental Health, Mental Health Project in BH, Banja Luka, Bosnia and Herzegovina.
Country - ies of focus Bosnia and Herzegovina
Relevant to the conference tracks Health Workforce
Summary The mental health reform in BiH was launched in 1996 focusing on community-based care and so far has made significant progress in the development of a large network of community mental health centers. In the centers multidisciplinary teams operate, however nurses are the largest and least skilled professional category of professionals and have the highest fluctuation rate within health system. The reform project in BiH (Mental Health Project in Bosnia and Herzegovina) is focused on the informal education of nursing staff with the objective of professional development, empowering and providing networking as a first steps toward a systematic re-profiling of nurses in mental health.
What challenges does your project address and why is it of importance? In 2008/09 the survey "Situation analysis and assessment of community-based mental health services in Bosnia-Herzegovina“ (Mental Health in SEE Project 2009) was undertaken. The findings of the 2008/09 survey were used as the baseline for the Mental Health Project in BiH to monitor changes and improvements made with the project's support. A self-assessment of the middle-level nursing staff in this survey revealed that the staff believed they were under-trained. 46% of nurses believed they had not received enough training to work in a mental health centre, and the MHC team members believed that the work of the nursing staff was not recognised by other health professionals and that there were prejudices caused by vaguely defined job descriptions for the nursing staff working in a MHC team. A new concept of nursing, as well as the empowerment of nurses within the system of community mental health, requires well trained nurses, whose knowledge is closely linked to psychological, sociological, philosophical, educational, medical and expert training. This would improve the ability of nurses to assume new tasks. This can be achieved through formal education, non-formal education, continuing professional education, as well as initiative and creativity in the field of nursing.
How have you addressed these challenges? Do you see a solution? The adequate re-profiling of nurses in mental health is optimally achieved through formal education. This project presented informal education as the first step to a systematic aproach. Education has garnered excellent results in terms of narrowing the gap of professional training, but the benefits of education are more reflected in the development of contacts, exchange of experiences and formal networking of these professional groups that did not previously exist in the form of professional associations. The results indicate that associated advocacy for the development of nursing legislation on education and employment in mental health is required.
How do you know whether you have made a difference? The results of the performance evaluation of the Conducted Educations suggested key improvements in the work of this professional group. 96 % of respondents felt that the education contributed to providing quality services to patients and their families through individual or team work. Particular emphasis was upon the acquisition and use of new knowledge, skills and techniques in work (88%), the rights and obligations of medical professionals and patients (66%) and combating the stigma of mentally ill patients in society (32%). 90 % of respondents observed changes in the area of respect for the professional attitudes of mental health nurses by other team members. Particular emphasis was on the experience exchanges among colleagues (65%), the level of self- confidence in the process of presenting opinions to their superiors (64%) and an additional level of competence to work within a multidisciplinary team (53%). With continous collaboration with mental health staff in MHCs there is greater viability for the initiatives taken by nurses to process their difficulties in work.
Have you or the project mobilized others and if so, who, why and how? The key project holders and implementers were the Ministries of Health, and their key responsibility was to make the entire process a success by ensuring the participation of nursing stuff and relevant experts and key stakeholders in the implementation of activities, as well as to provide further support to the continuing education of nursing staff.
When your donor funding runs out how will your idea continue to live? Sustainability is ensured through cooperation with other projects whose main goal is to work on legislation that would provide a legal framework for the employment of nurses in mental health, including formal education, by providing needed information and support.

Integrating neuro-psychiatric disorders at the level of primary health care centres: Guinea

Author(s) Abdoulaye SOW1, Oury SY2, Amatigui DIALLO3, Abdoulaye KOULIBALY4, Mouctar DIALLO5, Binta BAH6.
Affiliation(s) 1Mangment, Medical fraternity Guinea, Conakkry, Guinea, 2Physian, Medical fraternity Guinea, Conakry, Guinea, 3Physian, Medical fraternity Guinea, Conakry, Guinea, 4Physian, Medical fraternity Guinea, Conakry,Guinea, 5Physian, Medical fraternity Guinea, Conakry, Guinea, 6research, Medical fraternity Guinea, Conakry, Guinea.
Country - ies of focus Guinea
Relevant to the conference tracks Chronic Diseases
Summary Mental, neurological, and substance use disorders make a substantial contribution to the global burden of disease. According to the World Health Report 2000 neuropsychiatric disorders (a component of mental health) are the second cause of disability-adjusted life years (DALYs), behind the infectious and parasitic diseases. Under the theme “Stop exclusion, Dare to care”, the year 2001 was dedicated by the WHO as the "Year of mental health”. Since ancient times, epilepsy has remained a controversial subject for many world populations. This is because mental illness has been perceived as socio-anthropological for many societies.
What challenges does your project address and why is it of importance? Primary health care strategy aims to make accessible to as many people as possible healthcare according to people’s needs, at an affordable cost and taking into account a country's given resources. Equity and social justice are the basic principles of this strategy.
According to the World Health Report 2002, neuropsychiatric disorders account for 13 % of the global burden of disabilities adjusted life years (DALYs). In Guinea, while significant progress has been made in primary health care programmes, little improvement has been measured in the field of mental health. The psychiatrist ratio per capita is one of the lowest in the world. A similar gap in the number of neurologists prevails throughout the country.
In order to address this gap, the Guinea Medical Fraternity (a Guinean association of doctors) opted for the integration of neuropsychiatric consultation into the daily work of the general practioners working in its health centers.
At the opening of its health centers in the 90's, one missing element was the lack of data about the number of patients who sought consultation for mental health problems. At that time, no information was available due to the lack of qualified human resources and poor access to medicines. To tackle this challenge, Guinea Medical Fraternity initiated the project SaMoa, and used 'action research.'
How have you addressed these challenges? Do you see a solution? The model of care employed is based on the three-dimensional approach used in outpatient mental health management: medical, socio-psychological and the community. These three dimensions are combined for almost all patients in our centers, without following neither a chronological nor a hierarchical order.
For the two groups of diseases described in this abstract, epilepsy and mental health disorders, a care package is offered to the patient. This includes: identification of fixed and advanced strategy for the patient, medical treatment (with antipsychotics and/or anticonvulsants), follow-up and psychosocial support (individual interview, with family members, home visits), family and community reintegration through discussion groups and reintegration workshops (graphical expression, apprenticeships) and finally social support interventions (such as supporting the recovery of a lost job or supporting patients in rebuilding a couple in crisis).
In order to ensure continuity of care, a number of materials have been developed.
These include:
• Personal health record (first visit and follow up)
• Home visit notebook
• Reintegration notebook (describing the patient personal project)
• Group workshops notebook.
• Monthly collection sheet.
• Monthly report
Regular inter-professional encounters have been established in order to promote synergies and complementarity among caregivers and has been used to foster continuous staff training. This framework is supported by:
• A joint consultation between a generalist and a specialist (neuropsychiatrist ) at the beginning of the project
• A daily joint consultation between doctors and social workers
• A weekly team meeting between doctors, social workers and community volunteers, to discuss specific cases
• A monthly coordination meeting, which brings together the heads of unit of each health center and the officials of the NGO.
How do you know whether you have made a difference? From January 2000 to June 2013, 7079 mental health problems were diagnosed among which 47 % were psychoses, 33% were epilepsy cases and the remaining 20% represented by depression, dementia, neurosis, social problems and cerebral motor deficiencies.
Among patients put under treatment, two main molecules were used for psychosis (different forms of Haloperidol and Akineton as corrector) and for epilepsy, four essential generic drugs (carbamazepine, phenobarbital, phenytoin and sodium valproate). We found a positive impact for both patients and their families, health care providers as well as for health centres.
For the patient, the impact is assessed by how much healthcare management has improved by integrating the socio-cultural context of the patient and his/her family, how much the intervention has strengthened patient-provider relationship and contributed to better adherence and how much the intervention has facilitated patients social reintegration and has strengthened their economic capacity.
At the level of health centers and providers: the impact is felt at many levels
 Improved patient-provider relationship (beyond mentally ill patients).
Indeed, GP’s trained to adopt a more holistic bio-psycho-social approach with psychiatric patients and spontaneously applied a similar approach vis-à-vis other patients, spending more time, listening and discussing with them and paying more attention to their psychosomatic problems.
 Improved relationships between health centers and the communities they serve.
Communities started to see healthcare providers and the health centres as partners and contributed to the development of the relationship.
 Improved relationships between primary health centers and referral hospitals.
Given the fact that the care package provided by the programme is not available in district hospitals, the project has reversed the usual pattern of the health pyramid that usually sees PHC centers referring their patients to a hospital. In this case, the opposite took place, hospitals sending their patients to the lower level of care.
 Implementation of several community initiatives around the health centres.
The momentum created by the project has allowed the emergence of community-led initiatives such as economic interest groups among intervention communities, involvement of young people in the village around health promotion activities and the establishment of patient support groups.
 Health centre as a training and internships for medical students in public health and community health workers. Successful health centres are coveted by academics whose students are engaged in the internships and the development of dissertations.
Have you or the project mobilized others and if so, who, why and how? The project involved several actors in different and various socio-medical fields.
In Guinea, networking is not integrated into the system. Each association operates in isolation and tries to protect its field of competencies as a private territory. Initiatives are confined to a limited territory or to a given intervention and do not benefit neither the beneficiaries nor field social workers. To break this single thought mindset, our project has created an inter-professional approach mobilizing a supportive and dynamic network of various health workers, social workers and human rights advocates in order to improve the management of heavy neuropsychiatric disorders.
Among the objectives, this initiative attempted also to demedicalize some health problems, to push healthcare providers to pay more attention to social problems and to involve other social stakeholders in medical work.
As an illustration, health centres provide care (medical consultations, nursing services and drugs) to all populations. Social centres provide services (psycho -social support, legal support, rehabilitation, social and professional reintegration) to the same populations. The interaction of these two levels of intervention can only be beneficial for patients, providers and medical-social structures.
Our methodology involves the organization of platforms for dialogue between actors, field visits, referrals of patients or target groups and the organization of joint actions.
The platforms are organized around a theme: clinical, social, results or best practice.
Field visits take place upon request in order to assess the social and/or medical situation of an identified patient, or to meet with an association that wants to share its experience and best practices or seek advice.
Social workers refer their clients to a healthcare professional for a medical condition and the healthcare professional refers their patients to social workers in order to be more effective not only in medical care but also to delegate certain activities (counseling, search of lost to follow up) in order to deal with other aspects.
Joint actions are put in place to identify, plan and agree upon a synergic mode of implementing activities that improve the quality of services offered.
When your donor funding runs out how will your idea continue to live? The project initially depended on single funding, but since its activities are integrated into health centres, it has become routine and no longer dependent on external funding. Yet, the fact that we are in the process of replicating and scaling up the programme in several other health centres, funding will be needed in order to train staff, provide a starting stock of essential generic drugs, conduct reintegration workshops and provide supportive teaching materials.

Relations and Communication of the Centres for Mental Health with Other Relevant Stakeholders in Bosnia and Herzegovina.

Author(s) Ahmed Novo1, Sinisa Stevic2, Srdjan Dusanic3, Darko Paranos 4, Vera Kerleta-Tuzovic 5, Nadja Bascausevic6
Affiliation(s) 1Agency for Quality Improvment and Accreditation in Healthcare of Federation of BiH, AKAZ, Sarajevo, Bosnia and Herzegovina, 2ASKVA , ASKVA RS, Banja Luka, Bosnia and Herzegovina, 3Faculty of Philosophy, University of Banja Luka, Banja Luka, Bosnia and Herzegovina, 4Mental Health Project in BiH, MHP BiH, Sarajevo, Bosnia and Herzegovina, 5Agency for Quality Improvment and Accreditation in Healthcare of Federation of BiH, AKAZ, Sarajevo, Bosnia and Herzegovina, 6Agency for Quality Improvment and Accreditation in Healthcare of Federation of BiH, AKAZ, Sarajevo, Bosnia and Herzegovina.
Country - ies of focus Bosnia and Herzegovina
Relevant to the conference tracks Health Systems
Summary Within scope of the Mental Health Project in Bosnia and Herzegovina (BIH) two BIH agencies for safety and quality improvement and accreditation in health care, AKAZ and ASKVA conducted series of training seminars in order to improve the importance, role and visibility of the Centres for Mental Health (CMH) in the health systems, as well as their relations with other relevant stakeholders in health and social systems of Bosnia and Herzegovina. Two surveys at the beginning and the end of the project activities have been performed in order to measure the successes of the training seminars. Final survey results have showed that CMH have improved their importance as well as communication.
Background Activities were conducted within the scope of the Mental Health Project (MHP) in Bosnia and Herzegovina (BIH). The Mental Health Project in BIH is a result of continuous commitment of the health ministries to continue the mental health reform in BIH. The mental health reform was launched in 1996 and focused on community-based care as a contrast to the traditional model which was mainly oriented towards hospital treatment of persons with mental disorders.The overall goal of the Mental Health Project in BIH, in the period June 2010 - December 2013, was to improve general mental health of the population and enhance the capacities of policy makers and competent institutions in complying with European standards in mental health care in BIH.Since 2008, two Agencies for quality improvement AKAZ and ASKVA were involved in training and accreditation of health centres in field of mental health with the aim to improve the quality of provided care. Therefore they were selected to perform training for representatives of relevant stakeholders in order to improve importance, role and visibility of the Centres for Mental Health, as well as their relations with other relevant stakeholders in the health systems of Bosnia and Herzegovina.
Objectives The objectives of the Mental Health in BiH Project from the period June 2010 to December 2013 were as follows:1.Improved administrative and legislative framework to enable efficient operations and processes in mental health care in both BiH entities, Federation of Bosnia and Herzegovina and Republika Srpska.
2.Persons with mental problems have access to improved and better quality services of mental health care at the community level.
3.Provision of high-quality mental health services at the community level supported as a priority of the reform process by the management structures in Community Health Centres.
4.To strengthen the capacities to fight against stigmatisation and discrimination related to mental disorders.Within the objective 3, the specific objectives include: a) Improved understanding of managers of DZs and centres for social welfare on the importance and role of mental health centres within DZ organizational structure and b) Establishment of improved cooperation between centres for mental health and other services within primary health care centres, other relevant sectors and local community.
More precisely, AKAZ and ASKVA needed to conduct a series of training seminars in order to improve the importance, role and visibility of the Centres for Mental Health in the health systems, as well as their relations with other relevant stakeholders in health and social systems of Bosnia and Herzegovina. It was also planned to perform two surveys at the beginning and the end of the project activities in order to measure the successes of the training seminars and to examine whether the training made a difference in the initial and final report, emphasising the following questions and tasks:
•Assessment of the current human resources and technical capacities of centres for mental health;
•Assessment of the cooperation established among centres for mental health and other relevant stakeholders in the sector (family medicine teams - FMT and primary healthcare centres - PHC as a whole, psychiatric clinics/wards, centres for social welfare - CSW, local community);
•Definition of the major challenges in inter-sectoral and intra-sectoral cooperation among the aforesaid stakeholders;
•Identifying the respondents’ attitudes toward mental health (centres for mental health, working professionals, individuals with mental disorders);
•Assessment of the respondents’ acquaintance with basic terms and data in the field of mental health.
Methodology Within the MHP in BiH, Agencies for healthcare quality, AKAZ and ASKVA, conducted a series of surveys on “Relations and Communication of the Centres for Mental Health with Other Relevant Stakeholders in Bosnia and Herzegovina. Both Agencies have compared results of the baseline and final survey on respondents’ view and evaluation of the capacity, role and importance of the Centres for Mental Health and their relations with other relevant stakeholders. AKAZ and ASKVA applied different research methodologies. AKAZ developed five questionnaires for the survey: for mental health centres staff, for social work centre staff, for DZ management, for members of the family medicine teams and for staff from psychiatry departments/clinics. All participants completed questionnaires anonymously and questionnaires did not contain questions about the identity of respondents. Questionnaires had seven parts: data on respondent, cooperation between CMH and management of DZ, cooperation between CMH and family medicine teams in DZ, cooperation between centre for mental health and and psychiatry department/clinics, cooperation between CMH and centred for social work, cooperation between centre for mental health and other services and part seven was for comment, suggestions and questions in an open end format. The first survey was conducted in January-March 2012 and the second was conducted in February 2013. Questionnaires were sent by e-mail to the survey participants who filled it in and sent it back in electronic format or as hard copy. ASKVA conducted interviews in two different phases, at the beginning of the first round of seminars and at the end of project implementation, during the third round of seminars. There were four rounds of trainings and seminars in whole, organised regionally (Banjaluka region, Herzegovina region and Teslic region). The baseline survey was conducted in December 2010 and the final survey was conducted in November 2011. The same respondents participating in the survey, fulfilled questionnaire both at the beginning and at the end of the survey and their responses were compared. The interviews were conducted by the RS Agency’s staff. The survey was quantitative, since it was questionnaire based. Respondents needed approximately 30-45 minutes to fill in the survey questionnaire. Data processing was completed in SPSS statistical software. Responses to the survey questions were presented in form of frequencies, percentages and arithmetic averages.
Results In Federation of BIH AKAZ conducted two surveys in the period from January 2012 till March 2013. 40 organisations participated in the first survey from primary health care level (12 DZ, 14 CMH and 14 FMT), 16 CSW and 6 hospitals. 60 organizations from primary health care level (19 DZ, 24 CMH and 17 FMT), 9 CSW and 5 hospitals participated in the second survey.
Analysis of the results of cooperation between CMH, FMT and management of DZ shows obvious progress in cooperation. Significant contribution provided CMH with improved service through the use of accreditation standards and development of cooperation protocols, working procedures and better communication with management of DZs and FMTs. Furthermore, cooperation between CMH and CSW was also improved. Analysis of the results shows the progression of attitudes of both institutions. Improvement is especially noticeable in the area of general cooperation and frequency and quality of communication. Cooperation between
CMH and psychiatry departments/clinics are also ameliorated (efficiency of the referral system, role and importance of CMH and psychiatry departments, etc.). None of the results from all stakeholders and participants in the survey show that disagreement in general cooperation, frequency in communication and definition of mutual relationships are still present.
In RS, ASKVA conducted the first survey in December 2010, using the sample of 77 respondents and the second was conducted in November 2011 with the sample of 61 respondents. Results show that the capacities of the Centres for mental health (CMH) are improved when compared to the initial survey and respondents are more pleased with cooperation they have between CMH and other institutions. The biggest impacts are related to regular communication and signed protocols of cooperation. The following challenges are recognized in inter-sector cooperation: development of better communication, organization of meetings within healthcare centres, better positioning of CMH within health centre, development of procedures and work standards, more intensive work and better cooperation in smaller communities.
Challenges in the intra-sectoral communication are as follows: better communication and information, defining and realization of protocol on cooperation, provision of more education/training for all employees. Participants have positive relations towards mental health and there are no open signs of stigmatization.
Conclusion Summarized conclusions in regards to the survey on “Relations and Communication of the Centres for Mental Health with Other Relevant Stakeholders in Bosnia and Herzegovina” are as follows:
• CMH capacities are improved when compared to the initial survey. Respondents are satisfied with premises, furniture and technical equipment as well as professional instruments and additional education.
• Respondents are mainly satisfied with cooperation of CMH and other institutions in the final survey. They are the most pleased with the cooperation with organizational units within healthcare centres and the least happy with cooperation with associations of beneficiaries.
• The biggest leap forward was made in the final survey with regard to more regular communication and signed protocols of cooperation between CMH and CSW. Besides, there is a progress in regular communication between CMH and family medicine teams.
• There is a positive attitude of participants towards the mental health, CSW and psychiatric clinics.
• At the end of project, the number of those who think they knew the Strategy of Mental Health Development increased. Besides, participants evaluated that the Strategy was better implemented in practice.
• Challenges in intra-sector cooperation are: development of better communication and organization of more meetings within healthcare centres, better positioning of CMH within healthcare centres, development of work procedures and standards, intensified work and cooperation in smaller communities.
• Challenges in inter-sector cooperation are as follows: development of better communication and information, defining and realization of protocols on cooperation, provision of better education for employees.A complex organisational health care structure and the complex political structure in BIH may jeopardise the project implementation in the planned timeframes. Different understanding of roles and functions by mental health authorities at different levels could be also be one of the risks. Through the intra- and inter-sectoral cooperation, the Project should develop clear allocation of responsibilities between the institutions and stakeholders involved. Clear commitment of the BIH health care authorities to the sector reform and kind support and joint efforts of Donors (SDC and the Swiss Cantons) and the ensured domestic ownership of the project should guarantee the sustainability of the reform process.

Decentralized nurse training in rural Zambia – triplicating the output of trained nurses.

Author(s) Martina Weber1, Toddy Sinkamba2, Klaus Thieme3.
Affiliation(s) Zambia, SolidarMed, Chongwe, Zambia, 2 St. Luke's School of Nursing, Mpanshya, Zambia, 3 SolidarMed, Chongwe, Zambia.
Country - ies of focus Zambia
Relevant to the conference tracks Health Workforce
Summary The SolidarMed pilot project decentralized practical nurse training in rural Zambia started in 2012 with St. Luke’s School of Nursing in Mpanshya. The project aims at providing nurses for rural districts of Zambia by triplicating the annual student intake, and by delivering quality theoretical and decentralised practical training to meet quality standards. It is a pilot project presented as a valuable model for nurse training in Zambia to the Ministry of Health and other interested stakeholders. The project is based on the recommendations of WHO Global Policy Recommendations (2010) on Improving access to health workers in remote and rural areas through improved retention.
What challenges does your project address and why is it of importance? Zambia, like many other low income countries in the region, faces considerable challenges in providing sufficient human resources for health. In Zambia only about half of the health facility workforce are trained. Nurses and midwives are crucial in an already struggling health system, and not having enough key staff like nurses weakens the health system. Zambia has a shortfall of 9’000 nurses which is approximately 60% of its requirement. Rural hospitals particularly illustrate a drastic gap between the planned medical staff and the actual staffing situation. Historically, Zambia has not invested enough in its health training institutions. The under-funding of health institutions, poor training and accommodation facilities, inadequate equipment and study materials, as well as inadequate teaching staff have resulted in high attrition rates from pre-service training (like nursing), fewer graduates and an overall deterioration in the quality of outputs.
How have you addressed these challenges? Do you see a solution? The SolidarMed pilot project tries to target all these recommendations in the partnership with St. Luke’s School of Nursing at St. Luke’s Mission Hospital in rural Mpanshya / Zambia. The school had 30 students in 2009. The project target is to double the output of students by decentralisation of practical training. The first external practical training site is Sacred Heart Mission Hospital in Katondwe – a small hospital in a very rural and remote part of the Province. Experiencing clinical practice is essential for the student nurses to understand their professional future. Nurses are likely to find themselves as one of the few health professionals within a rural health institution. If they have never experienced the reality of rural practice and learnt to deal and adapt to its challenges, the outlook for their retention in the rural areas is not good. Given the limitations of a rural posting, where there is likely to be staff and equipment shortages as well as crumbling infrastructure, nurses need to be trained for this. And this kind of training is only possible if you actually train within a rural, peripheral context. The second external practical training site will be Chongwe District Hospital. This Level 1 District hospital is quite close to Lusaka, in the District capital of Chongwe and here nursing students supplement their experience of clinical practice in a remote rural area with practical training in a more urban hospital. Patient numbers are high, which is also valuable preparation for their professional future. In addition, being based in Chongwe allows nursing students easier access to Chainama Hills Hospital where they complete a practical rotation in mental health. Two clinical instructors are placed at all three practical training sites. The combination of learning and experience available at these three quite different hospitals provides a balanced mix of exposures to various professional settings. This allows nursing students to experience as many aspects of their practical work as possible, and thus gives them the best possible training for their future career.
How do you know whether you have made a difference? The project is on-going. The overall goal is to improve the provision of nurses for rural health care in rural districts of Zambia. In order to achieve this goal, SolidarMed invested in infrastructure and equipment at the decentralised training sites by building a student hostel and staff houses for the clinical instructors at Sacred Heart Mission Hospital in Katondwe and at Chongwe District Hospital, as well as staff houses for the clinical instructors at St. Luke’s School of Nursing in Mpanshya. Additionally, teaching and learning equipment is constantly upgraded. Furthermore, SolidarMed is supporting the training of one nurse tutor and six clinical instructors, incentivising the latter and supporting St. Luke’s Nursing School by placing them on the payroll of the individual practical training sites. To ensure cooperation between the Nursing School and the decentralised sites works smoothly, a comprehensive Framework Agreement is drawn up to define roles and responsibilities. The relevant Ministry of Health and Ministry of Community Development, Mother, Child Health are very interested in both the negative and positive outcomes of this pilot project. It is seen as a way of increasing the output of trained nurses in a relatively cost effective way with the additional benefits for the participating decentralised practical hospitals. Since the start of the project the intake of nurse students has been increased to 103 in 2013. This triples the number of students since the Nursing School started.
Have you or the project mobilized others and if so, who, why and how? This project is a pilot project for the Zambian training system for medical personnel. As well as the training institution, St. Luke’s School of Nursing and its Hospital involved other parties at the decentralized training sites at Katondwe Sacred Heart Mission Hospital and Chongwe District Hospital. All lessons learnt are shared with all stakeholders – e.g. the General Nursing Council of Zambia, the Ministry of Health and the Ministry of Community Development and Mother & Child Health and all other training institutes interested in scaling up their output. The involvement of the General Nursing Council is crucial for the success of this pilot project. This professional body registers nurses and midwives and regulates their professional conduct and education while also registering nursing and midwifery schools. It also has an advisory role in the Ministry of Health on matters relating to nurses and midwives. With regard to nursing and midwifery schools, the General Nursing Council sets the monitoring and evaluation standards, decides whether facilities are suitable for training, conducts supportive supervision visits and evaluates the training programmes offered at individual institutions. Furthermore, the General Nursing Council also develops and reviews curricula, teaching and learning materials, evaluates the implementation of these curricula and conducts knowledge and skills updates for teaching and clinical staff. The lessons learnt could be applicable for other job training institutions in Zambia that focus on topics other than health.
When your donor funding runs out how will your idea continue to live? The design of the SolidarMed project is that the decentralized nurse training can continue after funding runs out. The nursing school benefits from investment in its infrastructure and faculty and will be strengthened in the area of quality assurance. SolidarMed experienced that the practical training sites hosting the students benefited from their participation in nursing training. Nurses in training are a form of additional manpower in the context of a human resource crisis. SolidarMed has not created separate cadres of health professionals or designed its own brand of training, but rather supports Zambian training programmes, tailored to Zambian requirements. The project supports local ownership of human resource for health strategies. So it is fully consistent with Zambia’s national health priorities and strategies as defined in the Government of the Republic of Zambia’s Fifth National Development Plan 2006 -2010 as well as the Ministry of Health’s National Health Strategic Plan 2006 -2010, and the Human Resources for Health Strategic Plan 2011-2015. Preliminary drafts of the Sixth National Development Plan 2011-2015 suggest that this project is in line with Zambia’s future national health priorities and strategies. Local ownership is key to sustainability. SolidarMed supports Zambian solutions to Zambian problems, and this project is fully in line with this strategy. In doing so, SolidarMed recognises that a home-grown solution is more likely to be effective in addressing context-specific challenges, and more efficient and affordable. SolidarMed seeks out local knowledge and expertise to achieve its aims and contributes its own experience to build capacities and strengthen its partners.