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MODULE 7: Partnering with Local Communities

Importance of partners(1)

Q: “Which single intervention would do the most to improve the health of those living on less that $1 per day?”
A: “Hire community health workers to serve them.” – Dr. Paul Farmer(2)

Research on global health NGO effectiveness leaves little doubt as to the importance of working with local partners:

“The balance of evidence from published literature and case study accounts is clear… The greater the level of local community involvement in setting agendas for action and in the practice of health promotion, the larger the impact.”(3)

“Health programs should involve community members at all levels of assessment, design, implementation, and evaluation.”(4)

“To increase quality of interventions, communities must become partners of the health system.”(5)

Involving local community leaders, volunteers, health workers, and clinics is essential to effect sustainable improvements in healthcare for many reasons. The following six aims of global healthcare programs outline the many roles of local workers, and illustrate why partnerships are so vitally important.

Confidence: When patients are skeptical of visiting doctors, local leaders are trustworthy, and can inspire confidence in the mission of the global health organization. Alternatively, if global health organizations fail to work with local medical personnel, they may undermine the community’s confidence in their local health system, which will further diminish community health.

Continuity: Without the dedication of local on-the-ground partners, healthcare improvements implemented by global health organizations can only be temporary at best. Follow-up, ongoing, and preventive care all depend on the presence of local medical providers. Local partners are permanently in-country, and only they can link patients with year-round medical care.

Comprehensiveness: Local leaders and local health professionals are best-equipped to assess community needs. While visiting physicians can observe patients’ symptoms and superficially assess the current status of community health, local doctors are familiar with the underlying roots of health problems, as well as with patterns of disease and treatment. On-the-ground collaborators are similarly familiar with which communities are most needy, and can act as case-finders. Without the insights of locals, it would be nearly impossible to get the right healthcare to the all the right people.

Coordination: Global health organizations often face enormous logistical challenges when entering communities with poor infrastructural systems. A local staff can facilitate everything from transportation and lodging to assessing medical needs to publicizing healthcare programs in needy communities.

Cultural Sensitivity:

“From the local world of the community clinic or oncology unit to the transnational workings of human rights agencies, attentiveness to the concept of culture can illuminate how patients, family members, and health care providers interpret illness, healing, and moral obligations.”(6)

Local health workers are themselves part of the target community. They understand local cultural norms and can usually relate better to patients, improving healthcare delivery. As the interface between the community and the healthcare system, local partners are vital to ensuring effective communication and cultural sensitivity.

Capacity:(7) Healthcare delivery systems must be maintained and continually improved. Without community collaborators, health improvements implemented by global health organizations are only transient. Healthcare workers are essential to healthcare delivery, and are thus part of the healthcare infrastructure. In order to achieve the ultimate goal of a permanent, effective medical system, global health organizations rely on capable local medical providers, community workers, leaders, and organizations. Only after building local capacity can a healthcare system be self-sustaining.

What is the role of the nonprofit/NGO’s role in the partnership relationship?(9)

• Recruitment 
  • A global health organization must not begin programs before finding and mobilizing local collaborators. Initial contacts should include local medical clinics. Once a commitment to the common goal of health improvement is established, NGOs and their collaborators can move on to recruiting community health workers and volunteers. With so few doctors and nurses, global health organizations must recruit and train trustworthy, competent, and caring local community members to serve as health workers. In resource-poor settings, there are often many available unemployed workers to fill this role, and local leaders and community members can be surveyed to ensure the recruited workers and volunteers have the necessary motivation and character.
• Training
  • Global health organizations can engage in the training of local health workers and volunteers. The tasks of these partners include education, case-finding, health assessment, and more, all of which require new skills and knowledge. When necessary, educational opportunities for physicians and nurses should be provided as well.
• Funding:
  • A primary role of nonprofits and NGOs is to fund global health endeavors. While some local community members will volunteer as coordinators, health workers and other community collaborators should be paid for their efforts. They are trained to carry out essential healthcare, educational and logistical tasks, often under difficult circumstances. It is important for payment to be in line with salaries of other local workers to avoid fostering resentment and disrupting the local economy. If a medical facility is lacking essential medical equipment, NGOs and nonprofits should provide it. Funding must also be provided to subsidize the cost of medical care, as patients targeted by global health organizations generally cannot afford to pay out of pocket
• Monitoring
  • To ensure effectiveness and progress, all aspects of a global health endeavors must be subject to evaluation and feedback. Volunteers and health workers should have associated supervisors, such as a community nurse or doctor, to whom they can report, and who can monitor their activity. Communication between global health organizations and their local collaborators must be open and frequent. A lack of responsiveness, honesty, or flexibility are all signs of a failing partnership.

Who ultimately has authority?

Local doctors should be in charge of local programs. When it comes to assessing who needs what resources, community leaders and medical providers know best. Global health organizations are to provide support and direction, but cannot hold sustained decision-making power. Top-down approaches to global health development place the power in the hands of government or large organizations have proven inefficient, ineffective, and susceptible to corruption, and thus NGOs and non-profits must implement a bottom-up, grassroots approach.(10) By working with local partners from the bottom-up, global health organizations encourage communities to invest in and take ownership of their healthcare systems, which ultimately leads to sustained improvements. Dr. James Clarke, an ophthalmologist in Ghana who partners with Unite For Sight, explains how working through communities instead of through governments has facilitated healthcare expansion:

“We really need to encourage a lot of NGOs who are interested in eye care to follow Unite For Sight’s example, namely to work from the bottom up. You know, when NGOs come into a country and they approach the government, the authorities, they don’t come and do eye care. When it starts, there are a lot of costs – the overhead, the running of the program – so very little actually goes to those who should benefit from the program. But in the case of Unite For Sight, they came, they got in touch with us – a very small clinic – and when we started outreaches to communities, people started benefitting… Initially when it started we would write letters to districts, to churches, to communities asking if we could do outreach. When we started and people started seeing the results, they were calling us and writing to us and inviting us. We don’t have to make any contacts again. There are so many people that are waiting for us.”(11) -- Dr. James Clarke, Crystal Eye Clinic, Unite For Sight Partner in Ghana

Go To Module 8: Ethical, Quality Volunteering >>

Footnotes

Global Health Course

• Table of Contents
• Module 1
• Module 2
• Module 3
• Module 4
• Module 5
• Module 6
• Module 7
• Module 8
• Module 9
• Module 10
• Module 11
• Module 12