Institutional Health Partnerships
Institutional Health Partnerships (IHP) are collaborative relationships involving at least two institutions. Their ultimate objective is to catalyse health service improvements. ESTHER Switzerland supports IHPs that bring together one partner from Switzerland and one or more partners from low- and/or middle-income countries (LMIC).
To be successful, partnerships must be based on trust, equity, and mutual interests, with all parties working as peers in the pursuit of common objectives. Successful partnerships are also characterised by mutual recognition that all participants possess expertise essential to the project’s success. Thus we replace the hierarchical paradigm “West is Best”—involving medical experts from Switzerland who teach their partners to implement new methods and technologies—with an approach that harnesses the knowledge of both partners.
Sustainable change requires a priori identification of the needs in the country where the partnership will be implemented. Thus, an initiative should be a demand-driven process. It is also essential that both institutions contribute actively to the concept, design, development, implementation, and review of their joint initiative. Partners should work with open minds, so that learning can be bi-directional and mutual. Finally, a sustainable partnership needs a long-term perspective.
WHO Twinning Partnerships for Improvement (TPI) model
The model that ESTHER Switzerland uses to implement IHPs is the Twinning Partnerships for Improvement model developed by the World Health Organisation (WHO). The TPI model takes a structured approach to implementing IHPs, and was based on the former hospital-to-hospital model from ‘African Partnerships for Patient Safety’ (APPS). The emphasis is on ‘doing while learning”.
Fundamental to the approach is that it prioritizes alignment with national health plans and strategies, while at the same time working to achieve the Sustainable Development Goals (SDGs).
The TPI model has three consecutive objectives which ESTHER Switzerland has also adopted in its strategic approach:
1. The development of the partnership, with a focus on fostering strong bi-directional collaboration between health institutions.
2. The improvement of health care through implementation of effective interventions which are based on needs identified at the front lines of service delivery.
3. The spread of learning and experience within the local and national health systems and beyond.
Thus, the approach promotes not only collaboration but also co-development and sharing of both tacit and explicit knowledge, enhancing the spread of successful approaches to improvement. As a global network of twinning partners develops, there is an opportunity to learn from and share learning across the TPI network.
ESTHER Switzerland is the only organisation in Switzerland that officially partners with the WHO TPI initiative, and it adopts the methods developed in the WHO Twinning Partnerships for Improvement (TPI) model. The leading WHO expert involved in developing this approach participates in ESTHER Switzerland’s strategy development, attends Steering Committee meetings, and provides technical support.
Health System Strengthening (HSS)
Strengthening Health Systems is central to ESTHER Switzerland’s mission and objectives.
According to the WHO, health systems strengthening is “(i) the process of identifying and implementing the changes in policy and practice in a country’s health system, so that the country can respond better to its health and health system challenges; (ii) any array of initiatives and strategies that improves one or more of the functions of the health system and that leads to better health through improvements in access, coverage, quality, or efficiency.”
ESTHER Switzerland’s approach has two aspects. First, it supports partnerships which are actively implementing change on the ground in ways that are scalable, reproducible, and have the potential for influence beyond the immediate local environment, thus strengthening the health system as a whole. Second, it encourages the use of implementation research to better understand the interventions that it supports.
It is widely recognised that IHPs supported by ESTHER Switzerland can play a critical role in strengthening health systems.
Health Care System
In 2000, the WHO proposed a definition of six core components that all healthcare systems should strive toward:
- adequate infrastructure (health centres, specialised hospitals)
- well-trained and motivated health workers
- reliable supply of and access to medical products
- well-functioning information systems (monitoring, research, epidemiological analysis)
- patient-responsive governance
- sustainable financing
These components were recognised by all member states.
Reciprocal learning and reverse innovation
Paternalistic notions of knowledge held both by Swiss and LMIC partners can lead to one-sided power dynamics. A change of mindset is required: high-income countries must be open to ideas from low- and middle-income countries, and LMIC participants must be empowered to work on equal terms in a bi-directional partnership. This opens the path to reciprocal learning.
Typically, this learning takes place at the individual level, through personal and professional development. However, there is increasing interest in the adoption of ideas and procedures used in LMICs. Health care developed in other cultures and under other constraints has lessons for highly technical, extremely regulated ecosystems like Switzerland’s.
For example, a technology or solution initially developed, tested and adapted to a context characterised by resource constraints, typically in a low-income country, might lead to more efficient or effective care, better access, or lower health care costs in a wealthier country. It might also give high-income countries new ideas for community-based organisation of health care or environmentally sustainable solutions.
The process by which the party introducing the innovation also expands its knowledge is known as ‘reverse innovation’. It is ESTHER Switzerland’s a long-term goal to achieve reverse innovation through long-lasting partnerships, in an environment of trust and intensive learning.
ESTHER Switzerland supports partnerships that work towards bi-directional dialogue between the parties, and the strengthened knowledge flow that results. It adheres to the ESTHER Alliance Charter of Quality of Partnerships, which supports this vision.
Implementation research seeks to understand and work within real-world conditions, in populations that will be affected by an intervention. It is designed to understand the pathway from scientific findings to practical benefits, addressing implementation bottlenecks, identifying optimal approaches for a particular setting, and promoting the uptake of research findings. Implementation research is especially concerned with the users of the research and not purely with the production of knowledge. ESTHER Switzerland supports population-centred research that contributes to health system strengthening and improved access to quality health services.
Sustainable Development Goals
The Sustainable Development Goals (SDGs), also known as the Global Goals, were adopted by all United Nations Member States in 2015 as a universal call to action. Their focus is to end poverty, protect the planet, and ensure that all people enjoy peace and prosperity by 2030. The 17 SDGs are integrated—that is, they recognize that action in one area will affect outcomes in others, and that development must balance social, economic and environmental sustainability.
ESTHER Switzerland focuses on goal 3, Good health and well-being, and goal 17, Partnerships for the goals.
Goal 3 is fundamental to our human rights and contributes to our understanding of a life with dignity. Good health is also essential to sustainable development. Enormous improvements have been made in health in the past century. However, this progress has been spread unevenly. According to the UN Development Programme, the gap between the countries with the shortest and longest life expectancies is more than 30 years. The policy goal of closing this gap and providing equal access to health for all is enshrined in the basic Human Rights Declarations to which Switzerland is a signatory. However, in a globally connected world, differences in the ability of health systems to respond to the demands made upon them will affect all countries, thus making efforts to strengthen health systems not only an ethical imperative, but in the interest of the donor countries.
As Bill Gates wrote in The Economist of August 18, 2020: “Millions more are going to die before the Covid-19 pandemic is over. Most of these deaths [will] be caused not by the disease itself, but by the further strain on healthcare systems and economies that were already struggling.”
Goal 17, Partnerships for the goals, emphasises the importance of cooperation to strengthen implementation and to revitalize the global partnership for sustainable development. This is at the very core of ESTHER Switzerland’s work.