The words “capacity building” have been thrown around increasingly frequently in various medical settings in countries where resources are fewer. The principle is great, that rather than simply dumping aid in the form of medical supplies and care onto countries with fewer resources, it would be better to train local staff to care for the people living there. The goal would be to continue to bring long term hope of change to the systems which often do not serve those who need them most, so that when the aid-worker/missionary/volunteer has left a strong system remains.
Like any well-worn phrase, over time capacity-building simply adopts a hundred different meanings with different implications for everyone using it. Often used in conferences and fundraising discussions, what does it mean for the patients and healthcare staff who are being served? A one-week workshop with people running around wearing badges and certificates afterwards? Or perhaps a day spent presenting at a conference somewhere?
I hope we can aim to care with greater insight.
Has anyone asked the people being served what capacity they would like to get? And what about the patients? Are those with the greatest needs truly being served by the many “trainings” operating in multiple different directions, often offering conflicting information not relevant to the setting where the teams are working?
Having been involved in healthcare and staff development across Sierra Leone and Liberia for the last 12 years I’ve seen a lot. “Workshops” where the only goal of the participants was to get the “per diem” and the only goal of the trainers is to add something to their CV. Groups flying into both countries for a week each year to run courses where the recommended treatments are not available outside of America or Europe. One organisation flew a dozen management level personnel into a resource-poor country only to have the majority of them sit on a beach for a week.
So what is actually working? Firstly, listening works! There are nuances even to listening. Much energy in Wales goes into listening to patient support groups and advocates, yet so often this step is bypassed in discussions around healthcare in Africa. Strange though it may seem, mothers of sick children have a good idea what “help” they would like to see. Listening takes time as many children from disadvantaged groups are less able to speak up for themselves and take energy to find and hear above the many requests for funding.
Secondly, recognise the limitations of “single-strategy” initiatives. By simply providing a skillset without the ability for those trained to use their skills results in a deeply frustrating experience for all involved. Children are simply left unwell and facing delays in receiving even basic care. Health workers know what to do but are left short of the resources needed to move into action.
Thirdly, working together leads to far stronger efforts. Watching the group of organisations gathered around the ELWA children’s program has been a huge privilege because each group brings something unique to the partnership. LIVE2540 bring with them superb supply chains and logistics. Samaritan’s Purse bring resources in the form of skilled staff, medication and supplies. Swansea Bay bring technical support and prior experience of operating Emergency Triage, Assessment and Treatment (ETAT) plus training courses. This experience has meant that rather than re-inventing a new training program we have been able to learn from other countries.
And most importantly working together with Liberian leaders has brought understanding of the local landscape.
Many of the finest moments of work here in Liberia have taken place when I’ve actively removed myself from the canvass of medical activity and watched as the ETAT plus team have taken charge of showing their fellow-Liberians how to resuscitate a newborn who is not breathing, or how to look after a child with severe acute malnutrition. The majority of the ETAT plus trainers are now Liberian, and this is an intentional move to help national ownership and give our team a sense of responsibility for the children who come to the hospitals. Even more encouragingly, many of these trainers have taken the lead in resuscitation situations at the hospital, forming part of a determined effort to lower child mortality in Liberia.
Getting our team to this point has taken years of lived frustrations, failed resuscitations, baby’s lives saved, mistakes, advocacy, collaboration and the relentless compassion of a few Liberians and International people working together. There are no short cuts or magical ways to repair broken systems.
Perhaps a healthier overlap between compassion (intelligent kindness) for the most vulnerable children and capacity building should push our discussions?