A Charter for InternationalHealth Partnerships in WalesCONNECTING PEOPLE, SHARING KNOWLEDGE, IMPROVING

When it comesto global health,there is no ‘them’.only ‘us’.Global Health CouncilAcknowledgementsThe International Health Coordination Centre (IHCC) through the Task and Finish Group,Strengthening Our Links developed the Charter for International Health Partnerships inWales. The document was edited by Lauren Ellis, IHCC Project Support Officer, Public HealthWales; Professor Mark A. Bellis, Director of Policy, Research and Development, Public HealthWales with group members Su Mably, Consultant in Public Health, Public Health Wales;Malcolm Ward, Principal Health Promotion Specialist, Public Health Wales; Chris Riley, PolicyAdvisor, Welsh Government; Tei Sheraton, Clinical Lead International Health and ConsultantAnaesthetist, Aneurin Bevan University Health Board (ABUHB); Gill Richardson, Directorof Public Health, ABUHB; Beth Houghton, Wales for Africa Health Links Network; TonyJewell Chair of the Wales for Africa Health Links Network; Hannah Sheppard, InternationalDevelopment Hub.Stakeholder consultation – thank you to all stakeholders who contributed to the developmentof this document.Designed at Creative pagePrevious page view

ContentsForeword2A Charter for International Health Partnerships in Wales4What is a Charter?5IntroductionThe Welsh ContextThe Global Context667The Charter: Our Promise8The Foundations of International Health Partnerships10Guidance Notes for Implementing theCharter for International Health PartnershipsDemonstrating Well-Managed Organisational ResponsibilitiesDemonstrating Reciprocal Partnership WorkingDemonstrating Good Practice ArrangementsDemonstrating Sound Governance Arrangements12What Does Success Look Like?18Definition of Key Terms24Appendix27References281Previous page view12141516

ForewordIt is a mark of an open andengaged country that we inWales are keen to work withpeople from other countriesin the pursuit of sharingknowledge and improvinghealth.However, it is also important, particularly wherepeople from the state sector are involved, thatit be done well, to a high standard and with aneye to achieving a significant impact of benefitboth to Wales and to partner countries. This iswhat I see as the value of this Charter.I hope the Charter for International HealthPartnerships in Wales will help consolidate anddevelop the reputation and the achievementof Wales in this field and will encourageorganisations and individuals to sign up andcontinue to develop these mutually beneficialrelationships around the world.Mark Drakeford AM, Minister for Healthand Social Services2Contents pagePrevious page view

Wales has a long anddistinguished record inthe field of internationalhealth with well establishedrelationships and newlydeveloping relationshipsaround the Wales has and does contribute tothe international efforts to aid those countriesand the people affected.The Charter for International HealthPartnerships represents a commitmentfrom Welsh Government and Welsh HealthOrganisations to support the internationalhealth agenda in Wales. This is of growingimportance in today’s changing world, withever increasing pressure on our health systemsto provide the best health care possible forWelsh Citizens. Whilst there continue tobe unacceptable global health inequalitiesbetween developing and developed countries,there are also significant inequities in lifeexpectancy between Wales and otherEuropean Regions, and we are not alone infacing challenges such as increased financialpressures, an ageing population, emergingglobal health threats and the continuingburden of non-communicable diseases.In the modern world, globalisation provideschallenges for communicable disease controlwith recent examples of Ebola virus diseaseand avian flu highlighting the speed anddistances that outbreaks can now travel ina very short time. Similarly, the impact ofnatural disasters, such as floods or famine andman-made catastrophes, require rapid andco-ordinated responses from the wider health3The Charter for International HealthPartnerships recognises the legitimacy ofinternational health engagement, with the aimof bringing knowledge and skills back to Walesto improve the health of Welsh Citizens alongwith sharing our best practice and working witha range of nations. By engaging in internationalinitiatives we can learn from others and workto reduce inequalities whilst sharing our ownexperiences and strengths in Wales.However, we have a duty to ensure our healthprofessionals travelling for work purposes areproperly insured, protected and prepared beforetravel to aid them in representing Wales to thebest of their ability and are able to report backand share learning once they return.I would like to thank those who havecontributed to the development of thisdocument. Your responses have helped toensure that this important Charter mostappropriately reflects the specific needsand aspirations in Wales and I would like toencourage health organisations in Wales tocommit to the Charter.Dr Tracey Cooper, Chief Executive,Public Health WalesContents pagePrevious page view

A Charter for International HealthPartnerships in WalesThe Charter for International Health Partnershipsin Wales, developed by the InternationalHealth Coordination Centre (IHCC), PublicHealth Wales, is based on Wales’ history ofaccomplishment and learning in this area andoutlines the four foundations of successfulinternational health partnerships.Information and updates on the Charterwill be provided on the IHCC website IHCC can be contacted [email protected] signatories are Welsh health organisationscommitted to these foundations, which valueand recognise the benefits to our overseaspartners as well as the benefits to the NHS andpatients in Wales.The IHCC will act as the custodian of theCharter for International Health Partnerships.It is a live document and will be reviewedannually by the IHCC.4Contents pagePrevious page view

What is a Charter?A Charter can clarify the direction of a specific movement, in this case internationalhealth partnerships, promoting equity and a clear structure for Welsh healthorganisations. It can guide action to achieve common goals, as set out in theFoundations of International Health and the subsequent guidance notes forimplementing the Charter.Why is a Welsh Charter needed?This Charter is intended to establish a standardlevel of partnership working that ensuresthat the broader principles and values of theNHS are reflected in our international healthactivity (see appendix). Wales’ commitmentto evidence-based practice, shared learningand partnership based on equality and thepursuit of mutual, tangible benefits extends tointernational activity.What benefits does it offer to Wales?Wales has a long history of being part ofinternational health partnerships, often leadingthe way in the UK, with staff working in andwith countries around the world. In orderto get the best for all concerned from thesepartnerships, be they in the developing ordeveloped world, we need to ensure we have acoordinated, professional effort.This Charter will benefit Wales by ensuringthat engaging in international activity is carriedout in a way that protects and enhancesWales’ international reputation, and producesdemonstrable gains both to Wales and itspartners abroad. It will establish such workingas a legitimate, recognised part of the way weoperate in the modern world.Who is the Charter for?This Charter is aimed at helping those workingin international health partnerships in Welshhealth organisations and beyond achieve thebest possible for themselves and those they areworking with.5Who are the Signatories?Signatories are Welsh health organisationsworking in international health partnershipsthat are committed to strengthening Wales’commitment to this work.A full list of signatories can be found on theIHCC website, this will be updated as newsignatories are received.What other Stakeholders are there?Stakeholders are those who work in fieldsrelated to international health partnershipsand are supportive of the work of the Charter,but for whom signing the Charter may not beappropriate.A full list of stakeholders can be seen on theIHCC website and will be updated accordingly.Contents pagePrevious page view

IntroductionThe Welsh ContextThe Welsh Government recognises theimportance of being engaged in theinternational health agenda. This was cementedin 2012, when the Welsh GovernmentFramework ‘Health within and beyondWelsh borders: An enabling framework forinternational health engagement’ was launched,building on and strengthening the 2006commitment to the Millennium DevelopmentGoals (MDGs) and recognising the importanceof engaging with nations outside of Wales.Health Boards and Trusts across Wales hadalready been encouraged, through the WelshHealth Circular (2006) 070, to join the globaleffort to work with sub-Saharan Africa andother developing health systems to improvehealth and quality of life. Since then, manyWelsh health organisations and individuals haveworked to support this agendaThrough the European Union (EU), the WelshGovernment needs to acknowledge particularpriorities. These will change, but currentlyinclude; life sciences, low carbon, energy andthe environment, and advanced engineering andmaterials, through initiatives such as Horizon2020. Much of the EU’s agenda, especiallytackling health inequalities and health impactassessments, complements the Welsh approach(Welsh Government, 2012).6The 2015 target date for the MDGs is drawingnear, although some have been completedprior to this date. There is a large amountof variation in success within and betweencountries. In order to build on the momentumcreated by the MDGs in the Post-2015 agenda,the Sustainable Development Goals (SDGs)are being developed. These will serve as a driverfor implementation and mainstreaming ofsustainable development in the United Nations(UN) system as a whole. The SDGs will apply toall countries, while taking into account differentnational circumstances, capacities and levels ofdevelopment and respecting national policiesand priorities. Wales has a strong commitmentto the sustainable development agenda, throughinitiatives such as One Wales: One Planet (2009),the Well-being of Future Generations Bill andthe Sustainable Development Charter, whichWelsh organisations are signing up to andwhich received international recognition at theUN High Level Political Forum on SustainableDevelopment (Sustain Wales 2014).Contents pagePrevious page view

The Global ContextEngaging in international health partnershipscan potentially address many issues, includinghumanitarian responses, antimicrobial resistanceand tourism. Here are some of them in more detail.Communicable and Non CommunicableDiseasesThe globalisation of disease is influenced bothpositively and negatively by economic, socialand natural environmental factors, as well astechnological advances (WHO 2004). The impactof the risk of infectious diseases should not beunderestimated; increased mobility of people,trade goods and services means that a greaterunderstanding of the potential risk is essential.Increasing collaboration in global healthsecurity will aid in protection from pandemics.Non-communicable diseases (NCDs), such asdiabetes and cardiovascular disease, are placingincreasing pressures on health systems, especiallyin low and middle income counties, where 80%of deaths occur as a result of NCDs (WHO 2013).Working with global health initiatives, such as thereduction of salt used in food by multi-nationalcompanies, can benefit the local populationthrough positive health outcomes such asreductions in blood pressure (WASH 2014).Migration and Health WorkersMore than 214 million people are livingoutside their countries of origin (InternationalOrganization for Migration 2013). The migrationof health professionals to richer countries leavesshortages and gaps in the health system, oftenin areas of the world where the need is most.This can result in ever greater health inequalities.Ethical recruitment of health workers is vital incontrolling this.Mobility of PatientsAs a member of the EU, Welsh residents havethe right to cross-border care. This meanspatients are entitled to be treated for medicalproblems in some other European countries, andbe reimbursed by their home country for anyeligible costs. There is also an assured standardof care, which may not be met in non-EUmember states.7Advances in TechnologyBy working on a global scale, the use ofpartnerships and collaborations can aid in thedevelopment of advances in technology andlearning from others. Advances in medicaltechnology have meant the eradication ofsmallpox and the near eradication of polio.Technology, such as mobile phones, can be usedto share learning in areas and target populationswhich would otherwise be difficult to reach.In order to address the international healthagenda, the Charter for International HealthPartnerships has been developed.Strengthening Health Systems andUniversal Health CoverageIn 2012 the UN signed a resolution on universalhealth coverage. Health is an important crosscutting policy issue in the international agenda,and the resolution urges governments to movetowards providing all people with access toaffordable, quality health-care services. OurInternational Health Partnerships should work tostrengthen health systems.Environmental Sustainability andClimate ChangeClimate change is a relatively difficult challengein terms of impact on human health, it isclear that if the world’s ecosystem declinesthere will be impacts on human healthalready demonstrated through issues such asair pollution. By following environmentallysustainable practices, our impact on climatechange can be reduced.In order to help address the international healthagenda, the Charter for International HealthPartnerships has been developed.Contents pagePrevious page view

The Charter:Our PromiseWe, the signatories of this Charter, agree to the principles of the Foundationsof International Health Partnerships and will apply them within all of ourinternational partnerships.In organising ourselves to supportinternational engagement we will:In undertaking international engagementwe will:Nominate a point of contact forinternational health partnerships to liaisewith the IHCC and staff. Information willbe signposted on the health organisationsintranet. (OR8)Follow the NHS principle of improving livesand do no harm. (RW1)Ensure our special leave policies are in linewith Welsh Government guidance andmade easily available to staff within ourorganisation. (OR1)Make formal arrangements, such asMemorandums of Understandings, at aninstitutional level. (SG1)Ensure international engagement isrecognised as Continued ProfessionalDevelopment. (OR2)Grant special leave, through establishedprocedures, on the condition that pre- andpost assessments are completed by staffas part of their Continued ProfessionalDevelopment plan.(OR1/OR2)Work collaboratively and prudently tomake best use of the available resourcesand reduce duplication by engagingin the Forum for International HealthPartnerships. (OR3)Base all of our partnerships on mutualrespect. (RW2)Undertake risk assessment and riskmanagement when health professionalstravel internationally through work. Thisincludes the provision of adequate travelinsurance. (RW3/SG2)Carry out needs assessments for newand existing projects. (GP2)Aim to strengthen existing health systemsand not offer replacement health care inour health partnerships. (RW4)Strive to ensure that carbon offsetting isapplied to international travel. (OR4)Ensure World Health Organization(WHO) standards on medical donations aremet when donating medical equipment andsupplies to international partners. (OR5)Commit to carrying out evidence-basedpractice and not compromise the qualityof work where evidence is lacking. (GP1)8Contents pagePrevious page view

To support learning from our internationalengagement we will:In our normal working we will:Monitor the cost effectiveness andefficiency of international partnerships.(SG3)Follow the Department of Health andWHO guidance regarding recruitmentof international healthcare personnel.(OR6)Undertake monitoring and evaluation ofprojects and submit project reports onan annual basis to determine the impactof the work, reflecting on the needsassessments and benefits to Wales.(GP3)Support coordinated internationalemergency humanitarian responseprocedures in conjunction with theDepartment for InternationalDevelopment (DfID) and promote theseto staff. (OR7)Publish reports from those working withinternational partnerships within theorganisation in a standardised formatand share these reports with the IHCC.(SG4/OR3)Engage the whole organisation throughglobal citizenship to legitimise theimportance of international connections.(GP4)Consult Diaspora organisations whenavailable. (RW6)Identify opportunities to collaborateinternationally and draw in funding.(RW5)NB: The code at the end of each commitment refers to the relevant Foundation of InternationalHealth Partnerships and supporting guidance note.9Contents pagePrevious page view

The Foundations ofInternational es (OR)Reciprocal PartnershipWorking (RW)Strong organisational engagement andcommitment are essential. This may includesupport for special leave, provision of resourcesto support the development of healthpartnerships and organisational processesreporting at an executive level on InternationalHealth Partnerships.It is essential to have a collaborativerelationship between two or more partiesbased on trust, equality, joint respect andunderstanding for the achievement ofspecified goals for mutual benefit.10Contents pagePrevious page view

Through our international healthengagement we seek to promote theexpertise of health professionals inWales, sharing common principleswith partners and learning new andbetter ways of working that we canbring back to the NHS in Wales.This strengthens our commitmentto action based on sound evidenceand respectful collaboration, whichpromotes health equity within andbetween countries. The Foundationsof International Health Partnershipsare laid out to ensure a clear andconsistent approach to internationalengagement. There are fourFoundations of International HealthPartnerships, each equally important.0304GoodPractice (GP)SoundGovernance (SG)An evidence-based approach searching outpositive results that should be celebrated, andan open culture willing to learn when things gowrong are essential.Clearly agreed aims, objectives and areas ofresponsibility for all partners involved in thepartnerships are essential.11Contents pagePrevious page view

Guidance Notes for Implementingthe Charter for InternationalHealth PartnershipsThis information is provided to give more detail on achieving the Charter andFoundations of International Health Partnerships.Demonstrating Well-Managed OrganisationalResponsibilitiesOR1. Special LeaveIn line with existing guidance outlined in theWelsh Health Circular (2006) 070 and theWelsh Government framework document‘Health within and beyond Welsh borders: Anenabling framework for international healthengagement’ a policy commitment to supportspecial leave for those involved in projectsworking between sub-Saharan Africa and otherdeveloping health systems has been made. Fairconsideration will be given to those working inother geographical regions.OR2. Continued Professional Development(CPD)Participation in international partnerships, whichis approved by the organisation, is formallyrecognised as contributing to ContinuedProfessional Development (CPD). Professionaland leadership development of those involvedin international health work is recognised. Thisis not limited to those travelling internationallyaround the health agenda, but also includesengagement at a distance through activitiessuch as training and research.12Contents pagePrevious page view

As a condition of granting special leave,participants will complete pre and postassessments to determine how theirprofessional role in Wales has developed aspart of their CPD plan.OR3. Mutual Learning and Sharing LessonsLearnedLearning gained from involvement ininternational health partnerships should beshared within and beyond Welsh borders toincrease awareness, reduce duplication andencourage collaborative working. This appliesto all parties involved in the partnership. Incommon with NHS Wales, international healthpartnerships and those signed up to this Chartersupport an open culture when problems arise.Useful lessons can be learnt if things do go asplanned, which can reduce the risk of othersencountering similar issues.An online forum will provide a platform forsignatories and shareholders to ask questionsand share learning. This will help to foster sharedlearning and will be hosted on the IHCC website.Monthly reporting of international activityshould be included in current reporting systemsand fed to Chief Executives. An annual reporton international activity will be included incurrent reporting mechanisms. This report mustinclude feedback on outcomes, outputs andimpact. This should then be sent to the IHCC.OR4. Environmental ImpactNot all international health partnerships involveoverseas travel, but when it does take place everyeffort must be made to ensure interventions areboth ecologically and practically sustainable.The signatories of this Charter will adopt equallysustainable practices in accordance with thesustainable development principles.Comprehensive guidance for the donation ofmedical equipment and medical supplies hasbeen developed by The Tropical Health andEducation Trust (THET).OR6. Code of Practice for InternationalRecruitmentHealth worker migration has been increasingworldwide in recent years, especially from lowerincome countries with already fragile healthsystems. The UK, through the Departmentof Health, is committed to ensuring ethicalrecruitment practices operate within the NHSthrough adherence to the Code of Practice (CoP)for International Recruitment. The CoP links toWHO guidance on recruitment. The CoP aims toestablish and promote voluntary principles andpractices for the ethical international recruitmentof health personnel and to facilitate thestrengthening of health systems. The IHCC willoffer advice on country profiles where required.OR7. International Emergency HumanitarianResponseEmergency Humanitarian Disaster Responsesare driven by the need to assist in times ofcrisis. Signatories and stakeholders will give fairconsideration to working with DfID by engagingin organised UK-wide efforts to develop acoordinated needs-based response, facilitatedby the UK International Trauma Register, hostedby UKMed (Humanitarian Emergency ResponseReview 2011) (see appendix). This opportunitywill be promoted to staff.OR8. International Health LeadA point of contact for international healthpartnerships to liaise with the IHCC and staffwill be nominated. This could be in a voluntaryrole or paid. This will be supported by an onlineresource for staff.OR5. Meeting WHO Standards on DonationsAcquisition of medical equipment and medicalsupplies can act as a barrier to effective medicaltreatment in low income countries. The WHOGuidelines must be followed regarding thedonation of medical equipment and medicalsupplies to ensure any donation is carried outappropriately and safely.13Contents pagePrevious page view

Demonstrating Reciprocal Partnership WorkingRW1. Improving Lives and Do No HarmDiligence and duty of care will be applied wheninvolved in a partnership, with the prudent useof resources based on the principle of doing noharm following the NHS Values and Standardsof Behaviour Framework. The central purpose ofinternational health partnerships is to improvethe lives, health and wellbeing of those involved.Activity which does not fulfil these aspirations orgoes against them must cease immediately.To ensure the economic and social implicationson health are considered, use of the socialdeterminants of health model should be applied.RW2. Respect, Fairness and EquityMutual respect of partners will be fosteredwith all parties of the partnership on an equalfooting. Partners should consider prioritiesand aspirations, taking them into accountwhen designing and delivering the project orprogramme. Communication should be clearand regular through mutually agreed means.Where there is a breakdown in communication,reasonable steps should be taken to rebuild therelationship. No partner or individual involved inthe partnership will be discriminated against ordisadvantaged. Each partner will be treated withequal respect and importance.RW3. Managing Risk in Professional TravelOrganisations and international healthpartnerships have a responsibility to ensure thewellbeing of those travelling internationally forwork purposes. Managing risk must compriseof documents including a risk assessment, basiccountry information including emergency contactdetails and basic language tips. Appropriate travelinsurance must be organised for those who aretravelling for work purposes as well as travel andaccommodation arrangements.RW4. Health Systems in DevelopingCountriesPartnerships with health systems in developingcountries must not offer replacement healthcare; they should strive to build capacity withinthe existing health services through sustainablemeans, which must be implemented withsupport and consideration for existing in-countryhealth systems.Where the partnerships are time limitedaround specific goals, the goals must be clearlyidentified prior to the full initiation of theproject. The benefits of the international healthpartnership must be intended to extend beyondthe lifetime of the partnerships, with successionplanning in place.RW5. Identify OpportunitiesIn order to ensure the best opportunities arecapitalised in Wales, health organisations willhorizon scan to look for opportunities to draw infunding and work collaboratively to increase thepotential of successful bids.RW6. DiasporaDiaspora organisations can provide Welshorganisations with a deep insight into theircountries of origin, and help in the developmentof projects. Diasporas should be engaged to buildinsight into working with the partner country.It is the responsibility of the healthprofessional not to engage in any riskybehaviour when on international placements.14Contents pagePrevious page view

Demonstrating Good Practice ArrangementsGP1. Quality and Evidence Based PracticeUse of the best possible evidence, throughEvidence Based Practice, must be applied ininternational health partnerships. Where thereis no available evidence from the region or acomparable region, research may need to takeplace to inform projects or interventions. Qualityof care must not be compromised by a lack ofevidence. Evidence and learning gained shouldbe shared.GP2. Needs AssessmentNeeds assessments can help to determinethe requirements, and also expectations of theproject. Where projects and partnerships involvedeveloping country health systems, needsassessment must be led by the requirements ofthe partner country in order to provide a robustfoundation for a new partnership or project,especially where the country is low income.Needs assessments must be carried out for eachnew project developed within a partnership.Assets Based Needs Assessment or RapidAppraisal Methods should be considered.GP3. Monitoring and EvaluationCarrying out monitoring and evaluation mustbe integrated into each project and partnership.In developing country health systems the‘Wales Africa Effectiveness Framework’ can beused by Welsh organisations that are workingwith partners in any low income settings. It isa collaborative piece of work between WalesAfrica Community Links, Wales InternationalDevelopment Hub, Network of InternationalDevelopment Organisations in Scotland(NIDOS) and Bond (formally known as theBritish Network for Overseas Development),and enables organisations to review theirwork against principles of good practice ininternational development, using practicalbenchmarks that are consistent across the UK.15In other partnerships, monitoring and evaluationarrangements will be identified that followrecognised methodologies that are appropriateto the activities and acceptable to all parties.GP4. Engaging the Whole Organisationthrough Global CitizenshipAll staff will be encouraged to understand thelegitimacy of engaging in the internationalhealth agenda. This can be fulfilled in anumber of ways, such as global citizenshiptraining, investment in Fair Trade produce andcollaborative working using online methods.Contents pagePrevious page view

Demonstrating Sound Governance ArrangementsSound governance helps to ensure goodpractice is adhered to.SG1. Formal ArrangementsWhere no other appropriate contract is in placea Memorandum of Understanding includingagreed outcomes, methods, accountabilityarrangements and communication arrangementshelps to demonstrate the clarity of thesearrangements and manage expectations.SG2. Risk in PartnershipsPartnerships involve risks as well as benefits,making shared accountability and an assessmentof the long-term sustainability of the projectcritical. This is especially the case where fundingis limited, although it should not be disregardedin any project. Risk assessments allow for theidentification of potential threats to the projectand those on whom it impacts.SG4. Reporting ImpactReports on the impact of projects supported bythe organisation must be carried out annually.Reports must include information on the outputsand outcomes of the project. Outputs are usefulas they provide a quantifiable way to determinethe impact of a project, such as

A Charter for International Health Partnerships in Wales The Charter for International Health Partnerships in Wales, developed by the International Health Coordination Centre (IHCC), Public Health Wales, is based on Wales’ history of accomplishment and learning in