Health Links Forum 6th February 2014

Edinburgh City Chambers

Health Links Forum: Terms of Reference

Objectives:(1) To represent, and raise awareness of, Scotland’s health links with Malawi: (2) To facilitate the free exchange of resources, ideas and experience relating to health linkages between Scotland and Malawi: (3) To answer questions and help address issues relevant to health partnerships between Scotland and Malawi: (4) To disseminate information relevant to Scotland-Malawi health links: (5) To encourage and facilitate greater joint-working across the health sector in Scotland:

Forum conduct:Forum meetings, discussions and associated engagements will be conducted in the spirit of the SMP’s values, to uphold:•Mutual respect•Cooperation•Internationalism•Service•Sector understanding

Health Links Forum: Activities in 2013

February 2013: Health forum on Maternal Health in MalawiFebruary 2013: Update from DfID on drug shortages in MalawiMarch 2013: Updated Maternal Health Review published on SMP websiteMay 2013: Health forum on SG-funded health projects and support for NHS Scotland links with MalawiOctober 2013: Health forum on NHS Scotland links with Malawi (update), SG small-grants programme and sustainability in health partnerships

Minutes and resources discussed at all the meetings above can be found on the SMP website at www.scotland-malawipartnership.org or on: http://tinyurl.com/SMPHealthLinksForum

Health Links Forum: Activities Planned for 2014

Food security and its impact on health•Can you suggest a good speaker?

Logistics, supply chains and transportation•Invited THET to come and speak about good practice in medical equipment donations (TBC)

Continuing support for SG research into framework for NHS Scotland involvement in Malawi links

Sustainability, capacity building and training

Health Links Forum: Sustainable Quality Partnerships

Health Links Forum: Sustainable Quality Partnerships

The attendees were asked to answer the following questions:

1. If you were writing guidelines for a partnership that was just starting out what questions would you want both the Scottish and Malawian partner to reflect on to help them develop a sustainable, effective and quality partnership? For example, “Who’s idea what the project?”

2. Beside each question you write, note down what underlying principle(s) of partnership it is helping to develop?For example, “Who’s idea what the project?” (Ownership, joint decision-making)

Health Links Forum: Sustainable Quality Partnerships

Input from MaSP Regional Meetings Nov/Dec 2013Suggested Questions PrinciplesHow much funding did you receive and how do you plan to spend it? Transparency

What will be the period of the partnership? Sustainability, exit strategyAre we dealing with the right organisation? CredibilityWhat contributions will be expected from both partners? Transparency, honesty, joint-decision-making

Where did the funds come from? TransparencyHow will we communicate? Reciprocity, participationWhat are the cultural similarities and differences between the partners? Mutual respect

How are the activities going to be monitored and evaluated? Transparency, accountability

How will this project meet the needs of the communities on the ground? Community owned, participation

What is the problem/need? Local ownershipWho are the beneficiaries? Local ownershipWhat is the time frame for the partnership/exit strategy? Sustainability

What are you doing? TransparencyWhat are the intended outcomes Exit strategyWhat are your areas of interest? Alignment, coordinationWhat do you expect from the partnership? Honest, trust, managing expectationWhat is the time frame for the partnership/exit strategy? Sustainability

Who has been consulted? Accountability, local ownership, transparencyWhere does the community fit in? Participation, local ownershipWhat are the partnership guidelines? Accountability, good governanceHow do you know when you have met the need/succeeded in your objectives? Exit strategy

Have you considered the cultural context in which the project will be implemented?

Mutual respect, equality

Health Links Forum: Sustainable Quality Partnerships

Input from SMP Health Forum October 2013

Suggested Questions Principles

Is it inclusive-who is it engaging? Community-led

Whose idea is it? Local ownership

How sustainable is it? Exit-strategy

Would we have use for it here (re goods)? Sustainability

Who asked for it? Local ownership

Health Links Forum: Per diems

Timeline for developing guidance:

Nov/Dec 2013: Consulted MaSP MembersNov 2013-March 2014: Research and draft literature reviewFeb-March 2014: Consulted SMP MembersApril 2014: First draft of SMP per diems guidanceMay 2014: SMP event on per diems to discuss guidance June/July 2014: SMP final guidance on per diems published on SMP website

o Latin for ‘by the day’ o Daily determined allowance for extra

expenses incurred while working away from normal duty stations, including travel, lodging and meal costs (Norad 2010)

o Also known as ‘administrative modalities’ o Used by governments, the development and

private sector

Health Links Forum: What is a ‘Per Diem’?

1. Reimbursement of work-related expenses 2. Encouraging capacity-building and

professional development 3. Improve efficiency and reduce extra costs in

detailing exact expenses (‘paper push’)

Health Links Forum: Functions of Per Diems

o Fair compensation for costs incurredo Aids in the development of skills, sharing of

information, capacity-building o Providing incentive for those with low salaries

Health Links Forum: Perceived benefits of per diems

o Ranges from ‘survival coping strategy’ to outright fraud and corruption

o Abuse is generally understood at its root as connected with low-wages (Chene 2009)

o High level officials taking place of lower-level employees

o Failure to harmonize on behalf of donors (Ridde 2010)

Health Links Forum: How have per diems been abused?

o Increased attendance, more productive training sessions and workshops

o But…..can also lead to ‘drain brain’ or ‘workshop syndrome’

o Feeds into low wage rates as per diems are viewed as salary supplements or coping strategies (feedback loop)

o Unhealthy institutional culture (Norad 2012) o Unequal playing field between larger

development organizations and smaller or locally-based NGOs

Health Links Forum: Short and long-term effects

Health Links Forum: Per diems

Input from MaSP members:•DEFINITIONS: a clearer definition of “per diems” was needed before a clear position can be made. Different understandings of the term caused confusion.•REFORM: look at per diems on a case by case basis, depending on the persons role, task, distance they have to travel, salary, etc. •STANDARDISED SYSTEM: across NGOs (a report has recently been published by NGOs in Malawi seeking to standardise rates-this has been made available to the SMP).•INCLUSIVITY: the absence of per diems can exclude those in rural areas from participating in meetings.A suggestion it might be fairer to include the costs of travel expenses in budget lines in funding proposals and project plans, rather than such costs having to covered from other operational budget lines. •ABUSE: Has led to people chasing allowances, instead of doing the work they are employed to do. •SALARIES: per diems have skewed basic salary levels.

Input from MaSP members:• DEFINITIONS: a clearer definition of “per diems” was needed before a clear

position can be made. Different understandings of the term caused confusion.

• REFORM: look at per diems on a case by case basis, depending on the persons role, task, distance they have to travel, salary, etc.

• STANDARDISED SYSTEM: across NGOs (a report has recently been published by NGOs in Malawi seeking to standardise rates-this has been made available to the SMP).

• INCLUSIVITY: the absence of per diems can exclude those in rural areas from participating in meetings.

• ABUSE: Has led to people chasing allowances, instead of doing the work they are employed to do.

• SALARIES: per diems have skewed basic salary levels in Malawi• TRANSPARENCY• ADVICE: Malawian CSOs are looking for more advice and guidance for a

strandardised system.

Health Links Forum: Per diems FAQs

Health Links Forum: Per diems forum questions

• Has the issue of per diems come up in your particular link with Malawi? Has this been a problem? If so how?

• Has your link developed productive and sustainable practices to address the challenge of per diems? Please give examples.

• Does the proposed format of FAQs on per diems provide the information you need to make informed decisions about per diems. If not what other information (statistics, current rates, academic literature) would you like to have in order to make informed decisions about per diems?

• What form would this be most useful in (pamphlet, research paper, web page, etc)?

• Would you attend a specific event with other SMP members looking at the topic of per diems. If so what content should be included in the event?