Establishment of Health Link
This is an established and unique Link between two regions in Scotland and Ghana in that are geographically similar. They are both rural and remote areas, sharing comparable challenges in service deliver and recruitment and retention of staff. The overall purpose of the Link is to establish a reciprocal and beneficiary relationship towards the improvement of health delivery and outcomes. Seed corn money from THET helped facilitate a shared scoping exercise in 2009 to identify healthcare delivery needs for the Upper West Regional Hospital and outlying areas. Three main clinical areas were identified- accident and emergency, midwifery and mental health.
Accident and Emergency Training
In 2010, a team of 5 visited the regional hospital in Wa (UWR) and provided on-site accident and emergency training. Student nurses in their 3rd year were part of this team having chosen to complete their elective in the UWR and self funded their visit. The project also benefited from a small BMA grant and money from NHS Highand Endowment Fund. The outcomes of this visit included enhancing relationships across the link and further identification of capacity building and training needs. VIEW REPORT
A further visit to the UWR (Wa and Tamale) was executed in September- October 2010 supported by a 3-year grant from the British Council (deLPHE Grant). This grant focused on education and training for midwives and mental health nurses framed within action research. The recent visit included a number of significant meetings. In Accra meetings were held with the Ministry of Health and other government departments, and the Nurses and Midwives Council of Ghana. This was to discuss the major health needs, human resource for health challenges in Ghana, nursing and midwifery regulations and training and policy directions of the Ministry of Health. In Wa (UWR) a meeting with all partners and wider stakeholders was held at the Regional Hospital to discuss and agree shared project outcomes. Mentorship training was conducted for 25 clinicians and tutors in midwifery in rural health facilities in the Upper West region. An action research workshop was conducted for over 60 health workers, lecturers, tutors and students from Northern and Upper West regions – held at the University of Development Studies in Tamale. There was also the signing of an MOU between University of Stirling, Scotland, NHS Highland, The Ghana Diaspora and University for Development Studies (UDS), Ghana. This received press coverage and was reported in the Ghana Times. VIEW REPORT
As part of the ongoing project, in April 2011, there was a group visit to Scotland of delegates from various institutions in Ghana to cement relationships between the various partners. VIEW VISIT PROGRAMME
We also received a visit from the head of Department for health sciences at the UDS in November 2012.
During 2011 further funding was secured through a THET Medium Paired Institutional partnership grant for a 2 year project to address the problem of harmful levels of alcohol use in Ghana and the rural Upper West Region. This is a problem which affects men and women, young and old but which has been seen to be increasing at its fastest rate in young women. The project was designed to tackle the issue from two angles: (i) by providing effective and sustainable support to people with diagnosed alcohol dependence and (ii) by reducing hazardous alcohol use in groups of people, and in particular pregnant women, who make contact with the health service. These aims are to be achieved via a programme of training and support which will be delivered to various Ghanaian healthcare professionals (e.g. volunteer nurse, CPN’s, midwives, local champions) who will cascade training to front-line staff. The training and subsequent mentoring provided will cover techniques to support and encourage those diagnosed with alcohol dependence to recover from addiction, and the use of screening and brief interventions to support and encourage behaviour change in pregnant women, and other patients who present to hospital with alcohol related conditions.
In 2012 the Assistant Nursing Director for UWR visited the Scottish committee for a 5 day intensive programme which provided the opportunity for exchange of information and helped inform details of the training programme to be delivered in Ghana for the treatment of alcohol dependency. In addition a Ghanaian PhD student also visited Scotland in 2012 and delivered a seminar on evaluation of ABI’s and offered a cultural context to further inform the training and support programme.
During October 2012 the first phase of the training programme was delivered when a group from Scotland, consisting of 2 mental health nurses, one nurse teacher and the Links professional co-ordinator visited Wa and Tamale. In total 89 participants received training in alcohol awareness, alcohol brief intervention (ABI), ABI in antenatal settings and alcohol dependency and 9 CPNs were established as the project champions who will be the main players in rolling out the training to other health staff. In addition during the visit an alcohol awareness raising day was held for key stakeholders and an “extra” unplanned awareness session was delivered to a church congregation and Sunday school class. Resources were also supplied which included training packs (electronic and paper) and educational posters for use in clinical areas to inform on alcohol related harms.
Planning meeting at Wa, following alcohol brief intervention training, involving trainers from Scotland and Champions and the Director of Mental Health Nursing from Ghana
Health professionals during group work at training in Wa
Health professionals during group work at training in Wa
Keeping training interactive in Tamale
A farewell photo marks the end of training in Tamale
Scottish training resources transfer well
A typical drinking spot where home brew is made
Powerful alcohol advertising
Following the first training phase of the Reducing health harm caused by alcohol project, the partners agreed to (1) apply training in the field in UWR of Ghana and (2) set up a continuous learning forum through mentorship and supervision by distance prior to phase 2 of the programme.
The final training programme was developed and designed by both partner teams. It was then delivered to the Ghanaian Champions when 4 volunteers from Scotland visited Wa (UWR) in July 2013. The programme included further training on screening and alcohol brief interventions (ABIs), training in behavioural change as an approach to negotiating change related to alcohol use (Motivational Interviewing underpinned by the Scottish National Health Behaviour Change Competencies Framework) and training in planning, designing and delivering training to others. The training used experiental learning techniques which involved role play, role modelling and shadowing activities.
North-West Region Alcohol Training Champions
Champions and scottish team at the end of the training exchanging t-shirts
As with the previous visit awareness raising sessions had also been organised to be held in a local church, a Sunday school and several High Schools, where the Champions, along with their Scottish partners gave health education talks about alcohol consumption. The local champions are planning on continuing this type of health education through a number of initiatives and speculative opportunities including drinking spot visits, radio slots and a proposal to a national TV company to provide information on sensible drinking to the nation. These activities will build on previous strategic work by the champions, who have built up local networks, and shared programme activities working with the Narcotics Agency and a key mental health NGO (Basic Needs) who operate in remote areas of the upper west, upper east and northern regions of Ghana. A further health education activity was also carried out during the visit when a poster providing information on sensible alcohol drinking was jointly designed by the Scottish trainers and Ghanaian champions. One hundred copies of the poster were printed and distributed to various departments in Wa Hospital, local high schools, and across the sub-districts covered by CPNs. VIEW POSTER
The Scottish team and the pastor at the Pentecost International Worship Centre, Wa Assembly where information about the project was given to the congregation
Following a talk on alcohol at Pentecost International Worship Centre, Wa Assembly Sunday School, Highland Alcohol & Drug Partnership bags were given to the children
A member of the Scottish team delivering a talk on alcohol to pupils at Tupaaso Senior High School in Wa
A nurse from OPD, Wa Hospital translating a public health talk on alcohol
Another outcome for the project is to ensure frontline staff are competent in identifying people at risk of harmful alcohol drinking. To work towards this outcome an auditing exercise was undertaken during the July visit which looked to identify admissions with a diagnosis that might infer a possible alcohol related illness. It is planned for the champions to expand on this work in their own districts over a period of several months to pilot a systematic auditing process and provide data gathered to the Regional Director of Health Services (UWR Ghana).
Auditing hospital admissions records for conditions which could be related to alcohol
After a very busy week the visit was rounded off with a stakeholders meeting where Scottish volunteers and local champions were joined by other key personnel from the UWR (Ghana) to consider care pathways, infrastructures, policy implications, service development and training gaps. A written report of this meeting will go to the Regional Director of Health Services (UWR Ghana) to provide information to support planning for a wider stakeholder event and for use in regional action planning meetings and at national levels.
The Assistant Nurse Director, UWR, provides an introduction at the Stakeholders meeting
Ongoing support to the champions will continue for the length of the project through the provision of simple self-assessment tools and long distance mentoring and coaching (via e.g. skype, telephone and e-mail). In addition it is hoped that a 3rd phase of the project can be funded in order to bring two of the Ghanaian champions across to Scotland for a study tour in the Highlands.
Senior Teaching Fellow / Professional Lead Health Links Co-ordinator
School of Health in Social Science
University of Edinburgh
Tel: 07511 199158
Dr Alexis Naang-Beifubah
Regional Medical Director
Regional Health Authority Buildings
Upper West Region
Tel: +00233(0) 244212143
Fax: +00233(0) 75622529