Kenya: Twinning partnerships as a form of international development

Staff from MUH and Londiani Hospital in Kenya

A twinning partnership between Mayo University Hospital (MUH) in Ireland and Londiani Hospital in Kenya has created shared learning exchanges in person and online that are building skills and knowledge across both hospitals. The arrangement is structured through the World Health Organisation's "Twinning Partnership for Improvement" - an approach utilised to improve different aspects of health service delivery. It is supported by Brighter Communities Worldwide - an NGO registered in Ireland and in Kenya.

The partnership is one of seven in ESTHER Ireland's Programme under which the Health Service Executive facilitates Irish hospitals and other health institutions to engage in partnerships with similar institutions in less developed countries. This provides a mechanism for health staff to contribute to health needs in low income countries while continuing to be based in Ireland. This also provides an opportunity for health staff based in Ireland to learn from staff based in low income countries.

Health systems are stretched beyond their capacity in Londiani county in northern Kenya. There are 136 health facilities in the county and one referral hospital with 2,084 health professionals of different cadre. Access to healthcare is a huge challenge. Almost 50% of the population are more than 5km from a health centre and the terrain is difficult over many hills with limited roads and transport is often not available.

MUH support has provided an operating theatre and maternal health shelter in Londiani. Recently, a group of doctors, midwives, managers and staff took part in the Westport Sea2Summit event and raised thousands for the project. The group was organised by Dr. Sara Mohan - a young doctor training in obstetrics and gynaecology - who worked in MUH last year and was hugely inspired by the partnership it has with Londiani Sub-County Hospital.

She told local media: "I worked with a fantastic bunch of midwives and doctors in MUH. I went to Londiani, Kenya, this year with some obstetricians from Ireland and with Brighter Communities Worldwide, an incredible Irish charity which is celebrating 20 years working with people in Londiani Sub-County across health, education and economic empowerment programmes. We met the wonderful midwives there and discussed a joint audit project between the two hospitals to improve outcomes for babies.

"I wanted to do something to raise as much money as I could for the baby unit and the Westport Sea2Summit was the perfect opportunity. The team doing the fundraiser was made up of midwives and doctors from Mayo University Hospital. It's a 30 km race with a few components to it: 4 km run, 11 km cycle, 3 km mountain run up and down half of Croagh Patrick, then finishing with another 11 km cycle and 4 km run. Sure, we'll have great fun.

"The team in Kenya has a wealth of knowledge on maternal and new-born care. However, they face challenges with the limited resources available to their new-born unit. It was clear from the time I spent there, that building on their current new-born unit is a project they are passionate about. Improving the unit will mean better scope to care for new-born babies reducing the need for referrals to the County Hospital. It is often in the referral process that challenges occur which cause further risk to baby's health and life.

"Support from Brighter Communities Worldwide will help them provide their excellent care with less stress for both patients and staff. We were excited in Mayo to raise money for our fellow Kenyan midwives and doctors who share the same goal and vision of giving great care to babies and mothers."

Brighter Communities Worldwide has been a catalyst for development in Kenya kick-starting opportunities in which people are encouraged to flourish, partnerships are encouraged, and true development is encouraged. It is this concept of partnership that the charity has excelled at, empowering communities to realise their dreams of personal and economic freedom, all the while providing support and friendship.

This collaborative approach - also known as North-South Partnerships - can be seen throughout its health, education, economic empowerment and water programmes. It is the thread that weaves hope, support and encouragement throughout all its work. It has been shining a light on the inequalities faced by women and girls since it first started working 20 years ago in Kericho County in Kenya. Its educational bursaries to keep girls in school and alternative rites of passage programme are particularly relevant in eliminating child marriages and female genital mutilation.

Founded in 2002, as Friends of Londiani, Brighter Communities Worldwide works in East Africa in partnership with a locally-led organisation of the same name in Kenya. It has expanded and developed its programmes and now works across Kericho County in Kenya with a population of almost one million people. It is currently expanding into other East African regions.

The charity was the happy result of an unhappy incident. In August 2000, an Irish tourist, Maria Kidney, was mugged on the streets of Nairobi. She sought refuge in the Kenyan Girl Guides' Headquarters. There she heard about the Kenyan Girl Guides' work with various communities and was inspired.

In August 2002, twenty adult leaders from the Irish Girl Guides and the Guide Association in Northern Ireland travelled to Londiani. The result of the visit was a community service project. It involved organising activities for children in the Bethel Children's Home and running a Life-skills Peer Education course for a group of local women in conjunction with members of the Kenyan Girl Guides.

From the success of that project, the Friends of Londiani was formed, later changing its name to Brighter Communities Worldwide to reflect its greater scope and ambitions across community development.

For more information see: www.BrighterCommunitiesWorldwide.org.

The partnership, which was accredited by ESTHER Ireland in 2014, has not only completed a number of public health and healthcare projects, including perioperative medicine training, mobile maternal and child health clinics but also a global health and development module for NUI Galway medical students. In 2019, representatives from Galway University (NUI), MUH and Brighter Communities Worldwide visited Kenya to meet with representatives of Kenyatta University in Nairobi, and the Ministry of Health in Kericho County. This led to the planning and negotiation of a new expanded partnership, with the addition of NUI Galway, Kenyatta University and the Ministry of Health in Kericho County.

The 'how' of partnerships is as important as the 'what'. Shared and joint planning are key. Shared decision-making and responsibility can only take place if the partners are equal and respectful towards each other. This requires vigilance to ensure that traditional hierarchical relationships - northern dominance - that have historically marked North-South partnerships do not inadvertently develop.

Reciprocity, another core principle, means there are benefits for both northern and southern partners. These can include operational and organisational cost-effectiveness in health service delivery and professional development for individuals in the organisation. Adherence to country national policies and strategies makes sense; the people of the land and their representatives know best how to implement health interventions tailored to the values, cultures and socio-economic circumstances of the population. Ethical considerations including evaluation, communications, scalability and sustainability of initiatives with judicious use of limited resources will also be taken into account. (www.globalgiving.org/pfil/55058/projdoc.pdf).

The five parties in the partnership have drafted a memorandum of understanding on the objectives, governance and partnership principles that will underpin all partnership activities. The principles and governance structures for setting up and maintaining a North-South partnership are set out in Europe's ESTHER Alliance, the UK's THET International Health Link Manual and the WHO-African Partnership for Patient Safety. A signing ceremony is being planned.

University collaboration has resulted in an ERASMUS+ International Credit Mobility (ICM) award to support both student and staff mobilities from NUI Galway with the Schools of Medicine, Nursing and Public Health in Kenyatta University. This includes clinical placements in Kiambu Teaching Hospital near Nairobi, clinical placements in Londiani Subcounty Hospital and community health placements in Kericho County. Kenyatta University and NUI Galway staff and students will participate in these mobilities and will have the opportunity to share their experiences and learning on their return with their peers and wider academic community.

Other health institutions in Ireland have form partnerships with similar institutions in Malawi, Tanzania, Mozambique, Sudan and Kenya. But twinning partnerships can take many forms. For example, the community of Westport in Co. Mayo established the Westport-Aror Partnership with the rural area of Aror in north western Kenya in 1982. The focal point of the partnership was a clinic operated at that time by Medical Missionaries of Mary from Ireland. That partnership has been highly successful and has allowed an Irish community to influence and support healthcare in a developing area where many lives have been saved and healthcare improved at minimum cost.

Speaking about it some years ago, the Archbishop of Tuam, Dr Michael Neary, described it: "As Christians, we are a people who are sent to others.... In the Westport/Aror Partnership, the people of Westport have reached out in a spirit of love to the people of Aror and have drawn them into communion. Many lives have been saved in Aror, as a result, and the people of Westport have, in turn, been enriched by the experience of sharing." I used that long-standing partnership as a case history in my 2016 book "The Legacy of Irish Missionaries Lives On". (www.westportaror.com/index.html).

Another such community partnership is that between Ballineaspaig Parish (often called Dennehy's Cross Parish) in Cork City and Turkwel Parish in the Diocese of Lodwar in Northern Kenya. The link between the two parishes started in 2005 through prayer for each other and through financial support to enable the digging of wells, construction of irrigation schemes, and the building and equipping of a health clinic in Turkwel. The parish priest in Turkwel at the time was Cork man, Fr Oliver Noonan SMA. The latest project supported by Ballineaspaig Parish was the building of a maternity unit adjacent to the health clinic to serve the Kalemunyang catchment area in Turkwel Parish that comprises 500 square miles. ( www.indcatholicnews.com/news/40279 ).

Matt Moran is a writer and author living in Cork. He has a particular interest in parish and other twinning partnerships as an effective means for collaboration and social development between communities in Ireland and in Africa. He is author of recently published book 'The Theology of Integral Human Development: the role of faith in international development and public affairs' available at www.buythebook.ie or www.lettertecbookstore.com.