Disparity in health care between the developed and developing world is a major global health problem. MedicineAfrica, an online health systems strengthening platform established in 2008, connects isolated health workers to the rest of the global health workforce in order to build capacity. The biggest programme is in support of health workers in Somaliland. Dr Alexander Finlayson is now working to develop MedicineAfrica for future users.
This podcast presents the research done by Dr Alexander Finlayson whilst working in the Nuffield Department of Medicine. Dr Finlayson now works at the Nuffield Department of Population Health.
MedicineAfrica is a tool which connects health workers from around the world in order that they can collaborate in education, in the design, delivery and evaluation of clinical services and in health research in order to strengthen health systems such that they can deliver better outcomes for patients.
Ultimately, medical research must translate into improved treatments for patients. At the Nuffield Department of Medicine, our researchers collaborate to develop better health care, improved quality of life, and enhanced preventative measures for all patients. Our findings in the laboratory are translated into changes in clinical practice, from bench to bedside.
Q: What is MedicineAfrica?
AF: MedicineAfrica is an organisation which basically consists of two components, one of which is a global health communications platform: an on-line technology to enable health workers in different locations to communicate. And then some programmes that we’ve built off the back of that to enable capacity building efforts to be scaled up at a distance on-line. To give some context the programme started in Somaliland, a country that has very fragile health indicators, and to give some illustration of that, it’s estimated that somewhere near 1 in 11 people will be shackled at some point due to mental ill-health, so a really fragile health system there. What we’ve done is build programmes on this platform MedicineAfrica to enable teaching, mentoring, support and service delivery interventions that have helped to build capacity across both medical and non-medical categories of health workers in Somaliland.
Q: What are the most important lines of research that have developed over the past 5 years?
AF: The interventions that we’re making, clearly it’s important to demonstrate that we’re both doing no harm and also doing good, and the good that we can demonstrate is also taking into consideration the indirect effects that one can have in the development of inventions such as supporting health worker training. Therefore we’ve done a lot of evaluation around the educational methodology, and we have a PhD student who is specifically studying whether or not you can actually train health workers in this way, remotely. The context in Somaliland is one in which there is very limited other infrastructure for supporting those health workers, therefore we hope that those interventions at least start towards that but clearly we have this PhD student studying the pedagogy, and then we have some public health physicians who have been evaluating the development impact of an intervention of this sort and health intervention of this sort.
Q: What are your plans for the future?
AF: The programme in Somaliland, we’ve currently used about £250,000 worth of NHS work-force time as volunteers to support health workers in various different ways in Somaliland. That programme is now expanding over the course of the next 3 years through funding from DFID-Somalia to support other health care workers, non-medical categories of health care workers such as pharmacists and nurses and clinical training officers. In addition we’ve started some new programmes, for example we’re now supporting a hundred medical students a week, a much smaller intervention but in partnership with doctors from Oxford, registrars to junior consultants who are supporting doctors and medical students in Al-Quds Medical Schools in the West Bank. Effectively the next period of time looks like scaling up the work that we’re doing in Somaliland, expanding into new countries including Palestine, and also a new partnership with Kenya, Rwanda and Uganda through the Royal college of Paediatrics and child health here in London.
Q: Why does you line of research matter, why should we put money into it?
AF: I think that I would create some kind of analogy between 1947 Britain where the Londoner and the Aberdonian weren’t necessarily very interdependent in terms of their healthcare, and the situation globally today. There is real potential that increasingly we’ll consider the denominator of responsibility for global health care interventions with the global population as opposed to the local or the national. Given that context and the potential for global health to increase equity across that denominator, interventions in global health which try to build capacity, particularly in countries that are fragile for example Somaliland or Palestine, I think bridging that gap is as important as the cutting edge Western science which clearly Oxford has such great expertise in.
Q: Can you tell us about any other projects you’re working on?
AF: I work here with Dr Raghib Ali in the INDOX group at Oxford University which is working around the areas of research capacity building and research collaboration in India, particularly in cancer. My role in that group is to support Raghib Ali, the Director of the Network, in order to find innovative ways of funding what is essentially predominantly research capacity building as opposed to traditional research funding streams, and supporting him to try to find sustainable ways in order to keep delivering a development intervention of that sort.
Q: How does your research fit into translational medicine within the department?
AF: Translational medicine is traditionally considered in the context of the biomedical development pipeline. There is an emergent new translational pipeline in global health which has global health research bridged across to the interventions occurring not necessarily through the pharmaceutical companies, as is the case often with the biomedical interventions, but through NGOs and ministries of health and the private sector in various different ways to build capacity in countries that have fragile health systems. This work in health worker strengthening, in supporting mentoring of healthcare workers, and in supporting the design and delivery of new services, for example a new clinic which we established in Somaliland seeing patients with mental ill health for the first time in one of its towns there, these interventions really contribute to the global healthcare translational pipeline if you like as opposed to the biomedical one. I think this is a piece of work that sits very much in that context.