Designing a global health partnership evaluation

BackgroundBirmingham Women’s and Children’s Hospital (BWC)- Malawi Partnership is a global health partnership (GHP) established in 2004 as an educational link between paediatric departments at BWC and Queen Elizabeth Central Hospital (QECH), Malawi. Regular monitoring and evaluation of GHPs is key for assessing relevance, effectiveness, efficiency, impact and sustainability.ObjectivesDesign a global health partnership evaluation in accordance with internationally accepted standards to accurately capture the impact of the BWC-Malawi Partnership.MethodsAn evaluation strategy was co-developed between BWC and QECH. The evaluation methodology was designed to assess contribution of the Partnership in accordance with its vision of improving child health sustainably through education and training. Domains for assessment were based on established determinants of effectiveness for GHPs1 2 and included shared vision and goals, commitment to joint learning, sustainable, accountable, respectful, reciprocal and responsible.A mixed-methods approach was adopted using quantitative questionnaires, semi-structured interviews and focus groups at both sites. Questions were written in consultation with the QECH team to ensure they were appropriate to the local context and to reduce communication barriers. Questions focused on specific Partnership education and training activities including bi-directional exchanges, specialty teaching visits and the Paediatric Assessment Skills (PAS) course.Operational planning involved input from both organisations, scheduling interviews to ensure representative numbers from all multi-professional staff groups, avoiding disruption to clinical care and ensuring interview techniques were empathetic and allowed equitable access to all voices. Practical measures included recruiting an evaluation team with previous knowledge of the artnership, timely advertising of the evaluation, organising rooms and timetabling staff for interviews, sourcing equipment, arranging travel itinerary and accommodation.ResultsA quantitative questionnaire consisting of nine closed-answer and Likert scale questions was devised, as well as thirteen questions for the semi-structured individual interviews, to complete in fifteen minutes. Mock interviews were conducted to test for understanding and time management.Due to the COVID-19 pandemic, a digital questionnaire method of evaluation was used for interviewing BWC.All aspects of the design and implementation was completed in time for the evaluation. Designing the evaluation and organising the strategic, operational and practical aspects of the evaluation took two months to complete.ConclusionsEvaluation is essential for effectiveness, credibility and accountability of GHP. Planning and perfecting the details of the evaluation to be context specific, capture key components of artnership interventions, address equity, collaboration and governance, requires considerable investment of time and manpower from both partners. Partnerships should take this into account while planning evaluations to ensure success of the process and sustainability of the artnership. Advance design of evaluation instruments and processes which are specific and relevant to the partnership circumstances is crucial for the collection of reliable information.ReferencesTHEThttps://www.oecd.org/dac/evaluation/49756382.pdf

Responding to the COVID-19 pandemic: The experiences of South Australia's Rescue, Retrieval and Aviation Services.

COVID-19 poses significant challenges to pre-hospital and retrieval medicine (PHRM) clinicians - and many are unique to this area of clinical practice. We share the experiences of the South Australian Ambulance Service (SAAS) MedSTAR Emergency Medical Retrieval Service in preparing for the COVID-19 pandemic in the pre-hospital and retrieval setting - including the role of a multidisciplinary leadership team; challenges and potential approaches to screening for COVID-19; personal protective equipment for pre-hospital and aeromedical taskings; issues arising with interstate retrievals; and the role of telehealth. Although novel solutions allowed SAAS MedSTAR to continue to deliver high-quality care, considering the resource implications involved in undertaking the transfer of patients with COVID-19, it is clear that significant community disease transmission threatens to overwhelm any PHRM service. Should Australia face a significant future outbreak, it is conceivable that some PHRM operations may need to be reduced or suspended entirely.

The Operation of Canada's Only Virtually Operated Radiation Oncology Service During the COVID-19 Pandemic.

PURPOSE: Our institution operates a remote radiation oncology service in Northern Ontario, Canada. Since the start of the coronavirus disease 2019 pandemic, this center has operated without radiation oncologists on site owing to safety precautions, and this study seeks to understand the effect of this shift. METHODS AND MATERIALS: Departmental level data reports were used to investigate differences in metrics between April to May of 2019 and April to May 2020. These metrics include the total number of referrals received, average wait time from referral to consult, the number of cases that underwent peer review before beginning treatment, the total number of fractions given over each period, patient-reported outcomes, and patient satisfaction. We also examined the importance of physical examinations and the use of SABR treatment. RESULTS: There was an observed decrease in the number of referrals received, total number of fractions administered, and number of patients providing patient-reported outcomes. We observed no change in patient wait times, cases undergoing peer review before commencing treatment, or overall patient satisfaction. Challenges were identified in the collection of patient- reported outcomes and the conduction of physical examinations. CONCLUSIONS: This paper provides proof of concept that a radiation clinic can function entirely virtually in the short term without sacrificing patient satisfaction, efficiency, or safety.

Decision support tool and suggestions for the development of guidelines for the helicopter transport of patients with COVID-19.

The novel coronavirus SARS-CoV2 emerged in December 2019 and is now pandemic. Initial analysis suggests that 5% of infected patients will require critical care, and that respiratory failure requiring intubation is associated with high mortality.Sick patients are geographically dispersed: most patients will remain in situ until they are in need of critical care. Additionally, there are likely to be patients who require retrieval for other reasons but who are co-incidentally infected with SARS-CoV-2 or shedding virus.The COVID-19 pandemic therefore poses a challenge to critical care retrieval systems, which often depend on small teams of specialists who live and work together closely. The infection or quarantining of a small absolute number of these staff could catastrophically compromise service delivery.Avoiding occupational exposure to COVID-19, and thereby ensuring service continuity, is the primary objective of aeromedical retrieval services during the pandemic. In this discussion paper we collaborated with helicopter emergency medical services(HEMS) worldwide to identify risks in retrieving COVID-19 patients, and develop strategies to mitigate these.Simulation involving the whole aeromedical retrieval team ensures that safety concerns can be addressed during the development of a standard operating procedure. Some services tested personal protective equipment and protocols in the aeromedical environment with simulation. We also incorporated experiences, standard operating procedures and approaches across several HEMS services internationally.As a result of this collaboration, we outline an approach to the safe aeromedical retrieval of a COVID-19 patient, and describe how this framework can be used to develop a local standard operating procedure.