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118

JCPSLP

Volume 18, Number 3 2016

Journal of Clinical Practice in Speech-Language Pathology

with higher level political influence, it is useful to consider if

there is a strategic role to influence change in conjunction

with majority-world partners. For example, in Ghana visiting

minority-world partners have met with government officials

or participated in media events in collaboration with the

local team, assisting with the local agenda to build

awareness of communication disability and lobbying for

improved services. Such meetings are carefully planned as

part of the partnership.

Environmental sustainability factors

Service environment

Investing time considering the wider service context when

considering relationships and support in a majority-world

country is prudent. Contacting a number of individuals or

groups to ask questions about the range and types of

services in the country (e.g., government, private and NGO

services) provides a perspective of “the lay of the land”,

including population needs and how services are organised.

For example, some independent SLP volunteers to Ghana

have previously liaised with a range of services and

clinicians to discuss the situation and need in Ghana, to

determine how and when to partner with a particular

organisation. Gaining such an overview of services and

need in-country can assist visiting clinicians or

organisations to determine where and how contributions to

that country may be most beneficial. Such an approach

also has the potential to increase communication between

SLPs and organisations who may collaborate with them on

projects during their visits.

Direct or indirect services

Working alongside a local partner will allow capacity

building, enable the local partner to follow-up initiatives, and

increase relevancy of services. Before providing direct

clinical services, consider the relevance, appropriacy and

sustainability of these services. Never offer direct clinical

services alone, without planning how such services can be

culturally relevant and sustained.

Professional networks

In Ghana, local SLPs routinely seek to engage with visiting

minority-world SLPs. Creating these professional networks

of practice is an effective way of building a knowledge and

resource base in a country with limited services for

communication disability. When visiting SLPs do not

engage with other SLPs or providers in the country the

potential to waste precious expertise and duplicate

resources is increased.

Work environment

Attempt to understand the constraints of local staff,

including SLPs. The reality of working in a majority-world

country is often challenging, with huge clinical demands,

low salaries, limited technology access (e.g., no reliable

internet or work phone), underdeveloped systems,

bureaucracy and sometimes unreliable basic services such

as water and electricity. For example, in Ghana access to

technology in government services is extremely limited.

There is currently no internet access in the hospital

speech-language pathology service and SLPs frequently

use their own resources to contact international SLP

colleagues. Limited access to technology can impact both

finances (and therefore willingness to call/log on) and

timeliness of responses for local staff which can sometimes

be perceived negatively by minority-world partners. Projects

with funding could consider limited support for the team to

access appropriate resources.

individual

], we offer our own perspectives on how minority-

world SLPs can best assist those in the majority world to

develop sustainable services. Based on our experience of

collaborations with minority-world stakeholders, we

considered the question, “What do we believe is best

practice for minority world SLPs to do, discuss or consider

when visiting Ghana to assist in sustainable service

development?”

Factors around sustainability are key to discussion of

how minority-world SLPs can best assist those in the

majority world to improve services for PWCD. Recently

the United Nations (2015) adopted 17 sustainability goals

for development. These goals address three commonly

recognised dimensions of sustainable development:

economic, environmental, and social and. In this paper

we use these three sustainability dimensions to structure

our views on partnerships between SLPs in minority- and

majority-world countries. The following observations

expressed are not intended to be exhaustive, but represent

our observations from the field.

Economic sustainability factors

Economics

For sustainability, services need to be both economically

viable and relevant to the needs of the population.

Minority-world partners who seek understanding of the

economic context, including factors such as service funding

models, costs of services, service affordability, can make

more informed choices about the nature of their

involvement. Researching economic indicators and seeking

information from majority-world partners can assist in

understanding economic factors. For example, all SLP

services in Ghana are fee paying, with costs varying

enormously. Understanding the type of service you are

partnering with, the types of clients who are able to access/

afford the service, and the cost relative to other services

can help give indications of the long-term sustainability and

impact of partnering with a particular service.

Opportunity costs

Understanding the opportunity costs which may impact

local counterparts (and which may not be immediately

obvious) can assist in project planning and implementation.

These factors may include:

1. How much money people attending training or therapy

sacrifice due to loss of income, or indirect costs (such

as transport) of meeting with you. Such costs can be

significant when families are struggling to make ends

meet.

2. Understanding of the time required by local service

providers to plan for visits or projects, and what

happens to existing, stretched services when additional

time is needed to assist planned visits. That is, what do

local staff stop doing to assist in organising international

programs or visits? For example, past visiting programs

in Ghana have taken a number of days of planning and

organising. Due to the lack of administrative support,

much of this time has been taken from clinical services.

It is necessary to understand and weigh up the cost-

benefit of such commitments.

Lobbying

Improvements in sustainability require developments in

economic and social policy. Activism, for improvements to

awareness, rights and services, forms a large part of

disability engagement in majority world countries, including

for SLPs (Wickenden, 2013). For minority world partners