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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