Case report from a collaboration on health research between The University of Sheffield, UK, and SolidarMed, Switzerland

How to overcome inherent gaps between NGOs and research institutions

Von Michael André Hobbins, Margi Bryant, Anna Häggblom, Peter Helmold, Julie Balen, Takeshi Miwa, Chendela S Masengu, Jochen Ehmer

The demand for evidence-based programme implementation, and the need for ‘real-world’ learning for University students in international health, suggests a promising collaboration opportunity for resource-limited NGOs and Universities. SolidarMed, a Swiss NGO working to improve health systems in Southern-Eastern Africa, and the Masters in Public Health and International Development Programme of The University of Sheffield, UK, engaged in such collaboration in the years 2014/2015. Besides the known – more general – success factors that were fully met by both parties, such as good communication, logistics and support, this case-example raised an inherent gap in expectations and interests between Universities and NGOs in the conduct of research.

How to overcome inherent gaps between NGOs and research institutions

Collaboration is like cooking, given the right ingredients, you can’t have enough of it! / © Marten Bril

The article concludes that in order to maximise the impact of a Masters student’s dissertation project for the NGO’s programme, the NGO is required to integrate research long-term within its country programmes and to plan the individual pieces of research according to the capacities and available resources of all parties involved. Obviously, this requires a basic understanding of research methodology and planning within the NGO, which may further stretch limited resources, but on the other hand, it has the potential for considerably contributing to problem solving within its programmes on-site, whilst ensuring scientific quality to meet the University’s expectations. 

The new research partners

There is increasing demand towards NGOs working in strengthening health systems in low-income countries to produce good quality evidence in their field and setting, however, resources and capacities are often limited within such organisations. On the other hand, Universities that aim to prepare students for further research and employment search for innovative teaching methods that provide “real-life” experience, such as, for example, placements with partner organisations working in low-income settings. Such placements allow students to learn and understand challenges and potentials of research in their chosen area and to produce results of interest to the placement organisations.  

SolidarMed is a Swiss NGO implementing evidence-based health system strengthening projects in five Southern-Eastern African countries. To increase its analytic and research capacities, SolidarMed actively engages in collaborations with Universities and other organisations to produce the necessary evidence to inform its projects and influence its partners’ decision making at policy level.

The University of Sheffield, UK, offers a Masters’ programme in Public Health & International Development (MPHID), which includes a thesis based on original research. The University looks actively for placement opportunities where students can carry out this research in collaboration with a host NGO.

In 2014/15, SolidarMed and the University engaged in collaboration with the aim to meet each other’s interests.

Collaboration as key factor in the process

The Sheffield University MPHID programme is a joint programme between the Department of Geography and the School of Health and Related Research. It is led by the Department of Geography, alongside additional International Development Masters programmes including MA in International Development, MSc in Environmental Change & International Development and MA in Intercultural Communication & International Development. The four programmes attract approximately 60 students in total, per year.

The opportunity to carry out first-hand research in collaboration with an international NGO is believed to be a key factor in both, the high student recruitment and retention levels, as well as the high future employment rates of the Masters graduates from the University. Furthermore, the collaboration is supposed to give the opportunity for students to work within the NGO setting and, in addition to their dissertation work, support the host NGO in any judged useful way on-site.

Currently, around 40 international organisations collaborate regularly with the Department’s Masters programmes, as placement student hosts. Around 60% offer placements in the Global South and 40% in the UK or elsewhere in Europe. Students are, additionally, able to set up their own placements under certain conditions.

Based on its experience, the University has a clearly delineated process and timelines for its host organisations. A Placement Agreement between SolidarMed, the University and the selected students enshrines the common understanding, roles and responsibilities behind the collaboration. Financial responsibility for most of the placement lies with the student. Generally, two students are placed in each agreed location. Hosts and students separately evaluate the placement experience at the end of the programme to address any shortfalls in the future.

The Lugala Hospital in Tanzania; Illustration: Anna-Lea Guarisco

Difficulties in meeting the expections

Overall, the collaboration was rated as very positive by all parties involved and further ventures are planned.

The defined process of the Masters Programme for student placements was followed by all participating parties (Figure 1). After an internal briefing involving all country programmes, SolidarMed produced a list of possible research topics in four countries. From 17 students on the MPHID programme in the 2014-15 cohort, two students selected projects from a list of 21 research topics in five countries offered by SolidarMed. The two selected topics were based in Tanzania, in a secluded rural hospital in the Ulanga District.

Figure 1: Process for the placement of Masters students from the Department of Geography at The University of Sheffield, UK

A placement coordinator from the University managed all the student placements and was in regular contact with the host, informing on progress and highlighting any logistical and/or administrative questions during the preparation phase. The students were responsible for communicating directly with the host about their research plans. At the same time, each student received academic guidance from his/her supervisor at the University. Students were responsible for balancing any divergent expectations between the host and the supervisor, with the placement coordinator resolving any issues if necessary. Direct communication between the host organisation and the students’ supervisors did not take place.

After a first contact and exchange of interest and background documents, the students drafted their proposals, which were shared with the host and allowed one feedback round, involving the field team of the host organisation. While the proposals took up the general topic presented, they did not initially meet the expectations of the field team (see Box 1). The feedback and wishes from the field team were then included in the research protocol – as far as still possible - and students arrived at site as planned.

The students complied with their protocol requirements, collected the data they judged necessary and left the site to analyse and write their thesis once data collection had been completed. Study 1 included secondary data analyses of pre-collected hospital records, whilst Study 2 was based on primary data collection via a series of Key Informant Interviews and Focus Group Discussions. As judged from regular feedback from the field, the students behaved in a culturally sensitive way, and concentrated mainly on completing the data collection for their theses. Furthermore, the students, the University and SolidarMed complied with all pre-defined outputs of the signed agreement.

A summary of a debriefing session between organisations, including the students, can be read in Box 2. The overall rating of the collaboration was high for all participating parties, and constructive feedback is being considered in order to improve some details of the collaboration, with the ultimate aim of increasing the impact of the placement outputs.

While the resulting theses led to the qualification of the Masters students, they had only limited impact on the ground within the country programme. The theses described, confirmed and refined known local challenges but did not meet the high expectation from the field team to suggest adequate solutions for future implementation. Whilst this may be a common pitfall of research more generally, it is highlighted through this new collaboration and requires careful thinking about how to ensure a balance in outcomes of such endeavours.

Given the non-medical academic background of the placed students, and the short timeframe of the placement, the possibilities for them to play a more active role within the setting were also limited (hospital/medical setting).   

 


Multi-sectorial collaboration for the ones in need / © Marten Bril

Discussion & Conclusion

How to overcome the limitiations on both sides

The case example highlights that collaboration between a specialised health NGO and a University Masters programme is feasible and holds significant potential to benefit all involved. In our case, the collaboration was rated as highly positive and future collaborations are planned for the 2015/16 cohort and beyond. Nevertheless, some lessons learnt can be drawn from this experience.

The expectations with regards to the outcome of the study can vary considerably between the host and the University. While the University is obliged to ensure that the study complies with the scientific quality outputs needed for a Masters thesis, the host may search for implementable solutions to be able to rapidly react to the problems they face on the ground in the host countries. As locally relevant information on the part of the University is often limited, only the host can bridge this expectation-gap by proposing suitable research topics. The outcomes can then subsequently – in combination with other evidence – support the host in formulating suitable solutions in that specific setting. This, on the other hand, requires more in-depth preparation and reflection on the host side for adequate, tailored topic identification. As a pre-requisite, the host organisation must not only be able to identify major areas for research within its programme, but also have a minimum knowledge and understanding of programme-related research and be able to define the necessary pieces of “sub-research”, either suitable for completion through rapid, student-led projects, and/or through more long-term collaborations.

To meet the part of the agreement and process of the University that the Student can support the NGO onsite and provide support and gain experience within an NGO setting, our case suggests, that student selection may pre-determine the possibilities for students to support the NGO. Neither of the students selected had a medical academic background. As a result, neither could work clinically in a remote hospital suffering from chronic lack of clinical staff. Furthermore, in the specific setting of this case example, the timeframe did also not favour the integration of the students in administrative work in the local office (which is already covered by local employees).

The students were able to collect the necessary data within the host’s country programme and with approval from the local partners. Nevertheless, for some studies, official ethical approval may be required and the time and process to receive official approval must be accounted for in the process. As this process (length, costs etc) varies in each country and by topic chosen for the thesis, the host is required to be well-informed on the necessity and the processes – including costs and duration to reach approval – to follow within each specific setting. Based on this, roles and responsibilities for the process can then also be better defined. Moreover, the host is required to inform the student of the process before the student decides on the posted theme.

Suggestions from the University

Over the last 6 years, the University of Sheffield’s feedback and review process suggests that the most successful placements happened where: 

  • The host organisation has a clear idea of the research it would like undertaken, at least in terms of broadly-defined topics, and a genuine need for and/or interest in the potential findings.
  • The host organisation is willing to let students take the lead on developing detailed research questions and research methods.
  • The host organisation provides good support for the research during the placement, e.g. briefings from local personnel, facilitating access to research participants.
  • The host organisation provides clear initial information about practicalities and costs associated with the placement and, where necessary, some practical help (e.g. help with finding accommodation if this is hard to find locally).
  • The host organisation gives a clear indication of what it expects from the students in terms of outputs, and all parties understand and agree on what is expected.
  • Students establish good communication with the host organisation as soon as their placement is confirmed, through emails, Skype calls etc, and follow host organisation guidance where offered from an early stage.
  • Students take a mature and flexible approach to the on-placement research, are able to think on their feet and adapt to unforeseen changes in circumstances.
  • Students prepare thoroughly for their research project through the formal research proposal that they produce ahead of the start of the placement, which is assessed by their University supervisor and also sent to the host organisation (if the proposal is not of an acceptable standard, they do not proceed with the placement and conduct desk-based research instead).
  • Students prepare themselves practically for the placement, ensuring they have all the necessary insurance, vaccinations, visas & permits (including ethical clearance) etc. and find out as much as they can about the local context through independent reading/browsing.

What matters for the future

Our case example confirms these findings and highlights three additional items considered of importance for the future:

1. More detailed formulation of the research and expectations of the outcome, and an earlier involvement of the field team in the research preparation process
Only defining the topic/title of the research is not enough, if not seriously reflected within the organisation beforehand. The host must be clear on how the specified research will fit within its programme and what can realistically be expected from it. In other words, the posted research topics must be tailored to a Masters student level, ensure that field expectations are met, and as such, increase the usefulness of the outputs. 

 2. The need for all parties to recognise that academic and NGO expectations and requirements are not identical and need to be negotiated
The alignment of field expectations and academic needs is a challenge that not all students are able to negotiate by themselves. More effective internal briefing for University supervisors, the involvement in a mediating role of the placement coordinator, and in some circumstances direct communication between University supervisors and host NGOs, are all possible ways forward. Direct involvement of supervisors poses challenges given the number of students supervised by each individual academic and the time constraints placed on student-supervisor interactions. In some circumstances a solution can be found through the student producing separate outputs, with the thesis meeting academic expectations and a supplementary report addressing NGO needs. Clarity about expectations should be established as early as possible, to maximise the value of research outputs and the overall placement experience.

3. The formulation of host’s guidelines on the formal needs, process and costs for e.g. ethical clearance of the study
Complying with legal requirements of the countries is essential for the host, as a trusted long-term government partner. As such, hosts must be fully informed on the ethical clearance procedures and costs, as well as the lead-time for ethical clearance applications to be approved. These may vary, depending on the place, the type of research and other factors. Often, the process may pose a threat of delaying the realisation of the Masters thesis and therefore, such information may also serve as pre-inclusion or -exclusion criteria to have such studies in the host’s programme in the first place.  

The above case example suggests that collaborations between NGOs such as SolidarMed, and Universities such as the University of Sheffield, hold high potential to bring useful outputs to all involved. Furthermore, given the financial resource constraints of small to mid-size NGOs, collaborations between Universities and hosts – that do not rely on external funding – hold great potential for providing rapid and good quality results at minimal expense. Though students bear most of the financial burden for this work, they gain invaluable skills and experiences as well as access to well formed networks for future career development opportunities.

Importantly, however, the preparation for such venture may require a high time investment for the NGO. This investment promises, however, to pay off over time, as study results support the NGO’s programmes and its local partners in evidence-based decision making, and will effectively contribute to solving relevant problems on-site.

Box 1: A comparison of study objectives, study results and initial field expectations in the 2014/15 cohort placements

STUDY 1 Thesis title: Rational drug prescription of Clinical Officers at rural Hospital
Study goal in protocol Results of the thesis Expectations from field team
To assess drug prescription patterns and identify key determinants of polypharmacy and antibiotic co-prescription with anti-malarials, in a private hospital of rural Tanzania

On average, 2.4 drugs/encounter were prescribed (61% incl. Antibiotics)

All patients with artemisinin-based combination therapy (ACT) underwent parasitological tests; 94% (579/614) were prescribed appropriately

Health workers with ≥3 years of experience prescribe half as many drugs vs. less experienced workers, highlighting the importance of staff training and development

How do our clinical officers take a medical history?

How do they examine the patient?

Do they ask for relevant additional investigations, examinations or diagnostics?
STUDY 2 Thesis title: Research on staff attraction and retention at a rural Hospital
Study goal in protocol Results of the thesis Expectations from field team
To explore factors related to staff attraction and retention at a rural church-owned hospital in Tanzania

Reasons for leaving: Pension scheme less favourable in church run hospitals vs. government public sector

Reasons for staying: Good infrastructure and work quality

Other factors: Lack of career development/appreciation, massive workload
Deducing a feasible benefit package from existing studies by conducting a feasibility study and identify solutions for Lugala Hospital


Box 2: A summary of the debriefing session between SolidarMed, the University and the two students involved in the 2014/15 placement collaboration

Positive Feedback
Very positive overall experience for all partners and clear statement to continue with future collaborations
Well-structured process and continuous follow-up of it by the University’s placement coordinator ensured that Students completed their Masters thesis in time and with good quality outputs
Responsive and open communication on all sides allowed addressing potential threats and worries early, and helped in discussion and agreement on solutions and ways forward
Problem solving mentality of all collaboration partners was the basis to deal with all potential threats and worries
Professionalism at placement site was rated excellent and students felt well cared for during their placement
Suggestions for improvement
Ensure that all parties are involved in aligning academic and NGO expectations as far as possible, and/or developing compromise solutions (e.g. dual outputs) effectively and efficiently.
Engage with and embed the field team early in the process to ensure reasonable expectations and usefulness of the research in the field
Encourage student selection to be aligned to the possibility of supporting the host on site (i.e. students with particular skills and experiences may be more in demand than others)
Generate host guidelines to students on needs, costs and duration for ethical clearance and according roles and responsibilities
Michael André Hobbins, Margi Bryant, Anna Häggblom, Peter Helmold, Julie Balen, Takeshi Miwa, Chendela S Masengu, Jochen Ehmer

Michael A. Hobbins, PhD, MSc
Epidemiologist, Programme Manager Mozambique & Focal Point for Research, SolidarMed Schweiz, Email

Margi Bryant
Department of Geography, The University of Sheffield, UK

Anna Häggblom, MPH
Programme Tanzania/Zambia, SolidarMed Schweiz

Peter Helmold, MD
Lugala-Spital, SolidarMed Tansania

Julie Balen, BSc (Hons), PhD
Section of Public Health, School of Health and Related Research, The University of Sheffiled, UK

Takeshi Miwa
Department of Geography, The University of Sheffield, UK

Chendela S Masengu
Department of Geography, The University of Sheffield, UK

Jochen Ehmer, MD, MA, DTM&H,
Director SolidarMed Schweiz, Swiss Organisation for Health in Africa,