Christina Naula 00:00

Excellent. So we've got our second

speaker, Michelle Hanegard so she's
going to be talking to you about
sustainability and capacity building
which is a really important topic to cover.
Well, essentially, everything that we cover
today is really important.

Unknown Speaker 00:23

And will be really, I think, really come into,

Christina Naula 00:28

talking about the exam I think, this will be
all the material that we cover today will be
really material that will be covered in your
preventive medicine exam paper. So you
know, there's a lot of kind of questions and
scenarios that we could think about. So I
think, from that perspective really
important. So I'll hand over to Michelle,
and she could tell you a little bit more
about herself, and then
present her talk. Thank you very much,
Michelle.

Michelle Hanegaard 00:58

Thank you so much, Christina, and it's nice
to almost meet everyone here. I can see
one person has got a video on. That's
great. Thank you. The rest of you. It's really
nice to to meet you. My name is Michelle,
Michelle Hanegard, and I'm the director of
learning and capacity building at UK-Med,
I've worked with UK-Med for 3 and a half
years now.
And my background really is in training
and capacity building, so less of a
kind of a pure humanitarian experience,
but much more on the longer term
considerations around how we make sure
that our interventions are sustainable
and how we try and make sure that our
health programs, even though they're
short term in UK-Med that they leave a
lasting change somehow behind. That's
that's the objective, at least. But I'll go into
that now. I have got a presentation that I
want to share.
It is here. Bear with me 1 second.
So
I'm going to

go full screen.
Let me.
Sorry I don't have Internet issues. I've just
got computer problems, I'm just thinking
about it. Let's bear with me 1 second.
There we go. Great. Okay so for the next
40 minutes or so/45 depending on how
much I talk
I'm
going to talk everyone through a capacity
building as one way that UK-Med tries to
make sure that our inventions are
sustainable.
We've got multiple approaches to
sustainability and I think this one is
probably our strongest direct intervention
that's related to sustainability.
We're also, on top of capacity building,
we're building partnerships with
both international and national partners
across the world as part of capacity
building actually as well. So there's a lot
going on within UK-Med
on the capacity building side, and actually
wider in the sector as well around the
where it's increasingly, I think, being
recognized that
humanitarian responses need to have
elements of capacity building is part of the
strategic objectives of the WHO EMT
secretariat to focus on preparedness and
readiness on national levels as well.
So this is one of the things I'll talk through
a little bit more.
So first of all, why, capacity building? I
think I've already kind of said that, but I
want to go into a bit more detail.
So David Anderson this morning would
have shown you this model, and as part of
delivering sustainable high impact.
Sorry I'm trying to move my bar here, just
bear with my second, I am sitting right in
the middle of
my screen. There we go.
So as part of deliver holistic humanitarian
interventions
UK-Med specifically works in 3 different
ways. We've got our EMT
surge responses which are short term gap
building, bridging, urgent health needs
and gaps in national health services.
And then we've got our longer term
humanitarian conflict responses where
currently we are working, both in Myanmar
and in Ukraine. And then we've got
capacity building which is
for our perspective it's really about
working with national and international
partners around making sure that there is

a stronger preparedness, because, as we

all know as and as I'm sure you'll have
heard several times today, the first
responders will always be the people who
are already on the ground. And
a strong emergency response is entirely
dependent on those first hours and days.
So if we work to make sure that the first
responders have a certain level of
preparedness
then that saves lives ultimately.
So that's where UK-Med's capacity
building is focused, it's around ensuring
preparedness, we'd never go in and
deliver capacity building on I don't know
advocacy because that's not really what
we do, it's really closely integrated into our
overall approach to a humanitarian
response
and health needs. Yeah.
Oh
Right okay.
See, I'm the trainer and I always have tech
issues, it's very embarrassing. There we
go. Right so we have got 2 different ways
that we deliver capacity building within. So
one way is as part of our responses. So I'm
sure some of my colleagues will have
talked about the fact that we always
integrate capacity building into our
emergency responses. So that is really
one of our
main
ways of working, it's part of our exit
strategy, if it's not part of
the original TOR so the original terms of
reference for an emergency response,
then it certainly is always part of the exit
plan. So when we feel that the urgent gaps
are starting to, or the urgent needs are
starting to
decrease
that's when we would provide
recommendations to Ministries of
Health/National colleagues around these
are some of the longer term gaps that
we've identified do you want some training
capacity building within that?
And we've not had anyone say no yet. So
it's really an integrated part of our strategy
and our approach to delivering
emergency responses.
Our ideal responses would have an
element of capacity building running
either fully integrated or in parallel with the
response from the very beginning.
And I want to give a couple of examples of
what we've done. And how we do it.
So these 2 are examples of training and
capacity building that we delivered as part
of our covid responses. So that is really
kind of technical training. You can see on
integration, and on specific clinical
protocols where we're working with
national staff on making sure
that best practice is implemented on
facility level. So that was a very large part
of our covid responses for almost 2 and a
half years to deliver this type of training.
That could be on integration, it could be
on IPC, it could be on referrals, it could be
on pretty much anything like patient flows
within a facility, referrals between facilities
we've given advice on as well. So
the majority of our responses within Covid
was actually this type of activity, to work
with national colleagues on making sure
that they had a sustainable way of of
dealing with the pandemics peaks and
troughs.
Then we have. So this is a picture, I
believe, from Samoa. I'm not entirely sure
where this is from but it's certainly
representing another capacity building
activity that we do a lot of which is one to
one mentoring and on the job training. So
not an actual
formal workshop or training activity, but
working in very close collaboration with
national counterparts and making sure
that general practice is strengthened in
certain areas.
And
again that was a big part of what we did
during Covid, and it's been a big part of
what we did, both in diphtheria and in
measles responses in the past as well.
And last, but not least, so
the observant student will notice that this
guy, who looks very poorly in the picture is
actually our current health director. So
that's Ram who you heard from this
morning. And that's Ram
in the middle of a big simulation exercise
that we did in Lebanon to to simulate a
mass casualty incidents during Covid.
And
that's another way we deliver training.
Simulating real events within facilities to
make sure that
either suggested protocols or future
protocols and are tested and improved,
based on
the outcomes of the exercises. So most
formal training activities we do within
responses would have some sort of very
practical element to it whether that's
simulation exercise, or it's kind of
on the job training, that really depends on
what is appropriate.
Okay.
So the other way in which we deliver
capacity building is standalone. So that
would be delivering capacity building
outside of emergency responses. We've
got a couple of
long term programs where we deliver
capacity building and work very closely
with national partners. We work very
closely with national NGOs, international
NGOs, UN agencies. On again, as I spoke
about in the beginning, increasing general
preparedness and readiness to respond
to emergencies.
And I'm gonna give a couple of examples
of what we do here as well. But again, just
to reiterate that what we do for
preparedness and readiness is always
around the emergency response phase or
the kind of the crisis phase of the
emergency cycle we'd never go in and
work
on,
or certainly we haven't yet, gone in and
worked on long term kind of resilience
building and system strengthening it's
mainly on service level and it's mainly on
preparing for that acute phase
where we need to, either where national
systems need to scale up reprioritize and
yeah, address an urgent need.
So one of the things we do here is...

There we go.
Because I can't see my pictures on this
thing. So I'm just going to try and
make this, it's cause I can see the video
and I'm just going to try and make it
smaller.
There we go.
Yeah, so these are some examples of
what we've done on kind of pure capacity
building, standalone capacity building
activities in the past.
These 2 pictures are from a training we
delivered in Afghanistan in collaboration
with IOM.
So we delivered both a training on Covid
and then we came back a couple months
later and delivered another training on
trauma, which is where the pictures here
are from.
And that's just to exemplify that
sometimes either international partners or
agencies
reach out to us directly and request for
specific training activities. So this was 2
stand alone, 2 week trainings that we kind
of just went in and delivered and went
back out. We do some of that but what we
do more of is what we've got to left now is
long term collaboration
with partners. So we've got a UK- Med is
part of the initiative which is called READY,
which is a consortium
which has got 5 partners in it, so it's led by
save the children and UK-Med is a partner,
Johns Hopkins is a partner and a couple
of others.

And it's outbreak specific. So basically,

what we do within READY is try and
strengthen global, it's very ambitious,
global preparedness for a outbreak
response.
And the target audience for READY
specifically is national and small
international NGOs. So the pictures here
are from training that we delivered in
Sudan. So the one to the far left is from a
training we delivered in Khartoum a year
and a half ago on outbreak readiness.
And working with a national organization
in Sudan on making sure that they had

their operational platform, was ready for

them to establish and mobilize a
response. So that's what we often find
with partners is that clinically, there are
actually quite strong
and that's that's often where where the
least gaps are found actually but it's the
ability to rapidly scale up
and be able to

from the operational perspective so

logistics, finance, HR,
training be able
maintain a response and have a plan in
place for how you want to actually make
sure that all the people get to the right
place at the right time to deliver the care
that's needed. So that's where we find the
most gaps and that's actually where we
find ourselves
as an organization working with most
partners which is quite interesting
because you might think that it's it's on the
clinical side but really it's quite often
around the kind of how do we actually do
the how? Of how do we actually deliver
responses? That's the biggest challenge.
So yeah, so that's an example from Sudan.
And the other example is from a very large
national organization in Cameroon, and
who run
more than a hundred health facilities, both
on kind of community all the way up to
secondary level. And we work with them
on making sure that outbreak response
was factored into their ways of working on
facility levels. It's quite cool.
So that's the sort of stuff we do
specifically for outbreak and specifically
working with national actors
which is quite impactful. An organization
we're working with in Ethiopia just let us
know the other day that they've now,
actually, because they've worked with us,
and they have a plan in place they've
managed to get funding to deliver a
cholera response which is ongoing in
Ethiopia
which is absolutely fantastic. To have been
part of making sure that that can happen
is a massive success for us, and I'm still
buzzing about it.
Right
I want to talk about Myanmar. So we've
been in Myanmar for almost 3 years. So
it's a safe hospital program
and the main thing, the main activity we
deliver in Myanmar. We started up the
program just around the time the coup
happened. So it took a while for for all
partners as part of this program to kind of
rejig and rethink what we were doing. But
what we're actually doing in Myanmar, and
have been doing for several years, is
working with
volunteer ambulance staff on making sure
that they can actually save lives in the
acute phase of the pre-hospital phase.
Yeah. So that's just another example of a
long-term engagement we've got when it

comes to capacity building.

And what they've done a lot of in Myanmar
is they've basically run a train the trainer
approach. So they've got a core group of
ambulance drivers who now have
probably not fully paramedic skills but they
used to be civilians. Now they've they've
got the skills to kind of
perform basic life-saving interventions
and they're now training their communities
in the same. So again

really, strengthening
on the ground abilities to respond in
crises.
Okay, I had one more example. Sorry I
forgot about that one. And we're also
working with National Ministries of Health.
And this is a picture from a recent visit in
Ethiopia
where we work very closely with the
Ethiopian National Emergency medical
team on supporting their journey to get
verified on the WHO.
And we are also working very hard on
making sure that we can respond with
them to emergencies both within and
outside of Ethiopia.
So that's another long term capacity
building engagement. We've been working
with Ethiopian colleagues since
November last year. And we're hoping to
carry on until the end of next calendar
year. So it's quite long term, it's slow but it
makes a big difference for these national
actors.
Alright. So
let me just check my time. Okay.
So our approach to capacity building is
quite broad. I'm not going to talk you
through every single detail of it because
that would be
boring, I think. But I do want to just explain
how we plan these things out and why that
is/why we make the choices we do?
Because obviously, capacity building is
about
making sure that we build skills, we build
knowledge, we build behaviors, practices,
and the way of doing that is
somewhat straightforward in some cases
and quite complicated in others. So
we've got 4 overall approaches that we
apply when we do capacity building. So
one is obviously, we use adult learning
methodologies.
And because of the field we work in it has
to be highly experiential, it has to be
practical, it has to be about
actually building skills. And if you want to
build skills you have to give people very
active learning activities so not what we're
doing today, where we have a lot of
presentations for you guys, it's actually
kind of working alongside people.
Also what is important for us and for our
partners to understand is that
we don't make the guidance up. So when
we train national health staff, when we
train anyone, really, we take point of
departure in international clinical
guidelines and protocols. So if we deliver
a response in

Turkey, we follow the Turkish

national guidelines and apply those. So
we embed fully within a national health
system in that way.
Ifthe country has no guidelines then we
follow WHO. Or if they ask us
that we want to strengthen national
guidelines then we kind of work with WHO,
best practice, EMT guidelines and
national guidelines in order to create
something/co-create something that
is

applicable in that context because you

can't just pick up a protocol and apply it
everywhere.
We are drawing on clinical and operational
standards and best practice and
experience. So that really refers to our
people who design and deliver the
capacity building
and then localization principles. I don't
know if you guys know about the
localization agenda but it's really big in the
humanitarian sphere, and I'll go into a bit
more detail about
some of the things that we try and
consider or
where we feel we feed into the localization
agenda with our capacity building
approach.
So first of all I

think I've talked about this before when I

talked for it. But I just want to kind of
reiterate that the way we learn or the way
we design learning interventions,
interventions within UK-Med is always by
following
a

set structure so we analyze what the

needs are, then we design a learning
intervention, then we develop the content,
then we implement it, then we evaluate it.
So that's what you can see, that's the
ADDIE.
And all of those steps are done in close
conversation with
the target audience, basically.
And then you've got this experiential
learning cycle that is over to your left,
which is basically around what I talked
about,
we
make sure that learning interventions is
about learners experiencing stuff being
able to reflect on it and then being able to
generalize and apply it. So that's how both
individual activities, but also sessions and
whole courses, are designed to make sure
that we go through that cycle because
that's how you build skills, basically.
And then
this is how we evaluate. I'm not going to go
into too much of that because
that is just to show you that we've got a
structured approach to that as well.
So our portfolio, I think I've already talked
through some of the portfolio but I did just
want to reiterate the topics I guess/the
themes we can and and do deliver training
within is pretty much everything from
technical training on very specific kind of
clinical niche areas
that we have and continue to deliver
training within. It's also operational as I
talked about with the READY initiative, so
really working closely with
the logistics department of a national
organization to make sure that they have
got the stuff they need to deliver a
response.
And then
we've got a couple of quite niche
capabilities when it comes to what we can
deliver. So there's a whole area which is
called medlogs and we're quite strong
within that so we also do deliver support
on that and
WASH for health facilities is also fairly
niche area that we support quite a lot on.
So I don't know if everyone will know but
WASH is water and sanitation and
hygiene.
And
then
TOT approaches so really developing and
preparing emergency response staff. So
that's a big part of what we do as well.
And the methodologies we use. Again, I'm
not gonna go into too much detail, this
very nerdy training specific stuff but just I
wanted to highlight that there is a range of
activities that you can choose, and then
we do choose to deliver when it comes to
capacity building, where you range from a
self-directed approach where learners sit
in their own time and learn their own stuff

which obviously is something that can be

made accessible to very broad audiences.
And then there's the very high effort in
person, on the job training and mentoring,
which is often one to one support, which is
the other end of the spectrum.
We pretty much do everything in between.
So we do simulation exercises where we
set up facilities and field hospitals
and kind of run through patient flows. We
run exercises for our leadership. We do
very niche remote support on a

I don't know HR processes for managing

emergency rosters. Yeah, so like anything
you can think of really, we kind of do when
it comes to the methods you can use to

train and prepare responders.

Okay, contextualization of guidelines. I
think I've spoken through that in quite
some detail. But I did just want to mention
that.
And I'm sure you've you've heard about
this already today but being
a classified emergency medical team with
the WHO means that every time we
respond, we do adhere to standards, and
that is kind of what we are being
measured against.
And those standards are
checked and monitored. And this picture
down on your left is from our
reclassification that happened a couple of
weeks ago in the pouring rain in
Manchester, in the UK. It was a very wet,
very cold day, but WHO came and double
checked that we were still alright to be an
emergency medical team. And I'm happy
to say we've passed that exam.

But yeah it's quite a detailed process. And

it does mean that there are very high

standards that we're able to live up to and

we've kind of got
reverified that that we are still able to do
that. There are also standards for training,
which I won't go into a lot of detail about
but I'm happy to take any questions on in
the panel later today, if that's of interest to
any anyone.
Here we go.
So our people
and
get all this up there we go.
So standards, best practice and
experience. This is really what in an
emergency response you want
experienced people, you want highly
skilled clinicians, you want highly skilled
operational staff, you need highly skilled
people who are also very resilient.
There's only so many of those in the world.
So what we do in UK-Med is that we
recruit our people from across
the entire world really. So we've got a very
big cohort on our register of about a
thousand people
who are from the national health system in
the UK. Increasingly we're also recruiting
international register members
to our register so our roster really. And we
draw from that roster
both for responses, but also for capacity
building delivery.
So we're currently working with a small
cohort within the roster to train them up to
deliver our capacity building interventions
with us
as well as training them to deliver the
responses.
So that's really where I think at least UK-
Med has a really strong
ability to deliver training and capacity
building in a sustainable way, because
we're always able, I say, always we're
almost always able
to source staff who know the region that
we're delivering training in, who are highly
clinical,
clinically competent and experienced and
combine a faculty really, that is able to
both provide that contextual and
humanitarian expertise and experience as
well as really highly, clinically experienced.
Sorry let me just move this.
Yeah and then obviously we were, as I've
said several times, we work alongside
Health Ministries, and partners in WHO
and other UN Agencies.
And we do that very closely. Our
partnership approach is very important to
us for several reasons: we're small we
can't do everything alone but also we want
to make sure that in the sector

it much more about actually saving lives

is
than it is about kind of protecting your own
domains. So we have a lot of partnerships
with a lot
of organizations and agencies across the
whole world.
And this is a big priority for us to grow as
well.
So many of the national NGOs that we've
worked with as part of the READY
initiative, for example, for the outbreak
preparedness side of things we continue
to work with as

implementing partners. A good example

of that is that we worked with

an organization from Syria, who works out

of Gaziantep as well, and we work very
closely with them in the early days of the
Turkey
earthquake response. So that's kind of
how we link capacity building with
response and the other way around.
It's quite organic in that way.
Last, but not least. And please don't worry
about the very busy slide that's coming up
here. I'm not going to go through all the
text. But I did wanna mention the
localization agenda because this is
something that is very, as I said, it's very
important within the humanitarian sector
and it's something that we challenge
ourselves as humanitarian actors to make
sure that we
reflect about, and this really, for me, at
least, I'm sure someone out there may
disagree but for me, this is where the
sustainability comes into it really, it really
is.
So there's 7 dimensions. I'm not going to
go into this. If you are interested in
localization, this is free to find on the
Internet, you can just Google localization
dimensions and this document will come
up, it's about 80 odd pages so not a light
read but really interesting. And has a lot of
very practical advice around how we can
strengthen, how international actors can
strengthen and
national actors space and ideas on how
we can make sure that that space grows.
So highlighted 4 dimensions out
I've of the
7, that that we feel applying UK-Meds
capacity building work.
So one thing, and I think, looking at the
range of types of activities we do within
capacity building this is quite a good
example. So we view
capacity building as knowledge exchange.
So a lot of our on the job training, our
protocol development, our
yeah, anything we do really is working with
our national counterparts. We never go in
and say, we know exactly how it's meant to
be done, we have advice we have
experience, but it's about working with
national counterparts on making sure that
what we advise is actually
feasible to implement. And
then the direct partnership. So basically
I've talked about that quite a lot. So

working directly with healthcare workers,

communities,
probably less so because we don't stay so
long that it's actually
for us we meet the direct patients but it's
not that often that we actually work
directly long term with communities we
leave that to our national counterparts.
There we go. And then building
coordination capacity. So that's working
with ministry level partners on making
sure that emergency
protocols are strengthened. And we've
worked with a number of of national
counterparts, specifically some of the
work we're doing with the Ethiopians at
the moment
and making sure that they are able to
deploy their EMT internationally is part of
this.

Yeah, I think that's it that I wanna go into

with that. I've only got a couple of minutes
left.

In those couple of minutes I want to talk

about and the preparation part. So I've
talked a lot about what
we do for sustainable interventions
externally
a big part of us being able to even deliver
a response is our work on preparing our
responders.
So we've got this list of a thousand people.
That I'm sure you've you've heard about
already today. What is very important to us
and is actually a requirement under the
WHO EMT mechanism is that we train and
prepare our responders.
So I just want to very briefly talk about how
we do that and the types of courses that
we take people through. I'm not going to
linger too much because it is not really
directly part of our capacity building
interventions it's more around making
sure that what it's quality, it's
preparedness from our side, basically and
this is what we also train
other agencies and partners on how to
build their own
preparedness pathways.
First of all
what is needed, we feel at least, is is a
clear competency framework. So
when you want to

work with freelancers and full-time staff as

well but if you want to adhere to standards
it's quite important to have something to
be able to measure those standards
against.
So a couple of years ago, we wrote a
competency framework that we are now
rolling out across
assessment training, across recruitment
processes
and these 6 core humanitarian
competency domains that you can see in
front of you are built into all of our training.
So a lot of it is really about making sure
that we either strengthen or pull out and
polish some of these competencies that
most of our registry members will already
have
but
some of them are specifically
humanitarian, and specifically
competencies that one may not meet in
one's day-to-day job in one's national
health system, regardless of where you
may work and live because it's about
delivering healthcare in
highly
volatile contexts. So it's about having
adaptable, flexible approaches and being
really able to
think on your feet, which most of us can
but if you're in a
volatile environment
your ability to do so is obviously
challenged. So this is our competency
framework. Again, this is actually pulled
from a global framework that was
developed by a series of international
NGOs
about
12 years ago I think it is so I believe it was
in 2011.

What we did in UK-Med was we took the

global framework, and then we pulled out
the most key pieces of it that we felt
related to us, and then we added a bit as
well. So that was kind of what these 12
National NGOs did back in the day. They
developed a global framework, did
massive consultation process across
numerous organizations,
and had this kind of very general
framework that they sent out and
launched for the entire world to for
organizations such as UK-Med to be able
to pick up and kind of

contextualize it to make it fit our needs.

Let me see what time I'm on, I've got
2 minutes.

So I think one big thing that I want to say is

we don't train our

staff,so our register members, we don't
train them on how to deliver their job. So
we recruit experienced nurses, medical
doctors, logisticians,
wash engineers, paramedics, and so on.
We recruit
professionals who are already very
experienced within their professional
background. So what we do is step 2 and
3 here in front of you.

We train and prepare for the humanitarian

context for the fact that it's gonna be
changeable, we are going to need to be
adaptable, we're going to need to adapt
our practice and
think out of the box with how we do things.
And in some cases we're gonna have to
adjust our expectations for what is
possible, both clinically and but also
practically.
And that can, I'm sure you guys can
imagine that that can be really tricky,
especially for clinicians to have to
sometimes, in their professional opinion
compromise on the quality of care. It's
never a compromise because it's about
doing what is practically possible within a
certain context and a certain situation.
And that is what we try and train and
prepare our staff for cause that can be
really tricky
and difficult to deal with. So this is why we
do a lot of simulation exercises, we do a
lot of case discussions on ethical issues
and that sort of thing as part of our
preparation activities.
And
yeah, I think I'll stop there and maybe just
leave there you go.
Iwas done. But yeah, I think that is the
main thing I want to to say. So I'll stop
sharing.
And say, Thank you for listening.

Christina Naula 45:22

Thank you very much, Michelle.

Unknown Speaker 45:25

So

Christina Naula 45:27

that's open for questions. If anyone has
any questions now, or we can, of course,
also you can save them up for the panel
discussion provided Michelle that you are
going to be coming along to that.

Michelle Hanegaard 45:41

Yes, I am.

Christina Naula 45:43

So would anyone like to get us started?
We've got a thank you on the chat.
Any questions?
You must be starting to feel a little bit
tired. We've just got one more session to
go, and the discussion hang on in there.
Questions.
No? It was fairly clear. So
Iguess we'll maybe then take a wee break
and let me just check the time. I'll give you
some moments to write let me just check
the time but our next session
so that's gonna be migration and refugee
health. We've got a 15 minute break so you
have time for a wee coffee? And yeah,
see you then. So let's say thank you to
I'll

Michelle. As I said, she'll be at the panel

discussion, so you can think about your
questions. And it was quite a lot of
information to take in.
And I'm saying that from a perspective of
having listened to Michelle for the second
time.
So you know, I'm a bit at an advantage
over you. So yeah, let's meet up again.
With Theresa
at 3:15. My brain is not working. Anyway,
I've set up multiple times today.

Michelle Hanegaard 47:11

So okay, thank you, Michelle. Thank you.

Christina Naula 47:18

I'll stop the recording.