AIHA's Partnership Model

The AIHA partnership program is a coordinated effort by the US health care provider community and US academic institutions to work with counterparts abroad to address common health care issues and concerns. Unlike traditional consultancies or individual professional exchange programs, the AIHA partnerships are voluntary, self-help technical assistance programs involving substantial contributions of professional time, by both sides of the partnership covering a wide range of health care issues. These partnerships, based on the peer-to-peer relationships of health care providers, focus on solutions to health care delivery problems that are technologically and economically sustainable in the host country. Although each AIHA partnership is unique, they all rest upon a common foundation of the following basic tenets:

1. Broad Based Institution-to-Institution Relationships

The partnerships are built upon institutional commitments embodied in formal Memoranda of Understanding between health care institutions and their larger related delivery systems in the US and the countries abroad. In both the US and the host country, partners are selected primarily on their commitment to the goals of the partnership and, particularly in the host country, their commitment to improving health care in their communities and their receptivity to innovation and change. This formal, institutional commitment helps assure the ongoing commitment of the US partner, the host country partner and, in many cases, the host country ministry of health.

2. Emphasis on Professional Exchanges

AIHA's partnership program rests upon the presumption that professionals in the countries abroad will be more receptive to the ideas and advice of their professional peers with whom they have developed a personal, trusting relationship, than they will be to "consultants" whom they may perceive as not fully appreciating their real world constraints. These trust relationships are based on regular professional exchanges between hands-on administrators, educators, physicians, nurses, and technicians of the partner institutions. Exchanges allow overseas participants to see for themselves the broad spectrum of different health care systems and begin to make decisions about what will work in their unique circumstance.

3. Voluntary Contributions and Leveraging Donor funds

AIHA and its donors are not the principal funding source for partnership activities, but rather supplement the voluntary and in-kind commitments of the individual health care professional, the partner hospitals and universities and their respective communities. Donor funds are generally limited to supporting travel and other items not easily subject to in-kind contribution and which may be a barrier to free, professional exchange. These public-private partnerships typically result in a notable commitment from non-government sources, with evidence from some partnerships of over three dollars of voluntary support for every donor dollar expended.

4. A Demand Driven, Non-Prescriptive but Rigorous Approach to Process

AIHA requires partners to develop their own specific programmatic objectives through a continuous process of strategic planning and adaptation. Objectives must address the major health problems of the community as defined by the overseas partner. This approach recognizes the need to adapt US approaches to the unique cultural, resource, and organizational needs of the host country. AIHA provides programmatic guidance in the form of process guidelines, advice and counsel in the establishment of appropriate achievable goals, and a variety of mechanisms for identifying and sharing successful approaches.

5. Recipient Investment and Ownership

As programmatic success and sustainability are only achievable through a sense of ownership, AIHA seeks active investment and participation on the part of the overseas partners and their respective governments. The joint planning of partnership programs helps assure that the overseas professionals feel the partnership meets their needs. Similarly, the involvement of regional and national health administrations and ministries assures that the partnership is firmly anchored in national priorities. In addition to the contributions of professional time, additional in-kind contributions are sought from the overseas partner and government in the form of housing, local transportation, office space, translators and meals. Partners overseas are expected to invest heavily in carrying out the partnership objectives. Capital improvements, purchases of equipment, and major changes in the system infrastructure are often required of the overseas partner in order to successfully implement partnership initiatives.

6. Dissemination of Knowledge

The partnership program is designed to have a system-wide impact. At the institutional level, for example, an emphasis is placed on disseminating a technique or approach adapted in one area to other areas where it might also be applicable. Beyond the institutional level, partnership activities are disseminated through a variety of means such as clinical conferences, "train-the-trainer" programs, internships, and the development of curricula and training materials for a wider audience.

7. Education

Whether at the university, clinical or community level, an emphasis on education is at the heart of the partnership program. Many of the AIHA partnerships focus on the formal education of health professionals through the development of undergraduate, graduate and continuing medical education courses and programs. Partnerships have also extended the scope to include local and national curriculum reform to improve the overall quality of health professionals. At the medical institutions, a focus is placed on continuing education for providers and the dissemination of new knowledge trough train-the-trainers programs. And on the community level, providers learn techniques to reach out to patients and non-patients to provide education about diseases and the importance of screenings and living healthy lifestyles.

8. Community Involvement

AIHA's partnerships extend past the medical institutions to include the local communities. Realizing that the health of the community replies not only on the quality clinical services available, but also on marketing of the services, the lifestyle choices of its residents and their willingness to take advantage of the services available, AIHA partners make community involvement a priority in their programs. From population surveys, to community boards, local residents participate in the health planning process, and through outreach programs such as school health education courses and health fairs, they receive information about things they can do to help stay healthy.

9. A Platform for Other Assistance Efforts

Once established, the partnership provides the broad-based management and strategic assistance necessary to enable the overseas institution and its parent health care system to coordinate and utilize other forms of government development assistance. The World Bank, the Peace Corps, the Muskie Fellows program, the US Commerce Department's Special American Business Internship Training Program, and the Department of Defense programs to donate medical equipment have all employed the unique advantage of the partnerships to support their programs.

10. Program Sustainability

Clinical and administrative program initiatives adopted under the partnership program are inherently sustainable because the program is demand driven: the partners themselves have identified and adapted programmatic elements to their own special circumstances and have invested in the implementation and dissemination. Both partners are mindful of the need to focus on low-tech, economically viable solutions that increase productivity rather than incur new burdens. The program goal is to increase productivity and efficacy to such a degree that the provision of essential services can be maintained or re-established. The large component of voluntary activity in the program from its inception, and the premium placed on community involvement, lead to long-term commitments and linkages which are likely to be continued at some level of effort beyond the AIHA funding period.