Five Questions With…Ian Walker

What impact has the AGP had on patients?

Most importantly, the programme has affected people who are on the front lines of delivering care. What you tend to find in Africa is that many people receive their care in the rural areas and in many respects, they are forgotten about. In Africa, it’s often at the tertiary university teaching hospital or the big Ministry of Health hospital that things happen but that’s not where people live. The strategic focus of the grants programme has been on rural areas and it is these areas that have been impacted. I’m delighted to see that the Africa Grants Programme has made a difference.

How does this round of the AGP differ from previous years?

This round of the AGP focuses on maternal and child health and saving mothers at delivery through surgical interventions and safe aneasthesia, such as safe C-section, post-partum hemorrhage and bleeding reduction, episiotomy repair and obstetric fistula repair. In previous years we have been a lot broader, the health of mothers and babies at birth is the strategic focus this time.

Why do you think widening access to essential surgery and anaesthesia for mothers and children is so important?

Maternal mortality is a key focus of every government and of the World Health Organization. Unless you take positive steps to reduce maternal mortality, you’re not going to start affecting the data. It’s one of the key drivers in terms of national surgical and obstetric plans where maternal mortality is at the top of the agenda. If you look at the data on maternal mortality rates, women in Africa are dying at the same rate as women in the UK were 200 years ago. In Europe, dying in childbirth is almost unheard of now, in Africa it is still very common. This isn’t acceptable and has a lot to do with the rate of women requiring a C-section outweighing the number of health workers who are able to deliver the operation. To carry out a C-section you need surgical expertise and you need an anaesthetist. In many health centres in Africa there is no trained anaesthesiologists and no trained surgeon to perform the essential surgery; Community Health Workers and nurse anaesthesiologists are taking on these tasks.

How will this programme improve patient safety?

Better outcomes: skilled clinicians will have a huge impact on patient safety and hopefully this will be shown in the data. Particularly for maternal mortality rates and the likelihood of dying in childbirth, safe surgical intervention will benefit patients to a large extent. C-sections are a common procedure not just in Africa but across the world and that’s why being able to receive a safe C-section is so important. In the UK, C-sections are not something to worry about, in Africa they can be a huge risk.

Why do you think Health Partnerships are an effective model for improving health care in Africa?

A quote that I often use is: ‘If you’re coming here with charity, then please don’t come. But if my future is tied up with your future then let’s partner.’ I absolutely agree with this – charity is one directional whereas Health Partnerships are bidirectional. The true route to partnership is through mutual benefit: we learn from our partners and they learn from us. This is one of the great things about THET – your commitment to partnership.