Norway Is Partnering with Malawi and Palestine

Acting on its strong conviction that public health doesn’t stop at its own borders, the Norwegian Institute of Public Health (NIPH) is partnering with Malawi and Palestine to build their public health capacity.

These “twinning” efforts aim to forge sustainable public health institutes even in the midst of ongoing political unrest, says Anne Bergh, director of international public health at NIPH.

The Malawi and Palestine efforts are part of NIPH’s portfolio of international projects that range from pure research to capacity building in low-and middle-income countries to health surveillance and meeting International Health Regulations. Global health preparedness and technical assistance comprise much of Norway’s outreach, some in partnership with the World Health Organization (WHO), some with developing public health institutes, others with its Nordic neighbors, Russia, and the European community.

The rationale behind Norway’s involvement beyond its borders recognizes that no country can actually solve many public health challenges on its own, Bergh says.

“We learn a lot from each other. We handle things differently in my country than in other countries, so this gives us the opportunity to look at how things are done in other places. These partnerships help us understand diseases better, understand prevention better, and understand how interventions work in different countries. For example, International Health Regulations require us to report if there’s an outbreak, but Norway has to depend on other countries to report their outbreaks as well, so everyone is dependent on each other.

Norway frequently uses IANPHI’s NPHI Framework as a starting point in its outreach efforts. “IANPHI is a very important organization because it makes links between all the different institutions that work within the public health field and puts them on equal footing,“ she says. “We face many of the same challenges. The Framework gives us common footing so we can focus on the practical side —getting better data, keeping track of health situations in our countries and beyond, and determining real issues. Many countries still need to meet the requirements of the International Health Regulations as well, and we can work together to help them do that.”

Norwegian interest in partnering with Malawi dates back to 2008 when IANPHI first began seeking twinning arrangements between its member countries. Since then, Malawi has moved closer to creating a coordinated public health system that can quickly and independently identify and respond to outbreaks. Despite challenges such as changes in ministry leadership, Malawi has developed a strategic plan, its Parliament has budgeted for and established the Public Health Institute of Malawi (PHIM), and work has begun on transforming the institute into a Public Trust reporting to the Office of the President and Cabinet. The goal of PHIM is to lead in disease surveillance, prevention, and control, and generate information to inform public health policies and practice. Discussions are now focusing on how to strengthen surveillance of environmental risk factors, improve compliance with International Health Regulations, set up a proper legal base, and strengthen existing outbreak response mechanisms.

“What we do is listen and learn about Malawi’s long-term strategy,” Bergh says, “and we discuss how we can work together based on mutual interests and complementary capacities to meet the strategic objectives that PHIM set for itself."

Adds PHIM Acting Director Austin Mnthambala, “The main aim of the collaboration is to support PHIM's development of its technical systems so that it develops the requisite competence, capacity, and trust of a national public health institute. This is really important especially in the early stages of PHIM's development so that it does not fall into pit holes where certain activities would not be of high impact and hence not provide necessary results. This is a mutual partnership where both parties learn from each other. We have discussed and agreed on specific areas to collaborate and implement activities together, and we hope that through this collaboration PHIM will strengthen its capacity.”

In Palestine, Bergh started discussing with stakeholders several years ago about how Palestine could build a better evidence base to guide the prioritization of scarce resources. “They didn’t have a public health institute, so we started from scratch,” Bergh recalls. After discussions with WHO, which is now leading the project, and getting the many various stakeholders on board, the effort was launched to establish the Palestinian National Institute of Public Health (PNIPH). Backed by WHO and with funding from Norway, the project is in the pilot phase now—conducting assessments, building and improving registries, and dealing with water issues and some infectious diseases, in addition to developing a governance structure for the institute.

For example, improving the quality and utilization of national health data is a core function for a national public health institute. To that end, NIPH Senior Technical Advisor Bjorn Iversen is part of a 15-member team in Ramallah assessing the cause-of-death registry, birth registry, cancer registry, and a national overview of burden of disease. They have found that the current death registry, for example, has a high proportion of nonspecific causes of death such as senility or cardiac arrest, and the cancer registry has many non-site-specific cancers registered. “Our focus is on bringing forms up to standard, setting up training on how to use them, and creating written guidelines and procedures. The people who are filling out these forms have never seen the reported results of the data they submit.”

He and Bergh expect the semi-autonomous PNIPH to be legally established in 2014.

“We see the public health institute as part of building a democracy, with health equity, food safety, environmental medicine, control of infectious diseases, and good evidence-based public health, “ says Bergh. “That is an essential part of making a state function, so it’s part of the state-building agenda in Palestine.”

Bergh believes that when building a national public health institute from the ground up, it is important not to load too much on the plate and to take a long-term view.

“A national public health institute in any country won’t be established in one or two years. It is a collaborative effort – including the government, the people who work within the public health system, the scientific community, the hospitals, the national bureau of statistics and other relevant partners. Once everyone is on board, the national public health institute will have a broad base, no matter what the political environment.”

She adds: “It’s also about the legal framework. It’s about getting sustainable funding in place. It’s about getting the right people to make decisions, finding qualified staff, and getting the right place to house the institute so people can be productive. These things take time—it’s a long-term endeavor to build an NPHI  that will last 100 years.”