Operating Together: Challenges and Solutions for Sustaining Impactful Global Health Partnerships From 18 years of the RCSI/COSECSA Surgical Training Collaboration

BACKGROUND: International support for surgery and healthcare in low-resource settings is primarily channeled through partnerships. To be truly impactful, such partnerships must endure long enough to mature, however longevity appears to be rare. Analysis of the challenges faced by successful long-term partnerships and how they were overcome may offer useful lessons for newer and aspiring global health partnerships. METHODS: The surgical training collaboration between the Royal College of Surgeons in Ireland and the College of Surgeons of East, Central, and Southern Africa has continued for 18 years and has delivered significant benefits for both partner institutions. Challenges faced by the collaboration and solutions to these challenges were elicited from key stakeholders in each college through an inductive approach. RESULTS: Challenges and solutions reported were grouped under four domains: power, operational capacity, changing needs, and maximizing impact. A set of governance structures are proposed to mitigate power disparities between partners and between individuals. Leveraging nonclinical staff members to support development of back-office systems increases local operational capacity to effectively engage in partnership activities. Constant change is a challenge for partnerships, which must both be accepted and planned for. The impact of work done through partnerships can be multiplied by expanding the collaboration to other comparable or synergistic institutions and making resources available open access. CONCLUSIONS: The RCSI/COSECSA collaboration program demonstrates that, over time, global health partnerships can play a transformational role in improving health outcomes in low-resource settings, while also benefitting high-income partners. Analysis of the development of the collaboration offers practical strategies for the development of other global health partnerships.