Area of work: Research Training, Drug Discovery
Location of work: Blantyre

Project lead: Suze Farrell
Contact details: s.z.farrell@dundee.ac.uk

Partner organisation: College of Medicine at University of Malawi
Partner contact: Fanuel Lampiao

Funding: Wellcome Centre for Anti-Infectives Research (Welcome Trust funding)
More information: https://wcair.dundee.ac.uk/training/expert-visits/college-of-medicine-malawi/

Description of project

The Wellcome Centre for Anti-Infectives Research aims to support scientists looking for new medicines for neglected tropical diseases. These diseases have a disproportionate effect on countries in Africa, South America and Asia. While research will continue in Dundee, there is a need to build capacity in the drug discovery science that occurs in the countries most affected by the diseases themselves.

The University of Strathclyde worked with the College of Medicine, Blantyre, on the development of a Master’s course in Traditional Herbal Medicine. Their programme was called IMMPAQKT. We have continued to support some of the aspects of this programme by providing training (both taught and practical) on drug discovery science.

Teaching is delivered on an annual basis for 2 weeks in the College of Medicine in Blantyre. This teaching is open to individuals from other institutions in Malawi. Participants must be working on some aspect of drug discovery, and can engage with training in basic concepts and techniques for this type of research.

Another aspect of the partnership is the placements that we offer in Dundee. Part of the remit of the Wellcome Centre allows us to bring scientists from low-middle income countries to train with us in Dundee for periods of up to 1 year. We accept technical and/or academic staff who are working in Drug Discovery.

Key successes and outcomes so far

We have only had one trip so far so it is early to share successes. We have 2-3 individuals coming to train with us in Dundee based on the training programme in 2018. We are hoping they will be able to implement more good practice when they return to their roles in Malawi.

A second trip to the College of Medicine was planned for 2019. Training will be split to cover similar topics for new scientists attending, but also build upon the techniques taught last year to those returning for further training. This year we will also include training on Drug Metabolism and Pharmacokinetics and this will be delivered to the Pharmacy students in the College as well.

Future and ideas for partnership development

Our funding is limited to train scientists in drug discovery. However, the development of a wider training programme in other related sciences may be beneficial to the country.

Public engagement with either public in the UK, Malawi or schools may be of benefit.

Trainees: we expect to have one PhD student from College of Medicine with us for a period of 9 months and a technician from MUST may join us in early 2020.

Area of work: Health, Education, Coaching
Location of work: Blantyre

Project lead: Prof. Peter Mossey
Contact details: p.a.mossey@dundee.ac.uk

Partner organisation: School of Public Health & Family Medicine, College of Medicine
Partner contact: Dr Susan Carnes Chichlowska
Contact details: MPHTutor@medcol.mw

Funding: GCRF

Description of project

Study Summary
An ethnographic study comparing HE versus HC in an urban primary care setting in Malawi is proposed. This method utilizes video technology, safe haven image storage, observer software and coding expertise from the University of Dundee (UoD). Training of healthcare professionals by the accredited health coach on the HC approach over 3 months will be followed by video recorded observations of 40 HC and 40 HE scenarios on 2 types of healthcare professionals` communication with their patients; (a) Dentists and (b) Dental Therapists at Queen Elizabeth Central Hospital in Blantyre, Malawi. A health professionals’ workshop by experts from the University of Dundee to be conducted in Blantyre, Malawi at the end of the study.

Background to the study
A significant cause of mortality and morbidity in Malawi is due to NCDs (Muula and Mpabulungi, 2007; Msyamboza et al, 2011). Over the years, the HE model for effecting behaviour change has shown relative ineffectiveness in NCDs prevention and control (Kivela et al, 2014). The HC approach is emerging as a potential tool which guides and prompts people to be active participants in managing change in their own behaviour (NHS England, 2019).

Key successes and outcomes so far

At the moment we are in the process of finalising the ethical application with the National Health Sciences Research Committee of Malawi (NHSRC).

Future and ideas for partnership development

The integration of the oral health agenda with other NCDs because of the shared risk factors will create collaboration with other health professionals. The recent affiliation of oral health to the NCD Alliance alongside partners in diabetes, CVD and cancers will provide an ideal platform for a cost effective health improvement strategy. This trans-sectoral approach with an emphasis on upstream factors such as the social determinants of health brings together oral and general health with potential for primary prevention of all NCDs.

Also, interdisciplinary health related research activities in Malawi have, via the Tayside Institute for Global Health (TIGH) and the Dundee Africa Research Network (DARN) raised awareness and uncovered a range of other research activities in different UoD schools which will mean great opportunities for coordination and cooperation.

The participants in this pilot will also be well placed to develop future study protocols e.g. a follow up RCT and jointly apply for major research and implementation grants.

Area of work: Health, Education, Research, Gender equality, Poverty reduction, Economic growth
Location of work: All districts in Malawi

Project lead: Prof James O. Garden
Contact details: o.j.garden@ed.ac.uk

Lead for ESO Outreach Strategy/ Co-Lead: Dr Oluseye A. Ogunbayo
Contact details: oogunbay@staffmail.ed.ac.uk

Partner organisation: Royal College of Surgeons of Edinburgh (RCSE); The College of Surgeons of East, Central and Southern Africa (COSECSA)
Partner contact: College of Surgeons of East, Central and Southern Africa (COSECSA)
Contact details: The College of Surgeons of East, Central and Southern Africa (COSECSA) 157 Olorien,
Njiro Road ECSA-HC PO Box 1009 Arusha, Tanzania

Funding: Johnson & Johnson, the Scottish Government, the Commonwealth Scholarship Scheme UK, and the National Institute for Health Research
More information: https://www.edinburghsurgeryonline.com/
https://www.edinburghsurgeryonline.com/scholarships

Description of project

Malawi, a landlocked country in sub-Saharan Africa, with a current population of over 19M people has the lowest physician-to-patient ratio (1:50000) in the world and less than 20 surgeons served the whole country in 2010. Current data however suggest that this alarming ratio remains unchanged. According to the Malawi Ministry of Health, major factors limiting the development of surgical services in Malawi include among others, inadequate production of medical graduates by medical training institutions to meet the country’s healthcare needs. This shortage of critical health staff is further worsened by the ongoing migration of young surgeons, whose personal training needs are not always met locally, to developed countries (the so-called brain drain). The resultant lack of surgeons on the ground and of specialist surgical expertise compromises further the training of the few available medical graduates. This shortage of surgical health care professionals is a trend in many other Sub-Saharan Africa countries. One novel solution by Malawi health Ministry, to address this critical staff shortage, is the piloting of cost-effective higher-qualification training methods, such as e-learning, distance learning, applied and part time learning. In 2007, in response to changes in surgical training which in some countries had reduced clinical exposure in the workplace, the University of Edinburgh in partnership with the Royal College of Surgeons of Edinburgh designed and launched an online, 3-year part-time Masters programme (MSc) in Surgical Sciences, to support trainees in the early years of their surgical training. Although this, and four subsequent advanced online ChM Masters programmes (General Surgery, Trauma & Orthopaedics, Urology and Vascular & Endovascular Surgery), were intended principally to support UK based surgical trainees, their flexible and contextual content and delivery now reach a global audience including trainees in Sub-Saharan Africa countries. The first three-year MSc in Surgical Sciences was based fundamentally on the professional curriculum of the Membership of the Royal College of Surgeons (MRCS) examination, and the later twoyear ChM programmes, on the Fellowship of the Royal College of Surgeons (FRCS) end of training curriculum. These online programmes augment in-the-workplace training without trainees having to leave their country. This has enabled surgical trainees to continue to practice in their own health care system, directly combating loss of regional workforce and increasing surgical practice capacity, especially in SubSaharan Africa, where unmet need is greatest, with 90% of the population having no access to basic surgical procedures. Our Malawian experience particularly has shown that trainee surgeons can be academically supported and professionally equipped through our educational programme. This has been facilitated through a generous educational grant from Johnson and Johnson since 2010, supporting two scholarships annually, for training surgeons. While the performance of these trainees remains very high and the level of applications is increasing, conversion to enrolment has been limited by funding, thus, highlighting the need for additional scholarship funding to support education and capacity building, and widen access to this academic and professional support. Based on the initial scholarship success and in response to this increasing need, we have explored ways of increasing financial support to surgical trainees in Malawi and other Sub-Saharan Africa countries. In 2017, funding was secured for 5 trainee surgeons from the Commonwealth Scholarship Commission (CSC), and 5 further matching scholarships were funded by ESO. This CSC support has continued to be made available but, in 2018, the University of Edinburgh, and the Royal College of Surgeons of Edinburgh launched its own ESO Global Scholarship programme, providing 20 additional scholarships to support surgical trainees from low and middle income countries including those in sub-Saharan Africa. In that initial year, 14 scholarships were awarded to trainees in the COSECSA region. In 2019, further CSC funding supported 10 successful applicants, and these were matched with 20 additional fully funded Edinburgh Surgery Online Global Scholarships from programme income. In 2020, some 50 scholarships will be available through CSC, the ESO Global Scholarship programme, NIHR funding and through philanthropic donation from the Caledonian Heritage Trust. The long-term support of Malawian surgical trainees has been a successful exemplar on which to build a sustainable scholarship programme in sub-Saharan Africa.

Project objectives:

1. To support Malawian trainees throughout surgical training:
   
   > to acquire understanding of applied basic surgical sciences and the surgical specialties
   > to consolidate knowledge base for professional examinations
   > to support professional development
   > to complement in the workplace training
   
2. To provide opportunity for ambitious trainees to acquire additional qualifications which:
   
   > enhance portfolio and promote career development
   > provide trainee with essential ‘academic tools’ to support life-long learning
   
3. To provide opportunity for prospective academic surgeons to acquire qualification which would:
   
   > identify career intentions
   > provide possible academic base for career development
   
4. To provide equity of access to academic opportunities
   
5. To empower front-line individuals in Malawi and other Commonwealth countries to be involved in
   collaborative research and health care strategic development projects:
   
   > by encouraging participation in GlobalSurg, an online world-wide, NIHR funded initiative
   > by promoting publication of quality surgical outcomes data in peer-reviewed journals, to inform
   policies within host countries, and to better understand regional healthcare needs.
   
6. To improve safety and care of surgical patients
   

Key successes and outcomes so far

• Since 2007, our MSc Surgical Sciences and ChM programmes in advanced surgical training have
  met successfully the academic and professional developments of over 1981 trainee surgeons in 75 countries,
  with over 150 trainee surgeons from sub-Saharan Africa.
• Since 2010, Edinburgh Surgery Online has supported 36 surgical trainees from Malawi with full
  scholarship funding (56% females). Of these, 19 have successfully graduated from our MSc programme,
  with 18 Full MSc and 1 student with Certificate award. Six students are currently enrolled
  
• Our first Masters’ graduate from Malawi, Dr Lughano Kalongolera, graduated from Edinburgh in
  November 2013, having never previously visited the city.
• ESO Graduates from Malawi are moving into key consultant leadership roles and continued to play
  a key role in teaching basic sciences to students on the BSc General Surgery for Clinical Officers (non medically qualified).
• Dr Vanessa Msosa completed her MSc in 2017 and has now enrolled on to the ChM in General
  Surgery to support her sub-specialty training. As a junior consultant in Lilongwe, she is leading a local
  research project on the implementation of the WHO Surgical Safety Checklist funded by NIHR Global
  Surgery Unit.
• Dr Wone Banda, an MSc Surgical Science graduate of 2015 is now a consultant and leads the
  specialist Burns Unit at Lilongwe.
• In recognition of the quality of our programmes, the University of Edinburgh in 2010, gave the
  Chancellor’s Award for Teaching, and the 2010 national eLearning Awards for Best Online Learning
  Programme (Education), to our director, Professor James Garden.
• The growing suite of online learning surgical educational programmes has continued to recruit
  strongly and was awarded the Queen’s Anniversary Prize for Higher and Further Education in 2013.
• Over 89 novel articles have been published to date in peer-reviewed journals, from 467 of our
  students, as an evidence of the academic goals of our Masters’ programmes.
• As part of the agreement for Commonwealth Scholarship Commission (CSC) funding, our First
  ever CSC Capacity Building Retreat aimed at students within one year of graduation was successfully held
  in Malawi in October 2019. Eleven Malawian Masters’ graduates attended the workshop at the Makokola
  Retreat, Mangochi, Malawi.

Future and ideas for partnership development

• To understand where there is an increasing need for online educational support in Malawi and to
  target scholarship resource appropriately
• To identify greater funding opportunities to support surgical trainees and widen access to Masters’
  programmes in Malawi as well as other Sub-Saharan African countries.
• To continue to involve Malawian graduates and alumni through engagement with our
  commonwealth scholars at our annual capacity building retreat as well as at other conference opportunities,
  in this way, supporting the further professional development of surgical trainees, with our funding partners.
• To determine the potential role of the newest online MSc in Patient Safety and Clinical Human
  Factors in supporting health care professionals in Malawi and in sub-Saharan Africa.
• To develop individual modules that might be made freely accessible to trainees and trained surgeons
  for their continuing professional development
• To develop new strategies to extend the global outreach of the Edinburgh Online Surgery
  programmes in Malawi and sub-Saharan Africa.
• To explore the value to our masters’ graduates of a new University of Edinburgh portal, Platform
  One, which will enable alumni to keep in touch with each other and mentors, as well as to provide access to
  university resource that may be valuable for further professional development.
• To further strengthen the relationship between Edinburgh Surgery Online and COSECSA.

Area of work: Maternal Health, Preterm birth, Stillbirth
Location of work: Lilongwe, Blantyre

Project lead: Prof David Lissauer
Contact details: david.lissauer@liverpool.ac.uk

Partner organisation: Malawi-Liverpool Wellcome Trust, University of Liverpool
Partner contact: Professor Mia Crampin
Contact details: mia.crampin@glasgow.ac.uk

Funding: National Institute for Health Research (NIHR)

Description of project

DIPLOMATIC: using eviDence, Implementation science, and a clinical trial PLatform to Optimise MATernal and new-born health in LICs (Low Income Countries).

We are a Global Health Research Group based in the UK, Malawi and Zambia. Our vision is to reduce mortality of children under 5 years (one of the targets of the Sustainable Development Goals) by reducing pre-term birth and stillbirth and to optimise outcomes for babies born preterm. The project transferred to the University of Liverpool in March 2021 and has been taken forward by Prof David Lissauer.

Key successes and outcomes so far

Further funding has been obtained to build on the success of work previously completed. This has been via the University of Liverpool.

Future and ideas for partnership development

Work is ongoing via the University of Liverpool.

Area of work: Reproductive health, cervical cancer, treatment and screening
Location of work: Nkhoma CCAP Hospital and 6 other hospitals across Malawi

Project lead: Dr Christine Campbell
Contact details: christine.campbell@ed.ac.uk

Partner organisation: Nkhoma CCAP Hospital
Partner contact: Mrs Beatrice Kabota
Contact details: Beatrice.kabota@yahoo.co.uk

Funding: Scottish Government International Development Fund for Malawi
More information: https://bit.ly/36YYHIe

Description of project

Objective 1 - Expand screening provision across Malawi.

Screening in 33 additional health centres/posts; Sensitisation, strengthening existing services in partner hospitals, and in rural health centres; Same-day treatment of VIA-positive lesions with thermal ablation, referral to partner hospitals, and routes to biopsy or palliative care will be set up and strengthened


Objective 2 - Capacity building.

Up to 80-90 additional VIA providers trained nationally; Training (both theoretical and experiential) delivered to nurses, midwives and clinical officers; Nine Ministry of Health training courses; Up to 14 experiential learning courses supervised by Malawian screening leads and Scottish clinicians; Work closely with the Reproductive Health Directorate.


Objective 3 - Mentoring, for building in-country capacity.

Develop a cohort of experienced and skilled Malawian providers who have skills and confidence to support their peers; co-development of a mentoring toolkit with experienced screening providers, field-tested by partners, then a revised version. The toolkit to draw on Malawian Ministry of Health guidance, best practice internationally, and critically on mentoring tools developed in Malawian context for providers of care for persons living with HIV

Key successes and outcomes so far

At one-year mark:

Four new hubs have been strengthened, and screening is now taking place in five additional health centres. Over 7,300 women have been screened for the first time and twenty-one new VIA providers have received comprehensive training. A screening database has been set up in REDCap and is used across all sites. A revised mentoring toolkit is close to launch, pending final edits and Ministry of Health approval. The Safeguarding policy has also been developed with training materials currently under development.

This project was developed collaboratively with Malawian colleagues, building on the experience in an earlier project (see Project 1), and addressing recognised needs in-country. Although still at a relatively early stage of the project, successes include:

• The MALSCOT project is running well, with strong national co-ordination and leadership from Nkhoma Hospital and enthusiastic adoption of objectives and approach by project partners, including the Reproductive Health Directorate, Ministry of Health
• A WhatsApp messaging group allows colleagues from across the country to share successes and to seek advice on clinical or practical queries
• The extent to which the Hubs have embraced the concept of Mentoring and use of the Toolkit has been very encouraging, with more mentors trained to support their peers than originally envisaged
• A successful ten-week visit by a volunteer Scottish recently retired gynaecologist
  

Future and ideas for partnership development

• Building on learning in MALSCOT, together with Malawian screening and academic colleagues we are pursuing collaborative research opportunities in similar screening contexts in other LMICs
• With national and international colleagues we are developing implementation research to support learning and strengthen the evidence-base for local delivery
• A key objective over the remainder of MALSCOT is to work with in-country partners to strengthen the complete pathway of care for women diagnosed with cervical cancer, hence there will be opportunities for volunteering in relevant disciplines; we anticipate close working with the Scottish Global Health Collaborative

Area of work: Childhood health
Location of work: Lilongwe, Chilumba

Project lead: Prof. Andrew McIntosh
Contact details: Andrew.mcintosh@ed.ac.uk

Partner organisation: MEIRU, Ministry for Health
Partner contact: Professor Mia Crampin
Contact details: mia.crampin@glasgow.ac.uk

Funding: MRC, Wellcome

Area of work: Climate Justice, Gender, Renewable Energy, Solar
Location of work: Northern Districts

Project lead: Eilidh Watson
Contact Details: eilidh.watson@gcu.ac.uk

Partner organisation: Currently exploring potential partner organisations within Malawi

Funding: Glasgow Caledonian University
More information: https://www.gcu.ac.uk/climatejustice/

Description of project

Energy poverty is defined traditionally as having no access to basic energy services like electricity. Despite reports of recent progress of improved electricity access figures, the International Energy Agency (IEA) states that the world is not on course to achieve Sustainable Development Goal (SDG) 7.1: “Ensuring universal access to affordable, reliable and modern energy services by 2030”.

In Sub-Saharan Africa, the IEA states that annual rates of connection would need to be tripled every year to attain on average 60 million people per year and achieve SDG 7.1. The population without access to electricity in sub-Saharan Africa is 600 million people, equating to 57% of the population (IEA, 2019) with 15 countries within this region having access rates below 25% (IEA, 2019). Malawi is one of these countries, the population with access to electricity is only 14.6% (IEA, 2018).

Electricity access is particularly low in rural areas, estimated to be less than 3%. This is a challenge for Malawi as there is a low urban population with over two thirds of the people residing in rural areas. Therefore, it is estimated that a high percentage of the population is experiencing energy poverty.

This research focuses on exploring how limited access to electricity is affecting women in rural areas, primarily as it is often a women’s responsibility to secure energy resources for a household. In order to meet household energy needs, women are responsible for collecting traditional sources of fuel like biomass, in the form of firewood and charcoal. With pressures from deforestation and climate change intensifying, collecting firewood is becoming increasingly difficult and women are spending more of their time collecting energy resources.

This research aims to explore, through qualitative interviews, what women in rural communities of Malawi hope for in terms of future energy aspirations and gain an insight into their energy reality. As women in these communities are often responsible for securing energy provisions, it is important for their knowledge and experience to be listened to.

In addition to this, this project aims to investigate the impacts of solar mini-grids for women within rural communities. Technological advancements of solar mini-grids mean that solar power in this form could be a low cost solution to meeting one aspect of a household’s energy needs.

Key successes and outcomes so far

The research project is within the first year. The research so far has involved completing an extensive literature review on the topics of energy, gender and climate justice. The next stage of the research project involves a field trip to Malawi between May and August 2020 to the Northern District in order to collect data.

Future and ideas for partnership development

Eilidh Watson is interested in collaborating or working with any academics or organisations that are working within energy spheres of Malawi. In particular, anyone working within rural communities in Northern Malawi with a focus on access to electricity.

In addition to this, Eilidh Watson is interested in connecting with other PhD students or researchers that plan to visit Malawi in 2020 and are looking for research partners.

Area of work: Health
Location of work: Blantyre

Project lead: Prof. Paul Garside
Contact details: Paul.Garside@glasgow.ac.uk

Partner organisation: College of Medicine, University of Malawi
Partner contact: Dr Mwapatsa Mipando
Contact details: comprincipal@medcol.mw

Funding: Scottish Government Directorate for External Affairs – International Division
More information: https://www.gla.ac.uk/researchinstitutes/iii/wcip/

Description of project

Our vision is the establishment and deployment of a Clinical Lab Facility at COM, identified by their senior management as their fundamental need and priority during a recent visit to Glasgow. This will enhance ongoing collaborations AND evidence-based development of research and training programmes, medical interventions and policy development in Malawi in the key area of NCDs and their interface with ID. This will bring to bear internationally renowned expertise in NCD and ID in Glasgow (The Wellcome Trust Centre for Integrative Parasitology, MRC Centre for Virus Research, BHF Centre of Excellence and ARUK Centre of Excellence) on national health priorities in Malawi. Significantly, it will complement existing Glasgow partnerships with the Malawi Liverpool Wellcome Trust Clinical Research Programme (MLW) and Centre for Global Health Research who fully support this highly synergistic proposal. In the longer term, this will provide a centre of excellence for the region in NCDs research.

Key successes and outcomes so far

The engagement with many partners in Malawi has been particularly successful. Collaboration with Malawi Liverpool Wellcome and Malawi Epidemiology and Intervention Research Unit (MEIRU) as well as University of Malawi, College of Medicine has afforded University of Glasgow and the wider Scottish economy many opportunities to develop research projects and apply jointly for grant funding. The initiative has generated interest from across the world and allowed University of Glasgow to recruit several research stars one notably from Harvard to relocate to University of Glasgow to continue his research activities with colleagues in Scotland and Malawi.

Future and ideas for partnership development

Many grant applications and collaborations are in the pipeline, and it is our aim to use this initiative as a springboard for greater collaboration with Malawian scientists and Institutions.

The specific objectives of the project are detailed below, we are in year 2 of our 5-year project

1. Identify and appoint key strategic personnel to establish CLF
2. Renovate an existing building to co-locate all four labs currently in different buildings.
3. Survey equipment in existing laboratories at CoM.
4. Initiate training of clinicians and allied health professionals on services by CLF and Laboratory Information Management Systems use.
5. Provision of limited clinical service.
6. Accreditation of CLF to internationally recognised standard.
7. Initial clinical surveys to assess inflammatory NCD burden in Malawi and provide preliminary data to support larger surveys and intervention studies.

Area of work: Health, Dentistry
Location of work: Blantyre, Lilongwe

Project lead: Prof. Jeremy Bagg
Contact details: Jeremy.bagg@glasgow.ac.uk

Partner organisation: College of Medicine, University of Malawi
Partner contact: Dr Mwapatsa Mipando
Contact details: comprincipal@medcol.mw

Funding: Scottish Government Directorate for External Affairs – International Division
More information: www.themaldentproject.com

Description of project

Oral and dental disease are very common in Malawi, but poor access to care is a major problem for the population of 18.8 million because of lack of a trained dental workforce. Currently there is no provision to train dentists within Malawi and the small number of dentists registered with the Medical Council of Malawi (39 in total) have all trained overseas.

In addition, the lack of a national oral health policy is a contributory factor to poor access to oral healthcare. It is essential that a national policy, led by qualified dental professionals, places a major focus on prevention of oral and dental disease, thereby reducing the need for extensive operative dentistry, which is expensive to deliver

The project is seeking to address these challenges by:

1. Establishing, in parallel with the existing MBBS programme, a Bachelor of Dental Surgery degree at the College of Medicine, an ambition since 1998.

The BDS programme, starting with an annual intake of 10-15 students, would establish an output of newly qualified dentists who would:

• Be involved in direct delivery of clinical care.
• Play a major part in rolling out a programme of oral health awareness and a national model of prevention.
• Lead on establishing a sustainable oral health infrastructure for Malawi, which would include all Districts.
• Begin to develop a small cohort of dental clinical academics who would provide sustainable staffing for the BDS programme moving forward.

2. Developing, through joint working between academic staff in all relevant specialities of the College of Medicine (Preventive Medicine, Public Health, Dental Surgery), the Dental Association of Malawi, the Ministry of Health and Scottish partners, a national oral health strategy as recommended by the WHO (Ndiaye CF, African Journal of Oral Health, 2005, 2, 2-9). This would include a national prevention programme aimed at children and could be based on a version of the well-proven Scottish Childsmile programme, which has already been adopted in multiple international settings to good effect.

Key successes and outcomes so far

The engagement of many stakeholders in a robust partnership has been particularly successful. In addition to the Royal College of Physicians & Surgeons of Glasgow, NHS Education for Scotland and the University of Dundee Centre for Medical Education, which were partners with the University of Glasgow on the Scottish Government grant application, the following organisations have become closely involved:

• Dentaid (www.dentaid.org) – very engaged with issues related to dental equipment and maintenance
• Bridge2Aid (https://bridge2aid.org/) – engaging with development of a partnership with the Dental Association of Malawi to develop a ‘work-shifting’ model for training in emergency dentistry of Clinical Officers in rural areas (recent successful grant application to Tropical Hygiene & Education Trust)
• Smileawi (www.smileawi.com) – involved in a pilot epidemiological study of child oral health in Northern Malawi
• Henry Schein (https://www.henryschein.co.uk/) – engaged with activities linked to equipment supply, installation, maintenance and consumables supplies
• Borrow Foundation (https://www.borrowfoundation.org/) – keen to develop a partnership in relation to prevention of dental disease in children (grant application for $75K submitted – outcome due in June)
• Strathclyde University – partnering on work linked to fluoride content of bore-hole waters and dental fluorosis / dental caries

Within Malawi, the strong cooperation from the Ministry of Health, Dental Association of Malawi and Medical Council of Malawi is invaluable.

Future and ideas for partnership development

We are already collaborating with Professor Bob Kalin at the University of Strathclyde.

We have engaged our own University of Glasgow dental students with the project. Five of our BDS 4 students and one from Dundee Dental School who visited Malawi in June 2019 to participate in a pilot child oral health epidemiological project with the charity Smileawi.

Two main areas of progress to date are:

1. Completion of the Bachelor of Dental Surgery curriculum, which was approved by the University of Malawi in March 2019. This has allowed the College of Medicine to advertise for applicants to study on the new programme, with entry of the first cohort in August 2019.

2. Significant enhancement of the dental surgery equipment at the Dental Department of Kamuzu Central Hospital in Lilongwe, through donation of dental chairs by NHS Greater Glasgow & Clyde and technical support from the charity Dentaid and the dental supply company Henry Schein. Pre-clinical skills equipment, donated and installed by Dentaid has provided a greatly enhanced teaching facility for existing dental therapists and, in future, BDS students.

Area of work: Renewable Energy
Location of work: Bwumbwe, Phalombe, Zomba, Lilongwe, Machinga districts of Malawi

Project lead: Dr. Nader Karimi
Contact details: Nader.Karimi@glasgow.ac.uk

Partner organisation: Abundance Worldwide
Partner contact: Dr. Deepa Pullanikkatil
Contact details: d.pullanikkatil@gmail.com

Funding: Scottish Funding Council Global Challenges Research Fund 2017-2018
More information: www.abundanceworldwide.org

Description of project

This project was an engineering, social and economic evaluation of food processing in the rural areas of Malawi and Kenya. The aim was to collect the information necessary for designing a clean and low-cost energy system for cogeneration of heat and electricity from agricultural waste to support food processing.

Background:

Agricultural activities are major contributors to many African economies. These activities require efficient downstream processes such as drying, roasting, boiling and refrigeration, which are all energy intensive and demand heat, electricity or both. Yet, severe energy issues in sub-Saharan Africa continue to hamper modernisation of these processes, stressing the economy, environment and public health of many African nations.

As a remedy, advanced technologies for thermochemical conversion of biomass are proposed to be combined with the state-of-the-art power-generation techniques. This results in a cost-effective integrated energy system, which takes biomass in the form of agricultural waste and converts it to heat and electricity with high efficiency and low emissions. The engineering applicants have strong track records in these areas. Nonetheless, knowledge of the local capacities, demands and challenges related to food processing industries in ODA countries remains as an imperative unknown. This calls for gathering information from the regional partners and evaluating the technical and social factors of the technology accordingly.

The essence of this study was to throw light on the differences between Kenya and Malawi in relation to technical, social and economic aspects of energy for food processing. The study aimed to understand the energy resources, availability, usage, cost, for food processing and its social and economic facets. This study is unique as it is multi-disciplinary, while other related research tends to be more narrowly focused. Addressing these various concerns will help provide a holistic light on energy issues and food processing in Sub-Saharan Africa. Comparing Malawi and Kenya gives insights into two economically different countries and provides insights to the similarities and differences when it comes to biomass use for cooking, which can provide understandings for policy recommendations.

Activities done:

Questionnaire surveys were conducted in Kenya and Malawi to collect information from farms, food processing units, local communities, governmental and other relevant organisations. The data collection fieldwork portion of the project began on 1 Dec 2017 and ended on 15 Jan 2018. Data analysis and writing up of the evaluation results was from January to June 2018. A total of 394 individual surveys were received from Kenya, and 137 from Malawi. A report was prepared and is online at University of Glasgow’s website.

Key successes and outcomes so far

The project was a research project and hence the impact is enhanced knowledge through primary data collection in Kenya and Malawi filling knowledge gaps on interdisciplinary aspects of fuel use, cooking and food processing and comparison between the two countries.

Future and ideas for partnership development

We would like to explore socio-cultural aspects of everyday cooking practices in Malawi. We are developing proposal to seek funding for this.

Area of work: Education, Sustainable Development
Location of work: Blantyre & surrounding districts

Project lead: Emma Wood
Contact details: ewood@qmu.ac.uk

Partner organisation: STEKA (Step Kids Awareness)
Contact details: stekaskills@gmail.com

Funding: STEKAskills received a feasibility study small grant from the Scottish Government
More information: www.stekaskills.com

Description of project

Our project, currently named The Unmunthu Dialogues, aims to co-produce a new model of voluntourism which empowers young Malawians to inspire their Scottish peers to communicate in solidarity to meet the UN’s vision for achieving the SDGs.

The UN states that voluntourism is a ‘powerful means’ of achieving the SDGs, but current models typically involve young people from the Global North going as volunteer-tourists to Global-South countries doing work which young people there could be paid for (building/ painting/ digging). Evidence shows this can disenfranchise local people, denying them agency. Our action research aims to co-produce an alternative approach with ‘beneficiaries’ of voluntourism, who have been denied a voice in determining how the practice can ‘help’ them. Young Malawian residents of a children’s home are working with a multidisciplinary team of academics and visionary Malawian activists to reinvent the voluntourism experience in a way which empowers them, reduces their donor dependency, provides them with high quality employment, generates sustainable income from visiting school groups and gives visiting Scottish pupils a deep understanding of global citizenship and ways to communicate in solidarity to bring about changes needed to achieve the SDGs.

The Dialogue Groups are run by young care experienced Malawians who have a range of diverse insights into live in Malawi. They tell stories they have chosen which relate to a number of SDGs in particular gender equality, climate change, poverty, education and the right to quality work and economic growth. They then facilitate critical analysis of the stories and topics with the young Scots. No ‘adults’ can take part or hear what’s discussed so the young people don’t need to perform in prescribed way as ‘learner’ or deliver the ‘right’ answers – they create new knowledge. Diversity means a range of different stories is shared and the ‘brave space’ enables them to be interrogated and interpreted from multiple perspectives.

Instead of giving donations, the Scottish school pupils pay to participate in these high quality Dialogue Groups (run by the young Malawians). The approach is based on Friere’s Pedagogy of the Oppressed, aimed at empowering young people to challenge social norms and critically analyse the way they communicate, and could communicate for change. The Dialogue Groups run by young Malawians for Young Scots challenge the aid framed view of travelling to poor countries to ‘make a difference’ sometimes known as ‘white saviour trips’ and, in particular, the use of selfies and photographs which disempower Malawians.

Profit from the Dialogue Groups will be used to sustain a STEKA Centre for Vocational Skills and Community Enterprise.

Key successes and outcomes so far

We have completed a feasibility study, so we know that the approach can work successfully. We now need to continue to develop the approach so that it can be scaled up and run on a commercial basis.

If funding was available, we would also like to further develop a ‘selfless selfie’ photoelicitation approach to co-creating content to be shared with wide audiences on social media and in real life. This would enable young visitors to Malawi to communicate what they learn through dialogue with each other in a way designed to bring about the change in attitudes and behaviours needed to meet the SDG challenges.

We have modelled the critical dialogue approach and used it to test the way in which it empowers the young people and have collected evidence indicating how it works, showing that young Scots are experiencing a transformation in the way they view Malawians and their trip to Malawi (and the Malawians, a transformation in the way they view some of their own cultural practices and values). They can all identify what they learn in relation to the SDGs, and also about resilience and solidarity and some of the ways they can engage in bringing about positive change.

The key here is that new knowledge is created through the dialogues. For example, in addition to the more obvious learning points, the Scots reflect on social isolation in Scotland in relation to community in Malawi, the importance of legislation being in place and enacted, inequality as the cause of poverty and so on.

Future and ideas for partnership development

We would like to collaborate with partner organisations interested in allowing young people to visit and hear about the work they are doing in Malawi (especially if it’s SDG related) . This could just be the group of young Malawians who could then share their insight with their visitors, or it could be visits from the young Malawians accompanying visiting Scottish school pupils to operate as citizen journalists (and not take inappropriate photographs or position themselves as the centre of the narrative).

Alternatively, our Dialogue Team could train other Malawians to facilitate respectful visits from Global North visitors.

Area of work: Public Health
Location of work: Across Malawi

Project lead: Georgina Pearson
Contact details: GPearson@qmu.ac.uk

Funding: Bloomsbury set
More information: http://www.lse.ac.uk/africa/research/Localised-Evidence-and-Decision-making-LEAD

Description of project

In sub-Saharan Africa, local public health practitioners are part of a larger global health system, wherein they implement disease-specific, global health interventions. While these are largely financed by external agents through development assistance, the information and evidence needed for effective decision-making at this level has not been extensively studied. The LEAD Project addresses this need in public health decision-making.

Through new research and an extensive series of workshops the project will create explicit links between local practitioners and the development evidence, identifying local evidence needs and elucidating the complexity of implementation from the local perspective. Using a complex systems approach, this information will influence the methodological choices, inputs and outcomes of modelling intervention implementations, and will inform the exploration of artificial intelligence techniques.

The activities of the LEAD Project are aimed at improving the development and use of locally-applicable evidence for decisions surrounding global health interventions by local public health practitioners, which will ultimately produce better health outcomes for the intended beneficiaries. The LEAD Project focuses on mass drug administration (MDA) for schistosomiasis and soil-transmitted helminths around the African Great Lakes Region, as a representative global health intervention. Fieldwork is focused on the epidemiologically relevant areas of Kenya, Malawi, Tanzania and Uganda.

The case of MDA is especially important in the context of antimicrobial resistance, with the mass distribution of tablets within child and maternal health for malaria, HIV, neglected tropical disease and chronic disease interventions potentially encouraging the emergence of resistant microbials, among other health concerns.

Key successes and outcomes so far

The project is currently in latter stages of conducting preliminary in-country workshops across the African Great Lakes Region. Current discussions are around what an ongoing partnership would look like, and what future work could result. The project is still in its early stages, so it is difficult to reflect, however a productive workshops was run in Malawi in December 2019.

Area of work: Livestock, Dairy, Economy
Location of work: Across Malawi

Project lead: Dr Cesar Revoredo-Giha
Contact details: cesar.revoredo@sruc.ac.uk

Partner organisation: LUANAR, AICC
Partner contact: Dr. Felix Lombe
Contact details: aicc@aiccafrica.org

Funding: DFID-ESRC Growth Research Programme
More information:https://www.sruc.ac.uk/info/120257/food_marketing/802/assessing_contribution_of_dairy_sector_to_economic_growth_and_food_security_in_malawi

Description of project

The purpose of this project was to address some of the key challenges faced by the dairy supply chain through an assessment of its operation that could help boost the potential contribution of the sector to economic growth and food security. In particular, the project assessed issues of efficiency, productivity, infrastructure quality, consumers’ interest for safe milk.

The methodology of project has involved several stages, some of which are:

• Review of the operation of each of the chain stages;
• Integration of results into a multimarket model to simulate the impact of different policy scenarios on food security indicators and sector growth;
• Propose solutions based on the quantitative and qualitative evidence and on the analysis.

Some of the work included:

• Survey of 460 dairy producers;
• Semi-structured interviews with 25 milk bulking groups;
• Interviews with most of the processors and several stakeholders (including donors);
• Interviews with consumers;
• Survey to retail shelves (retail audit to collect retail prices);
• Estimation of a demand system using the latest LSMS for Malawi 2010-11.

Key successes and outcomes so far

The project ended in 2015 but additional work was carried out supported by SRUC.

Information about the dairy sector in Malawi before the project was from 2004 and plenty of it was repeating older data. The project collected and updated the information available about the sector. This information was used for two purposes: one was for the processors to apply successfully for funds to improve the formal dairy supply chains, and second, it was used to carry out an analysis of the incidence of the VAT that the Government imposed for milk.

Future and ideas for partnership development

The website of our project has plenty of information to share about the dairy sector in Malawi. There is additional information that has not been uploaded due to confidentiality and may be accessed upon request.

It is important to mention that the project carried out a research project, not a development one, and therefore, its most important output was the provision of information. I believe that there are opportunities to do similar work for other sectors, considering entire value chains, from farmers to consumers. This can part of a project.

Key for the development of the food industry is to understand the demand that it faces, e.g., how they respond to prices, changes in income, advertising. The information about the food demand is limited and more work should be focused on it. It is important for issues of trade, sustainability, nutrition and health, etc.

Area of work: Agriculture, Genetics, Climate Change, Sustainability
Location of work: Across Malawi

Partner organisation: AICC
Project lead: Dr. Felix Lombe
Contact details: aicc@aiccafrica.org

Funding: BBSRC as a Global Challenges Research Fund (GCRF)
More information: https://www.sruc.ac.uk/homepage/1123/formulating_value_chains_for_orphan_crops_in_africa

Description of project

The current strategy regarding orphan crops focuses on genetic improvement to increase resilience to climate change and to improve productivity, under the assumption that increased diversity of crop species sown and harvested implies a greater diversity of consumption. However, this is not the case in rural or urban areas. The purpose of this project was to more effectively bridge current supply-side research on orphan crops with attitudes from consumers, to help have an impact on poverty, health, sustainable growth and food security in developing countries.

The project is multidisciplinary with the interaction of social, crop and food scientists. Its components comprised:

1. Supply chain and demand component – It aimed to understand the demand side of orphan crops and their value chains and how production systems interact with their political, economic, societal and cultural contexts. SRUC knowledge exchanged with the African Institute of Corporate Citizenship (AICC), which is interested in the generation of sustainable agribusinesses to reduce poverty through sustainable economic growth in the agricultural sector.
2. Food science component - The food science worked on ingredients and healthy products is targeted to food companies who will be contacted by the project's team members through links with other parties.
3. Crop Science component - This component worked on strategies for maximising crop productivity and quality, and ensuring resilience to increasing climatic variability and against pests and diseases for the selected orphan crops. In this way, it will complement other international promotion efforts on these crops.

Key successes and outcomes so far

The project ended in 2019 and the plans are to continue transforming the results of the project into papers to disseminate them.

Based on the impact so far, we would say that there are four key successes

1. The research showed the importance of including the demand on the development of orphan crops and this was understood by the African Orphan Crops Consortium. This was also clear from our discussion with Malawian stakeholders (African Institute of Corporate Citizenship).
2. The survey of breeders carried out showed their preferences in terms of what orphan crops should be prioritised amongst a list of 101 crops. It highlighted that three top bottlenecks to orphan crop’s use are: knowledge about crops and how they could be used was most often considered the most important constraint, availability of high-quality planting material and market availability.
3. The project highlighted the need for experienced traders specialised in organising supply chains as a key component for linking farmers to the markets. It was found that these traders require to be specialised on supply chain management.
4. There are opportunities to produce processed foods that are healthier and the research studied the possibility of substituting current ingredients at least in part with healthier orphan crop ingredients (e.g., amaranth and finger millet).

Future and ideas for partnership development

The survey of breeders carried out showed their preferences in terms of what orphan crops should be prioritised amongst a list of 101 crops. There is the possibility to do work about those crops to study the most important constraint, availability of high-quality planting material, market availability as well as consumers’ interest.

Key for the development of the food industry is to understand the demand that it faces, e.g., how they response to prices, changes in income, advertising. The information about the food demand is limited and more work should be focused on it to be passed to the industry and other stakeholders. It is important for issues of trade, sustainability, nutrition and health, etc.

Area of work: Disaster Management, Flooding
Location of work: Lilongwe, Chikwawa and Nsanje

Project lead: Hebe Nicholson
Contact details: Hn7@st-andrews.ac.uk

Partner organisation: Malawi Scotland Partnership
Partner contact: Vera Kamtukule
Contact details: vera@malawiscotlandpartnership.org

Funding: The University of St Andrews’ KE Impact Fund
More information: http://www.malawiscotlandpartnership.org/

Description of project

The project aim was to examine the impact of Cyclone Idai, which occurred in March 2019, on the management of flooding in Malawi. Cyclone Idai was a novel weather phenomenon in this region, with no previous cyclone of this magnitude occurring before. It had an international reach in a way unlike previous flooding events in this region. It also occurred just 4 years after the worst flooding experience in Malawi in living memory, which occurred in January 2015. Thus, this cyclone event has implications on how potential disasters are viewed, prepared for and managed in the future. This research produced a report for relevant stakeholders in Malawi and Scotland, which details what these implications entail. As well as highlighting future areas for relevant research.

The report was produced through information gained during fieldwork between September – November 2019. This fieldwork consisted of interviews and focus group discussions with relevant government, academics and NGO officials in Lilongwe, Chikwawa and Nsanje, and members of three flooding-vulnerable communities in Chikwawa and Nsanje. There were 21 interviews with government officials, academic and NGO employees, as well as six community focus group discussions. The interviews and focus group discussions focused on the impact of the March 2019 flooding and the difference this cyclone has or has not made.

The project built on research conducted by the PhD intern, which looks at government resettlement as a way to manage flooding in Malawi. Thus, the PhD intern had existing knowledge of the disaster management structure and process up until Cyclone Idai, which was expected to have changed the situation. How it is changed was the subject of the research.

Key successes and outcomes so far

We have finished the scoping project and are assessing what future projects can develop from this.

The scoping project produced interested findings, suggesting that weather systems forming from the Indian Ocean do have a significant impact on Malawi and are worthy of future research

Many of the interviews and focus group discussions conducted in the Lower Shire region of Malawi were with communities that the researcher had already worked with. This made a significant difference in the reception we received from these participants, which was particularly useful when we had such a short period of time for the scoping research. It enabled the participants to trust the researcher from the beginning and open up quite frankly about the impact of the cyclone and how the viewed the future of disaster management.

Future and ideas for partnership development

The research highlighted the need for future research exploring further the potential impact of weather systems (such as cyclones) formed in the Indian Ocean on Malawi. These weather systems are different from the monsoonal rains that Malawi normally receives, in that they are less predictable. They cannot be part of the seasonal forecast, as they only form a few days before they hit land. They are likely to become increasingly erratic and severe and have a greater potential for damaging countries further inland, like Malawi, which are less prepared for weather systems from the ocean. Whilst the government departments appear extremely capable to predict these weather systems, the general public of Malawi appear less aware of their dangers and how they may be different to normal monsoon rains. Therefore, more research could be conducted with Malawian academics and the support of the relevant government departments, exploring how to further prepare for and raise awareness of weather systems from the Indian Ocean.

Area of work: Health, Education, Coaching
Location of work: Blantyre

Project lead: Prof. Peter Mossey
Contact details: p.a.mossey@dundee.ac.uk

Partner organisation: School of Public Health & Family Medicine, College of Medicine
Partner contact: Dr Susan Carnes Chichlowska
Contact details: MPHTutor@medcol.mw

Funding: GCRF

Description of project

Study Summary
An ethnographic study comparing HE versus HC in an urban primary care setting in Malawi is proposed. This method utilizes video technology, safe haven image storage, observer software and coding expertise from the University of Dundee (UoD). Training of healthcare professionals by the accredited health coach on the HC approach over 3 months will be followed by video recorded observations of 40 HC and 40 HE scenarios on 2 types of healthcare professionals` communication with their patients; (a) Dentists and (b) Dental Therapists at Queen Elizabeth Central Hospital in Blantyre, Malawi. A health professionals’ workshop by experts from the University of Dundee to be conducted in Blantyre, Malawi at the end of the study.

Background to the study
A significant cause of mortality and morbidity in Malawi is due to NCDs (Muula and Mpabulungi, 2007; Msyamboza et al, 2011). Over the years, the HE model for effecting behaviour change has shown relative ineffectiveness in NCDs prevention and control (Kivela et al, 2014). The HC approach is emerging as a potential tool which guides and prompts people to be active participants in managing change in their own behaviour (NHS England, 2019).

Key successes and outcomes so far

At the moment we are in the process of finalising the ethical application with the National Health Sciences Research Committee of Malawi (NHSRC).

Future and ideas for partnership development

The integration of the oral health agenda with other NCDs because of the shared risk factors will create collaboration with other health professionals. The recent affiliation of oral health to the NCD Alliance alongside partners in diabetes, CVD and cancers will provide an ideal platform for a cost effective health improvement strategy. This trans-sectoral approach with an emphasis on upstream factors such as the social determinants of health brings together oral and general health with potential for primary prevention of all NCDs.

Also, interdisciplinary health related research activities in Malawi have, via the Tayside Institute for Global Health (TIGH) and the Dundee Africa Research Network (DARN) raised awareness and uncovered a range of other research activities in different UoD schools which will mean great opportunities for coordination and cooperation.

The participants in this pilot will also be well placed to develop future study protocols e.g. a follow up RCT and jointly apply for major research and implementation grants.

Area of work: Health, Wellbeing, Traffic Collisions
Location of work: Bangwe West, Limbe and Domasi

Project lead: Dr. Edward Duncan
Contact details: Edward.duncan@stir.ac.uk, Dr Greg Mannion - greg.mannion@stir.ac.uk

Partner organisation: University of Malawi College of Medicine, Polytechnic and Chancellor College
Pakachere Institute for Heath, Development and Communication
Jacaranda Foundation
Partner contact: Dr Wakisa Mulwafu
Contact details: wmulwafu2@gmail.com

Funding: Medical Research Council, The Arts and Humanities Research Council, the University of Stirling
More information: https://saferoadsafrica.com/

Description of project

Our work started in 2017 in Malawi, which has one of the world’s highest rates of road traffic related mortality (approximately 5,700 deaths as a result of RTCs each year) but one of the world’s lowest, though rapidly rising, rates of vehicle ownership.

Our Medical Research Councils and Arts and Humanity Research Council funded awards has the following long-term partnership aims:

• To establish lasting interdisciplinary and inter-sectoral research partnership to develop, evaluate and disseminate innovative and sustainable solutions that prevent and respond to road traffic related trauma in Malawi, and across sub-Saharan Africa.
• To investigate the barriers and facilitators, including cultural and contextual factors that influence the community prevention of and response to road traffic related trauma.
• To develop a programme intervention to improve community prevention and first-response within local communities highly affected by road traffic related trauma.
• To consider the potential transferability of the developed programme intervention across sub-Saharan Africa.
• To communicate the outputs of the partnership, and the interdisciplinary and inter-sectoral methods that are used to achieve its aims, to a local national and international audience.
• To develop a partnership funding plan to ensure sustainability of the partnership.

Key successes and outcomes so far

Following from our work to date 42 individuals in Bangwe and Domasi have been trained in an intense internationally recognised First Aid training Programme. Following our prevention intervention, improvements to the road infrastructure around two schools in Limbe have been made – a direct consequence of our work. Further details on this work can be found on Twitter by searching #saferoadsafrica.

Future and ideas for partnership development

To date the community resilience intervention has been co-developed with local communities and national stakeholders. In addition, a prevention intervention targeted at adolescents in schools has also been developed and feasibility tested. Research funding applications are currently under review and further applications are planned for the Spring of 2020.

We continue to aim to:-

• Reduce the number of road traffic related collisions in communities
• Save lives by responding better to collisions when they occur
• Enable people who have been affected by road traffic related trauma to recover and continue living healthy and productive lives
  

We are very open to collaborating with people who are interested in working to reduce deaths and injuries due to road traffic collisions.