1. Health Links Forum
6th February 2014
Edinburgh City Chambers

2. Health Links Forum: Terms of Reference
Objectives:
(1) To represent, and raise awareness of, Scotland’s health links with Malawi:
(2) To facilitate the free exchange of resources, ideas and experience relating to health linkages between
Scotland and Malawi:
(3) To answer questions and help address issues relevant to health partnerships between Scotland and Malawi:
(4) To disseminate information relevant to Scotland-Malawi health links:
(5) To encourage and facilitate greater joint-working across the health sector in Scotland:
Forum conduct:
Forum meetings, discussions and associated engagements will be conducted in the spirit of the SMP’s values,
to uphold:
•Mutual respect
•Cooperation
•Internationalism
•Service
•Sector understanding

3. Health Links Forum: Activities in 2013
February 2013:
Health forum on Maternal Health in Malawi
February 2013:
Update from DfID on drug shortages in Malawi
March 2013:
Updated Maternal Health Review published on SMP website
May 2013:
Health forum on SG-funded health projects and support for NHS Scotland links with
Malawi
October 2013:
Health forum on NHS Scotland links with Malawi (update), SG small-grants
programme and sustainability in health partnerships
Minutes and resources discussed at all the meetings above can be found on the SMP
website at www.scotland-malawipartnership.org or on:
http://tinyurl.com/SMPHealthLinksForum

4. Health Links Forum: Activities Planned for 2014
Food security and its impact on health
•Can you suggest a good speaker?
Logistics, supply chains and transportation
•Invited THET to come and speak about good practice in medical
equipment donations (TBC)
Continuing support for SG research into framework for NHS
Scotland involvement in Malawi links
Sustainability, capacity building and training

5. Health Links Forum: Sustainable Quality Partnerships

6. Health Links Forum: Sustainable Quality Partnerships
The attendees were asked to answer the following questions:
1. If you were writing guidelines for a partnership that was just starting
out what questions would you want both the Scottish and Malawian
partner to reflect on to help them develop a sustainable, effective and
quality partnership?
For example, “Who’s idea what the project?”
2. Beside each question you write, note down what underlying principle(s)
of partnership it is helping to develop?
For example, “Who’s idea what the project?” (Ownership, joint decisionmaking)

7. Health Links Forum: Sustainable Quality Partnerships
Input from MaSP Regional Meetings Nov/Dec 2013
Suggested Questions
How much funding did you receive and how do you plan to spend it?
Principles
Transparency
What will be the period of the partnership?
Are we dealing with the right organisation?
What contributions will be expected from both partners?
Sustainability, exit strategy
Credibility
Transparency, honesty, joint-decision-making
Where did the funds come from?
How will we communicate?
What are the cultural similarities and differences between the partners?
Transparency
Reciprocity, participation
Mutual respect
How are the activities going to be monitored and evaluated?
Transparency, accountability
How will this project meet the needs of the communities on the ground?
Community owned, participation
What is the problem/need?
Who are the beneficiaries?
What is the time frame for the partnership/exit strategy?
Local ownership
Local ownership
Sustainability
What are you doing?
What are the intended outcomes
What are your areas of interest?
What do you expect from the partnership?
What is the time frame for the partnership/exit strategy?
Transparency
Exit strategy
Alignment, coordination
Honest, trust, managing expectation
Sustainability
Who has been consulted?
Where does the community fit in?
What are the partnership guidelines?
How do you know when you have met the need/succeeded in your objectives?
Accountability, local ownership, transparency
Participation, local ownership
Accountability, good governance
Exit strategy
Have you considered the cultural context in which the project will be
implemented?
Mutual respect, equality

8. Health Links Forum: Sustainable Quality Partnerships
Input from SMP Health Forum October 2013
Suggested Questions
Principles
Is it inclusive-who is it engaging?
Community-led
Whose idea is it?
Local ownership
How sustainable is it?
Exit-strategy
Would we have use for it here (re goods)?
Sustainability
Who asked for it?
Local ownership

9. Health Links Forum: Per diems
Timeline for developing guidance:
Nov/Dec 2013: Consulted MaSP Members
Nov 2013-March 2014: Research and draft literature
review
Feb-March 2014: Consulted SMP Members
April 2014: First draft of SMP per diems guidance
May 2014: SMP event on per diems to discuss guidance
June/July 2014: SMP final guidance on per diems
published on SMP website

10. Health Links Forum: What is a ‘Per Diem’?
o Latin for ‘by the day’
o Daily determined allowance for extra
expenses incurred while working away from
normal duty stations, including travel, lodging
and meal costs (Norad 2010)
o Also known as ‘administrative modalities’
o Used by governments, the development and
private sector

11. Health Links Forum: Functions of Per Diems
1. Reimbursement of work-related expenses
2. Encouraging capacity-building and
professional development
3. Improve efficiency and reduce extra costs in
detailing exact expenses (‘paper push’)

12. Health Links Forum: Perceived benefits of per diems
o Fair compensation for costs incurred
o Aids in the development of skills, sharing of
information, capacity-building
o Providing incentive for those with low salaries

13. Health Links Forum: How have per diems been abused?
o Ranges from ‘survival coping strategy’ to
outright fraud and corruption
o Abuse is generally understood at its root as
connected with low-wages (Chene 2009)
o High level officials taking place of lower-level
employees
o Failure to harmonize on behalf of donors
(Ridde 2010)

14. Health Links Forum: Short and long-term effects
o Increased attendance, more productive training
sessions and workshops
o But…..can also lead to ‘drain brain’ or ‘workshop
syndrome’
o Feeds into low wage rates as per diems are
viewed as salary supplements or coping
strategies (feedback loop)
o Unhealthy institutional culture (Norad 2012)
o Unequal playing field between larger
development organizations and smaller or
locally-based NGOs

15. Health Links Forum: Per diems
Input from MaSP members:
•DEFINITIONS: a clearer definition of “per diems” was needed before a clear position
can be made. Different understandings of the term caused confusion.
•REFORM: look at per diems on a case by case basis, depending on the persons role,
task, distance they have to travel, salary, etc.
•STANDARDISED SYSTEM: across NGOs (a report has recently been published by
NGOs in Malawi seeking to standardise rates-this has been made available to the
SMP).
•INCLUSIVITY: the absence of per diems can exclude those in rural areas from
participating in meetings.A suggestion it might be fairer to include the costs of travel
expenses in budget lines in funding proposals and project plans, rather than such
costs having to covered from other operational budget lines.
•ABUSE: Has led to people chasing allowances, instead of doing the work they are
employed to do.
•SALARIES: per diems have skewed basic salary levels.

16. Input from MaSP members:
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DEFINITIONS: a clearer definition of “per diems” was needed before a clear
position can be made. Different understandings of the term caused
confusion.
REFORM: look at per diems on a case by case basis, depending on the
persons role, task, distance they have to travel, salary, etc.
STANDARDISED SYSTEM: across NGOs (a report has recently been published
by NGOs in Malawi seeking to standardise rates-this has been made
available to the SMP).
INCLUSIVITY: the absence of per diems can exclude those in rural areas from
participating in meetings.
ABUSE: Has led to people chasing allowances, instead of doing the work
they are employed to do.
SALARIES: per diems have skewed basic salary levels in Malawi
TRANSPARENCY
ADVICE: Malawian CSOs are looking for more advice and guidance for a
strandardised system.

17. Health Links Forum: Per diems FAQs

18. Health Links Forum: Per diems forum questions
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Has the issue of per diems come up in your particular link with Malawi?
Has this been a problem? If so how?
Has your link developed productive and sustainable practices to address
the challenge of per diems? Please give examples.
Does the proposed format of FAQs on per diems provide the information
you need to make informed decisions about per diems. If not what other
information (statistics, current rates, academic literature) would you like
to have in order to make informed decisions about per diems?
What form would this be most useful in (pamphlet, research paper, web
page, etc)?
Would you attend a specific event with other SMP members looking at
the topic of per diems. If so what content should be included in the
event?