The ‘Improved Healthcare in Rural Areas’ project, supported by the Norwegian Agency for Exchange Cooperation (Norec), aims to improve access to and utilization of health services in marginalized communities in Uganda and Kenya. The organizations involved reopen and staff old health clinics in rural areas, left by the former colonial rulers. These clinics are located in marginalized communities where there are either insufficient resources to offer healthcare services, or where it is challenging to find qualified professionals. Through the exchange of skilled health personnel, the project offers primary healthcare services in these marginalized communities. Furthermore, the young professional health workers train the locals in basic healthcare, thus ensuring sustainability in the provision of healthcare services. 

The project contributes directly to Sustainable Development Goal (SDG) 3 (Good health and well-being), and more specifically to target 3.8.  The overall objective is to:  improve preventive health education and services for maternal and child health; improve preventive health education and services for HIV and Hepatitis B; improve knowledge of malaria prevention in project placements; improve hygiene and sanitation; improve nutrition for children under five and breastfeeding mothers; update the guiding principles for health facility management; develop capacity in managing community development projects; increase knowledge and practice of community–directed intervention projects; and improve professionalism in cross-cultural settings. 

The key methodology used in this project is the mutual exchange of professional staff within the framework of institutional cooperation.  

To date, a total of 36 skilled health and administrative personnel from Uganda and Kenya, 18 each, were exchanged for a period of 12 months, including nurses, clinical officers, midwives, nutritionists, pharmacists and biomedical technologists. After going home, there is one month of follow-up work to secure that the knowledge the health personnel has gained abroad is transferred to their own workplace. This increases the chances of organizational learning, and thus of a greater sustainability of results. The project has gradually scaled up the number of health personnel sent. It started with the exchange of four people per year in 2017, and gradually increased to 12 people per year today. 

Key results from the project include improved access to and utilization of primary healthcare services in six marginalized communities in Kenya and Uganda, capacity building for local staff and increased health advocacy work in local communities. By training the local community in prevention, and building capacity of the local staff, the chances of sustainable results are also increased after the end of the project. 

Norec’s role in this initiative is to facilitate planning for meetings, the carrying out mid–term project reviews, as well as partner training, preparatory courses, and debriefing health personnel prior to the exchange abroad. The concept of exchange of health personnel within the framework of institutional cooperation is a highly versatile model to upgrade skills, knowledge and capacity. Since 2001, Norec has supported exchanges of personnel in the health sector in a variety of developing countries. The methodology of exchange can easily be applied in a variety of settings, and  is easy to scale up or down in response to the needs on the ground, thus making it a technically feasible solution.  

The innovative aspects of the project are its horizontal design and focus on reciprocity. Both partners are fully engaged in designing and implementing the project, and both partners contribute with their respective strengths and learn from each other. A joint sense of ownership and actions is the result of joint planning and implementation of the project. Development cooperation projects are often designed based on a transfer of technologies from a donor to a recipient country. The recognition of the value of all stakeholders’ knowledge creates greater ownership, participation and sustainability in the project.