* The current policies that are developed only focus highly
on Institutions based clinical service which has brought about severe cutbacks on the promotion, preventive and outreach services.
* The success will also depend largely on communities demonstrating worldwide that they can bring about effective and sustainable improvements in a cost effective manner.
* Corruption and its consequences.
* Progress towards the achievement of the MDGs is far from uniform across the goals with sub sahara Africa being in the epicenter of the crisis with continuing food insecurity, a rise of extreme poverty, stunningly high child and maternal mortality, a large number of people living in the slums and a widespread shortfall for most of the MDGs.
* Despite clear evidence that the social determinants of health affect health and illness, the health sector is still reluctant to champion policies that improve social conditions because areas of social and economic policy largely fall outside of the health department’s jurisdiction (Browne G. Nov;2002)
* Despite the increasing popularity and potential, there exists limited evidence of the effectiveness of partnership in achieving the desired outcomes. The measurements and indicators of public health changes as a result of partnership work , the quality of partnership processes and outcomes are failing to be measured effectively. The critical limitations of the existing research that constrain the way we think about and build evidence base for partnership work.
* While measuring functioning and the impact of partnership work over time is ideal, longitudinal designs are not always practical in community settings given limitations in time, funds and rewards of academics for collaborating in community work.
* Qualitative work related to the effects of partnership is not well published in journals, and although it is , findings of multiple studies are not well synthesized that the data and methodology are accessible to practioners and policy makers (Grammer , Sharpe, El Ansari et al.)
* Globalization that fosters the moving of people (labor) across borders and therefore the resurfacing of infectious diseases.
* Targets cannot be met if the resource estimates are not met,( Benjamin Johns et al in resource estimates for global maternal and newborn health services).
* Lack of incentives for communities to get involved in partnership, eg training, skill building and development, funding etc
* The need to increase incentives for universities and research organizations to conduct Community Based Participatory Research, carry out needs assessment to seek partnership
* Lack of trust by the communities highly embedded in social cultural ties.
* The bureaucratic power held by providers as owners of the knowledge related to health although they do not own those whose health needs is addressed to.
CONCLUSION
Partnership will not just happen if we arrange just a few meetings and keep hoping for the best. The ability to bring about participation has to be learnt and practiced; At the beginning many of the poorest and most exploited communities may not grasp the idea at all, nor show any interest. By making our aims clear, have community attachment through listening and respect for community members, and making the people realize that we are not merely providers, then their participation will be genuine. Avoiding professional biases that misguide real practice and aiming to bridge between academic work and practice.
Acknowledgement
VVOB / KHI Project - Rwanda
Kigali Health Institute – Rwanda
The Embassy of the Republic of Uganda in Rwanda.
TUFH Conference Secretariat 2007, Kampala – Uganda Conference.
Makerere University conference organizers.
Bank of Africa – Uganda.
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