Trust is earned and learned

Meaningful partnership requires a high level of trust and multiple lines of communication. Both u.s. and international partners must recognize that the other likely perceives risks in being totally honest. Both must listen for things said and unsaid, which takes both time and practice.

Is there a difference between the needs the U.S. partner perceives and the needs that the local community partner has identified?

• If the needs identified by the local and U.S. partners are not the same, an agreement must be made before proceeding. Resolving the discrepancy in the identified needs and determining the core source of problems must be done in a culturally sensitive manner which includes deference to local knowledge in many instances.
  
  

Do the organizational resources identified in the U.S. partner's self-assessment actually meet the prioritized needs voiced by the local partner's community?

• It is possible that the true needs of the community are outside of the U.S. partner's expertise or resources available for the project.
  
  

What liabilities does this bring to the organization?

• Lines of accountability must be drawn and understood by both partners. If a medical mission team performs a surgery, and three weeks later the patient dies, both partners need to have already understood who is accountable.
• If medical mission team personnel hand carry donations of medications (expired or other), this could be in violation of local and international laws.
  
  

What liabilities does this bring to the local partner?

• External presence may compromise the potential of growing a local economy in the wake of a disaster, or sideline local health providers if the activities are not at the invitation of and understood by all involved in the community.
  
  

What is measured? Are impact measures identified, or only measures of inputs and/or outputs?

• The amount of money donated or the number of patients seen is less important than the impact the interventions are meant to have.
  
  

Are practices and procedures appropriate for the local context?

• The local partner should know the competencies of the local staff and community and plan activities to dovetail with their capacity.
  
  

What is considered a "successful" project?

• Outcomes and not motivations should drive evaluation.
  
  

How will "failure" be dealt with?

• International health activities require transparency in communicating the challenges experienced and lessons learned, as well as an ability to reassess continued activities.
  
  

Are long-term or short-term measures being monitored?

• When a piece of equipment is given to a facility, the actual usage for a full year after donation and its impact on the health of the community should be evaluated.