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individual ], we offer our own perspectives on how minority- world SLPs can best assist those in the majority world to develop sustainable services. Based on our experience of collaborations with minority-world stakeholders, we considered the question, “What do we believe is best practice for minority world SLPs to do, discuss or consider when visiting Ghana to assist in sustainable service development?” Factors around sustainability are key to discussion of how minority-world SLPs can best assist those in the majority world to improve services for PWCD. Recently the United Nations (2015) adopted 17 sustainability goals for development. These goals address three commonly recognised dimensions of sustainable development: economic, environmental, and social and. In this paper we use these three sustainability dimensions to structure our views on partnerships between SLPs in minority- and majority-world countries. The following observations expressed are not intended to be exhaustive, but represent our observations from the field. Economic sustainability factors Economics For sustainability, services need to be both economically viable and relevant to the needs of the population. Minority-world partners who seek understanding of the economic context, including factors such as service funding models, costs of services, service affordability, can make more informed choices about the nature of their involvement. Researching economic indicators and seeking information from majority-world partners can assist in understanding economic factors. For example, all SLP services in Ghana are fee paying, with costs varying enormously. Understanding the type of service you are partnering with, the types of clients who are able to access/ afford the service, and the cost relative to other services can help give indications of the long-term sustainability and impact of partnering with a particular service. Opportunity costs Understanding the opportunity costs which may impact local counterparts (and which may not be immediately obvious) can assist in project planning and implementation. These factors may include: 1. How much money people attending training or therapy sacrifice due to loss of income, or indirect costs (such as transport) of meeting with you. Such costs can be significant when families are struggling to make ends meet. 2. Understanding of the time required by local service providers to plan for visits or projects, and what happens to existing, stretched services when additional time is needed to assist planned visits. That is, what do local staff stop doing to assist in organising international programs or visits? For example, past visiting programs in Ghana have taken a number of days of planning and organising. Due to the lack of administrative support, much of this time has been taken from clinical services. It is necessary to understand and weigh up the cost- benefit of such commitments. Lobbying Improvements in sustainability require developments in economic and social policy. Activism, for improvements to awareness, rights and services, forms a large part of disability engagement in majority world countries, including for SLPs (Wickenden, 2013). For minority world partners

with higher level political influence, it is useful to consider if there is a strategic role to influence change in conjunction with majority-world partners. For example, in Ghana visiting minority-world partners have met with government officials or participated in media events in collaboration with the local team, assisting with the local agenda to build awareness of communication disability and lobbying for improved services. Such meetings are carefully planned as part of the partnership. Environmental sustainability factors Service environment Investing time considering the wider service context when considering relationships and support in a majority-world country is prudent. Contacting a number of individuals or groups to ask questions about the range and types of services in the country (e.g., government, private and NGO services) provides a perspective of “the lay of the land”, including population needs and how services are organised. For example, some independent SLP volunteers to Ghana have previously liaised with a range of services and clinicians to discuss the situation and need in Ghana, to determine how and when to partner with a particular organisation. Gaining such an overview of services and need in-country can assist visiting clinicians or organisations to determine where and how contributions to that country may be most beneficial. Such an approach also has the potential to increase communication between SLPs and organisations who may collaborate with them on projects during their visits. Direct or indirect services Working alongside a local partner will allow capacity building, enable the local partner to follow-up initiatives, and increase relevancy of services. Before providing direct clinical services, consider the relevance, appropriacy and sustainability of these services. Never offer direct clinical services alone, without planning how such services can be culturally relevant and sustained. Professional networks In Ghana, local SLPs routinely seek to engage with visiting minority-world SLPs. Creating these professional networks of practice is an effective way of building a knowledge and resource base in a country with limited services for communication disability. When visiting SLPs do not engage with other SLPs or providers in the country the potential to waste precious expertise and duplicate Attempt to understand the constraints of local staff, including SLPs. The reality of working in a majority-world country is often challenging, with huge clinical demands, low salaries, limited technology access (e.g., no reliable internet or work phone), underdeveloped systems, bureaucracy and sometimes unreliable basic services such as water and electricity. For example, in Ghana access to technology in government services is extremely limited. There is currently no internet access in the hospital speech-language pathology service and SLPs frequently use their own resources to contact international SLP colleagues. Limited access to technology can impact both finances (and therefore willingness to call/log on) and timeliness of responses for local staff which can sometimes be perceived negatively by minority-world partners. Projects with funding could consider limited support for the team to access appropriate resources. resources is increased. Work environment

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JCPSLP Volume 18, Number 3 2016

Journal of Clinical Practice in Speech-Language Pathology