BACKGROUND : Health workers are at high risk of acquiring infectious diseases at work, especially in low and
middle-income countries (LMIC) with critical health human resource deficiencies and limited implementation of
occupational health and infection control measures. Amidst increasing interest in international partnerships to address
such issues, how best to develop such collaborations is being actively debated. In 2006, a partnership developed
between occupational health and infection control experts in Canada and institutions in South Africa (including an
institute with a national mandate to conduct research and provide guidance to protect health workers from infectious
diseases and promote improved working conditions). This article describes the collaboration, analyzes the determinants
of success and shares lessons learned.
METHODS : Synthesizing participant-observer experience from over 9 years of collaboration and 10 studies already
published from this work, we applied a realist review analysis to describe the various achievements at global, national,
provincial and hospital levels. Expectations of the various parties on developing new insights, providing training, and
addressing service needs were examined through a micro-meso-macro lens, focusing on how each main
partner organization contributed to and benefitted from working together.
RESULTS : A state-of-the-art occupational health and safety surveillance program was established in South Africa
following successful technology transfer from a similar undertaking in Canada and training was conducted that
synergistically benefitted Northern as well as Southern trainees. Integrated policies combining infection control and
occupational health to prevent and control infectious disease transmission among health workers were also launched.
Having a national (South-South) network reinforced by the international (North–south) partnership was pivotal in
mitigating the challenges that emerged.
CONCLUSIONS : High-income country partnerships with experience in health system strengthening – particularly in much
needed areas such as occupational health and infection control – can effectively work through strong collaborators in the
Global South to build capacity. Partnerships are particularly well positioned to sustainably reinforce efforts at national and
sub-national LMIC levels when they adopt a “communities of practice” model, characterized by multi-directional learning.
The principles of effective collaboration learned in this “partnership of partnerships” to improve working conditions for
health workers can be applied to other areas where health system strengthening is needed.
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