Maximizing the Benefits and Minimizing the Risks from the Contribution of “Outsiders” to the Development of Services for Persons with Communication Disability in Sub-Saharan Africa

Abstract

Abstract Background: Services for persons with communication disability are scarce in many low- and middle-income countries, including most countries in sub-Saharan Africa (SSA). Speech–language therapists (SLTs) from high-income countries have long been involved in supporting service developments in SSA. This has often been through short-, medium-, or long-term posts (e.g., through individuals being employed by nongovernmental organizations, working as volunteer expatriates, or being locally employed), delivering direct services to clients and their families, training other professionals, and/or educating SLTs. Consultants working on a short-term basis advise universities and government ministries on the establishment of speech–language therapy (SLT) services and educational programs. There is some professional literature guiding SLTs from high-income countries on how to prepare for such work, but little has been written about what low- and middle-income country-based professionals, clients, or their families think about or would like from outsider SLTs. Furthermore, there is little or no evidence indicating what makes outsider support successful. Methodology: Two SLTs, with a combined experience of over 40 years (a Ghanaian SLT and an SLT based in the UK with considerable experience working in low- and middle-income countries), present a written dialogue about insiders and outsiders working together in low- and middle-income country contexts. Four fictitious case examples of outsider-insider experiences of collaboration are then given, illustrating points made in the dialogue. The third author then reports on part of her PhD study of an SLT insider-outsider collaboration in Uganda. Results/Discussion: Learning from all three sections and the previously published literature is then used to generate recommendations for maximizing the benefits of insider-outsider SLT collaborations in low- and middle-income countries.