SIDA member EMMS International reflect on the lessons learnt following the successful completion of the Sunita project, a three-year initiative to improve access to palliative care in rural Nepal. Read on to learn more from Cathy Ratcliff, CEO of EMMS International, about the impact of UK aid match on the project.
Many people living in poverty around the world face illness and death without access to palliative care or effective pain relief. Scotland’s oldest international healthcare charity, EMMS International, has helped end needless pain and suffering through developing palliative care services, increasingly needed as Non-Communicable Diseases advance around the world. UK Aid funding has formed a significant part of our journey to advance compassionate care.
In March 2025 our Sunita project came to a close. This three-year project in Western Nepal exceeded expectations by reaching over 84,000 people with compassionate care and support. This project was made possible thanks to generous donations that were matched pound for pound by the UK government through UK Aid Match. This was EMMS International’s third UK Aid Match grant. Looking back, there are milestones to celebrate and lessons for navigating the current aid landscape.
EMMS, UK Aid and Palliative Care
EMMS International’s experience with UK Aid Match began with an unsuccessful application, many years ago. We have to admit that we simply weren’t ready for this funding, but we were ready to learn. The feedback gained, along with an existing commitment to enhancing our organisational effectiveness (pioneering the NIDOS Effectiveness Toolkit, for those who remember!), pushed our organisation forward. In 2014, EMMS’s second application for UK Aid Match was successful, as was our next application in 2017.
EMMS International therefore ran two consecutive palliative care projects with partners in Malawi. The development of a specialist BSc degree, centres of excellence, continuous professional development and advocacy around drug policy and availability contributed to the advanced integration of palliative care in the Malawian healthcare system, and all relevant pre-service training courses now include palliative care. Lessons learned and experience gained helped shape EMMS’s latest work in Nepal.
Recognising the Positive Impact of UK Aid
Since that first application to UK Aid Match, we’ve seen reduction and reallocation of UK Aid, as governments, ministers and departments changed, and so did Government priorities. While we’ve invested in cultivating other sources of funding, we do so with a determination to maintain the high standards that UK Aid embedded in us. UK Aid Match has had a hugely positive impact on our quality of work, that of our partners, and the lives of people with life-limiting conditions in Malawi and Nepal. UK Aid will continue to have a positive impact as we continue our other palliative care development in India, Malawi, Nepal, Rwanda and Zambia.
The recently ended Sunita project helped 84,414 people as it:
- Provided clinical care for 14,069 people and their 70,345 family members
- Trained 1,087 healthcare workers and 409 female community healthcare volunteers
- Helped 7 services, including 6 hospitals and 21 clinics, serving rural and urban areas, to have an improved supply of morphine and other pain medications, as well as staff and community groups trained in palliative care
- Equipped 596 teachers to support young carers and compassionate peers.
The direct cumulative impact during our two UK Aid grants in Malawi and one in Nepal is significant – 325,920 people cared for (patients and family members) and 9,370 health and social workers and volunteers trained. Once people are shown that their caring makes a difference, they eagerly improve the lives of people whose suffering previously went unnoticed or was thought to be beyond help. They care for their loved ones, their neighbours or their patients. We developed and evidenced the supportive health and social systems unique to each country that are needed for that to happen.
Research, which was our foundation to securing funding, has been part of each of our projects. Our UK Aid projects provided robust evidence on models of palliative care that we and our partners had created, and in the process trained new researchers and lecturers. The changes that we and our partners brought about in new training courses, evidence of what works, and newly skilled staff, mean that numbers of people cared for and numbers of people trained continue to grow.
Shifting the Power
UK Aid helped scale up work which we had piloted, and built on other small strategic inputs which we had made, such as translations of training materials and research on palliative care delivery in a disaster. Now we’re revisiting these niche, discrete approaches, yes because funding is more limited, but also because these FCDO-funded projects brought lasting change.
The increased experience and capacity of our partners is giving more opportunity for South-South collaboration and also for capacity-building of the North by the South. We and our long-term partners are taking project management skills, research results and clinical advice gleaned in Nepal and Malawi to our new partners in Rwanda and Zambia. Our Nepalese partner has since 2020 provided professional advice on civil engineering to our partner in Bihar, India, will soon provide IT capacity-building to the same Indian partner, and in June will deliver an expert seminar to pain relief practitioners in Glasgow.
Government aid made this possible, letting us experiment, research and generate evidence at scale, and influencing the policies of governments. The changes that UK Aid brought about in EMMS and our partners and national systems are embedded enough for us to be confident that the impact of our work will continue to spread. Our success shows the value of large donors with exacting standards. UK Government priorities have changed for now, and the West is not the biggest donor, but its aid brings a capacity-building that we must cherish. UK Aid has a worldwide reputation for quality, particularly when we can use it to shift the power, enable South-South and South-North co-operation, and build respectful relationships between partners.
Aid is also part of soft power, spreading knowledge exchange between peers, understanding of cultures, and trust between individuals who work together but live continents apart. It benefits international relations, particularly important in times of international tension, which it may reduce or even prevent. It cements relations between countries of strategic importance to each other – Nepal, for example, is a long-standing friend of the UK, and provides 5% of the British Army’s soldiers, through the Gurkhas.
What’s next?
EMMS remains committed to our vision of global health equity. We have proven our innovation and ability to bring about large change. Deciding to seek new donors, rekindle known donors, and support South-South, South-North and North-South colllaboration, requires continuing innovation, solidarity and research.
We shall keep growing our innovative work to develop health workforces in India, Malawi, Nepal and soon Scotland, to ease the acute shortages of healthcare workers in many countries through our Global Healthcare Workforce programme, improving the lives of women whom we train into guaranteed jobs in hospitals.
We shall keep working in this spirit of solidarity with our partners, and health workers and patients everywhere, as we address the worldwide, major and growing problem of Non-Communicable Disease (NCD), developing national palliative care systems, and spreading expertise in strokes, for example, and dignity in healthcare.
We shall keep developing and using robust research and evidence on all of this, to support our continuing innovation and bring about large-scale change.
Our role is increasingly to facilitate collaboration. We have always innovated, operated in solidarity with our partners, and most recently developed their research. Now we help them to build the capacity of each other and of UK practitioners. At this moment in history, it is surely a priority for the UK Government to remain at the heart of such international trust-building through this type of soft power.
Author: Cathy Ratcliff, CEO of EMMS International and Chair of SIDA
EMMS International are holding an online event on Tuesday 3rd June with Sarah Gibson and Dr. Amrita Shrestha to discuss the impact and lasting legacy of the Sunita Project, where Dr. Shrestha will share her personal experience and insights into the project’s achievements and future aspirations.