Working within existing systems

Competency 2: Working with(in) existing Health, Social Care and Education Systems


Most LMICs will have some formal state health and education systems; these are often supported by private and / or non-governmental organisations. Navigation of health, social care and education systems in LMIC can be very different from HIC contexts where services are more established, regulated and publicised. For services to be effective and sustainable there is a need to embed new services and ways of working within the countries’ existing systems. Be aware that it may be difficult to obtain information about government policies, objectives and service developments. As a visiting professional your working practices need to be sustainable and appropriate to the local context. When there is no shared language, you may need to access translation and interpreting support.



Aware Proficient Advisor
Is aware of and has researched existing services (such as contacting RCSLT, CTI and conducting own research and contacting relevant local individuals and organisations)


Is aware of health/ education services the local population can access and how they are funded



Aware of some of the key stakeholders in local services (e.g. service users, government clinics and hospitals, special school, NGOs, voluntary organisations)



Awareness of local self-help support groups and able to refer to them


Ensures existing services are aware of own service/projects aims and objectives






Knows most and has contact with some of key stakeholders in local services and can develop good working relationships


Knows of current health targets and policies for the country (e.g. governmental, NGOs, foreign aid)






Able to set up self-help groups and support groups, encouraging basic self-advocacy for people with communication and swallowing disorders and their families.

Can refer clients/ families to existing local self-help/ support groups

Works with stakeholders and colleagues to ensure high quality services which complement and are integrated with existing services



Works with other services to ensure a wide population is reached




Works with stakeholders and partners to develop ethical frameworks.







Able to advise and supervise/support colleagues to set up and facilitate such groups. Helps problem solve challenges. Supports groups to work towards becoming national support organisations. Shares information on onward referral agencies




Key knowledge and skills


  • Knowledge of health policy at national and international level
  • Knowledge of political climate of the country being worked in
  • Strong negotiation and advocacy skills
  • Skills in publicising services and supporting local groups to self-advocate