Table 8 Success of the LINK based on the components of a successful link [23] (Eastwood et al., 2005)

1. Regular personal contact between individuals from both groups

Occurs through curriculum workshops, TTT courses, annual fellowship examinations, and annual scientific congress.

2. Mutually agreed, locally relevant aims: clinical priorities, teaching programs, research objectives, and staff

Are articulated as the 5 strategic objectives in the memorandum of understanding and there are targets for each phase of the grant.

3. Clear written guidelines, preferably at the institutional level as to how the link will be fostered and supported

Are in the form of the VISION 2020 LINKS TOOLKIT. This is a general tool for all overseas partners. Although it is available online, most participants were not aware of it. There is also a memorandum of understanding signed at the launch of the LINK, whose content most participants were not conversant with.

4. Acceptance that the scope of the collaboration will not be limited by the priorities of funding agencies

The scope of collaboration is determined by the needs of COECSA and this is indicated in the MOU.

5. Bilateral annual visits

Occur in the context of observing exams and attending annual congress in both United Kingdom and COECSA.

6. Vision of a long collaboration (>10 years), not a transient one

The LINK is envisaged to be long term, although the actual duration is not explicitly stated. It is to continue “as long as the partners wish to collaborate” according to the MOU.

7. Training of individuals from developing countries taking place in their own country as much as possible

All training courses and workshops that are meant to achieve the strategic objectives occur in COECSA region

8. Ability to respond to a changing environment at either end

Is demonstrated by the setting up of committees as organs of decision-making and use of effective communication. The decision to postpone COECSA congress 2014 in view of the Ebola outbreak in West Africa during that period exemplifies this.

9. Involvement of nurses and other health workers in the collaboration

This has not been adequately achieved and participants reported the need for it:

“You will note that COECSA is college of ophthalmology…not really college of ophthalmologists…so we should involve more cadres. We want to begin with the colleges that train the mid-level cadres” (COECSA participant)

10. Consider honorary contracts for individuals taking in established links; these can strength the links

This has not been achieved; facilitators usually work on a volunteer basis.

11. Early planning as to means of securing future funding

This has been pursued and achieved. A participant expressed:

“We are alert to find out when the next round of funding is around the corner, and we put in (submit to funders) our proposal early”

12. Independence from commercial sources of funding, avoiding possible future conflicts of interest

There has not been any funding from commercial sources. However, one participant suggested that:

“Funding from suitable commercial sources such as equipment manufacturers who have an education component may not present a high risk for conflict of interest and may be considered in the future”

13. Foster the development of other links and contribute to an international philosophy of links in general

The LINK is established in the context of 27 other VISION 2020 LINKS and supports the establishment of additional twinning LINKS in the foreseeable future. It is complementary to other links such as the Munich link without duplication or conflict.