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2 5 Y E A R S 129070 94 THE NETWORK TOWARDS UNITY FOR HEALTH

VOLUME 23 | NUMBER 01 | JUNE 2004

CONGRATULATIONS to The Network: TUFH on its 25th anniversary! In those 25 years our organisation has broadened its focus point from improving health through innovative health professions education, to improving health through linking academics with other stakeholders. This change is also reflected in the Newsletter.

See this issue: health professions education is addressed in an article on accreditation and quality assessment in Switzerland, health managers get a voice in an article on the Indian Society of Health Administrators, the community is put in the limelight in our section Community at the Heart, and health professionals get attention in an overview on family doctors.

New in this edition is a section especially for the ‘South-to-North’ diffusion of innovations (within The Network: TUFH), and a column on health promotion.

In addition to all these informative articles, you can have a look at the collage with photos from 25 years Network: TUFH. It will certainly bring back good memories!

Marion Stijnen and Pauline Vluggen Editors

In the Newsletter we refer to The Network: Towards Unity for Health as The Network: TUFH.

THIS NEWSLETTER HAS BEEN PRODUCED IN COLLABORATION WITH WHO

NEWSLETTER IN THIS ISSUE, AMONG OTHERS: The Network: TUFH and 'South-to-North' Diffusion of Innovations 05 'Let's Communicate Health': Educating the Community via Local Radio 10 Starting from the Beginning: Sharing Key Lessons 15 Family Doctors Contribute Towards Unity for Health 18 Belgian Students Involved in Community Diagnosis 22

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CONTENTS 03 FOREWORD The Network: TUFH in the 21st Century 04 THE NETWORK: TUFH IN ACTION 04 Conference of The Network: TUFH Overcoming Health Disparities | The Network: TUFH and ‘South-to-North’ Diffusion of Innovations 05 Position Paper New Position Papers 06 Book Review For Those Who Struggle With Writing 07 Education for Health EfH Officially Accepted in MEDLINE! | Call for Papers | Mentoring System for Authors | Education for Health Online 09 IMPROVING HEALTH 09 Yellow Papers Therapeutic Patient Education: The Experience of an Italian Hospital 10 Health Promotion ‘Let’s Communicate Health’: Educating the Community via Local Radio 11 Health Authorities Health Administration Improvement in India 12 INTERNATIONAL HEALTH PROFESSIONS EDUCATION 12 Multiprofessional Education Interprofessional Rural Programme of British Columbia 13 Accreditation and Quality Assessment Accreditation of Basic Medical Education in Switzerland 14 New Institutions and Programmes Centres of Support in Medical Education | Online HIV/AIDS Education 15 Leadership Column Starting from the Beginning: Sharing Key Lessons 16 COMMUNIT Y ACTION 16 Community Interview Community at the Heart 17 PARTNERSHIPS A Medical School - Community Partnership | Family Doctors Contribute Towards Unity for Health 20 THE LIKE-MINDED WORKING TOGETHER INCLEN 21 STUDENTS’ COLUMN 21 Out of the SNO Pen Strategies and Aims 21 Students’ Speakers Corner Story of a Friendship | Belgian Students Involved in Community Diagnosis 24 INTERNATIONAL DIARY 2004, 2005, 2006 AND 2007 28 MEMBER AND ORGANISATIONAL NEWS 28 Messages from the Executive Committee The Network: TUFH and GHETS Relationship Develops | WHO 29 Taskforces An Overview of the Network: TUFH Taskforces | Integrating Medicine and Public Health | New Coordinator Taskforce MPE 30 Represented at International Meetings/Conferences Meetings/Conferences | INCLEN Global Meeting 30 Re-assessing Full Members 31 Introducing Members John Snow Inc. 31 About our Members Moving on: Changes in Leadership | The Wynand Wijnen Award 2004 | President of the Colleges of South Africa | New Members | Members Helping Members | The Network: TUFH on the Map | Interesting Internet Sites

FOREWORD

Global Dissemination of Innovations in Primary Care In conjunction with the World Health Assembly (WHA), held in May 2004 in Geneva, Switzerland, The Network: TUFH held a briefing session for 70 invitees. Due to delay, Arthur Kaufman unfortunately was not able to present a statment about The Network: TUFH to the whole Assembly.

This statement, from which you can read the text below, will be included in the preceedings of the WHA.

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* You can read more about the ‘South-toNorth’ diffusion of innovations within The Network: TUFH on page 5.

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Dr. Arthur Kaufman

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Some of the most important innovations in primary care service and education which exemplify this broader vision, and which are locally relevant but universally applicable, are emerging from developing countries.

These models are diverse. In rural Kenya, a regional university and local public health authority collaborate with village leaders in the creation of a malaria prevention and economic development project. In an urban slum in Brazil, a partnership was forged between a local women’s collective, a nearby university and a primary care clinic. Community outreach workers are trained from among the unemployed and they survey homes, and address priority community health needs.*

Arthur Kaufman | Secretary General Email: akaufman@salud.unm.edu

THE NETWORK: TUFH BELIEVES THAT ACADEMIC INSTITUTIONS AND HEALTH SYSTEMS MUST CREATE A BROADER VISION OF PRIMARY CARE.

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"The Network: Towards Unity for Health (TUFH) is an international non-government organisation in official relationship with the WHO, comprised of individuals and groups, of institutions and organisations committed to improving the health of communities. To raise the level of peoples’ health, The Network: TUFH believes that academic institutions and health systems must create a broader vision of primary care. This entails a re-allocation of funds toward more accessible and affordable preventive and curative interventions, and the formation of partnerships with other healthcare stakeholders in the community and with other sectors of society.

These important models often are hidden from the rest of the world because of language barriers or poor access to the means of dissemination. The Network: TUFH has set as a priority the dissemination of these primary care models through annual Conferences, the Network: TUFH website, and the triennial MEDLINEindexed Network: TUFH journal Education for Health."

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THE NETWORK: TUFH IN ACTION CONFERENCE OF THE NETWORK: TUFH Every year The Network: TUFH organises an international scientific and networking conference.

This year the Conference will be held in Atlanta (Georgia), USA, from 6 - 10 October.

Co-sponsored by Community-Campus Partnerships for Health.

Overcoming Health Disparities • International Conference of The Network: TUFH and CCPH, October 6 - 10, 2004 • Anniversary Day, 25 years The Network: TUFH), October 5, 2004

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Community-Campus Partnerships for Health (CCPH) and The Network: TUFH are co-sponsoring an international Conference this year that replaces their individual annual Conferences for 2004.

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Conference Theme The theme of this years Conference is Overcoming Health Disparities: Global Experiences from Partnerships Between Communities, Health Services and Health Professional Schools.

Health is more than not being sick. Health is a resource for everyday living. It’s the ability to realise hopes, satisfy needs, change or cope with life experiences, and participate fully in society. Health has physical, mental, social and spiritual dimensions. Achieving optimal health means attending to the important influences of health. This vision is bigger than our systems of public health and healthcare. All individuals, systems and institutions in the community share responsibility for – and reap the rewards of – optimal health. Health is influenced by important factors such as the physical environment, health practices and coping skills, biology, healthcare service and the social and economic environment (the social conditions, or the social determinants of health) in which people live their daily lives.

The Conference theme is intended to focus attention on the persistent problem of health disparities within nations and between nations around the world, to high4

light promising strategies for overcoming health disparities, and to stimulate constructive actions that can be taken at multiple levels. Effective responses to these concerns require cross sector co-operation and coordination that bring communities, health services, and health professional schools together as partners for change.

CCPH Community-Campus Partnerships for Health (CCPH) is a USA-based organisation that promotes health through partnerships between communities and higher educational institutions. CCPH members - over 1.000 communities and campuses in over a dozen countries - are pursuing servicelearning, community-based research, coalitions and other partnership strategies as powerful tools for civic engagement and healthier communities.

Community-campus partnerships that increase the diversity of the health workforce and eliminate health disparities are strategic priorities for CCPH. Founded in 1996, the organisation is interdisciplinary, includes all sectors of higher education - including students -, and serves both academic and community-based constituencies. CCPH advances its mission primarily through information dissemination, training and technical assistance, research and evaluation, policy development and advocacy, and coalition-building.

Conference Programme (draft) • Pre-Conference Workshops:Effective Communication for Health/ Essentials of Community-Based Participatory Research/Getting an Article Published/Service-Learning as a Strategy for Addressing Health Disparities • Brown Bag Lunch Sessions • Community Site Visits • Didactic Sessions • Keynote Addresses • Mini-Workshops • PEARL Sessions • Poster Hall • Story Sessions • Thematic Poster Sessions Anniversary Day Programme (draft) • Morning: scientific programme at Morehouse School of Medicine • Afternoon: leasure programme in Atlanta • Evening: dinner

Now available through Internet Programme, Registration forms and more Conference details. www.the-networktufh.org/conference www.the-networktufh.org/conference/ programme.asp www.the-networktufh.org/conference/ registration.asp www.ccph.info Visit the Conference site frequently, as the programme will be updated regularly.

POSITION PAPERS

The Network: TUFH and ‘South-to-North' Diffusion of Innovations For the past 20 years, the University of New Mexico has adapted innovations from other institutions and programmes in developing countries.

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Bob Bulik, Associate Professor, University of Texas Medical Branch, USA, has offered to write a Position Paper on the changing role of faculty in medical education. Anyone interested in collaborating on this Paper can mail to rjbulik@utmb.edu

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Such examples of ‘South-to-North’ diffusion of innovation exist world-wide, but are not well known. One expects the flow of innovation to be from ‘North-to-South’ in light of the imbalance in wealth and the ‘digital divide’.

The Network: TUFH has helped create a balance in this regard. With our strengthened organisation, and communications opportunities afforded us by our journal Education for Health, Newsletter, annual Conferences and website, a bi-directional exchange should be highlighted and

IT IS IMPORTANT TO DOCUMENT HOW INNOVATION SPREADS BETWEEN NETWORK: TUFH INSTITUTIONS AND PROGRAMMES, SO WE CAN BECOME MORE EFFICIENT IN THE PROCESS AND RECOGNISE ANOTHER BENEFIT OF PARTICIPATION IN OUR ORGANISATION.

NEW POSITION PAPERS In the last Newsletter we invited all our members and everyone interested in The Network: TUFH to write new Position Papers on issues that are close to the heart of The Network: TUFH. Since then we received a number of suggestions for new topics: • The ultimate challenge: Higher professional education for adapting to change and for participating in the management of change • Dealing with diversity • Developing and keeping the workforce healthy: The main challenge for the modern society • Community-based care for the elderly • Changing role of faculty in medical education

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In Londrina, Brazil, the New Mexico team observed a programme in which unemployed local citizens became employed by a local primary care clinic to serve as community health workers, bridging the needs of the poor community with the programmes and resources of the health centre. This year we adapted the model we saw in Londrina and hired our first community health workers to serve a similar function in our own communities.

Arthur Kaufman | Secretary General Email: akaufman@salud.unm.edu

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For example, the University of the Philippines addressed the problem of poor access to care on the islands of Samar and Leyte by recruiting local youth into health careers, then training them locally so they wouldn’t move to the big cities. In New Mexico, we adapted this model to our reality by preferentially admitting to medical school students from the state’s rural and ethnic minority communities, training them with rudimentary clinical skills in their first year, then immersing them back in rural communities to work and learn that same year.

broadcast. It is important to document how innovation spreads between Network: TUFH institutions and programmes, so we can become more efficient in the process and recognise another benefit of participation in our organisation.

The Network: TUFH Executive Committee decided to undertake the writing of a series of ‘Position Papers’ on issues that are closely related to the aims and objectives of our organisation. They must be seen as starting points for further discussion. You may contribute by submitting a letter to secretariat@network.unimaas.nl, by participating in sessions on these issues at Network: TUFH Conferences, or responding to the electronic versions of these Position Papers at the Network: TUFH’s Internet site (www.the-network.org/position).

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THE NETWORK: TUFH IN ACTION BOOK REVIEW

For Those Who Struggle With Writing Book Review of: The Work of Writing: Insights and Strategies for Academics and Professionals Elizabeth Rankin

journal for example) and finding one’s own voice. Strategies are given to find a balance between an unreadable text and a too personal essay.

This review has been published before in Education for Health, Volume 16, No. 3.

“Writing is easy. All you do is stare at a blank sheet of paper until drops of blood form on your forehead.” (Gene Fowler)

Jan van Dalen | Coordinator Teaching and Assessment Communication Skills, Skillslab, Maastricht University, the Netherlands Email: j.vandalen@sk.unimaas.nl

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Most of our knowledge and insights stem from the scientific debate that goes on by means of text, be it in a journal like Education for Health or through the Internet. If we want to get our work across, it is therefore necessary that we are able to write our thoughts and findings in such a way that we catch the reader’s attention and keep it.

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Rankin’s book The work of writing (2001) is a fine text for those who struggle with putting their thoughts on paper. It addresses issues like: “What am I trying to say in this piece of writing? Is it something that others have written about before?

If so, what is new and important about what I have to say? Or does my saying it in somewhat different language serve a purpose for those who will read it?” No quick fixes, shortcuts or formulas for academic and professional writing are promised, and indeed, they are not given. However, vivid descriptions of recognisable dilemmas that writers face introduce issues like: ‘the work of writing’, ‘contributing to the professional conversation’, ‘meeting readers’ needs and expectations’ and, importantly, ‘seeing the project through’. In the book attempts are made to make the work of writing easier, more comprehensible, manageable and productive. The author has found a balance between narratives and a clear organisation with points of advice. Rankin spends a section on the dilemma between the conventions of writing (in an academic 6

The only minor criticism I have about this book is that while it is well written, it is in a colloquial, American style. It may therefore be a little more difficult to follow for readers who are not so familiar with this language. However, in my view the benefits of this book far outweigh this disadvantage. It can be a great help in sharing our findings with others!

For reviews of Network: TUFH books, go to www.the-network.org/publications/ books.htm

Throughout the book, the importance of sharing your early writing attempts is stressed. In every chapter there is a section on ‘getting feedback from others’, suggesting strategies to involve others in order to test how well you have succeeded in getting your message across to others, and how to improve your text. On the other hand, the actual work of writing and the investment that takes is not neglected: in every chapter there is also a section on “writing on your own’. These sections give guidelines on how to get started and how to keep on working.

Pertinent throughout the book is the message that writing is something that one cannot do by him/herself. Feedback from others must be sought. In Rankin’s view writing groups are an excellent forum for mutual assistance. She argues that it could be beneficial if these groups are composed of writers from different disciplines: what better audience to judge whether you can get your message across? An appendix is devoted to organising writing groups.

MY WISH FOR THE NEXT 25 YE A R S My association with The Network dates back to the 1970’s. For several years, I served as the Chairman of the Executive Committee. Here’s a story that for me captures what The Network is all about. One evening, during a meeting in Geneva, three of us had dinner together. In addition to me (a Canadian), the trio included the late Professor Zohair Nooman from Egypt, and Professor Cosme Ordonez from Cuba. As the conversation proceeded (I’ll admit it - facilitated by a bottle of fine red wine!), we reflected on this question: Why are each of us still serving The Network - after more than 15 years? We agreed on three reasons: a shared worthy goal, a strong determination to achieve it, and mutual collegial respect.

My wish for The Network is that these three features will continue to describe its work - for the next 25 years, and more.

Vic Neufeld | Former Chairman Executive Committee, Hamilton, Canada Email: neufeld@mcmaster.ca

EDUCATION FOR HEALTH Three times a year The Network: TUFH publishes its peer-reviewed and MEDLINEindexed journal Education for Health: Change in Learning & Practice (EfH).

For contributions, please contact efh@network.unimaas.nl

EfH Officially Accepted in MEDLINE!

Authors can submit suitable articles to either journal and should ensure that they clearly indicate their wish to be considered for the joint EfH/RRH issue in their cover letter/email. Manuscripts should be submitted electronically: either via email to Education for Health: efh@network.unimaas.nl, or via the webbased system of Rural and Remote Health : http://rrh.deakin.edu.au Submission deadline is 31 October 2004.

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If you have specific questions, please contact Ron Richards, PhD Editor of Education for Health: Change in Learning and Practice

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Marie-Louise Panis | Managing Editor EfH Email: efh@network.unimaas.nl

The technical requirements and submission instructions for contributions for this special issue will be the same as the Education for Health Instructions for Authors, which are available at: www.the-network.org/efh/instructions

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Education for Health also encourages aspiring authors who are relatively new to academic writing and/or whose English is not their first language by providing assistance in getting their ideas published in a scientific fashion.

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We also invite thoughtful analyses, innovative ideas, and conceptual statements that may not necessarily be the product of formal research but which have implications for the decision-making of the teachers and educational leaders who are the primary readers of our journal.

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MEDLINE is available on the Internet through the NLM home page at www.nlm.nih.gov/ and can be searched free of charge. No registration is required.

Access to various MEDLINE services is available from medical libraries, many public libraries, and commercial sources. The List of Journals Indexed in Index Medicus is published annually and is available at www.nlm.nih.gov/pubs/pubcat.html.

This special issue will focus on articles that jointly address the themes of the two journals - innovative health education oriented towards rural and remote communities.

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International Access We expect that the indexing of our journal in MEDLINE will greatly enhance its international access and will be of value to health professional education worldwide. Medical educators will benefit from the innovations and explorations that are regularly reported in Education for Health.

We hope this MEDLINE designation will make our journal more attractive to both readers and writers.

Inviting Authors Education for Healh invites reports on original quantitative and qualitative research that can inform educational practice.

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We are very proud to confirm the official acceptance of Education for Health: Change in Learning & Practice for inclusion in Index Medicus/MEDLINE. This is an important milestone in the evolution of our journal. The acceptance has been announced previously, but it has now been formally approved. MEDLINE indexing will have all issues available, back to and including the 2000 Volume of Education for Health (Volume 13).

C ALL FOR PAPERS In late 2005, Education for Health and Rural and Remote Health will publish a unique, joint issue of their journals. This provides authors the opportunity to have their article published simultaneously in The Network: TUFH’s acclaimed Medlineindexed, print-based journal Education for Health and the freely accessible web-based Rural and Remote Health journal.

Ron Richards and Paul Worley | Editor EfH, Editor-in-Chief Rural and Remote Health Email: richards@uic.edu, paul.worley@flinders.edu.au

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THE NETWORK: TUFH IN ACTION EDUCATION FOR HEALTH

Mentoring System for Authors Are you interested in writing an article for our journal Education for Health, but you have no prior experience with writing for an international, MEDLINE-indexed journal?

Are you considering submitting a paper for our consideration, but English is not your first language? Do you have a manuscript about a worthy project you’re involved in, but you are not familiar with academic writing at all?

Education for Health has a system that can help you.

Mentoring can be provided at a distance via email, involving exchange of material and commentary, or ‘live’ during one of the Network: TUFH Conferences.

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Since many of our aspiring authors are relatively new to academic writing and/or English is not their first language, and since one of our premises is to be as helpful as possible to our authors, we have established a ‘mentoring system’. We have a database of experienced writers, who have generously volunteered to help authors of papers that appear to have promise, but which are not ready for publication yet.

Our mentoring system has been set up to provide assistance to authors like you. Our mentors can help you in at least one of the following areas: • Converting your paper to better English • Enhancing the quality of your writing, in general • Thinking through your goals and problem identification • Organising your way of conceptualising and reporting the research you have done • Converting your paper’s abstract into a ‘structured’ format • Refining your analysis However, although mentors will provide guidance and suggestions, they will not do any writing for you. The actual writing is up to you.

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author's submission

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technical check

EfH’s review process (Read more about EfH’s review process in the Editorial of our journal’s second issue, Volume 17, July 2004)

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author rewrite

initial review by an associate editor

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mentor

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withdrawn | no author reaction

3 reviewers editor's decision minor revisions major revisions reject accept copy editor 8

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publication

The process of writing is something that very few people can do by themselves.

That’s why we hope we can assist you in sharing your important ideas and projects.

We look forward to hearing from you !

Ron Richards and Marie-Louise Panis | Editor and Managing Editor EfH Email: efh@network.unimaas.nl

EDUC ATION FOR HEALT H ONLINE For the Table of Contents of Education for Health - Vol. 17, No. 1 please visit angelina.ingentaselect.com/ vl=6453712/cl=125/nw=1/rpsv/ c w / w w w / t a n d f / 13 5 76 2 8 3 / v 15 n 2 / c o n t p 1 -1. h t m

IMPROVING HEALTH YELLOW PAPERS Between those outstanding publications that were already published in leading journals, and some preliminary notes scribbled on the last page of an agenda, there are also papers or reports that belong to the in-between (‘grey area’) category. Papers that, for whatever reason, have not been published before. Within this ocean of ‘grey’ papers, there are some which by content are most relevant to the Network: TUFH’s mission and aims. We will pick those pieces of gold from the ‘grey’ ocean, change their status to ‘yellow’ (because we can’t print in gold) and publish these in this section. Below you will find a contribution by Renzo Marcolongo of Padua University Hospital, Italy.

Therapeutic Patient Education: The Experience of an Italian Hospital

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In conclusion, TPE is a low-tech and reasonably priced strategy1 that, by the empowerment of patients and their families, actually makes of them an effective health resource (see figure below).

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Therapeutic Education a continuing process assuring healthcare continuity

Hospital Health Team establishes with patients a 'security agreement' to prevent the causes of hospitalisation Direct engagement of patients and their families in the management of the disease

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• Chronically ill patients (Alzheimer, cardiovascular, arthritis and joint diseases, disabling illness, etc.)

• Terminally ill patients • Psychiatric patients • Day-Surgery e Day-Hospital • Elderly patients Hospital

Patient education was first introduced into Italy in the early sixties (Marcolongo et al., 2001). In 1995, Padua University Hospital and District Health Service started several experimental TPE programmes targeted to patients suffering from different chronic diseases, including systemic lupus

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Methodological Steps All programmes follow some definite methodological steps (Guilbert, 1991; d’Ivernois & Gagnayre, 1995; Gagnayre et al., 1998): • Educational diagnosis has the goal to draw a patient’s complete clinical and

personal profile in order to assess precisely her/his educational needs and aptitude.

• Learning objectives can be either general or specific. The general ones identify the final end point to attain (e.g., a certain degree of autonomy and self-management). Specific objectives may concern intellectual, psychomotor, and psychoaffective domains (Bloom, 1975).

• Teaching methods can be either of individual or collective kind. When possible, collective methods are preferred since they help socialization and teamwork.

• Regular assessment of educational and clinical outcomes.

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Patient Empowerment Therapeutic Patient Education (TPE) is a distinct branch of health education aimed at patient empowerment and self-management. TPE consists of helping the patient and his family to understand the disease and its treatment so that they can actively collaborate to its control. In this way, a patient becomes directly involved in the care and management of her/his own health status and quality of life (Deccache & Lavendhomme, 1989).

erythematosus, systemic sclerosis, bronchial asthma and multiple myeloma. The TPE programmes concern the following general domains: prevention of disease’s complications and drugs’ adverse effects; self-management in everyday life (treatment, selfmonitoring, clinical follow-up, diet, job, school, physical activity and sport, sexual life, pregnancy, leisure, etcetera); coping with emotions and physical changes (fear, anger, guilt, stress, mental images and representations of disease and treatment, information and media, etcetera); physical activity and rehabilitation; access to social security facilities and resources.

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Diseases, by forcing patients to previously unknown limits, compel them to find new meanings in their lives and more advantageous survival strategies for coping with difficulties. In fact, hospitalisation, drugs, diet, rehabilitation and complications become a new part of the patient’s reality, influencing crucial aspects of their life such as marriage, sexual relationships, pregnancy, family, work, school, physical activity, leisure, etcetera (Pitzele, 1986). According to the WHO, these important changes require a different approach of healthcare personnel toward their patients. Consequently, to help patients adapt and cope with this new condition, it is important to provide them with adequate skills for everyday life by means of specific education and training.

Disctrict Health Facilities Disctrict Health Team establishes with patients an 'individual health agreement' dealing with everyday patient's needs

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IMPROVING HEALTH YELLOW PAPERS

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References BLOOM, B.S. (1975). Taxonomie des objectifs pédagogiques. Quebec: Presse de l’Université du Quebec.

DECCACHE, A. & LAVENDHOMME, E. (1989). Information et éducation du patient. Des fondamentes aux méthodes.

Paris: De Boeck Université.

GAGNAYRE, R., MAGAR, Y. & IVERNOIS (d’), J-F. (1998). Apprendre à éduquer le patient, approche pédagogique. Paris: Ed. Vigot.

GUILBERT, J-J. (1991). Guide pédagogique pour les personnels de santé. Genève: O.M.S. IVERNOIS (d’), J-F. & GAGNAYRE, R. (1995).

Apprendre à éduquer le patient, approche pédagogique. Paris: Ed. Vigot.

MARCOLONGO, R., ROSSATO, E., PAVAN, V., LAVEDER, F., BONADIMAN, L. & RIGOLI, A.M. (2001). Current perspectives of therapeutic patient education in Italy. Patient Education and Counseling, 44, 1, 59-63.

PITZELE, S.K. (1986). We are not alone.

Learning to live with chronic illness. New York: Workman publishing.

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Renzo Marcolongo | Corresponding author on behalf of the writing group, Physician/Immunologist, Clinical Immunology Unit/Therapeutic Patient Education Laboratory, Padua University Hospital, Italy Email: renzo.marcolongo@unipd.it

1 Bonadiman, L., Belleggia, G., Rossato, E. &

Marcolongo, R. (2002). Therapeutic patient education can help networking between hospitals and outpatient health facilities. Proceedings of

HEALTH PROMOTION

‘Let’s Communicate Health’: Educating the Community via Local Radio The Environmental Health Students Association of Moi university (EHSAMU) and the Student Network Organisation (SNO), proposed to establish a radio teaching programme, in order to facilitate and create a forum for the expression and exchange of health ideas, healthcare experiences, research findings and other matters pertaining to the general health and welfare of the Kenyan rural and peri urban communities. The programme was to have a regional focus and function through participatory research and teaching by the environmental health students. This plan was proposed in the spirit of integration and enforcement for health restoration and promotion. Based on the fact that health education today is an integral aspect of the fight against the HIV/AIDS pandemic, the choice for this mode of information dissemination was timely and welcome. In today’s rural settings, more households rely on radios than on any other media units. The programme plans started in November 2002, with an initial aim of enlightening the local communities in the North Rift and beyond on HIV/AIDS and related health issues. The Let’s Communicate Health talk show uniquely incorporates a participatory approach between the students and the communities, blended with invited specialists and debates to air relevant information, appropriate lessons and reviews on community health matters. Following every weekly programme, a ten-minute question and answer time has been incorporated to address individual needs of the listeners. We are also now partnering with healthcare providers from other sectors by way of special interviews. Moreover, the dynamism of the programme has led to the introduction of dramas and short play skits as presentation methods.

the 10th International Conference on Health Promoting Hospitals (HPH), pg. 10, Bratislava, Slovakia.

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A Model of Symbiosis The partnership between the two student bodies and the Sauti ya Rehema Radio and Television Network (SAYARE RTVN) is unique

and works well. This local radio station provides a free airtime of between 27 and 30 minutes every week. The environmental health students at the Faculty of Health Sciences present the programme on their own and at no pay from the station. Research and editorial work is managed by the SNO, Moi University chapter. Both the students and the radio station are able to achieve their objective of reaching the target communities with the intended health information and at minimal costs. We are, however, now reviewing this approach, and we are developing funding proposals to strengthen the system and possibly establish a similar television component.

Integrating in the Community Disease Fight The SAYARE RTVN today has a listeners’ capacity of up to eight million, across the Great Rift Valley and western Kenya region, including four important ethnic communities impacted

by HIV/AIDS. The Let’s Communicate Health programme uses this catchment area to disseminate into these communities some basic and effective prevention strategies against the spread of HIV, besides demystifying certain beliefs and stigma surrounding the disease.

The programme, designed to run in phases of eight months each, now has completed its first phase and poised to begin the second phase. The driving force is that the community is eager in the second phase several appropriate changes are expected to feature, and the community is eagerly waiting. The immediate future objective of the programme is to introduce special interest subjects on other issues of health, for example, malaria, diarrhoeal diseases, dental and oral health, environmental health, health and culture and women’s health.

Fred Ross Oketch | Student, Faculty of Health Sciences, Moi University, Kenya Email: fros2001@hotmail.com

HEALTH AUTHORITIES

Health Administration Improvement in India In modern India, since the Independence in 1947, revolutionary changes are progressing towards socio-economic and health development. From an agrarian society in 1947 - on which 90% of the population depended - it moved on quickly to an industrial society - with 60% of the population urbanised - and now it is emerging as a leader in information technology.

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Today, over 100 institutions are training hospital/health administrators to help develop systems for excellence of healthcare around the world.

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In the last three decades there is a greater concern for professionalisation of health services. Major factors include the establishment of large numbers of corporate and private hospitals, increasing medicolegal issues, the Consumer Protection Act, International Certification of Hospitals for Quality Assurance, consumer awareness, Parliament Acts, and Supreme Court judgements. As a result, many health institu-

Contribution of ISHA The Indian Society of Health Administrators (ISHA) has taken a leadership role in health and development in India and South-East Asia in the last 27 years. More than 5000 noted medical professionals and over 400 health institutions are members of the Society. Its major contributions in health administration improvement have been as follows: • Formulate health policy and programme development in India. ISHA works with the Planning Commission, Ministry of Health, State Governments and international organisations in advising on health planning in India.

• Develop capacity of health personnel.

ISHA conducts about 50 training programmes each year for medical, nursing, and health administrators in the fields of: hospital administration, public health, nursing care administration, leadership development; hospital clini-

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Professionalisation of Health Services In spite of this achievement, there is a high morbidity and mortality due to malaria, TB, HIV-AIDS, cancer, diarrhoeal and respiratory diseases. Some states in India still have poor health systems and structures. Among other things, modern health administration systems are needed to manage effectively the limited resources to meet the unlimited needs of the growing population.

tions are being professionalised. Hospitals are developing goals and a mission statement. The institutions are engaged in leadership development, designing systems of patient satisfaction and quality assurance, employee motivation, infection control and waste management systems, cost reduction systems, appropriate technology, community involvement, and organisational structural changes.

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The country has over 2.75 lakh* health institutions engaged in delivery of healthcare from periphery to national level. The system employs over 12 lakh doctors of all systems of medicine, over 8 lakh nurses, and over 10 lakhs bed capacity. Bangalore alone has over 5000 beds cardiac care facility.

These hospitals meet international standards and can provide qualitative, economical and quick care, compared with the developed countries where the patients have to wait for months.

cal waste management and infection control; disaster preparedness and emergencies management; HIV-AIDS prevention and control; national programmes management; TB and malaria; clinical updates; emergency care management; computerisation of health systems; and medico-legal aspects of healthcare.

• Assist the Central, State, and International Bodies in research and evaluation of projects. E.g. conducting studies on health manpower requirements by 2025, on blood supply and requirements by 2010, and on bio-medical waste management systems in public and private hospitals.

• Plan, design, and establish medical colleges, hospitals, and resort homes for the elderly. Rejuvenate sick hospitals.

Develop hospital systems, medical technology in hospitals. Computerisation of hospitals.

• Develop academic and training resources. ISHA publishes its journal Health Administrator twice yearly. Each issue is devoted to one theme, e.g. TB management in India. ISHA has published nearly 65 books, reports, and manuals, and has prepared several films on hospital management in India.

Ashok Sahni | Honorary Executive Director, Indian Society of Health Administrators, India Email: ashoksah@blr.vsnl.net.in * one lakh is 1/10 of a million

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INTERNATIONAL HEALTH PROFESSIONS EDUCATION MULTIPROFESSIONAL EDUCATION In this recurring column topics are discussed regarding multiprofessional education (MPE). The Network: TUFH has decided to adopt the terminology ‘multiprofessional’. Readers are invited to share their views and/or experiences on/with MPE, or react to articles in this column.

Interprofessional Rural Programme of British Columbia In 2003 the British Columbia Academic Health Council, Canada, developed (in collaboration with rural communities, postsecondary institutions and government) the Interprofessional Rural Programme of British Columbia (IRPbc). This programme is designed to foster rural recruitment of health professionals, and cultivate interprofessional education for client-centred collaborative care.

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The goals of the IRPbc are to model and evaluate interprofessional learning; understand practice education and expand capacity for educating health professionals; recruit and retain health professionals in rural communities; and - the ultimate goal - to enhance the health of rural communities.

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The British Columbia Ministry of Health provided initial funding in January 2003, with the expectation that the IRPbc would become a long-term programme in the province.

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Rural Communities The IRPbc places teams of four to six students from a wide range of health professional programmes into smaller communities where they experience rural life and practice, as well as acquire advanced teamwork skills in addition to discipline-specific knowledge.

Five rural communities in British Columbia currently participate in the programme: Bella Coola, Hazelton, Port McNeill, Fort St. John and Trail. These sites were selected based on a strong commitment to rural medical education, a range of health professionals to preceptor students and healthcare leaders to champion the programme.

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Strong Foundation Since 2003, the IRPbc has established a strong foundation for interprofessional learning for patient-centred collaborative care in rural communities. Significant work has been invested in establishing the key concepts and processes, particularly relating to interprofessional competencies, orientation, team activities and evaluation. Participating communities receive funding for education infrastructure to foster student and health professional learning. Interprofessional preceptor training is provided in each community. Student incentives include travel grants, shared accommodation, and a two-day orientation session.

The response to the IRPbc has been overwhelmingly positive by students and communities. Several students have already returned to rural practice in these communities. Many are sharing their stories and lessons learned through professional conferences/school presentations, journal articles, media interviews, etcetera.

Work Underway By summer 2004, 12 teams will have been placed in these communities, with over 60 senior level student participants. These students represent a wide range of professions including audiology, medical laboratory, medical radiology, medicine, nursing, occupational therapy, physical therapy, pharmacy, social work and speech language pathology.

Evaluation is underway by the College of Health Disciplines, University of British Columbia, to determine how IRPbc team experience influences student competencies.

In addition, work is underway to develop a detailed programme logic model for the longer-term evaluation of the programme.

Hazelton

Fort St.John

Bella Coold Port McNeill Troil

Kathy Copeman-Stewart | Programme Manager, Interprofessional Rural Programme of BC, Canada Email: kcopeman@telus.net

VERY BEST WISH E S We extend our very best wishes to The Network: TUFH on its 25th anniversary.

There has been much change these past 25 years. As oldtimers we recall, for example, the strong initial focus on PBL and the need to satisfy those criteria in order to gain membership. Over the years that focus changed to include more of a community orientation, which found its focus in a meeting held in Sicily two years ago when the Towards Unity for Health (TUFH) concept was incorporated into The Network. In essence, TUFH reinforces the community focus through issues of social responsibility, the role of multiple stakeholders, and the training of healthcare workers to be managers, sensitive to their communities and the needs of their patients. In the years ahead, I believe we will continue to touch chords of need, and our vitality and credo will undergo further definition in an ever changing world.

Buz Salafsky | Regional Dean (ret), College of Medicine at Rockford, University of Illinois, United States of America Email: buzs@uic.edu

ACCREDITATION AND QUALITY ASSESSMENT

Accreditation of Basic Medical Education in Switzerland rapid development of the profession and the various disciplines, while maintaining transparency and liability in the overall accreditation process. It is easy to adapt learning objectives to a changing environment, somewhat more difficult to change accreditation standards. It may take much longer to adapt the law.

Following pilot accreditations of all programmes on basic medical education in Switzerland in 1999, the Swiss Faculties of Medicine developed a set of quality standards based on the WFME Global Standards on Basic Medical Education. The aim was to boost quality development of medical study programmes in Switzerland and to be prepared for accreditation at the same time.

new legislation on medical professions in Switzerland by 2008.

Karl Zbinden | Centre of Accreditation and Quality Assurance of the Swiss Universities (OAQ), Switzerland Email: karl.zbinden@oaq.ch

ONE CRITICISM OFTEN HEARD ABOUT ACCREDITATION IS THAT IT DOES NOT PUT ENOUGH WEIGHT ON LEARNING OUTCOMES.

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The accreditation of basic medical education in Switzerland will be based on the following elements: the university law (law for medical professions from 2008); generic quality standards for institutions and programmes (national requirements); specific quality standards for basic medical education (professional requirements); and discipline specific elements (discipline specific requirements introduced in the form of the Swiss Catalogue of Learning Objectives).

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Flexibility Switzerland now has a system of voluntary accreditation. The OAQ has developed internationally compatible generic accreditation standards for institutions and programmes.

Accreditation instruments such as guidelines for self–evaluation, guidelines for experts and lists of questions and points of reference (operationalisations of standards) were established as well (see www.oaq.ch).

A similar procedure to set standards is planned for postgraduate medical education in Switzerland.

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Outcome-Orientated One criticism often heard about accreditation is that it does not put enough weight on learning outcomes. In order to improve this guideline, it was decided to integrate outcome-oriented elements by means of a single new standard1, which refers to the Swiss Catalogue of Learning Objectives for Undergraduate Medical Training2 as an important element of the accreditation framework. The catalogue defines the profile of a doctor at the end of his education in basic medicine and a range of general as well as discipline specific objectives. This addition included a range of outcomeoriented points to the ones already present in the WFME template. Many of these learning objectives will in fact be required by the

Dr. Karl Zbinden

The accreditation procedure as such is structured according to the Basic Medical Education WFME Global Standards for quality Improvement, in order to assure the international recognition of accreditation decisions.

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Gold Standard The Centre of Accreditation and Quality Assurance of the Swiss Universities (OAQ), which has operated as the national accreditation body in higher education since 2001, and the Swiss Federal Office of Public Health (SFOPH) compared the quality standards developed by the Faculties of Medicine with the national requirements for academic accreditation and the future legislation on medical professions, which will introduce compulsory accreditation for basic medical education in Switzerland. The result of this comparison was an adapted set of quality standards, which may serve as a ‘gold standard’ in the forthcoming accreditation process.

1 The wording of the standard: “The curriculum

must observe the objectives listed in the Swiss

The advantage of using all these elements is the introduction of flexibility. The new approach takes into account the present

Catalogue of Learning Objectives for Undergraduate Medical Training” 2 www.smifk.ch/

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INTERNATIONAL HEALTH PROFESSIONS EDUCATION NEW INSTITUTIONS AND PROGRAMMES

Centres of Support in Medical Education The Central and Eastern European and Central Asian Interest Group of the Association for Medical Education in Europe (AMEE) has been convening regularly as part of the annual AMEE meetings.

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During the past two years, there has been a discussion about ways to help further develop medical education among the schools in the region. There is general consensus among this group’s member schools that they need to be more proactive in the continuous development of medical education. Two years ago the group considered a proposal to consider development of Centres of Support in medical education.

The basic concept is for schools with experience and successes in areas of education to serve as Centres of Support for other schools that could visit and learn collaboratively within the region. Centres of Support could be focused on different aspects of medical education such as student-centered learning, performancebased assessment, accreditation, community-based medical education, programme evaluation, curriculum development, the change process, etcetera. Schools would learn from each other as well as from outside experts.

Miriam Friedman (Dundee / Edinburgh, Scotland), Henk Schmidt (Erasmus, the Netherlands), John Hamilton (Sheffield, UK), and Stewart Mennin (University of New Mexico, USA) have expressed interest in assisting and advising this process. Three international NGOs, AMEE, The Network: TUFH, and the Education Commission for Foreign Medical Graduates (ECFMG), are supportive of the basic concept. A small grant from the Global Health through Education, Training, and Service (GHETS) foundation has been obtained to initiate planning for a pilot proposal among three 14

Dr. Stewart Mennin institutions: Dokuz Eylül in Izmir, Turkey, the Institute for Higher Medicine in Plevin, Bulgaria, and the National Centre for Assessment in Ukrainia.

The idea of Centres of Support will continue to develop at the next AMEE meeting at a special pre-conference session on September 5th in Edinburgh. All interested persons are invited.

Stewart Mennin | Assistant Dean, School of Medicine, University of New Mexico, United States of America Email: smennin@salud.unm.edu

SCHOOLS LEARN FROM EACH OTHER AS WELL AS FROM OUTSIDE EXPERTS.

ONLINE HIV/AIDS EDUC AT I O N The Virtual Institute for Higher Education in Africa has started enrolling candidates for its first online course on HIV/AIDS education, which has begun on the 1st of March 2004. The goal of the Institute, which is being spearheaded by UNESCO Harare and National Universities Commission of Nigeria, is to develop a critical mass of teacher trainers who will train others and propagate the UNESCO (and UNAIDS) message of preventive HIV/AIDS Education in Sub-Saharan African countries. The programme goal is to help the African citizenry to understand the nature and impact of HIV/AIDS and to change behaviour in favour of HIV/AIDS prevention.

Registration is free and all staff of educational institutions in Sub-Saharan Africa are eligible candidates. The module specifically targets teachers and teacher trainers who are involved in the delivery of basic and higher education in Africa.

Those interested are welcome to visit the Institute’s site: www.viheaf.net

C AN MIR ACLES BE MADE? June 1979: The Network was initiated in Kingston, Jamaica. Participants of the Conference - supported by WHO - decided to create an organisation to improve the quality of medical education. Looking back, it is evident that The Network had an important influence on medical education in the past 25 years. Although many participants of the Kingston Conference dreamed their dreams of innovative medical education, some of them had doubts about the possibilities of a network. Many participants pioneered small pilot models in their own countries. Unfortunately, the founding fathers of The Network do not have an opportunity to see what hard-working people in the framework of The Network performed to realise the dreams of these inspiring pioneers. As a member of the Kingston Conference and on behalf of the founding fathers, I want to thank all workers of The Network for creating this miracle. Miracles can be made.

Wynand Wijnen | Emeritus Professor, Faculty of Medicine, Maastricht University, the Netherlands Email: w.wijnen@educ.unimaas.nl

LEADERSHIP COLUMN Within The Network: TUFH there is an increased attention for the role of leaders in educational innovations. Studies in this field demonstrate that leadership is not only an inherent characteristic of certain gifted people but can be learned as well. For that purpose some successful leaders share their experiences as a ‘change agent’ with the Network: TUFH membership-at-large.

Starting from the Beginning: Sharing Key Lessons

Dr. Sílvia Mamede Difference Despite these difficulties, strategic planning made a difference for us. In a short time, the School’s ‘identity’ was built up.

Student-centred, problem-based, community-oriented education was assumed as a basic principle. Values included commitment to innovation, relevance to local needs and high quality of the programmes. Instead of fragmented, isolated actions, we focused on main areas – health management and primary healthcare - considered more relevant by stakeholders. Efforts were concentrated and faculty’s expertise developed. A unit of educational development was created and led to well-designed programmes. The School was the first institution in Brazil that entirely adopted problem-based learning.

The School’s credibility increased, it became recognized for its educational innovations, and attracted increased external support.

When I left the Dean position, the institutional portfolio included a set of well-recognised programmes, which attracted large numbers of applicants. Partnerships with several international and national institutions ensured technical support and 80% of the budget.

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Strategic Planning The second issue that comes to my mind is the importance of strategic planning.

The School was established with a major challenge: to justify its principles. This demonstration required positioning the institution in the local context, which demanded the involvement of School’s professionals, potential clients, partners and government representatives. In the first year, we conducted a series of workshops for strategic planning with the participation of these stakeholders. From them emerged the School’s mission, our values, a vision of the School in the future, the main areas for our initiatives.

This long-term goal was regularly reviewed; the School’s teams set up a plan for each year, guided by the strategic mission. The major activity to accomplish goals was workshops that attracted around 30% of the Schools’ staff.

Strategic planning is not easy. When a culture of guiding management by planning does not exist, there are pressures to abandon priorities and paths collectively defined. Within the School, difficulties in communication were not rare and mechanisms for participation in managerial decisions did not always function well.

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Building a Team Creating a team from the beginning offers several advantages. The weight of heritage is lower. It is easier to set up new directions, and to build up new values. On the other side, everything must be constructed.

In my case, the first challenge was to put together a team to assume the directive roles and conduct the development of the School. I needed colleagues who shared similar values, brilliant persons, able to conceive and bring to life an entirely new organisation. It was not easy to attract professionals who were highly recognised by their peers and could ensure credibility to the new institution. Money is usually not a key factor at this stage of their career (fortunately, by the way, because it’s never available). In our context, public services have lost credibility. Physicians are sceptical that things may change, and their daily activities tend to become routine. Therefore, it is key to focus on innovation to gain the interest of these faculty. Indeed, colleagues who came to the School’s directive board were certainly attracted by the challenges involved, the avenues open to innovation

and professional development, the prospect of building up a public organisation with different patterns of work and relationships, and the values underlying the School’s proposal.

During the eight years I served as Dean, this small group of colleagues really shared the direction, working and keeping together in the crucial moments. As a first lesson, I would point to the importance of building a team of brilliant pioneers and sharing power with them.

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The School of Public Health of Ceará, one of the poorest Brazilian states, was one year before I became Dean in 1995. The institution came to life under extraordinary conditions. The School’s mission was not clear, which led to conflicts with other organisations. The administrative structure and budget were not established, and external resources needed to be sought. The School did not have its own faculty team, and there was no recruitment plan to attract professionals who worked in other institutions. Recruitment was also hindered by a law forbidding any extra payments or other financial incentives.

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COMMUNITY ACTION COMMUNITY INTERVIEW There is a lot of attention for partnerships between academic institutions and communities, but who are the people who are implementing these projects?

This column gives a voice and face to the community representatives, faculty members and students that have the community at their heart.

Elements for Success Two abilities were essential for strategic planning: scanning present situation and tendencies, and visioning the future. A clear view of the institution’s mission and future development, stimulus to creativity and innovation, an internal atmosphere of enthusiasm and commitment with values, were crucial for our results.

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Long-term relationships with key international institutions and professors also played an important role in our case. They enabled the faculty to keep in touch with recent developments, visualise tendencies, incorporate innovations and build on them to generate new programmes. In my view, exchange and cooperation with more advanced institutions is an important element of success.

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Flexibility A final lesson: pros and cons of flexibility in organisational structure. Despite our attempts, circumstances prevented the official establishment of the School’s boards and faculty. Without rigid structures, we had flexibility to adjust to needs. We could, for instance, set up our own processes for quality assurance or decision-making. However, when huge political changes occur, the absence of solid, sometimes conservative structures makes the institution vulnerable to all types of interests. But the School was itself a source of change agents, who will certainly use capabilities acquired there to promote innovation where they are.

Sílvia Mamede | Former Dean School of Public Health, President Innovare Institute, Technical Adviser Medical School - Federal University, Ceará, Brazil Email: silviamamede@uol.com.br

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Community at the Heart This interview was conducted with Pura Rodriguez-Caisip, faculty member at the Faculty of Medicine and Surgery, University of Santo Tomas (Manila, the Philippines).

She was Chair of the Department of Preventive and Community Medicine until 2002. Nowadays she is module leader in Community Medicine and involved in community development programmes in rural areas, where students are required to do health education, research and service.

Key issues are education of the health volunteers and parents, livelihood, nutrition and out-patient care.

1. What is your definition of a community?

A community is a group of people usually in the same geographical location (or belonging to different places), sharing a common purpose, vision, or work for the good of the majority and in the service of all, especially in our developing country, in the service of the underserved.

2. What is in your opinion the most important factor in the relationship between the Faculty and community?

Sincerety and humility. Compassion and dynamism.

3. Does the fact that a faculty is settled in a community with its educational programme have any impact? Does it lead to anything within the community?

If a faculty is settled in the community, (s)he will strongly feel for the community.

(S)he will better appreciate the environmental and other social pressures that make life difficult or vulnerable to health problems. A faculty in the community will lead to closer and better interpersonal relationships. Communication would be easier and perhaps his/her sincerity to

Dr. Pura B. Rodriguez-Caisip help the community would be felt better by the community. They can more easily build friendships and include community members in the learning process 4. What contribution can the Faculty make to improve community health?

Empowerment of the community regarding their own capacity to help themselves by teaching them on healthcare and managment, livelihood, and optimism that life could be better if we work and focus on how to improve from our present poor conditions.

5. If you were in charge, what changes would you make in the relationship between faculty and the community?

Put them closer to each other. Assign faculty to the community so they can better see the recipients of their talents.

Schedule the faculty in the community to see how they can serve and contribute through what they are capable of doing.

Bring the community closer to the faculty so that they will know in their hearts and minds that there really are people who are sincere and desirous to help them.

PARTNERSHIPS

A Medical School – Community Partnership In 2002, Morehouse School of Medicine (MSM) and its community partners on the south side of Atlanta, Georgia, USA, received the first Community-Campus Partnerships for Health Annual Award. We are quite proud of the award, coming from the organisation that represents over a thousand health-related partnerships between academic institutions and communities in the USA. The following is a brief description of the partnership.

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Education, Service, Research The partnership has matured since 1987,

Community Empowerment The underlying goal in all aspects of the partnership is community empowerment.

This term has been overused and abused in recent years but, in our view, means community control of scarce resources.

We do not subscribe to the model that refers to a ‘community classroom’ for educational programmes, a ‘community laboratory’ for research programmes, and a ‘needy community’ for service programmes.

We say instead: “The community is not a classroom, to view it this way reduces the people who live there to the status of props for a teaching programme; the community is not a laboratory, to view it this way reduces the people who live there to the status of guinea pigs for a research project; and the community is not a charity case, to view it this way denies dignity to the people who live there”.

Rather, in all three domains - teaching, research, and service - the community is a partner or a collaborator that joins with an academic institution to develop programmes that benefit both.

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Over 40% of community residents live below the poverty level and approximately 40% of adults lack a high school diploma. Several surveys over the past decade indicate that community residents view alcohol and drug abuse, teen pregnancy, STDs, crime and violence, and environmental pollution as the community’s most important healthrelated problems. The community, however, is not without assets. These include public schools, a new Boys and Girls Club facility, small businesses, parks and other green space, and numerous churches.

THE COMMUNITY IS NOT A CLASSROOM, NOT A LABORATORY, NOT A CHARITY CASE. J U N E

Partners MSM, the lead academic partner, is joined

by Georgia State, Clark-Atlanta, and Emory Universities. MSM is a historically black medical school established to recruit and train minority and other students as physicians, biomedical scientists, and public health professionals committed to the primary healthcare needs of underserved communities. Agency partners include the county health department, the Atlanta Public Schools, the Atlanta Housing Authority, and a community health centre. The community partners include a number of organisations in a section of Southside Atlanta with a population of about 25.000, more than 90% African-American.

when MSM first organised a communitydirected drug abuse prevention project in the community. Since then, activities have developed in pursuit of each of the three missions of academic medical centres: education, service, and research.

• Education: Schools and communities on Atlanta’s Southside host MSM’s unique Community Health course, in which small groups of students conduct community health needs assessments and implement health promotion projects.

• Service: This includes projects that are not conducted primarily for the purpose of research or student education. One example is a neighbourhood organisation’s rodent control project conducted with a grant from MSM. Another is the installation of a bank of computers in a community centre. Adults use the computers to access the Internet and children use them to do their homework. Another MSM grant supports low-impact exercise programmes at several senior centres. Other projects address environmental issues: green space and water pollution.

• Research: The MSM Prevention Research Center (PRC) is located in rented office space on the Southside. A set of bylaws dictates the composition of the Community Coalition Board that sets policy and establishes research priorities for the Center. Representation on the Board includes all the members of the partnership. Community representatives are always in the majority and the Board Chair is reserved for a community representative. A Board committee reviews every project or protocol proposed by Center researchers to insure its consistency with community priorities and values.

The Center maintains about 20 projects in its portfolio, focusing on the prevention of teen pregnancy, violence, substance abuse, cancer, HIV infection, and cardiovascular disease.

Daniel Blumenthal | Chairman/ Professor, Department of Community Health and Preventive Medicine, Morehouse School of Medicine, United States of America Email: danielb@msm.edu

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PARTNERSHIPS

Family Doctors Contribute Towards Unity for Health

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Family doctors are uniting to strengthen primary healthcare, to address health needs of communities, to transform medical education, and to improve health outcomes for disadvantaged populations.

Family doctors are specifically trained to work as members of primary healthcare teams to address the health needs of individuals, families and communities. Family medicine is the only medical specialty that does not limit care based on the patient’s age or health problem. Due to their broadbased training, holistic orientation, and ability to work in virtually any setting, family practitioners are uniquely positioned to contribute towards unity for health (Boelen et al., 2002). Evidence is accumulating that links population health outcomes to access to comprehensive primary healthcare (Macinko, 2003).

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Wonca Until recently, family medicine was not recognized as a distinct specialty in many countries. This situation is rapidly changing as this discipline is evolving to respond to the health needs of communities in many regions of the world. As a result, the World Organization of Family Doctors (Wonca) has seen explosive growth in membership and collaborations in the last decade (Heffron, 2004).

Over the past five years Wonca has had a close association with the WHO-initiative Towards Unity for Health (now The Network: TUFH). Consistent with this spirit of collaboration approximately 30 family medicine leaders, selected by the Wonca Executive Committee, representing over 20 countries and all regions, met in South Africa in 2001 to explore how the discipline of family medicine could participate fully in the TUFH movement. During this workshop they considered the challenges involved, developed general conclusions that represented the consensus of par18

ticipants, delineated specific recommendations, and formed an action plan to guide the organisation and its members over the coming years. The report of this meeting emphasized the contributions family doctors can make to health services delivery through integration of individual and community health activities for a given population and development of productive and sustainable partnerships among key stakeholders, while focusing on high quality, relevant, sustainable and cost-effective primary healthcare for citizens throughout the world (Hunt, 2001).

Just a few examples of the status and rapid development of family medicine follow.

The Americas In Canada family doctors comprise 50% of the physician work force and serve as the foundation of the Canadian universal healthcare system. Family doctors are leading medical education reforms to increase the social accountability of Canadian academic medical centres (Woollard, 2002).

In the USA, they are the only physicians

distributed according to the population (AAFP, 2003). Family doctors in Mexico are planning to involve medical students in community health and to shift medical education to become more responsive to the primary needs of communities (GomezClavelina).

In 1994, the Brazilian government initiated the Family Health Programme (PSFPrograma de SaĂşde da FamĂ­lia) to provide comprehensive healthcare to the entire population. Family health teams - comprised of a family doctor, nurse, social worker and dentist - are being deployed throughout the country to provide healthcare for communities of 3.000 individuals.

Medical students are forming interest

Family doctors in training at Makerere University in Kampala, Uganda

groups, and schools are developing family medicine curricula, as residency-training programmes are established in many regions. The need for family doctors cannot keep pace with the demand (Blasco, 2004).

Chinese family doctors in a community practice of Fuxing Hospital in Beijing, China

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References AAFP: American Academy of Family Physicians, 2003 facts about family practice, www.aafp.org BLASCO, P.G., RONCOLETTA, A.F.T., MORETO, G., LEVITES, M.R., JANAUDIS, M.A., & LEOTO, R.F. (2004). Principios da medicina de família (Principles of family medicine). SOBRAMFA (Brazilian Society of Family Medicine).

BOELEN, C., HAQ, C., HUNT, V., RIVO, M., & SHAHADY, E. (2002). Improving health systems: the contribution of family medicine; a guidebook.

Singapore: Wonca, Bestprint publications.

DU, X., ZHOU, H., & QIAN, N. (2003).

Comparison study regarding changes in medical service between Fuxing Hospital and Yuetan CHS during SARS times. Personal communication, Capital University of Medical Sciences, Beijing.

GOMEZ-CLAVELINA, F.J. Personal communication, Presidente de la Academia Mexicana de Profesores de Medicina Familiar.

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Asia Family medicine is rapidly evolving in many Asian nations since its inception in the 1980s and 90s. China is developing postgraduate training programmes to address the ultimate goal of providing family doctors for the entire population (Wu, 2004).

In Beijing, family doctors teamed up with community health nurses, epidemiologists and other specialists to address the SARS epidemic. They identified potential cases in the community, referred patients to hospitals, and provided post hospital care (Du, 2003). In Thailand, family doctors are actively involved in community health promotion, surveillance and AIDS education (Saipan). Iran is planning to train family doctors to work with behvarz (community health workers in Iran) to provide comprehensive primary healthcare for the defined populations (Haq, 2003).

Future Challenges Global developments provide numerous examples of family doctors who are working to meet the challenge of providing comprehensive primary healthcare for all.

Family doctors have the potential to serve as pivotal members of comprehensive primary healthcare teams and as catalysts to transform health systems to better address people’s needs. Great accomplishments and possibilities unfold when family doctors unite synergistically with other key stakeholders to contribute towards unity for health.

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Africa Most African nations are struggling to address the health needs of rapidly growing populations and the double burden of infectious and chronic diseases in the context of severely limited resources. While South Africa and Nigeria have well established training for family doctors, many other African nations are just developing such career pathways. The East African Association of Family Physicians was formed in 2002 to unite key stakeholders from Kenya, Uganda and Tanzania to reform medical education and health systems. Representatives of academic medical centres, governments, health managers, communities and health professionals are working to tailor family medicine education to meet the health needs of the population (Hunt, 2003).

HAQ, C., MOHAMMADI, A., & SMITH, S. (2003). Medical education reform in Iran. Family Medicine, 2003, 616-617.

HATHIRAT, S. Personal communication.

Program Director, Dept. of Family Medicine, Ramathibodi Hospital, Mahidol University, Thailand.

HEFFRON, W. (2004). Full speed ahead for Wonca’s membership. Wonca News, 30 (1), 7.

HUNT, V.R. (2001). Towards Unity for Health and Family Medicine: A working paper based on the proceedings of the Wonca-WHO collaboration meeting in Durban, South Africa.

HUNT, V., FRANSCH, A., GREENBERG, J., & CHIN, M. (2003). Family practice and community-oriented primary care training programmes, East Africa needs assessment report, Report to Wonca, The Network: Towards Unity for Health and Global Health through Education Training and Service.

MACINKO, J., STARFIELD, B., & SHI, L. (2003). The contribution of primary care systems to health outcomes within Organization for Economic Cooperation and Development (OECD) countries, 1970-1998. Health Services Research, 38(3), 831- 65.

WOOLLARD, R. (2002). AHSCs: the complex simplicity of service.

Healthcare-papers, 2(3), 90-5; discussion 111-4.

WU, Z. (2004) Chinese society of general practice celebrates its 10th anniversary.

Wonca News, 30 (1), 13-14.

Cynthia Haq | Professor, Department of Family Medicine, University of Wisconsin, United States of America Email: chaq@fammed.wisc.edu

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THE LIKE-MINDED WORKING TOGETHER

INCLEN

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The Phuket Declaration (2000) of The Network: TUFH states: “Each person has the right to healthy environments and equitable, effective, humane and ethical health services.” Similarly, INCLEN is dedicated to improving the health of disadvantaged populations, particularly in low- and middle-income countries, by promoting equitable healthcare based on the best evidence of effectiveness and the efficient use of resources (www. inclentrust.org). INCLEN has established a global resource network to support fundamental changes in the way physicians, medical educators and policy makers around the world think about health and disease.

The network is comprised of more than 700 healthcare professionals based in 29 academic or research institutions world-wide, with 23 based in developing countries.

INCLEN’s long-range goals are to strengthen national health systems and to improve healthcare practice globally by providing health professionals with the tools to analyse the efficacy, effectiveness, efficiency, and equity of health interventions and preventive measures. INCLEN investigators apply cross-cultural and multidisciplinary research methods to discover what interventions work best, why aberrant practices continue in the face of good knowledge, and to effect the adoption of more rational practices.

Global Programmes As an international network, INCLEN faces many of the same challenges confronted by Network: TUFH members. Health practitioners from low- to middle-income countries (LMICs) comprise the majority of members in both networks. Globally, the network operates through initiatives like its Knowledge Plus Programme (KPP) and the Leadership and Management Programme (LAMP). KPP aims to develop and implement healthcare practice guidelines (Knowledge Plus Packages) on priority problems of the underserved in developing countries. The programme evalu20

ates relevant evidence in terms of efficacy, effectiveness, and efficiency of key health interventions, but the ‘Plus’ component goes further and determines local appropriateness including the use of ‘tacit knowledge’ and impact on equity of these interventions.

The goal of LAMP is to support effective leadership at al levels of the network, propelling the organisation forward as a leader in international health research and training for improving equity, efficiency and quality in healthcare.

INCLEN’s global initiatives function through management by key faculty members from its seven regional networks. A programme in the offing, the Global Virtual Campus, involves faculty members of its Clinical Epidemiology Units (CEUs) and Clinical Epidemiology Research and Training Centres (CERTCs).

At the local level, CEUs and CERTCs offer training programmes that range from short courses in research methodology to evidencebased medicine to formal graduate programmes in clinical epidemiology. Individual members also collaborate with their local partners in research and training endeavours relevant to national and local priorities.

Information and Communications Technology The Network: TUFH and INCLEN also face the challenge of maximising access to the information and communications technology (ICT). Unless continually addressed, the digital divide can be more pronounced in networks such as INCLEN and The Network: TUFH, where members’ access to ICT ranges from non-existent to state-of-the-art technology. Due to restrictive costs of managing global networks, including the expense of face-to-face meetings, both networks have adjusted their communication strategy to incorporate virtual tools including email, eprojects, e-groups and e-discussion boards, interactive websites, and virtual and teleconferences. Distance learning tools and a

strong, virtual infrastructure are essential not only to the training programmes but also for research project management. This challenge is greater for INCLEN than for most other international networks as it is mainly based in the developing world.

Working Together The two networks can indeed complement and learn from each other: both networks focus on the health of populations in LMICs; both have involved training as a core strategy in the past two decades (The Network: TUFH for community-based learning, INCLEN in population-based healthcare and related disciplines); and both experience the many challenges of working in LMIC settings. As partners, the two networks should thus work more closely together in addressing a common goal – reducing health inequities using their niche areas and strengths.

The networks can examine the academic curriculum and identify areas where both the principles of clinical epidemiology and community orientations can be incorporated.

One of these possibilities is the introduction of clinical epidemiology in the medical undergraduate programme, which has been started in a number of institutions in INCLEN. There is a need for avenues for the medical students to apply and integrate this knowledge into practice. The community orientation is one possibility where such applications can be done. The focus can be on applications of clinical epidemiology skills in planning and implementing community-based researches and in monitoring and evaluation of community programmes.

For a report on the INCLEN Global Meeting, February, 2004, see also page 30.

Cynthia Cordero and Tina Heiler | Member, Board of Trustees - Coordinator, INCLEN Southeast Asia; Development and Grants Management Officer, INCLEN Email: intiang@pacific.net.ph

STUDENTS’ COLUMN OUT OF THE SNO PEN

ST R AT E G I E S A N D AIMS I would like to take this opportunity to congratulate all of the Network: TUFH members, institutions, organisations and individuals with the 25th anniversary of our organisation. Expressing our glory by the achievements of this organisation in education, research, and community health development all over the world.

I should thank The Network: TUFH for their Conferences, during which we not only learn a lot, but also have the chance to meet new friends from different places in the world and from different cultures.

This is the most worthy achievement of them all.

Mohamed Khalifa | Secretary General SNO, Sudan Email: mkhalifam@maktoob.com

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At the reception I was introduced to a very funky and decent guy, Al-Samari from the Kingdom of Saudi Arabia, with whom I felt an immediate connection: in no time we found ourselves talking like old friends. To be honest, what made things more easy was that he spoke in my mother tongue Arabic. From that first meeting, we stuck to each other: together we participated in all conference activities, and we even discovered the country together. Our friendship grew with each breath, with every second.

We met again at the Network: TUFH Conferences in Kenya and Australia.

Before the Australia Conference we met up in Dubai, and travelled to Australia together. After the Conference we went to Sydney for a few days.

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The Conference passed like a dream. One night Al-Samari came to say goodbye.

I hate to say these words to someone I grew fond of. Al-Samari had become like a brother to me. I stayed for four more days, and then went my way to ‘home sweet home’. Home is always the best, but I kept thinking of those happy days in Brazil. And I also kept in contact with my brother AlSamari by postal mail, email, phone and text messages.

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Since the Conference in Brazil our friendship has become very close, and I was very pleased when he accepted my invitation

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Elfayadh Saidahmed | Chairman SNO Email: elfa7@maktoob.com

After a very long and exhausting trip, I finally found myself in an amazing country where I had never been before: Brazil.

I’d been very worried about everything: the people, the language, and the call of this mysterious land. But in no time my fears were blown away: the people were very kind, nice and co-operative. And it was quite fun to try to talk with them in Portuguese; they were understanding, insisting in helping me, realising my fears as a stranger.

to come and visit me in Sudan. We’ve spent a great couple of weeks together, during which I showed him the green and lovely Gezira (in the middle of Sudan). I introduced him to my family and friends, who welcomed him warmly (as Sudanese do). He also registered as a postgraduate student in a course Epidemiology at Al Gezira University.

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Finally, let me take this opportunity to encourage all the SNO Executive Members to communicate and work hard to maintain SNO activities, in spite of communication difficulties and declining resources.

This story of a friendship started in October 2002, at the Network Conference in Brazil.

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SNO achieved some of the educational aims by organising workshops in community-based education, management and leadership in student organisations, PBL, etcetera. Two workshops were held at Gezira University, Sudan and others will be scheduled soon in most of the regions covered by SNO representation. SNO members are discussing and writing proposals for other strategies to achieve SNO aims, and to be a strong presence in the 2004 Conference in the USA.

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The Student Network Organisation (SNO) works hard to maintain and accelerate the development of the student branch of Mr. Elfayadh Saidahmed The Network: TUFH. Many target aims for coming years are established, such as promoting the student role in student-centred medical education institutes, creating student exchange programmes between member institutes, learning and sharing experiences with each other, enhancing the students’ participation in the annual Conference, etcetera.

STUDENTS’ SPEAKERS CORNER

Mr. Mohamed Khalifa and Mr. Al-Asmary Mufareh Sarrah 21

STUDENTS’ COLUMN STUDENTS’ SPEAKERS CORNER

Belgian Students Involved in Community Diagnosis how his socio-economical situation and his health conditions interacted in a negative way: the disease hinders in the development of his possibilities on the one hand, on the other hand financial problems and limited social support make it difficult to deal adequately with his disease. Our feeling was that this man’s main problem was isolation, that he not only missed his family, but especially people who could help him and with whom he could share his experiences.”

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Students visiting a patient in the community

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As part of the unit Health and Society 2, medical students of Ghent University in the 3rd year of their training participated in a project Community Diagnosis in April 2003.

The medical students worked together with students from the 4th year of the Socialpedagogic Training. Amélie Dendooven en Jelle van den Ameele were two of the medical students who participated.

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The students worked during the project at a community welfare centre in one of the four deprived areas of the city of Ghent.

“The idea of exploring specific problems of a community and discovering the impact of these problems on the health of a person was fascinating and looked quite attractive.

Maybe we would be able to make a little contribution to the improvement of the situation for some people, just by understanding their living conditions and discussing it with others. In this way, the theory that had been taught in so many lectures could finally be illustrated in practice.

On the other hand, we had some doubts and questions. How could we possibly be able to discover in a single week what exists in the community and be able to present wellfounded solutions for the problems?”

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The project started with a visit to a patient by small groups of four to five students.

“Although we thought we are aware of the difficulties people can be confronted with, for most of us this visit was an awakening.

There is an enormous difference between ‘to know’ and ‘to experience’. We also learned to communicate. We learned to inspire people’s confidence, with some hesitation we questioned personal affairs that we would not investigate otherwise.

It became clear to us that the task of a doctor is much broader than just the treatment of a disease. We have to understand how a patient is living, what are his possibilities and limitations. Moreover, as a family doctor you’re able to see the healthcare network around the patient. To establish the necessary cooperation is not an easy task, but it shows how attractive it may be to work as a doctor in a complex society.”

Jelle visited a man from Ghana, living ‘illegally’ in Belgium for some years already.

“He tried to do his best to integrate in our society. He was studying Dutch and enthusiastically followed a course to become a painter. However, he had serious health problems and was hospitalised frequently for problems of his diabetes. It was striking

After the visit, the students met with three professionals involved in the care for the patient they visited.

“We learned from them about the complexity of the structures and services in the healthcare system. Yet, it was remarkable that, despite the big diversity of the services, there was intensive cooperation. It is important that patients find their way in this complex network. Thanks to a very accessible primary care system, coordinated through the community health centres in Ghent, receiving services becomes easier for them.”

Based on all the information they had gathered, plus statistical data on the communities that had been visited (demographic data, employment, quality of housing, criminality figures) the students had to come to two main community diagnoses.

“The problems were quite obvious. Housing conditions, integration of migrants, possibilities for leisure activities and traffic safety were topics that were most prevalent, and probably this is not different in other Western European cities. After some discussion we could define two main problems.

The analysis of the problem was much more difficult than we thought. We had the feeling that in the approach of the problem we were looking too much through the eyes of ‘our’ patient. But by bringing the parts of the puzzle together, we were able to broaden our perspective.”

Mr. Jelle van den Ameele and Ms. Amélie Dendooven In mixed groups of social pedagogic and medical students, the students had to formulate proposals for improvement of the situation of the communities.

“It was an enrichment for both groups. Both medical and social pedagogic students did not limit their perception to their own dimensions. The cross-fertilisation made our community diagnosis more differentiated.”

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Amélie Dendooven and Jelle van den Ameele | Students, Faculty of Medicine and Health Sciences, Ghent University, Belgium Email: ameliedendooven@hotmail.com; jelle.vandenameele@UGent.be

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Finally the groups had to present the community diagnosis and proposal for improvements to an audience of local stakeholders and politicians, including the mayor of Ghent.

“The politicians confronted us with reality (“will that not be the 10th or 20th youth group?”, “who’s going to pay for such a sport accommodation?”). Afterwards, some of us were disappointed by the limitations of our analysis and the fact that our solutions were rather naive. This was a consequence of the time constraint. But was it not our duty to demonstrate some idealism? Were we not allowed to stimulate the policy makers through our ‘dreams for a better world’?”

This project contributed to the creation of campus-community partnership.

“For us it was a very positive experience to see that activities in the framework of a learning experience can contribute to improve the situation of the local population. We think that this can be a worthwhile approach, also for students from a lot of other Faculties. This kind of cross-fertilisation between campus and community can have a considerable impact on society. As a healthcare worker, we will have to play our role in society. By learning to know the community, we may be able to better understand the needs.”

IT BECAME CLEAR TO US THAT THE TASK OF A DOCTOR IS MUCH BROADER THAN JUST THE TREATMENT OF A DISEASE. WE HAVE TO UNDERSTAND HOW A PATIENT IS LIVING, WHAT ARE HIS POSSIBILITIES AND LIMITATIONS.

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CO NG R ATUL ATIONS F O R 2 5 GREAT YEARS! The Network has been the most unifying and bonding association among all organisations, societies and professional bodies in health professions training and service that I have known. It has united races, nationalities and people as one family during its annual cycle of events. Transcending barriers in all parts of the world, it uses communication, local talents, available local resources and international efforts to organise the most successful conferences, which are eagerly awaited by new and old attendees.

My students from Eldoret, Kenya, who have participated in organising and presenting posters and keynote addresses, had their whole perceptions and personalities shaped in a very positive manner towards service to humanity and dedication to the underserved in society. Long live The Network! The voice of the students, health professionals, training institutions, communities and the future leaders of healthcare provision in the 21st century!!

Simeon Mining | Senior Lecturer and Head of Immunology Department, Faculty of Health Sciences, Moi University, Kenya Email: skmining@africaonline.co.ke 23

INTERNATIONAL DIARY

Diary 2004

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15 - 17 August, 2004, Karachi, Pakistan International Conference on Innovative Trends in Medical Education with an Special Emphasis to Community-Oriented Medical Education. Organised by Baqai Medical University, Karachi, Pakistan.

Further information: Dr. Zakaullah Khan, Secretary Organising Committee, Center for Medical Education, Baqai Medical University, P.O. Box 2407, Karachi 74600, Pakistan; fax: 92-21-6617968; email: zaka_khan@hotmail.com / cme_bmu@yahoo.com; Internet: www.baqai.edu.pk/ConPage.htm

Annual International Conference of The Network: Towards Unity for Health Celebration of 25 years The Network: TUFH 5 October, 2004, Atlanta GA, USA Internet: www.the-networktufh.org/ conference/default.asp?id=15&aid=15

5 - 8 September, 2004, Edinburgh, Scotland, United Kingdom AMEE 2004 Conference. Organised by Association for Medical Education in Europe. Further information: Association for Medical Education in Europe, Centre for Medical Education, Tay Park House, 484 Perth Road, Dundee DD2 1LR, United Kingdom; tel: 44-1382-631967; fax: 44-1382-645748; email: p.m.lilley@dundee.ac.uk; Internet: www.AMEE.org

International Conference on Overcomong Health Disparities: Global Experiences from Partnerships Between Communities, Health Services and Health Professional Schools.

6 - 10 October, 2004, Atlanta GA, USA Co-sponsored by The Network: TUFH and Community-Campus Partnerships for Health. Further information: Network: TUFH Office, P.O. Box 616, 6200 MD Maastricht, the Netherlands; tel: 31-43-3881524; fax: 31-43-3885639; email: secretariat@network.unimaas.nl; Internet: www.the-networktufh.org/conference

15 - 18 September, 2004, Torino, Italy 16th Annual Conference of the European Association for International Education.

Organised by European Association for International Education (EAIE) in collaboration with Universita degli Studi di Torino. Further information: fax: 31-20-5254998; email: eaie@eaie.nl; Internet: www.eaie.org

12 - 15 October, 2004, QuĂŠbec, Canada 2nd International Conference on Local and Regional Health Programmes. Organised

by QuĂŠbec Public Health Association (ASPQ). Further information: tel: 1-4186586755; fax: 1-418-6588850; email: info@colloquequebec2004.com; Internet: www..colloquequebec2004.com

22 - 25 September, 2004, Manila, the Philippines 4th Asia-Pacific Conference on Problembased Learning. Organised by Asia-Pacific Association for Problem-based Learning in Health Sciences (APA-PHS) in collaboration with Association of Philippine Medical Colleges (APMC).

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Further information: fax: 63-2-5210184; email: PBLreg@mail.upm.edu.ph; Internet: www.upm.edu.ph/PBLconfab2004

13 - 17 October, 2004, Orlando FL, USA 17th Wonca World Conference: Family Medicine - Caring for the World.

Organised by AAFP. Further information: fax: 1-913-9066082; email: woncacongress@wonca2004.org; Internet: www.wonca2004.org

19 - 22 October, 2004, Amsterdam, the Netherlands 21st International Conference: Patient Central. Organised by the International Society for Quality in Health Care (ISQUA). Further information: fax: 61-3-94176851; email: isqua@isqua.org; Internet: www.isqua.org 5 - 10 November, 2004, Boston MA, USA AAMC (Association of American Medical Colleges) annual meeting. Organised by Association of American Medical Colleges.

Further information: Internet: www.aamc.org 6 - 10 November, 2004, Washington DC, USA APHA (American Public Health Association) annual meeting. Organised

by American Public Health Association.

Further information: Internet: www.apha.org/meetings/ 16 - 20 November, 2004, Mexico City, Mexico Forum 8 - World Summit on Health Research: Health Research to Achieve the Millenium Development Goals. Organised by the World Health Organization in collaboration with the Mexican Ministry of Health. Further information: Internet: www.globalforumhealth.org/pages/ 7 - 10 December, 2004, Singapore 2nd Asia-Pacific Medical Educational Conference. Organised by Faculty of Medicine, National University of Singapore. Further information: Conference Secretariat, Ms. Sarah Ng, Medical Education Unit, Faculty of Medicine, National University of Singapore, Block MD 11, Level 1, 10 Medical Drive, 117597 Singapore; tel: 65-6874-1049; fax: 65-6872-1454; email: medbox6@nus.edu.sg; Internet: www.med.nus.edu.sg/events/apmec

Diary 2005

Diary 2006

Annual International Conference of The Network: Towards Unity for Health October 2005 Organised by The Network: TUFH.

Annual International Conference of The Network: Towards Unity for Health 9 – 14 September, 2006, Ghent, Belgium Organised by The Network: TUFH and Ghent University, Faculty of Medicine and Health Sciences.

4 - 8 November, 2006, Boston MA, USA APHA (American Public Health Association) annual meeting. Further information: Internet: www.apha.org/meetings/

Further information: Network: TUFH Office, P.O. Box 616, 6200 MD Maastricht, the Netherlands; tel: 31-43-3881524; fax: 31-43-3885639; email: secretariat@network.unimaas.nl 4 - 9 November, 2005, Washington DC, USA AAMC (Association of American Medical Colleges) annual meeting. Further information: Internet: www.aamc.org

It is possible to add events to this International Diary from behind your computer. Information inserted in our website database www.the-networktufh.org/contributions. asp will be automatically included in the International Diary in the Newsletter.

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5 - 9 November, 2005, New Orleans LA, USA APHA (American Public Health Association) annual meeting. Further information: Internet: www.apha.org/meetings/

27 October - 1 November, 2006, Seattle WA, USA AAMC (Association of American Medical Colleges) annual meeting. Further information: Internet: www.aamc.org

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A Q UA R TER OF A CENTURY is certainly an occasion for reflecting on what was needed, what has been done and what has been achieved. It will be equally important to use this opportunity to look forward to the next 25 years, their potential needs and thus the challenges which The Network would wish to accept.

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When The Network was created on the initiative of Professor Tamas Fülöp at the World Health Organization, the need was to support pioneering medical schools, their leaders and colleagues in all corners of the world. The inaugural Conference was convened in the Caribbean, an affirmation that the greatest need for support was in the developing countries. The emphasis in the 70s was on reform of medical education at a time when healthcare systems were trying to respond to the challenge of Health for All. The foundation member institutions of The Network, therefore, agreed that mutual support should focus on educational change which was based on a better understanding of how adults learn more effectively and how such education might be redirected from preparing for hospital-based specialisation to communitybased healthcare. Thus, problem-based learning and community-oriented and community-based education became the priority for the growing number of Network programmes and activities. Consultancies, annual Conferences in changing locations across the world, workshops at Maastricht University, McMaster University and elsewhere, a superb Newsletter, a series of books and a journal have been the mainstay of the Network’s programme. A variety of special interest groups and a robust approach to the admission to, and reconfirmation of, Full Membership have contributed additional value and reputation. Many 100 medical educators that have been joined by educators in the other health professions will wish to pay tribute to a galaxy of outstanding leaders, so ably supported by the dedicated members of the superbly effective Secretariat at Maastricht University.

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What, then, will The Network do to support its members in the changing needs of the next quarter century? Will it wish to review present and potential needs of academics and their students in relation to changing demands of healthcare systems with their respective political and financial imperatives? What will The Network do in support of hard pressed academics who are asked to participate in educational innovation – in addition to their clinical, research and administrative commitments? What will The Network do in relation to the most fundamental responsibility of the healthcare professions, namely to act as the advocates of their patients, their communities and society at large?

Charles Engel | Honorary Member of The Network: TUFH; Centre for Higher Education Studies, University of London, UK Email: charlesengel@lineone.net 25

HOMAGE TO THE FOUNDING FATHERS. ALL HONOUR TO THEM!

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Tamas Fülöp Felipe Bojalil Hemang Dixit Florentino Herrera Jr David Maddison Alvaro J. Mercado Zohair Nooman Cosme Ordoñez Eldryd Parry

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MEMBER AND ORGANISATIONAL NEWS MESSAGES FROM THE EXECUTIVE COMMITTEE

The Network: TUFH and GHETS

Relationship Develops

Global Health through Education, Training and Service (GHETS) is an NGO closely affiliated with The Network: TUFH. While originally it focused on The Network: TUFH’s Fundraising Taskforce - given its status as an independent NGO with a broader mission - the relationship between GHETS and The Network: TUFH has grown and matured in the past year. Considerable progress was made in defining this expanded relationship at The Network: TUFH’s 2003 Conference in Newcastle, Australia.

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In a broad sense, The Network: TUFH and GHETS have common goals. However, they possess unique strengths and strategic approaches which complement each other.

While The Network: TUFH has an organisational structure which supports a broad, global agenda related to its mission, it does so with a very limited budget. Its funds are generated mostly from membership fees and support from the Maastricht Faculty of Medicine. Voluntary labour is offered by individuals from member institutions and organisations. The Network: TUFH ‘s Office in Maastricht lacks the capacity to effectively undertake fundraising and faces the barrier of donors and foundations preferring to fund specific projects, countries or regions, not the global initiatives supported by The Network: TUFH. GHETS is far better equipped than The Network: TUFH to raise funds. It has raised funds and selectively targeted those funds to specific Network: TUFH projects (ex. Women’s Health) or specific regions (ex. East Africa). They provide seed money to jump-start the projects, help coordinate initial technical and planning assistance for grantees, and then explore larger and more sustained funding options. GHETS core funding also helps in areas The Network: TUFH initiated, but was unable 28

to fund (ex. Healthcare for the Elderly). To clarify and define how The Network: TUFH and GHETS work together, a Memorandum of Understanding has been ratified by The Network: TUFH’s Executive Committee and GHETS’ Board of Directors. This Memorandum states that virtually any activity undertaken by GHETS may be assumed to be undertaken on behalf and with the consent of The Network: TUFH. And any planned activity undertaken by The Network: TUFH relevant to the work of GHETS will be discussed with GHETS. This encourages each organisation to inform each other of relevant actions in a timely manner. But it is intended that needed action should never to be delayed due to inefficient communications between the two organisations. To simplify and streamline communications, the Memorandum identifies Ms. Pauline Vluggen, Executive Director of The Network: TUFH and Ms. Jessica Greenberg, Executive Director of GHETS as the primary communications contacts. Both organisations were pleased with the benefits derived from this collaboration during its first year.

WHO NEWS • After reviewing the collaboration between The Network: TUFH and WHO, the WHO Executive Board has decided to maintain the official relations with The Network: TUFH. In making its decision, the Board commended the efforts of The Network: TUFH in support of the work of WHO. • The Centre for Research and Development in Medical Education and Health Services (CRD), Faculty of Medicine, Suez Canal University at Ismailia, Egypt, was re-designated as a WHO Collaborating Centre for the 4th time after thorough evaluation from the WHO office at the regional and international levels.

• The WHO Executive Board has appointed two WHO Regional Directors. Dr. Samlee Plianbangchang has been newly appointed Regional Director for the South-East Asia Region. He will serve for a period of five years, beginning March 1, 2004. Dr. Shigeru Omi has been re-appointed Regional Director for the WHO Western Pacific region. He begins his second five-year term on February 1, 2004.

Gerard Majoor | Chair, Executive Committee The Network: TUFH Email: g.majoor@oifdg.unimaas.nl

SILVER JUBILEE The Faculty of Medicine at Maastricht University feels proud to have been the ‘home base’ for The Network over the past 25 years. Being so closely and personally involved with The Network in all those years has enabled us to witness the organisation’s good work, which also inspired and motivated us. We congratulate The Network: TUFH with its silver jubilee, and we hope to continue our roles as Full Member of - and ‘home base’ for The Network: TUFH. Harry Hillen | Dean, Faculty of Medicine, Maastricht University, the Netherlands Email: h.hillen@facburfdg.unimaas.nl

TASKFORCES

Integrating

Medicine and Public Health

Health services are fragmented by the division in individual healthcare and community health services, biomedical and psychosocial models, curative and preventive care, services provided by generalists and specialists, public and private sectors.

This lack of integration prevents unified organisation of healthcare. Approaches have been suggested to deal with this situation and some of them have been implemented.

• Strategic partnerships • Rural health/health indigenous communities • Multiprofessional education • Integrating medicine/public health (see this page)

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Dr. Betsy VanLeit

In addition to teaching, Dr. VanLeit has worked extensively as an occupational therapist in community-based healthcare. She has lived and worked in rural communities in the United States, and has great appreciation for the importance of multiprofessional collaboration in healthcare. She has directed multiprofessional teams, and has a special interest in the attributes of effective teamwork in a variety of healthcare settings. Dr. VanLeit has lived on several continents including North America, Africa, Asia and the Middle East.

Through those experiences she has gained firsthand knowledge of the importance of sharing and learning from each other across countries and cultures.

• Women and health

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Jaime Gofin | Coordinator Integrating Medicine and Public Health taskforce Email: jaime@md.huji.ac.il

• Community-based care for the elderly

AN OVERVIEW OF THE NETWORK: TUFH TASKFORCES

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We are planning a session at the coming Atlanta Conference (October 2004) of The Network: TUFH, to discuss relevant experiences and alternatives of joint efforts with other partners in the healthcare system.

Members of The Network: TUFH - and of other health organisations who are planning to attend the Conference and are interested in participating in the session - are invited to email (see email address below) an abstract of 250 words, to be considered for presentation during the Conference.

Dr. Jaime Gofin

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The first activity of the taskforce has been the development of a working paper that will soon be released. This paper should be used as a framework for discussions on purposes and actions towards integration.

VanLeit, PhD, OTR/L, FAOTA (bvanleit@salud. unm.edu) is currently an Assistant Professor at the University of New Mexico (UNM), USA. She teaches Occupational Therapy and Physical Therapy to graduate students in the UNM Health Sciences Centre. Dr. VanLeit is also Director and Principal Investigator of the Rural Health Interdisciplinary Programme (RHIP). This long-standing multiprofessional programme provides an annual opportunity for 100 students in 12 different health professional programmes to gain experience and confidence in working together. In addition the RHIP facilitates student involvement in healthcare practice in rural and underserved communities throughout New Mexico. By working collaboratively with each other and community members on local health projects, students develop appreciation for communitybased care and the importance of teamwork.

Dr. VanLeit has also recently become Co-Principal Investigator for the New Mexico Area Health Education Centre (AHEC), a statewide programme responsible for encouraging the development of a strong multiprofessional health professional workforce throughout rural communities.

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A few moths ago, The Network: TUFH established a taskforce on Integrating Medicine and Public Health. The taskforce aims to promote the discussion on developing approaches for integrating activities of these two disciplines in different organisational contexts. The taskforce is composed of seven members from the USA, Spain, Philippines, Benin, South Africa and Israel.

N EW CO OR DIN ATOR TASK F O RC E MP E Betsy VanLeit will serve as the new coordinator of the Multiprofessional Education taskforce.

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MEMBER AND ORGANISATIONAL NEWS REPRESENTED AT INTERNATIONAL MEETINGS/CONFERENCES

RE-ASSESSING FULL MEMBERS

The Network: TUFH is being represented at meetings/conferences all over the world.

INCLEN Global Meeting Agra, India, February 11 - 14, 2004 The 20th INCLEN Global Meeting was held in Agra, in the Shadows of Taj Mahal - one of the Seven Wonders of the World. The theme of this year’s Meeting was Leveraging Research through Policy and Practice.

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There were more than 300 participants from the various INCLEN institutions. I had the pleasure of representing The Network: TUFH. There are over 20 institutions that are members of both INCLEN and The Network: TUFH. It was good to meet the Network: TUFH members from Indonesia, Thailand, Philippines, Australia, Africa and South America.

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Both INCLEN and The Network: TUFH have a common goal: to improve the health of individuals, families and the community. While INCLEN does this through evidence-based clinical care and research, The Network: TUFH approaches this goal by improving the quality of education, by educating health professionals of various disciplines to identify and address the priority health needs of the community, and by working with the community, government and policy makers.

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There is awareness within INCLEN that community-based research influences policy makers. There is also a greater understanding of its role in influencing policy. It was good to observe that the emphasis of INCLEN has moved from clinical bedside research to community-based health systems research. The initial reluctance to make this change has decreased.

A presentation was made on Increasing the Relevance of Health Professions Education.

How can The Network: TUFH meet your needs. The activities of The Network: TUFH were highlighted, and it was suggested that the two organisations should work together with greater coordination. The 30

two organisations have much in common and should aim to complement each other.

The Network: TUFH institutions could benefit from inputs in research methodology.

INCLEN institutions would probably benefit by adopting a multidisciplinary approach and innovative teaching methods. At the end of the presentation several members showed interest in becoming members of The Network: TUFH.

Since 1998 Full Member Institutions (FM) are being re-assessed on a regular basis. As part of this re-assessment procedure FM perform a selfevaluation report.

It is with pleasure that we would like to inform you that the following Full Member has been awarded a continuation of their Full Membership up to 2009: Istituto Superiore di Sanità, Roma, Italy

I thank INCLEN for the opportunity given to me to participate in the Meeting and renew my acquaintance with many members of INCLEN whom I have known since the 80s.

For more information on INCLEN, see also page 20 in this Newsletter.

Abraham Joseph | Director Schieffelin Leprosy Research and Training Centre, Full Member of The Network: TUFH, India Email: directorate@karigiri.org

MEETINGS/CONFERENCES • Conference on Health Services Innovations, December 2003, Spain Represented

by Arthur Kaufman and Jaime Gofin.

• 113th WHO Executive Board Meeting, January 2004, Switzerland. Represented

by Charles Boelen and Perti Kekki.

• INCLEN Global Meeting, February 2004, India. Represented by Abraham Joseph.

• 10th International Congres on Public Health (WFPHA), April 2004, United Kingdom. Represented by Ron Richards.

• World Health Assembly, May 2004, Switzerland. Represented by Arthur Kaufman, Gerard Majoor, Perti Kekki and Rogayah Ja’afar.

THE N’S 25TH In 1978, Tamas Fülöp organised a meeting in Kingston, Jamaica, chaired by David Maddison, then Dean of the new medical school at the University of Newcastle, Australia. It was the organising meeting of a group that fondly became known as The Network. Dr. Fülöp’s purpose was to show the world that it was possible to create medical schools that were more socially relevant than many existing schools, that is, to promote the Alma Ata Declaration. I was there as a representative of Michigan State’s Medical School, and especially its Upper Peninsula Education programme. It was a very memorable gathering of ‘like-minded’ leaders. To this day, although with some very important additions, The Network is true to its original mission: creating health professions schools that are accountable to the people of their society. After 25 years, that same mission still holds: be more community-oriented, use problem-based learning, broaden out beyond medical education to health professions education, involve community representatives, practitioners, policy-makers, and associations, but don’t compromise those values. And it never has!

Ron Richards | Professor of Public Health, University of Illinois, United States of America Email: Richards@uic.edu

INTRODUCING MEMBERS

ABOUT OUR MEMBERS

John Snow Inc.

MOVING O N: CHANGES IN LEADER SHI P The Secretariat received information about changes in leadership with the following Network: TUFH members. We have listed the name of the new and former (Vice-) Deans/Directors for you:

John Snow Inc. (JSI) is proud to have joined The Network: TUFH as an organisation philosophically committed to an integrated health system’s approach to health improvement.

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Theo Lippeveld | Vice-President International Division, JSI, United States of America Email: tlippeveld@jsi.com

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To know more about JSI, please visit www.jsi.com

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Divisions Headquartered in Boston, USA, JSI operates from four US and 26 international offices, with more than 375 US-based staff, 700 host country national field-based staff, and more than 4.000 consultant experts. JSI has two operational divisions: the International Division and the Health Services Division.

The International Division aims to improve management, public health, community involvement, medical resources, technology, information and operations in health systems around the world. The Health Services Division is committed to improving primary healthcare delivery in the USA. Through

Example JSI has longstanding experience in implementing health system integration interventions at all levels, focusing on integration of healthcare services; integration of public health interventions with healthcare services; and multi-sectoral integration. For example, in the USA, JSI - in conjunction with the Harvard Medical School is the Coordinating Centre for a five-year project to evaluate the impact of integrating primary care and mental health service on access, adherence, patient outcomes and cost of care. In Uganda, JSI implements the Uganda Programme for Human and Holistic Development (UPHOLD). UPHOLD promotes an integrated approach to social services delivery at the district level, building human capacity and creating synergy between the social sectors.

• Dr. Batool Al Muhandis, College of Health Sciences Ministry of Health, Manama, Bahrain has been replaced by Dr. Shawki Ameen • Dr. Julio Terán Dutari, Facultad Experimental de Medicina, Pontificia Universidad Catolica del Ecuador, Quito, Ecuador has been replaced by Dr. José Ribadeneira Espinosa • Dr. Moustafa Abd El-Aziz, Faculty of Medicine, Suez Canal University, Ismailia, Egypt has been replaced by Dr. Somaya Hosny Mahmoud • Dr. Leticia Zavaleta de Amaya is the new Dean of Facultad de Medicina, Universidad Nacional de El Salvador (UES), San Salvador, El Salvador • Dr. Abraham Thomas, Christian Medical College and Hospital, Ludhiana, Punjab, India has been replaced by Dr. Mohan Verghese • Dr. Shekhar Koirala, B.P. Koirala Institute of Health Sciences, Dharan, Nepal has been replaced by Dr. Lok Bikram Thapa • Dr. Ramon L. Arcadio, College of Medicine, University of the Philippines Manila, Ermita Manila, the Philippines has been replaced by Dr. Cecilia V. Tomas • Dr. Bernard Salafsky, College of Medicine at Rockford University of Illinois Rockford, IL United States of America has been replaced by Dr. Martin Lipsky • Dr. Phan Van Cac, Thai Nguyen Medical College, Thai Nguyen, Vietnam has been replaced by Dr. Nguyen Thanh Trung

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Since its founding in 1978, JSI has built a portfolio of more than 500 projects in 84 countries, and has become a recognised leader in public health, including such areas as family planning, maternal health, child health, HIV/AIDS and other infectious diseases. Focused on sustainable change, JSI helps local partners to develop the infrastructure to support service delivery in their communities through organisational development, programme planning, health financing, training, social marketing, monitoring and evaluation, information systems, and commodity security.

an emphasis on health policy, training and management consulting, the staff applies practical, technically sound and innovative solutions to challenges faced by healthcare organisations and policy makers in both the public and private sectors.

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Leader in Public Health Named in honour of Dr. John Snow, the father of ‘modern epidemiology’, JSI was founded in 1978 as a public health organisation to bring practical approaches to health crises and disparities by nurturing collaboration among governments, non-governmental organisations, academics, health providers, communities, and individuals.

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MEMBER AND ORGANISATIONAL NEWS ABOUT OUR MEMBERS

The Wynand Wijnen Award 2004 Emeritus Professor Wynand Wijnen made a pivotal contribution to the implementation of the educational approach of Maastricht Medical School. He has dedicated his life to the innovation and improvement of education. In 1999, at the occasion of his retirement, a Wynand Wijnen Award was created to commemorate his important work.

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Gerard Majoor requested the readers of this newsletter to submit nominations for this Award. The jury was impressed by the high quality of the 45 received proposals.

It is clear that in many countries there are institutions and organisations that try to improve the health of many by changing the educational system.

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From three selected proposals, the jury elected one winner. The Award goes to the Medical Committee Netherlands Vietnam (MCNV). The jury was very much impressed to learn that, over the long years of its existence, the MCNV has managed to mobilise such large numbers of volunteers, who have contributed to the MCNV’s continuous efforts to improve the health of the Vietnamese people. This is a clear indication of the relevance of the organisation’s activities. What also inspired the jury’s admiration were the many diverse projects undertaken by the MCNV. The efforts to enhance the health of the people in Vietnam have been characterised by a high degree of organisation.

This structure offers a strong guarantee that the results of the projects will be sustained to improve the living conditions of future populations. Not only does the MCNV provide assistance to the Medical Faculties, it is also involved in projects at other educational levels, such as the training of midwives and nurses. They have achieved considerable health benefits for the Vietnamese people and will continue their efforts.

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The jury decided to grant the two other projects an incentive prize. One goes to the Medical Faculty of the Gadjah Mada University (Indonesia) for their continuous effort to maintain and to develop innovative education and also for their effort to develop a quality assurance system.

The other winner of the incentive prize is the Faculty of Medicine of the Catholic University of Mozambique. This Faculty started under extreme difficult circumstances. However, it succeeded and the first students will graduate soon.

The Award includes the amount of € 13.000; the incentive prize winners receive € 500 each.

Henk van Berkel | Chairman of the jury, Maastricht University, the Netherlands Email: vanberkel@educ.unimaas.nl

HAPPY BIR THDAY As we celebrate our 25th anniversary, we need to take stock of the past and look into the future. In his opinion, Dr. Jan van Dalen sees “The sharing of experiences and providing evidence of successful activities is the main strength of The Network: TUFH”. I agree with his view, but also hasten to add that The Network’s ongoing evaluation of the process of teaching and learning of health professional students - and whether it has the desired positive impact on people’s health - is a target or vision that is a major underlying strength which must be kept alive.

No wonder Arthur Kaufman this year, after 20 years in The Network, stated that The Network is the most moral of the professional organisations to which he and his colleagues in New Mexico belong.

A major challenge, though, is how to improve the scientific rigour of the studies or evidencies produced in The Network.

Happy birthday.

Nelson Sewankambo | Dean, Faculty of Medicine, Makerere University, Kampala, Uganda Email: sewankam@infocom.co.ug PRESIDENT OF THE COLLEGES OF SOUTH AFRICA Lizo Mazwai - Member The Network: TUFH Executive Committee and Dean and Professor of Surgery at the University of Transkei (Republic of South Africa) - has been elected as the next President of the Colleges of South Africa. He has been appointed for the next three years, starting from May 2004.

Dr. Lizo Mazwai

New Members Full Member Institutions • Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon

• Department of Medical Education, University of Illinois at Chicago, Chicago, USA • International Center for Health Leadership Development, University of Illinois at Chicago, Chicago, USA Membership Withdrawals Individual Members • Dr. Jon Martell, John A. Burns School of Medicine, University of Hawaii, Honolulu Hawaii, USA Re-activated Associate Member Institution • College of Medicine (HUCOM), Hadhramout University, Mukalla, Yemen

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Associate Member Institutions • Curso de Medicina, Universidade de Alfenas (UNIFENAS), Belo Horizonte, Brazil • AFEME, Ministry of Public Health, Central University of Ecuador, Quito, Ecuador • Faculty of Medicine, Jordan University of Science & Technology, Irbid, Jordan • Al Qaseem College of Medicine, Buraidah, Saudi Arabia • Faculty of Medicine, Omdurman Islamic University, Khartoum, Sudan • Morehouse School of Medicine, Atlanta, USA

Education + Development, Quito, Ecuador • High Institute of Nursing, Port-Said, Egypt • Christian Medical College and Hospital, Ludhiana, Punjab, India • Iran University of Medical Sciences and Health Services (IUMS), Tehran, Islamic Republic of Iran • Lagos University Hospital, Lagos, Nigeria • College of Medicine, University College Hospital, Ibadan, Nigeria • Civil Hospital, Bolan Medical College, Quetta, Pakistan • King Edward Medical College, Lahore, Pakistan • Ensino Universitário, Instituto Superior de Ciências da Saúde - SUL, Caparica, Portugal • Faculty of Medicine, University of Lisbon, Lisbon Codex, Portugal • Harvard Pilgrim Health Care, Harvard Medical School, Boston, USA • International Consultants and Communication, Chicago, USA

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Membership Expirations Associate Member Institution • Latin American Centre for Development (CELADE), Capitan Santa Fe, Argentina • St. Matthew’s University School of Medicine, San Pedro, Belize • FUNEDESIN Foundation for Integrated

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Individual Members • Dr. Anne Deborah Atai-Omoruto, Mulago Hospital Complex, Association of Family Physicians of Uganda, Kampala, Uganda

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Associate Member 13 21 14 19 9 12 13

Individual Members 17 6 26 15 13 26 5 33

MEMBER AND ORGANISATIONAL NEWS ABOUT OUR MEMBERS Occasionally the Network: TUFH Alert is being used for members who are asking for help from the Network: TUFH membership.

Here we give you the results from these ‘quests’. Carol Nyambura was looking for assistance in quality assurance.

Members Helping Members Dear Network: TUFH, My name is Carol Nyambura, and I’d like assistance from Network: TUFH members. This would especially be from those within a teaching hospital, and who have a quality assurance system in place. In relation to this, I’d like to request for material on quality assurance in health facilities; sample standards for all areas, both clinical and nonclinical; clinical guidelines; administrative procedure manuals/standard operating procedures; teaching supervisory guidelines/manuals for the clinical areas; and checklists for quality assurance. I look forward to your assistance, Carol Nyambura | Quality Assurance Department, Moi Teaching & Referral Hospital, Kenya cnyabz@yahoo.com

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Dear Carol, I used to be with the Hospital Operations and Management Service of the Philippine Department of Health. I also worked with the Nursing Research Division of the Philippine General Hospital, the biggest hospital in the country and the base hospital of the University of the Philippines Colleges of Medicine and Nursing. At present I am the chair of the Department of Research of the Philippine Nurses Association. Our hospitals (both government and private hospitals, particularly the training - teaching) are in different levels of QA activities. It is really difficult to start a QA programme, but it was difficult about a decade ago when we started introducing QA in our government hospitals. It is now ‘easier’ because it is required for the accreditation of hospitals wanting to participate in the Medicare Programme provided for by the National health Insurance Act. How to start? It would be good to have a QA Committee for the whole hospital that will start defining your QA framework and the general guidelines for the different QA sub-committees (e.g. medical, nursing, pharmacy, laboratory, radiology, etc).

Talk about QA, and we start with standards -- structure, process and outcomes. It is a long and tedious work, that is why there is a need for a highly committed hospital/health agency leadership. I suggest that initially there’s a core group that can do brainstorming.

My realisation when I met with the top management of the nursing service of a medical centre (training hospital) is that they have not progressed in their QA activities/efforts after 10 years. That’s why I suggested that they work on key indicators of quality nursing care. There was no point focusing on so many items because they did not have the time (and other resources) to even process the data that they collected. Naturally, nothing came out of their QA efforts.

Most of the institutions here I would say basically rely on discussions from textbooks (most of which are from the USA). However, many of us have recognised that standards should be defined within our context (most of our hospitals suffer from problems of understaffing, inadequate physical/material resources). I always emphasise that given the constraints in the healthcare delivery system (and the unique socio-cultural context) we should have our own standards.

Rosalinda Cruz | Chair, Department of Research, Philippine Nurses Association, the Philippines rearnshaw@pacific.net.ph

Dear colleague, When starting with a QA programme I would advise to start from what is needed in your hospital. Start with one progressive department and use a Performance Improvement Approach. Collect what you need and adjust it during the PI process, otherwise you get lost. There is an incredible amount of stuff available on the Internet but this will demotivate you. Please receive a PowerPoint presentation on PIP and check out the information on Performance.

Lucas Pinxten | Performance Improvement Advisor, Johns Hopkins University, Indonesia lpinxten@jhpiego.net 34

Dear Carol Nyambura, There are numerous materials in your area of interest produced by many institutions. As examples, and if you have Internet access you can search at: www.ahrq.gov; www.sign.ac.uk; www.qaproject.org But furthermore, the Department of Standards and Regulations of the Kenyan Ministry of Health, headed by Dr. Tom Mboya, has produced a Comprehensive framework to address the kind of concerns you are pointing out, under the name of ‘the Kenyan Quality Module’. You can contact Dr. Mboya at the MoH. I believe his e-mail address is the following: dsrs@africaonline.co.ke Itziar Itziar | Officer for Quality Improvement, Department Health Services Provision, World Health Organization, Switzerland larizgoitiai@who.int

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Dear Carol, Uganda has been making recent strides in these areas such as the Yellow Star QA standards for health facilities and the Uganda Clinical Guidelines. If you feel these would be of use you can either visit MoH in Uganda or at the very least I should be able to obtain copies and send them to you.

Mark Blackett | Programme Director, Marie Stopes, Uganda

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Dear Carol, You might find this useful: Guideline Improving Quality in Health Care: An Imperative for Health Districts and Hospitals. Written by Jannie Hugo (Medunsa) and myself. This guideline aims to provide district and hospital management teams with an understanding of the rationale for and processes of quality improvement, together with a framework for doing quality improvement. We are willing to advise and assist healthcare teams wishing to be involved in quality improvement. There are also a number of resources on quality improvement available from the Quality Assurance Project. Go to www.qaproject.org or write to Quality Assurance Project, Center for Human Services, 7200 Wisconsin Ave., Suite 600, Bethesda, MD 20814, USA. Ian Couper | Professor, Rural Health Department of Family Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa, couperid@medicine.wits.ac.za

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Many members advised to visit the Internet. These are some of the websites that were suggested: www.ihi.org; www.qualityforum.org; www.ncqa.org; www.ahrq.org; www.cms.gov; www.jcaho.org; www.cohsasa.co.za (Council for Health Services Accreditation of Southern Africa. They address both clinical and non-clinical aspects); www.ahrq.gov (which has either answers or links for all or most of your queries, including www.guideline.gov/); www.change-management-toolbook.com/(for management).

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These maps are proportionately incorrect

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Denver

Colima

Kingston

Havana

Atlanta

Temuco

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Londrina Marília, São Paulo Botucatu, São Paulo

Georgetown

Bahia Blanca

Buenos Aires

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Belo Horizonte Quito Circulo de Cumbaya

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San Salvador Santa Marta Barquisimeto San José

Mexico-city

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Ottawa Sherbrooke Hamilton White River Junction Cambridge Rootstown East Lansing Boston Attleboro Philadelphia

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Monterrey

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Vancouver Seattle

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Linkoping Malmo

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Jimma Kampala Eldoret Nairobi

Kubang Kerian

Ho Chi Minh City

Tuguegarao Manila Cavite

Hanoi

Xi'an Jiujiang

Yogyakarta

Sarawak

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Abottabad Tehran Irbid Jammu Amman Isfahan Ismailia Beer-Sheva Kathmandu Dharan New Delhi Cairo Buraidah Manama Mymensingh Riyadh Karachi Dhaka JiddahRiyad Ahmednagar Makkah Khartoum Chiang Mai Sana' a Omdurman Thai Nguyen Vellore Wad Medani Mukalla Pathumthani Karigiri Bangkok Sennar Can Tho City Tamil Nadu

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Roma

Maiduguri

Torino

Zaria Kumasi Accra Ilorin Ikeja Accra Yaounde Buea Buea Mbarara

San Juan

Ferney Voltaire

Krakow

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Derby Berlin Reading Witten Maastricht Wuppertal Prague

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MEMBER AND ORGANISATIONAL NEWS The Network: TUFH on the Map ABOUT OUR MEMBERS

Individual members

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Akamul

Memphis El Paso Ashville

Little Rock

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Bangalore Kerala Dist.

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Al Khobar Hafr

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Kampala

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Sodra Sandby Leeds Amsterdam Warsaw Nijmegen Cardiff Maastricht Cornwall London Gent Hradec Geneva Zagreb Reijeka Pècs Sofia Thessaloniki Porto Izmir Lisbon Bornova

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HOMAGE TO THE FOUNDING FATHERS. ALL HONOUR TO THEM!

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Moshe Pryw Ronald Richards John Sibley Kennh Standard Wynand Wijnen Samuel Wray Henry van Zile Hyde George Miller Ramon Villarreal José Roberto Ferreira Frederick Katz Jean-Jacqu Guilbert

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1979 2004

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S R A E 2 5 Y N E T W O REALKTH T H E UNITY FOR H DS TOWAR

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MEMBER AND ORGANISATIONAL NEWS

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I N T E R E ST I NG INTERNET SITES The Network: TUFH Interactive - Recommended Internet sites www.the-network.org/interactive.htm Supercourse. Epidemiology, the Internet and Global Health www.pitt.edu/~super1/ The Global Curriculum Bank for HIV/AIDS Preventive Education www.unesco.org/education/ibe/ichae International Center for Equal Healthcare Access (ICEHA) www.iceha.org AOEC (Association of Occupational and Environmental Clinics) www.aoec.org/default.htm The Newest AOEC Educational Module ‘Pesticide Illness’ www.aoec.org/LLDIR.htm#PowerPoint Top Medical and Scientific Societies Commit to Providing Free Access to Medical and Scientific Research www.dcprinciples.org/ World Blood Donor Day, 14 June 2004 www.wbdd.org/ WHO registry provides free access to research results www.unwire.org/UNWire/20040405/449_22474.asp

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Newsletter Volume 23 | no. 1 | June 2004 ISSN 1571-9308 Editors: Marion Stijnen and Pauline Vluggen Language editor: Sandra McCollum The Network: TUFH Publications P.O. Box 616, 6200 MD Maastricht the Netherlands Tel: 31-43-3882440, Fax: 31-43-3884142 NEW NUMBERS AS PER JULY 9 Tel: 31-43-3885633, Fax: 31-43-3885639 Email: secretariat@network.unimaas.nl www.the-networktufh.org Lay-out: Graphic Design Agency Emilio Perez Print: Drukkerij Gijsemberg

The designations employed and the presenta-

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tion of the material in this newsletter do not

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imply the expression of any opinion whatsoever on the part of the World Health Organization

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NETWORK: TUFH BROCHURE UPDATED The Network: TUFH brochure has been updated. For information, or if you would like to order brochures, please contact Yoka Cerfontaine y.cerfontaine@network.unimaas.nl. It's also possible to download the brochure from Internet: www.the-network.org/brochure

and The Network: TUFH concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.

The mention of specific companies or of certain manufacturers’ products does not imply that

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they are endorsed or recommended by the World Health Organization or The Network: TUFH in preference to others of a similar nature that are mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.

The World Health Organization and The Network: TUFH do not warrant that the information contained in this newsletter is complete and correct and shall not be liable for any damages incurred as a result of its use.

Any named authors are responsible for the views expressed in their signed articles.

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