The Network towards unity for health
VOLUME 26 | Number 01 | June 2007
NEWSLETTER
New developments are at the basis of this Newsletter; new healthcare systems in India, Ghana and the Netherlands; a new Network: TUFH Position Paper; a new approach to teaching the population perspective; a new brochure and open access e-journal for Education for Health; new ways of assessing and evaluating; new Executive Committee Members to be elected; a new Network TUFH Directory of Accredited and Admitted Full Members; new innovative curricula implemented; a new Network: TUFH weblog; and - last, but not least - new partnerships.
In this issue, among others: Breastfeeding: The Biological Option 6 Education for Health Now Freely Available Online! 7 Allow More African People to Study in the West 14 Mutual Recognition of Accreditation Decisions 17 Fostering the Health of Communities 31
Anything you would like to share with the Network: TUFH membership at large? Deadline for submissions for the December 2007 Newsletter is October 31, 2007. Marion Stijnen and Pauline Vluggen Editors In the Newsletter we refer to The Network: Towards Unity for Health as The Network: TUFH.
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contents 03 Foreword It Takes a Community to Improve the Health of Communities 04 The Network: TUFH in Action 04 Annual International Conference ‘South-South-North’ Collaboration Uganda - Kenya - the Netherlands | The Conference in Uganda in Brief 05 Position Paper Community-Based Education for Older Persons 06 CD-ROM Review Breastfeeding: The Biological Option 07 Education for Health Education for Health Now Freely Available Online! | Mini-Themes Editions 08 Improving Health 08 Health Services University and Primary Care: To Foster Leadership in Healthcare 09 Health Authorities Improving Drug Supply in Local Health Centres | Health Insurance for Services to Masses in India | One Health Insurance Scheme for All Ghanaians | New Dutch Health Insurance System 14 Health Professions Allow More African People to Study in the West 16 Women’s Health De Madres a Madres 17 International Health Professions Education 17 Accreditation and Quality Assessment Mutual Recognition of Accreditation Decisions | Logbook: Effective Field Training and Assessment Tool | Letter to the Editor 20 Yellow Papers Field Visits: A Tool for Public Health Education | Attitudes and Confidence in Providing Palliative Care 22 Leadership Column Participatory Leadership is the Best Leadership 23 New Institutes and Programmes UDS Medical School: A Short Story 24 Medical Education Longitudinal Integrated Learning: An Approach to Teaching the Population Perspective? 25 Problem-Based Learning and Community-Based Education Enhancing Community-Based Education in Vietnam 26 Partnerships 26 The Like-Minded Working Together Natural Allies 27 International Diary 27 Diary 2007 28 Member and Organisational News 28 Messages from the Executive Committee General Meeting 2007, Uganda | Network: TUFH Weblogs | Out of the SNO Pen: News 30 Represented at International Meetings/Conferences A Call to Action: Ensuring Global Human Resources for Health 31 Re-Assessing Full Members Fostering the Health of Communities 32 About our Members New Members | New Brochure EfH | Unity of Purpose and Action | Moving On: Changes in Institutional Leadership | Interesting Internet Sites | Tribute to… | Advertising Opportunities With The Network: TUFH | The Network: TUFH Hall of Fame 35 Introducing Members Monash School of Rural Health 36 Network TUFH Conference 2008 in Colombia
FOREWORD
It Takes a Community to Improve the Health of Communities
Dr. John Norcini
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Another area for sharing strategies between FAIMER and The Network: TUFH is in helping our educational innovators influence health service delivery and policy in the communities they serve. This approach is difficult in countries where the service delivery system is under the authority of a Ministry of Health, and where the educational system is under a Ministry of Education. However, much educational innovation is diluted when graduates face an inhospitable work environment. How such barriers can be overcome will be an important focus for both organisations, so we will be sharing models and strategies from different parts of the globe that have been successful in integrating education, service and policy change.
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The great value of such networking is the opportunity it affords both organisations to share complementary strengths and to learn from each other. For example, the Network: TUFH’s journal Education for Health (EfH)
Dr. Arthur Kaufman
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Underpinning good educational practice is reliable evidence; the goal of FAIMER’s Research Programme is to understand, track, and assess the impact of educational experiences and migration patterns on the health of populations. Simultaneously, we work with partners like The Network: TUFH to support the work of Education for Health, which publishes original contributions of interest to educators, administrators, and learners in the health professions. All these
We will be sharing models and strategies from different parts of the globe that have been successful in integrating education, service and policy change.
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In terms of faculty development, FAIMER offers fellowship programmes, consultations, and institutional grants. The fellowship programmes are intended to provide individual faculty members with the tools and skills to serve as educational resources in their communities. The institutional grants and consultations seek to tie these Fellows together into regional networks to implement educational improvement in a self-sustaining manner. In turn, these regional networks of Fellows can join with other local groups to form a community of practice.
John Norcini | President and CEO, FAIMER, United States of America Email: jnorcini@ecfmg.org
not only gains from the fine articles FAIMER Fellows submit, but also receives base funding, editorial assistance. In turn, EfH and the Newsletter, and the Network website serve as a vehicle for dissemination of information about FAIMER. FAIMER has provided leadership, from which The Network: TUFH can learn, in developing regional training and communications programmes for its Fellows. At a time of limited resources when international travel costs are prohibitive for many, regionalisation has the advantage of bringing together those facing similar problems, with perhaps a similar culture and language together at a fraction of the cost of distant trips.
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There are many approaches to improving the health of communities. Like The Network: TUFH, the Foundation for Advancement of International Medical Education and Research (FAIMER) seeks to do so by contributing to the community of practice in health professions education. In concert with other organisations, FAIMER attempts to enhance and support this community by engaging in faculty development and conducting targeted research that informs medical education.
activities aim to enhance the health of the community by sharing evidence of what works in medical education. As we do our work, FAIMER actively seeks collaborations with a broad range of partners in the community of educators, especially local experts with whom we can share experiences and learn how to best respond to the needs of the communities. Through this collective exploration and problem-solving, we strive for tangible results that we believe will lead to healthier communities.
Arthur Kaufman | Secretary General Email: akaufman@salud.unm.edu 3
THE NETWORK: TUFH IN ACTION ANNUAL INTERNATIONAL CONFERENCE Every year The Network: TUFH organises an international scientific and networking conference. The Conference 2007 will be held in Kampala, Uganda, from 15-20 September.
Makerere University, School of Medicine and Mulago Hospital (Uganda) has an 80-year history of training medical professionals for East Africa. It has for a long time been revered as ‘the cream’ of higher education institutions in Africa; studying at Makerere University was a great personal achievement. In a study carried out by Makerere’s School of Medicine (SoM) in 2001, it appeared that the society was not receiving the kind of graduates who could contribute optimally to the changing needs. Weaknesses were felt strongly in the areas of management, communication skills, financial planning, community mobilisation, leading a healthcare team in a clinic or ward, et cetera. The reaction of the SoM was to undertake a major curriculum change including didactic approach. Staff was sent to all corners of the globe to investigate alternative approaches fitting Uganda’s needs.
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‘South-South-North’ Collaboration Uganda - Kenya - the Netherlands
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Maastricht University’s problem-based learning (PBL) and skills training was chosen, and an exchange of knowledge about and experience with this approach started in 2001. In spite of its wealth of experience and knowledge in these fields, Maastricht was not able to share their Community-based Education and Services (COBES) programme, because the communities Makerere and Maastricht serve differ too much. At this point, the College of Health Sciences, Moi University, Kenya was approached as a potential partner. In 1988 the College of Health Sciences started as a PBL school with skills training and a full-fledged COBES programme. From the start Maastricht University was intensively involved in the introduction of PBL and skills training. It was therefore a logical move to introduce Moi University as a very resourceful partner in educational reform to Makerere University.
Since 2002 a close collaboration between Makerere University, Moi University, and Maastricht University and Groningen University (the Netherlands) has existed, focusing on workshops, training of Faculty staff both in Uganda and abroad, study visits, training of Masters in Health Professions Education, research co-operation, construction of teaching space and procurement of materials. The first students in the PBL curriculum started in 2003. In January 2007, they had their first oral examination in the hospital. “They did even better than the batch one year ahead of them” was the remark of several departments. The appreciation by clinicians was the proof of the pudding: PBL is effective! Students under the PBL/ COBES curriculum have developed more effective communication skills, are using the library more and demonstrating very good clinical skills. Makerere University works hard to develop educational research skills and will soon be doing continuous research in the effectiveness of the curricula innovations and how best to implement them. Another challenge for the faculty is to improve coordination of the implementation of the curricula. The implementation of the innovations is accomplished by coordinating various teams or taskforces, which benefit from the input of the different partners. Maastricht University and Groningen University are sharing the underlying educational principles and research insights, whereas Moi University shares experiences in implementation of PBL in a more similar context. This is turning it into a very inspiring and motivating cooperation.
Carol Nyambura has worked at Moi Teaching and Referral Hospital, Eldoret and helped establish and then headed the Quality Assurance Department. She has a Master of Health Professions Education from Maastricht University, a postgraduate diploma in Quality of Health Care from Makerere University, and a BSc Environmental Health from Moi University.
Ms. Carol Nyambura (standing) in action during a PBL workshop at Makerere University Geraldine van Kasteren was based from 2001 to 2003 in Eldoret, Kenya working as project manager of a project to strengthen health professions education at Moi University under the Maastricht University Centre for International Co-operation in Academic Development (Mundo). As project manager she is, among others, involved in the project to increase the quality and relevance of education of health professionals at Makerere University and to develop a Master’s degree programme in Family Medicine at Moi University. Carol Nyambura and Geraldine van Kasteren | Consultant on higher education and HIV and AIDS prevention and stigma reduction, Kenya; Project manager Mundo, Teacher Medical Skills at Maastricht University, the Netherlands Email: cnyabz@gmail.com
POSITION PAPER
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The time for community-based care for older persons is now. Community-based care services for older persons include a wide variety of out-of-hospital, non-medical community-based residential facilities or support in their homes that provide liv-
Community-based care of older persons must be based on principles of care and community resources mobilised to achieve improved quality of life of older persons. Activities that are essential to the successful implementation of community-based care and to the achievement of the overall goal of improving health-related quality of life of older persons are: community surveillance, health promotion and social policy interventions, projects to improve care of chronic illness, human resource management, and, education and training programmes as well as satisfaction of older persons with the care provided.
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This global transition of the last 100 years occurred primarily due to a decrease in fertility and mortality rates. In developing countries the use of antibiotics, vaccines and oral rehydratation supplements has contributed to increased life expectancy despite the absence of positive changes in living conditions and decreased quality of life. Improvement in the quality of community-based care also may increase life expectancy.
The overall goal of community-based care is to help older persons maintain an acceptable level of quality of life: good physical health and function, good mental health and function, engagement with life, high morale and life satisfaction, and the skills to adapt to changes in their life.
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In developing countries, the demographic transition occurred much faster than developed countries. In France, it took 120 years for the proportion of older people to increase from seven to 14%. Developing countries like China, Malaysia, Jamaica, Brazil and Thailand will have had a doubling of their older persons from seven to 14% in less than 30 years.
ing arrangements, meals and protective oversight. The aims of such care are to: keep older persons at home, promote independence, strengthen primary health and community services, and strengthen voluntary and neighbourhood support.
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Todd LeCesne | Participant Network: TUFH Conference Belgium, Lecturer at the University of New Mexico, United States of America: “I felt very proud to be a part of the delegation from the University of New Mexico. In reflection, I have grown considerably from the experience; I learned much, established new contacts, and returned invigorated and inspired as an educator. Most importantly, I felt that the experience validated what we are doing at our own institute as far as educational curricula and innovations in teaching methodologies”.
Community-based care for older persons has reached a crisis level due to the global demographic transition that is affecting both developed and developing countries. In 2000, about 232 million or 60% of the world’s elderly population lived in developed countries. This number is expected to increase to 394 million in 2050. In contrast, in developing countries the rise will be from 375 million in 2000 to 1.5 billion in 2050.
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After the Conference (September 21 - 23) there will be an optional Post-Conference Excursion to the Faculty of Medicine, Mbarara University of Science and Technology, Uganda.
Community-Based Education for Older Persons
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The Conference in Uganda in Brief • When: September 15 - 20, 2007 • Where: Kampala, Uganda • Theme: Human Resources for Health: Recruitment, Education and Retention • Conference site: www.the-networktufh.org/conference • Preliminary programme: www.the-networktufh.org/conference/ programme.asp • Registration: www.the-networktufh.org/conference/ registration.asp www.the-networktufh.org/conference/ registrationform.asp
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 website (www.the-networktufh.org/publications_resources/positionpapers.asp).
You can read the unabridged version of this Position Paper at www.the-networktufh.org/publications_ resources/positionpapers.asp Larry Chambers | Corresponding author on behalf of the writing group Email: lchamber@scohs.on.ca 5
THE NETWORK: TUFH IN ACTION CD-ROM REVIEW
Breastfeeding: The Biological Option
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CD-ROM Review of: Breastfeeding: The Biological Option: A Self-learning Module for Students of the Health Professions Prepared by: Tejinder Singh http://healthlibrary.com/reading/ breastfeeding/index.html
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One might be forgiven for thinking that the practice of breastfeeding should need no special promotion or teaching. After all, it is 100% natural, free of cost, instinctual to the infant and biologically programmed in the mother. The health benefits of breastfeeding to mother and child are undisputed in the medical community. Yet anyone providing maternity health services soon learns that it is insufficient to simply tell a new mother that exclusive breastfeeding is the healthiest option for herself and her baby. Those who wish to promote breastfeeding need accurate information, specific practical skills, and a familiarity with the wide variety of obstacles to the initiation and continuation of breastfeeding and how they may be overcome. Breastfeeding: the biological option, a selflearning programme in PowerPoint format by Dr. Tejinder Singh, is a potentially useful tool for training healthcare professionals who are beginning to learn how to promote breastfeeding. It is divided into eight sections, each consisting of about 40 to 80 slides, and each concluding with a brief, self-correcting quiz. The slide sets review basic anatomy and physiology of lactation, its advantages (with particular emphasis on the prevention of infection), and the institutional practices and individual skills which can support breastfeeding. Particularly useful are the sections on spe-
cial situations, such as prematurity and caesarean section, and on solving common problems, such as engorgement, sore nipples and refusal to feed. Given the PowerPoint approach, the amount of material touched upon is admirable in breadth, though limited in depth. A number of problem-solving techniques are explained only by a picture or diagram; mastery of these would be impossible without supplemental reading or clinical mentoring. This is a practical tool and not a scholarly work; there are no footnotes and no references given, although there is a short list of recommended texts, and a rather useful page of Internet links at the conclusion of the module. The evidence behind the claims and recommendations that Singh makes is never given, except for two brief mentions of studies favourable to breastfeeding without bibliographic information or description of the methodology. Nevertheless, the information presented is accurate and well-supported in other sources (such as the American Academy of Pediatrics’ Policy Statement on Breastfeeding). The only two questionable statements I noted were claims that breastfed babies were less likely to cry, and less likely to become jaundiced than artificially fed babies. At the very least, these claims deserve an asterisk, as they are controversial. Since the material is based on the WHO/ UNICEF training course in breastfeeding counselling, the focus is international, with information that is clearly meant to be generalisable to as many settings as possible. This is mainly a strength, but occasionally leads to statements that do not hold true in the USA. For instance, the author states that pumped breast milk should usually be discarded, due to difficulties in maintaining its sterility. Similarly, he makes the point that the advantages of breastfeeding for infant
mortality may outweigh the risks of HIV transmission when the mother is seropositive; this is clearly not the case in the USA or in other developed countries. As indicated in the subtitle, this programme will be most useful for students of the health professions: nursing, midwifery, medicine and medical support services. It is not sufficiently detailed for use by lactation consultants. A well-educated mother or a lay patient advocate might find it helpful, but the programme does assume a pre-existing knowledge of basic anatomy and physiology, as well as an ability to evaluate mothers and newborns for medical problems such as dehydration. Some students will appreciate Dr. Singh’s simple syntax, straightforward explanations, and friendly, conversational style. Others may prefer to seek more concentrated information from textbooks or scholarly articles. On the whole, this module is an accurate, clear and welcome addition to the menu of options for learning how to provide effective encouragement and support for the nursing couple. This review has been published before in Education for Health, Volume 19, no. 3, 2006. Lise Weisberger | Director of the Obstetrics Curriculum, The University of Illinois; Advocate Illinois Masonic Medical Centre Family Medicine Residency, United States of America Email: lise.weisberger-md@advocatehealth.com
EDUCATION FOR HEALTH
Education for Health Now Freely Available Online!
Marie-Louise Panis | Managing Editor Education for Health Email: efh@network.unimaas.nl
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If you have any questions or feedback on how to enhance this site, please contact the journal office at efh@network.unimaas.nl Feel free to forward this information to any
of your colleagues who may also find our journal of interest.
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The new website is now live at: www.educationforhealth.net We invite you to visit this site and view the first free online issue of Education for Health: Volume 20, Issue 1 (May 2007).
Access to the information in Education for Health is unrestricted, and site users are permitted to download and print articles for personal use. Site users who choose to register as a journal user have additional benefits. You should register as a journal user if you: • want to receive email alerts about publications in your designated areas of interest; • intend to submit an article (either as corresponding author or as a co-author); • would like to join the moderated discussion forum about current or past articles and/or matters of global health interest; • are a reviewer for the journal.
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We are delighted to announce the launch of Education for Health as a free, open access e-journal. This online, Medline-indexed journal of the Network: TUFH will replace the existing print version, distributed through a publishing house. This is a very exciting development as the content of the journal is now available to all internet users free of charge. There are no subscription or submission fees. For the Network: TUFH, there can be no better way to fulfil its mission of furthering knowledge than by making its journal, Education for Health, freely available to a global audience.
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also keeping up with the steadily increasing number of submissions to EfH.
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The mini-theme format allows us to be responsive to and provide commentary on relevant health and health education topics. Please feel free to forward suggestions for mini-theme editions to us. We look forward to meeting with you and sharing ideas in Uganda.
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To provide a forum for dissemination of information and discussion on these types of
topics, EfH will be publishing a series of special issues that feature the following themes: Global Poverty and Human Development; Global Health Workforce Crisis: Developing Country Solutions; and Indigenous Community Health Workers. These will be published on-line as ‘mini-theme’ editions of the journal, where approximately one-half of the papers in each issue address the particular topic of focus. The remainder of papers represents a variety of topics reflective of the general pool of papers submitted and selected for publication. This enables us to target a variety of issues deemed important by the Network: TUFH membership, while
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Mini-Theme Editions Health workforce development and distribution, as well as quality of life and social determinants of health, continue to be major concerns internationally as attested to by the formation of the Global Health Workforce Alliance, administered by the World Health Organization and representing a partnership of numerous stakeholders. These are concerns that will be addressed in upcoming issues of Education for Health (EfH).
Michael Glasser | Co-editor Education for Health Email: michaelg@uic.edu
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IMPROVING HEALTH HEALTH SERVICES
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University and Primary Care: To Foster Leadership in Healthcare
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This article explores the collaboration of primary healthcare systems and universities to improve health of people and populations around the world, to define the needs of research, teaching and training. Individual healthcare is put into a population (community) oriented framework to address social and economic determinants of health to address equality (the same high quality of care, irrespective of patients’ and societies’ social, economic or cultural status) and equity (availability of care according to needs) of care. General practice (or family practice) is the medical discipline of primary care. This article focuses on general practice and general practitioners (GP) - with their long ties as a discipline to universities - as exemplifying primary care. The terms ‘general practice’ and ‘primary care’ are used interchangeably. Determinants of Health In the strict medical sense, ‘determinants of health’ are defined in relation to the individual patient: genetic constitution and exposure to health threats, of which ‘life-style’ is particularly important. But socio-economical background, working conditions, transportation or the living environment have an overriding influence on the health status of communities. The impact of individual medical care on populations’ health is consequently limited. The model of Ecology of Health Care (Green et al., 2001) describes where patients with health problems receive care. In a community about 80% of the population experience at any given time an episode of poor health, while one in ten of them actually are consulting a GP. This fact is also referred to as ‘the iceberg’ of illness and disease: 90% of the individuals with a health problem are outside professional care, emphasising the importance of self-care, lay care and self-efficacy. Outpatient departments, emergency rooms
and hospital care account for only a small part of the ‘sick’ in the community: about 10% of those who have contacted a GP, or 1% of the sick in the community. This stresses three key aspects of primary care: • a morbidity domain of its own right, different - in nature, presentation and prognosis - from the hospital sector; • the legitimisation of professional healthcare: why some seek consults when most others do not; • the community perspective in its orientation on the most important health problems of the population under care. Social Determinants Primary care provides individual patient care, directed at the most important health problems in the community, and takes into account those in greatest needs. Surveillance of the population health is essential to accomplish this goal. Primary care, as the point-of-entrance into the healthcare system, has to consider the limitations of medical care to prevent medicalisation. Prevention of (chronic) health problems is often directed at individuals’ lifestyle, but effectiveness of individual prevention is largely enhanced when pursued in collaboration with public health, populationdirected measures. From its knowledge of the community it serves, primary care is able to speak-out on behalf of the population (advocacy) to direct prevention and care to those in greatest needs. Collaboration with community leaders and representatives of patients improves its effectiveness. Effectiveness of Healthcare The content of primary care may be universal, but important differences in the structure of healthcare exist that determine the effectiveness of care. Healthcare based on a primary care footing (Van Weel, 2006) provides the most effective and efficient care. A continuous, empathic and caring
Dr. Chris Van Weel
relationship between GP and patient appears to enhance the effectiveness of medical-instrumental interventions [Van Os et al., 2005]. This reality leads to the generalistspecialist divide. Specialists do approach health problems with a focus on their (organ) specific technical skills; generalists analyse through a multi-level approach. The generalist engagement is a ‘horizontal’ one, taking into account all health problems and all determinants of health relevant to an individual or a population. The in-depth specialist approach is vertically directed to aspect of health (care). Critical for the effectiveness of healthcare is that the generalist and specialist domain integrate but unfortunately, often communityneeddesigned programmes (AIDS, malaria, TB, diabetes mellitus, cardiovascular risk management) are rolled-out in a standalone, vertical way. Knowledge, Skills and Competences From this information, the required knowledge, skills and competences of future practitioners and other professionals can be derived, along with a research agenda. Knowledge has to be directed at the most prevalent conditions in society.
HEALTH AUTHORITIES
Improving Drug Supply in Local Health Centres Epidemiology surveillance and risk assessment provide an essential basis. Social and interpersonal knowledge and skills are required to be able to engage with individuals and communities and to strengthen self-efficacy.
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The kits currently in use contain drugs that have not been revised over many years. These are standard for all areas in Kenya, yet different parts of the country experience different health problems. This ‘push system’ results in a situation where a health centre is undersupplied in drugs for which it has a high demand and oversup-
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Financing in this sector is a problem. There is lack of financial commitment from the Government which previously promised to ensure that all citizens would have access to drugs at all times. Bilateral and multinational donors are generally reluctant to fund recurrent, long-term costs needed to sustain the programme.
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Chris van Weel | Head, Department of General Practice, University Medical Centre Nijmegen, the Netherlands; Executive Committee WONCA Email: c.vanweel@hag.umcn.nl
Challenges Most of the patients said that they did not get the drugs prescribed for them. Infrastructure problems like poor transport and communication were evident.
Strategies to Address the Challenges • Drugs in the essential drug kit should be reviewed. They should be issued on the basis of what a health centre needs in order to avoid waste, i.e. the ‘pull system’ should be employed. • There should be an estimation of demand, to ensure a constant drug supply. Proper record keeping methods should be adopted. • Human resource currently in place should be increased. •C omputerisation of the procurement and distribution system will help optimise and manage the daily distribution of deliveries. Higher levels of accuracy in inventory management will also be achieved. • Health centres’ stock of drugs should be frequently supervised. Consistent monitoring of stock levels will ensure that there is always enough stock for the health centre.
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References GREEN, L.A., FRYER, G.E., YAWN, B.P., LANIER, D. & DOVEY, S.M. (2001). The ecology of medical care revisited. New England Journal of Medicine, 344: 202125. VAN OS, T.W., VAN DEN BRINK, R.H., TIEMENS, B.G., JENNER, J.A., VAN DER MEER, K. & ORMEL, J. (2005). Communicative skills of general practitioners augment the effectiveness of guideline-based depression treatment. Journal of Affective Disorders, 84:43-51. VAN WEEL, C. (2006). Towards a GP in every community in the world. The New Generalist, 4:80-81.
The Study The objectives of our study were to analyse the drug supply system that is currently in use; to identify its shortcomings; and to outline feasible strategies that can be implemented. We performed a crosssectional study involving both health centre staff and community members in Burnt Forest. Patients, health centre staff, and staff from the Kenya Medical Supplies Agency (KEMSA) were interviewed. KEMSA (a state corporation) is in charge of warehousing and distributing drugs. A kit system is used to supply essential drugs: drugs are packaged in two kits.
plied in drugs for which it has low demand. Inadequate stock in the health centres can also be attributed to: • inefficient supervision by pharmaceutical coordinators. They are too few to effectively make visits to all the health centres under them and submit timely reports regarding the situation; • drugs being supplied quarterly and not enough. Stocks are exhausted before the next supply arrives; • inventory records not being well kept. As a result, need for replenishing stock goes unnoticed. J U N E
In conclusion, at the core of the enterprise is the safeguarding of the social and societal acceptance of medical care, which requires an inter-sectorial approach, directed at what matters most. It needs research that dares to ask questions that matter. From this basis independent practitioners can be trained who are able to respond to the needs of society and can be accepted by society to do so.
Drugs are an integral part of any healthcare system. It is sad that many local health centres lack this very precious commodity, and as a result, people continue to suffer from treatable diseases. Here we focus on challenges and strategies in improving access to drugs.
Faith Mahinda | Student, Faculty of Health Sciences, Moi University, Kenya Email: fwmahinda@yahoo.com
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Health Insurance for Services to Masses in India Insurance Type General Institutional Inpatient slip Village Jawar
In the fifties, a small hospital offered services to the poor, using a variety of insurance strategies. The insurance plan, Annual Family Health Registration (AFLR) provides resources and attempts to create awareness of health needs.
Table 1: Types of schemes used over seven years
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Health is not a priority for the poor, who have to struggle for survival, food and shelter. Health providers and communities also have resource constraints, but with provisions from health facilities, communities can contribute to their own health.
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Community hospital in India
The objectives of insurance options are to create health consciousness, encourage participation and reach desired health services to the needy. There are six schemes: • General: A registration fee of Rs.150 ($3.5) - this year coverage increased Rs.250 ($5.60) - five members of a family are covered. Benefits are: 50% concession in charges, outpatient inpatient (hospitalised to this hospital). However, there is no compensation for meals and private services and 10% reimbursement for CT scan MRI. • Institutional: Under this scheme employees of any institution/industry, and their family members, can be insured at Rs.30 ($0.66) per head - increased to Rs.50 ($1.17). Benefits are the same as the general plan.
2001 20619 2264 480 24714 4122
2002 22075 3370 533 26402 7839
2003 21222 5433 1085 27567 6125
• Inpatients slip: One time use for Rs.60 (around $1.25) per slip - recently increased to Rs.100 ($2.35). Benefits are the same as general, but only for hospitalised cases. • Rural: Premium is Rs.15 ($0.33) - increased to Rs.30 ($0.66) - per member, when ≥75% population of village is insured. Benefits are the same as general. • Bachat gat: Similar to rural but is for registered Self Help Groups, of any number. • Jawar Yojana: Beneficiaries pay in kind Jawar (Sorghum) according to their capacity and income; 75% population of village contributes. Benefits are 100% waiver for all emergencies, first birth and 50% for other illnesses, outpatient services and meals. People use these plans for getting health services at referral. Over the years all categories are being used especially for rural emergency services (Table I). This insurance has led to prevention of maternal, perinatal infant mortality in the communities, prevention of overall morbidity mortality and health promotion in rural areas. Other schemes are used by people from all walks of life for cost effective healthcare. There are reports of nominal contribution on monthly basis for free outpatient inpatient services (Som, 2007). Affordable health insurance in ICICI Lombard, India (2005) offers coverage to the population residing in remote regions of rural India. In 1944 a health facility was established with 15 beds for women and children. When it grew to 50
2004 22882 7001 455 20880 9628
2005 23290 2689 465 6293 2174
2006 24070 754 530 10702 2027
2007 21844 365 508 14194 2962
beds, services were extended to men, but expenses were so high that managers sought government subsidy. Workers/communities did offer to make contributions, by providing sorghum at harvest time; every one gave as much as (s)he could afford, the birth of the concept of ‘Health Insurance’.
Insurance plans are not designed only to make money, but also to create health consciousness among the poorest of societY. The driving force behind the initiative was compassion and the concept of self help (Jajoo, 1984). Insurance plans are not designed only to make money, but also to create health consciousness among the poorest of society. Users also get affordable healthcare, and tertiary healthcare institutions can help the marginalised in seeking the required healthcare.
One Health Insurance Scheme for All Ghanaians Earlier in a study in relation to satisfaction/ dissatisfaction of health services, it was revealed that one of the major sources of satisfaction was insurance schemes; the major dissatisfaction was that insurance plans are not well known to those from distant areas (Chhabra et al. 2004, 2006). Our experiences reveal that referral institutions can make a difference in health by having a system by which the poorest of the poor can use referral health facilities by health consciousness with little contribution.
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Another measure that was introduced was a three-month waiting period between entering the scheme and the first payment for services received in order to prevent people from not taking out insurance until an accident happened or serious illness developed. Everyone would be eligible for coverage by the scheme irrespective of age and medical history. Participants were to pay a fixed premium which was not dependent on their income.
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In the end it was decided that the scheme should cover among other things hospital admissions, surgical procedures, x-rays, laboratory tests, and drugs. Deliveries without complications requiring hospital admission of the mother for 24 hours or less would not be covered by the scheme. Outpatient care was also excluded because of fear that it would be highly susceptible to fraud. Despite the use of identity cards it was considered impossible to prevent those without insurance sending relatives who had insurance to the hospital to ask for information and advice or to obtain drugs.
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In Ghana, the concept of a health insurance scheme was totally new. That is why it was of the utmost importance that good and effective information was given to the population when the new insurance scheme was introduced in Damongo and the surrounding region. Meetings were held in market places. There were leaflets for the minority of Ghanaians who are able to read. Schools were visited to tell students about the insurance scheme. T-shirts, stickers, umbrellas and belt bags with the scheme’s logo were handed out. Talks were organised with institutions and with political and religious leaders who had good contact with the general population and would be able to spread information about the scheme. Volunteers went door to door to tell people about the insurance scheme. They also tried to find out whether people were interested in the scheme and they shared their findings with the scheme’s organisers.
Fraud The inhabitants of Damongo showed a keen interest in finding ways of financing their healthcare. Because such a scheme can only work effectively when it meets needs that people are actually experiencing, the population was involved as much as possible in developing the details of the scheme. Which services should be covered? What premium should be paid?
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Stickers and Umbrellas In 1995 a health insurance scheme was set up in Damongo (administrative capital of northern West Gonja District), aimed at bringing hospital care within reach of poor Ghanaians. Until then financial barriers meant that this group had no access to hospital care. Many poor patients did not go to hospital until disease had progressed to an advanced stage, with families getting into debt or the hospital being landed with unpaid bills.
Logo of the health insurance scheme Damongo
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Shakuntala Chhabra and U.N. Jajoo | Professor and Head, Department of Obstetrics & Gynaecology; Professor, Department of Medicine | Kasturba Hospital, India Email: chhabra_s@rediffmail.com
Generally, health status and healthcare provision are of poor quality in the rural underdeveloped parts of the country, with the situation being the worst in the North.
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References CHHABRA, S., SHIVKUMAR, P.V. & MISHRA, S. (2004). Health seekers’ and providers’ perception of the quality of services to women suffering from gynaecological cancers. Indian Journal of Gynaecological Oncology, 4, 11, 30.31. CHHABRA, S. (2006). Perception of quality care at tertiary care facility. Health for the millions. 13-18, ICICI Lombard India (2005). Taking health insurance to rural India, 1-2. JAJOO, U.N. (1984). When the search began. Printed by Desai.R Wardha. 2,7. SOM, N.Y. (2007). To the rescue. Dignity Dialogue.
Poverty is widespread in northern Ghana. Small farmers make up almost 90% of the working population and most of them barely manage to provide for their own needs. Illiteracy is common, especially among women and girls.
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HEALTH AUTHORITIES
Fourth-year student of Maastricht University assisting at an operation at the West Gonja District Hospital. West Gonja District already had a regional health insurance system before the Ghanaian Government implemented a national system Danger of Overconsumption In addition to the scheme in West Gonja District, a regional insurance scheme was set up in Nkoranza District as well. Later, the Ghanaian Government launched a nationwide scheme for all Ghanaians: the National Health Insurance Scheme (NHIS). Today, the NHIS is in operation in almost all districts. The Damongo insurance scheme by now has over 40,000 participants, together representing approximately 26% of the local population. Nationwide, only 18% of Ghanaians have health insurance and the goal is to achieve almost 100% participation by around 2009. The annual NHIS premium for adults is about 74,000 cedis (circa $ 9.15). Children below the age of 18 whose parents have insurance do not have to pay a premium. The Government pays the premiums for elderly people and those who are too poor to afford insurance. Whether the new scheme will be successful is hard to predict with any degree of certainty. The threshold for attending a hospital will be lowered considerably, which may spark overconsumption. There is also the danger that it will be mostly those with high health risks who will take out insurance, which will make premium increases inevitable.
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Furthermore, it is of vital importance that the population feels confident that the healthcare system has something to offer which is really of value to them. Hospitals should not be too far away and an ambulance should be available in case of emergencies: when people have to walk for a day to reach a hospital or have to pay for very expensive transportation, they will be less inclined to join the insurance scheme. Hospitals should also have enough qualified staff and adequate facilities. This article has been published before in Dutch in Arts & Auto (members’ magazine of the Organisation for Doctor and Automobile) in March 2006. Lobke Bastings | Medical student, Maastricht University, the Netherlands; member of the Maastricht University Students Twinning a North Ghanaian Hospital (MUSTANGH) foundation* Email: mustangh@oifdg.unimaas.nl
* The MUSTANGH Foundation’s mission is to give an impulse to healthcare in the North of Ghana. For more information, please visit www.mustangh.nl
BEcause such a scheme can only work effectively when it meets needs that people are actually experiencing, the population was involved as much as possible in developing the details of the scheme. Which services should be covered? What premium should be paid?
New Dutch Health Insurance System As of January 2006, a new insurance system for curative healthcare came into force in the Netherlands. Under the new Health Insurance Act (Zorgverzekeringswet), all residents of the Netherlands are obliged to take out a health insurance.
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The ‘No-Claim’ Rebate In the Netherlands, everyone who pays
Based on information on the website of the Dutch Ministry of Health, Welfare and Sport (www.minvws.nl/en/).
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The new health insurance comprises a standard package of essential healthcare. The package provides essential curative care tested against the criteria of demonstrable efficacy, cost effectiveness and the need for collective financing.
Not Insured On 1 May, 2006, some 241 thousand people in the Netherlands were not insured for the costs of medical care. This is 1.5% of the Dutch population.
The percentage of uninsured among benefit claimants was relatively low, according to figures form Statistics Netherlands. On 1 May, 2006, 0.7% of benefit claimants did not have medical insurance. This is less than half the average for the total population. The percentage among people on income support was also lower than average for the total population, namely 1%.
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The insured pay a nominal premium to the health insurer. Everyone with the same policy will pay the same insurance premium. The Health Insurance Act also provides for an income-related contribution to be paid by the insured. Employers contribute by making a compulsory payment towards the income-related insurance contribution of their employees.
The no-claim rebate rule was introduced on 1 January, 2006. An evaluation held in 2006 revealed that the public was now more aware of the actual costs of healthcare services. For example, many people now opted for less expensive prescription drugs and medical aids. Accordingly, the Government decided that the rule would remain in place and would not be replaced by a mandatory ‘own risk’ (excess) payment.
Many families with children were also not insured for medical costs. Around fourty thousand children did not have medical insurance. This is surprising, as no premium has to be paid for underage children. These uninsured children are members of families in which the parents are not insured for medical costs. Nearly 60% of uninsured children have a native Dutch background.
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Private and Social The new system is a private health insurance with social conditions. The system is operated by private health insurance companies; the insurers are obliged to accept every resident in their area of activity. A system of risk equalisation enables the acceptance obligation and prevents direct or indirect risk selection.
The costs of GP consultations and maternity care (prenatal and neonatal) are disregarded when calculating the rebate entitlement. The no-claim rebate rule applies only to the standard insurance cover, and not to any supplementary policies. Moreover, the rule does not apply to persons under the age of 18 (since they do not pay premiums).
Dutch people. Moreover, the percentage of uninsured among first generation immigrants was four times as high as that among the second generation.
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Before 2006, there were two types of health insurances: compulsorily and voluntarily. Employees, people entitled to a social benefit, and self-employed people with incomes to a certain level were compulsorily insured under the Social Health Insurance Act (Ziekenfondswet). People on a higher income could choose to either take out a private health insurance or to go through life uninsured.
health insurance premiums is now entitled to a rebate of up to E 255 ($ 344) if no claim is made during the preceding year. The scheme is known as the ‘no-claim rebate rule’. Those who do incur health costs, but less than E 255, will receive a reduced rebate equal to the difference between the actual costs and the maximum rebate amount. Those whose healthcare costs exceed E 255 will receive nothing. At the end of 2006, almost four million Dutch policyholders received a full or partial rebate.
People with a foreign background were relatively more likely not to be insured than native Dutch people. More than 4% of people in the Netherlands with a foreign background did not have medial insurance, compared with less than 1% of native 13
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Allow More African People to Study in the West
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It has often been suggested that the brain drain from developing countries may be stemmed by admitting as few students from those countries as possible. I say this idea is wrong.
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This summer Idriss finished his first year in architecture at the University of Ouagadougou. He sent an email to me. Luckily there had been no strikes this year. But Idriss, who used to be my neighbour, had not been admitted to one of the exclusive working groups doing projects with European partners - the only way, he says, to really learn something. Without special connections he is unlikely to get into one of these groups next year. That is why Idriss wants to study in Europe and he asked me about the possibilities. I really want to help him. However, it is often said that chances are that his talent will be lost to his country, because he may not return there. Against this backdrop of the brain drain from developing countries, recruiting students from those countries, even offering study grants to them, is a highly sensitive topic. It is often suggested that the brain drain can be stemmed by allowing as few students as possible from developing countries to go to Europe. That is a very misguided assumption and there are three reasons why this is so. Paternalism Firstly, the brain drain is not caused by study grants or places. People wanting to leave Africa for an extended period have different reasons. They want to get away from excessive corruption and demands from relatives, from lack of democracy, a proper education for their children, opportunities to develop as a researcher. Many studies have shown that highly educated Africans who go to Europe or the USA do so because they are attracted by intellectually satisfying jobs and better salaries. Study grants are not a decisive factor.
Secondly, it seems awfully paternalistic for us in Europe to tell a student like Idriss what his duty is towards his country. In a discussion on this topic at the recent EAIE (European Association for International Education) conference, an American woman with a Ukrainian background said: “What I hear here to me seems very much like the communist repression from which I have fled. People seeking better lives, will not be stopped.” She said this in reply to an African participant who proposed to tackle the brain drain by limiting the mobility of highly educated Africans, for instance by refusing to give them exit visa. Minimum Thirdly - and this is the most pressing reason - the marginalisation of Africa must not be allowed to continue while the rest of the world is becoming more and more interconnected. Quite the opposite, Africa should increasingly take part in the worldwide exchange of knowledge and highly educated people. Less than one per cent of residence permits issued for study and research in the Netherlands are issued to people from Africa. This means that in a globalising world Africans are making only a very small contribution to the production of knowledge, are unable to engage in many relationships that would enable them to join in the discussions in international organisations and are only minimally involved in international technological developments. All of this does not mean that the brain drain should be dismissed as a minor problem or that nothing can be done about it. Countries who are suffering the consequences of the brain drain are faced with a shrinking middle class, reduced economic growth, political instability and erosion of public services. The UN Economic Commission for Africa has calculated that every professional leaving Africa will cost
the continent $ 184,000 and that as a result Africa is missing out on $ 500 million on a yearly basis. It must be said, however, that on the other hand migrants from poor countries are sending back home tens of billions of dollars every year (remittances) - according to the World Bank this is one and a half times the amount that rich countries spend on government development assistance.
Since the 1970’s international efforts have been aimed at finding the best policy to reduce the brain drain or compensating poor countries for the damage it causes by donating funds which governments are expected to spend on improvement of education. This alleviated our feelings of guilt, but did nothing to reduce the brain drain. Indeed it failed to combat the causes that incited individual migrants to leave Africa. Today policymakers are paying more attention to the choices made by individual migrants and to efforts to encourage highly educated people in the ‘diaspora’ to return to their country. Organisations like the United Nations, NEPAD (New Partnership for African Development) and the African Union are convinced that the brain drain can only be staunched through economic recovery, better government, and better education in the countries concerned. For examples they look to the successes of Taiwan, India, Pakistan and other Asian countries, which are enticing their highly
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educated people to return by investing in science parks that offer excellent work opportunities, modern housing, tax advantages and salaries that are similar to those in the West.
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Dorrit van Dalen | Former Secretary for Policy and Strategy with Nuffic (Netherlands Organisation for International Co-operation in Higher Education), Journalist specialised in education - science - Africa, the Netherlands Email: dvdalen@wxs.nl
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This article is based on a speech to the EAIE conference in Krakow in September 2005. The article has been published before in Dutch in Transfer in November 2005.
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It is up to us to give African students better access to our education programmes while at the same time linking study grants as much as possible to existing or new programmes aimed at strengthening higher education capacity in their country of origin. One way of doing this are sandwich study programmes. Another way is to link study grants to research projects in which African and European institutions
These are all worthwhile initiatives stimulating brain circulation. Allow Idriss to study abroad, and prevent him from feeling isolated when he decides to return to Ouagadougou.
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Joint Projects African governments are not in a position to make such investments. They are doing two other things however. They are tightening their relationships with their countrymen abroad to make it easier for them to return (temporarily) (Ghana and Eritrea for instance are offering double nationality and the right to vote, Nigeria has a special advisor for the diaspora and Senegal and Mali even have appointed a Minister for this purpose). Through the African Union, the Commission for Africa and the Association of African Universities they seek support from rich countries to strengthen their higher education and research, for instance by setting up joint projects and by facilitating access to information. This call for help is first of all directed at us: universities, institutions for higher education and funds with connections in Africa.
It is up to us to give African students better access to our education programmes while at the same time linking study grants as much as possible to existing or new programmes aimed at strengthening higher education capacity in their country of origin.
collaborate, or a learning model called a ‘tutoring chain’. This model offers students from developing countries who are studying in Germany the opportunity to attend seminars and summer courses preparing them for work in their own country. Courses and traineeships are organised by German universities and employers, including hospitals. After new doctors have returned to their country the German institutions stay in touch with them and with the institutions where they are working. This means that the institutions can be assured that their German partners will remain involved and help with problems relating to management, education, ICT et cetera, which makes these institutions more attractive as employers to graduates from their own country.
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IMPROVING HEALTH WOMEN’S HEALTH
De Madres a Madres
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The De Madres a Madres (‘Mothers to Mothers’) programme was begun in 1990 to empower indigenous women through unity, the validation of women as key health promoters, and an acceptance of a community’s ability to identify and redress its own health needs. It began in the Houston (the 4th largest city in the USA) North Side Community. This community has a population of 20,000; 95% is Hispanic, most of whom are foreign-born and do not speak English. Community Empowerment When the programme began, most women did not receive early prenatal care and infant mortality was high. Using Pablo Freire’s methods of community empowerment, the objective of the programme was to empower volunteer mothers with knowledge to increase access to healthcare. Community empowerment began with enhancement of individual women’s selfesteem and power, followed by the collective enhancement of community selfesteem, power, and economy. Strategies for community empowerment and coalition building, beginning with grass-roots education and decision-making, occurred in gatherings at faith communities, civic associations, and local school gatherings. The mothers formed community coalitions with churches, local businesses, schools, elected officials, and the media to get the word out about healthy pregnancies for healthy infants. They worked with local businesses to schedule health fairs, volunteered at the local clinic to befriend women, and actively spoke about the needs for pregnant women to their faith community; they were offered training in leadership development, including how to work with elected officials. Growth Community health measures of infant mortality and maternal health improved 16
dramatically over the course of the programme, as well as the accessibility of social and community health programmes. In five years, five volunteer mothers and one nursing faculty member grew to a community-owned and managed programme with 40 volunteer mothers, a staff of six community residents, and an annual budget of $200,000 that serves over 10,000 persons each year. The programme purchased a house in the community from which it offers its services including a food pantry, clothing, job counselling, guided referrals to community services, and support groups for abused women and troubled youth. Additionally the mothers address issues of low levels of immunisations and lead in the homes with door-todoor campaigns of community awareness and empowerment to action by knowledge of the whole community. The mothers formed a board of directors comprised of 50% volunteer mothers and 50% community leaders. Articles of incorporation were written by the mothers along with a mission statement, yearly goals, and a plan for future community needs. More Information The empowerment of indigenous women is central to community action for health for all. The following articles give more information about the De Madres a Madres programme: MCFARLANE, J. (1996). De Madres a Madres: An access model for primary care. American Journal of Public Health, 86(6):879-880. MCFARLANE, J. & FEHIR, J. (1994). De Madres a Madres: A community, primary health care program based on empowerment. Health Education Quarterly, 21(3):381-394. MCFARLANE, J., KELLY, E., RODRIGUEZ, R. & FEHIR, J. (1994). De Madres a
Madres: Women building community coalitions for health. Health Care for Women International, 15(4):465-476. RODRIGUEZ, R., MCFARLANE, J., MAHON, J. & FEHIR, J. (1994). De Madres a Madres: Programa comunitario para un mayor acceso a la atencion prenatal. Boletin de la Oficina sanitaria Panamericana, 116(1):82-87. Judith McFarlane | Nurse faculty, Department of Nursing, Texas Woman’s University, United States of America Email: jmcfarlanetwu@yahoo.com
The mothers formed community coalitions with churches, local businesses, schools, elected officials, and the media to get the word out about healthy pregnancies for healthy infants.
Figure 1: The ECA road map towards mutual recognition
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Mutual Recognition of Accreditation Decisions
Mutual Recognition of assessment results
2006 | A greement: no substantial differences 2006 | A ccreditation of joint programmes 2007 | E xternal evaluation of ECA members 2007 | Bilateral projects within ECA
Mutual Recognition of accreditation decisions
2005 | Joint declaration ECA - ENIC/NARICs 2007 | London 2007: progress report 2007 | Information Tool for Accreditation Decisions 2007 | F ormal agreements on mutual recognition
ments (e.g. Lisbon Recognition Convention) to facilitate recognition of foreign qualifications by providing transparent and reliable information on the quality of higher education institutions and programmes.
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The ECA approach and road map towards mutual recognition have delivered clear results and have brought mutual recognition agreements within reach. This approach could therefore be useful for other accreditation and quality assurance organisations in Bologna countries (and beyond).
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European and international stakeholders and networks have been involved in the work of ECA towards mutual recognition. Because of the potential benefits to European and global student mobility it is important to intensify this co-operation within and outside of Europe.
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Mutual Recognition These activities have helped to increase mutual understanding of the various accreditation systems and resulted in mutual trust between the involved accreditation organisations. The combination of formal agreements and principles with practical co-operation projects and mutual observations has been particularly useful. The ECA approach towards mutual recognition supplements existing initiatives and instru-
2004 | Code of good practice 2005 | P rinciples: selection of experts 2006 | E quivalent accreditation frameworks 2006 | Common publication format
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The ECA approach of mutual recognition is based on an intensive process of trustbuilding through information exchange, commonly agreed tools and instruments, external evaluations of members and co-operation projects aimed at mutual recognition. The recognition authorities (European Network of Information Centres/
Road Map ECA has established a road map towards mutual recognition (see Figure 1). The major milestones include the Code of Good Practice in which ECA members commit themselves to implementing 17 standards for accreditation organisations. The compliance with these standards will be tested by independent external reviews. Another milestone is the Principles for the Selection of Experts which sets out the expertise of assessment panels and fair procedures for the selection of these experts. Moreover, in six countries a Joint Declaration has been reached between ECA members and ENIC/ NARICs on the ‘automatic’ recognition of qualifications following the mutual recognition of accreditation decisions. Recently, ECA members have agreed that members’ accreditation tools and instruments are compatible and free of substantial differences. It is expected that the first mutual recognition agreements between ECA members will be signed in December 2007.
Mutual Recognition of accreditation procedures
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Trust-building Against this background, 15 national accreditation organisations from 10 European countries (Austria, Flanders, France, Germany, Ireland, the Netherlands, Norway, Poland, Spain, and Switzerland) work together in the European Consortium for Accreditation in higher education (ECA). The aim of ECA is to achieve mutual recognition of accreditation decisions among members.
National Academic Recognition Information Centres) of ECA member countries have been involved in the project in order to strengthen the link between accreditation decisions and recognition of qualifications. Both accreditation organisations and ENIC/NARICs are moving towards a situation in which differences are accepted because there is trust in each others’ (accreditation and recognition) decisions.
2004 | Surveys of accreditation systems 2005 | A ccreditation profiles 2006 | Mutual co-operations/ observations
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Comparability of the quality of study programmes is a prerequisite for the implementation of the common European Higher Education Area and for the mobility of students and staff. Mutual recognition of accreditation decisions can substantially reduce existing barriers in the recognition of qualifications and thereby enhance academic and professional mobility in Europe. Agreements between accreditation agencies should lead to the trust needed by national recognition authorities and higher education institutions to recognise qualifications from study programmes or institutions that have been accredited by an acknowledged accreditation organisation. Moreover, mutual recognition of accreditation decisions would prevent the need for joint programmes and joint degrees to be accredited in each of the participating countries. If an accreditation decision in one country would also be recognised in another country, it would be much easier for institutions and students to participate in these cross-border programmes which by definition increase mobility.
Mutual understanding of accreditation organisations
Mark Frederiks | International Department, Dutch Flemish Accreditation Organisation, the Netherlands Email: m.frederiks@nvao.net 17
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Logbook: Effective Field Training and Assessment Tool
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Field training is one of the main activities of Community-based Education (CBE) in the Faculty of Medicine, Suez Canal University (FOM/SCU). Since its establishment in 1978, students get in contact with a variety of factors that might affect health and healthcare services. Students are exposed to certain age categories in schools, workplaces, and geriatric homes. They also experience various types and levels of healthcare settings, including specialised hospitals, national health insurance, primary healthcare, vocational and rehabilitation centres. Moreover, field training involves exposure to other healthrelated services, such as water purification and waste and sewage disposal plants. Students’ activities include case studies, family visits, reports, and mini-projects. Field training is facilitated and supervised by field tutors from Faculty staff as well as tutors from field settings, under supervision of field coordinators. Assessment One of the main challenges of field training is monitoring and evaluating students’ progress. For years, assessment depended mainly on monitoring students’ attendance, reviewing reports, and field exams, which proved to be insufficient. Recently the logbook method was introduced to enable students to regularly record their field training experience. It is used in medical education to enable educators to have a broad vision for every single student’s activity along the past educational period, and not only to judge him/her for a single case for the exam. It serves a dual purpose. For the student, it is a kind of learning resource, where activities and related learning objectives and outcomes are recorded, and can be retrieved when needed. For faculty, it is used to monitor every student’s activity to ensure its appropriateness to the level of required training, and to re-plan future training activities.
Students using a logbook in a primary healthcare centre Implementation The logbook was introduced five years ago in years 2 and 3 (phase II), and three years ago in year 4. At the start of each year, field tutors attend orientation sessions explaining philosophy, concepts, objectives, and procedures of the field training, in addition to the use and importance of the logbook. For each educational block in phase II, the logbook should contain: ten shortcases written by the Subjective, Objective, Assessment, Plan method; one case study; task reports; family visit reports, including family assessment, screening and health promotion activities; and reports about health education seminars done by the group. In year 4, students and tutors were provided with a guide sheet for each field setting, which clarified the related learning objectives and activities. This sheet also monitors the activities achieved, and also those not met, and the reasons for lack of achievement. Students are advised to fill in the logbook on a daily basis, to avoid retrospective recording and associated recall problems. They would thereafter add any additional information acquired from various learning resources, such as library, subject matter experts, lab, Internet, et cetera. At the end of the training period, the logbook is used for student assessment. An
evaluation checklist is used for this purpose. The examiner reviews the monitor sheets in the logbook to assess the achieved and unachieved objectives. Then, three case studies, reports or records are randomly selected from the logbook for discussion with the student. This discussion centres mainly on the selected field activities and related scientific background, using a problem-solving approach. For example, this might involve a discussion of the growth chart of an infant, a morbidity record of a healthcare unit, et cetera.
The logbook serves a dual purpose. For the student, it is a kind of learning resource. For faculty, it is used to monitor every student’s activity. Challenges and Constraints The application of the logbook was not without challenges. First, students thought they would be totally accountable for unachieved activities and objectives. Therefore, they tended to check all activities as achieved, and this was unfortunately accepted by some tutors. However,
Letter to the Editor real accomplishments and unmet goals were discovered at the time of assessment. Therefore, both tutors and students were informed that certain activities might have not been achieved by the group(s) because of logistic problems, or even because they are not achievable or attainable in the designated setting. Hence, accurate recording is essential to enable planners to change or omit such activities.
J-J.Guilbert | Honorary Member of The Network: TUFH Email: guilbertjj@yahoo.fr
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Long term observation of the medical education scene shows that ‘evaluation/assessment’ is the weakest link in the educational spiral. This short article mentions several times the concern that accreditation should verify “quality/excellence”. I hope that those involved in the Central Asia Republics project will indicate explicitly what those two politically correct words imply in real professional life. No advance information is given in the article. The expression ‘community-oriented’ (so warm to the heart of long-term readers of this Newsletter) is not even mentioned as one of the expected “qualities” that would be included in some manner in the accreditation process. Apart from the World Federation for Medical Education, the eight American supporting agencies
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My 45-year experience (including 21 years in WHO in charge of ‘planning and evaluation’ - education and training of health personnel - with very meagre results) has resulted in a healthy humility.
For a better promotion of health of the population of those four Asian countries, this project deserves success. Let us hope for a longer article in Education for Health that will bring the good news to its community-oriented readers.
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I agree with the national rectors who “believe that quality improvement can be driven by an accreditation process”. It is indeed a “belief”. Documented evidence of “quality improvement” as a result is quite rare in the literature. Let us hope that it can help. Will it help? If past history is an indicator it is bad news.
The article adds that this accreditation project could help “assure that students acquire certain competencies”. It will be very revealing to see the development of this ‘rationale’. We shall have an idea of the expected “quality of the education offered” once the word “certain” is replaced by a list of (observable and measurable professional) competencies. The National Board of Medical Examiners, one of the American supporting agencies, has, since the early sixties and thanks to John P. Hubbard and his team, a very good track record in “developing standardised graduation examinations”.
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Somaya Hosny and Adel Mishriky | Vice Dean for Education, Director of CRD; Professor of Community Medicine, Director of Students Projects | Faculty of Medicine, Suez Canal University, Egypt Email: crdmed@ismailia.ie-eg.com
This interesting article summarises a significant and complex project. Apart from the heavy political background (collaboration of eight American agencies with leaders from four Central Asian ex-Soviet territories) the educational component by itself merits close attention.
are not renowned as specially active in the area of community-oriented education.
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Another problem was the students’ wrong belief that the logbook would be evaluated according to the amount of scientific content. Therefore, they tended to include in it related and unrelated subjects. When the true purposes of the logbook were clarified to them, this trend declined. The future plan is to prepare a list of the unachieved objectives and activities to review the reasons and take subsequent appropriate action for next year.
Regarding the article Accreditation of Medical Education in Central Asia (vol. 25, no. 2, December 2006):
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INTERNATIONAL HEALTH PROFESSIONS EDUCATION 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 two of such yellow papers.
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Field Visits: A Tool for Public Health Education
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The Institute of Community and Public Health (ICPH) at Birzeit University is based in the occupied Palestinian territory. Since 1995, it has been managing two post- graduate teaching programmes: the Diploma in Primary Healthcare and the Masters in Public Health. Students are selected every year to join the diploma programme in primary healthcare, after which successful candidates apply the following year to finish the masters programme in Public Health. A field visit to a student’s work environment The students are mainly health professionals currently working in health and healthrelated fields. In general, they tend to enrol as part of a mid-career human resource development scheme. This article describes the integration of the ICPH teaching programmes and the health practices of the students, which has been observed and documented through systemic visits to their work place. Enable, Provide and Equip The specific objectives of the teaching programmes are to: • enable students to approach healthrelated problems with an appreciation of the broad determinants of health, including the social, political, economical and environmental determinants in addition to the biomedical ones; • provide students with a foundation of basic concepts necessary for rational, efficient, effective, and ethical practice of public health that is relevant to the needs of the Palestinian society; • equip students with the analytical and technical skills necessary for identification of health-related problems, design of appropriate interventions, and
monitoring and evaluation of practices; • enable students to approach health services with the idea of inter-sectoral co-operation as an essential component of ‘system-building’. These goals are achieved through a multidisciplinary approach to health, covering a range of topics that may change over time: primary healthcare, social epidemiology, statistics, classical and advanced epidemiology, medical and nursing skills, communication level 1 & 2, research methods, environment, management, community assessment, seminars and special lectures. In addition, students are trained to use computer, Internet and statistical tools for analysis. Assess, Identify and Evaluate The specific objectives of the field visits are to: • assess the student’s work environment; • identify skills needed by students at their workplace; • identify challenges and obstacles that hinder the students’ performance at work, and; • evaluate the teaching programme.
Field visits to the students are arranged and carried out by the academic staff. Each student is visited at his/her work place at the beginning of the first year, then again at the end of the second year. The questionnaire at each visit has been continuously modified to incorporate changes in the political environment, such as the Israeli re-occupation of the West Bank (2000-2002), travel restrictions (20002007), and lack of salaries (2006-2007). Routine questions include: structure of the organisation, scope of work, job description, in-service training and continuing education, and challenges faced in the workplace. The second visit is for more specific questions that address the curriculum at ICPH, and what has been the most or least useful and suggested change. Results From 1996-2002 there were 119 graduates. Almost half (45%) worked in Governmental institutions, 35% in Non-Governmental Organisations, 12% in United Nations and Relief Work Agency, and 8% in the private sector.
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Chiroj Soorapanth | Department of Orthopaedic Surgery, Bangkok Metropolitan Administration Medical College and Vajira Hospital, Thailand Email: csoorapanth@vajira.ac.th
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In summary, this research reports preliminary results of a Thai self-assessment tool. Students could improve their attitudes and confidence on target behaviours of healthcare professionals. Further research is needed to fully validate the instrument and findings.
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A questionnaire of palliative care was constructed based upon the WHO definition and upon professional competencies issued by the Medical Council of Thailand. This questionnaire was administered to a group of sixth-year students for pilot study. The results lead to a revision of the questionnaire. Then it was given to all sixth-year students. The validity, reliability, and item and factor analysis of the questionnaire were considered.
in multidisciplinary and multiprofessional approaches, euthanasia, and confidence in patient evaluation. Twenty-seven of 30 students (90% response rate) participated in the study. Most students had favourable attitudes and adequate confidence in providing palliative care except in the introduction of palliative care in early stages of diseases; psychological support to patients and their families; and breaking bad news.
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Samia Halileh | Institute of Community & Public Health, Birzeit University, Occupied Palestinian Territory Email: samia@birzeit.edu
There was inadequate evidence supporting their competencies and there was no assessment tool for palliative care among Thai medical students. Developing, assessing and evaluating palliative care teaching is a necessary component of the undergraduate education of doctors. The aims of my study were: • to develop a self-assessment tool to measure attitudes about, and confidence in, providing palliative care among sixthyear medical students, and; • to evaluate student self-assessment in one Thai medical school.
Dr. Chiroj Soorapanth
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References http://icph.birzeit.edu/
For most students palliative care issues are hidden topics during their six-year undergraduate medical curriculum. They usually study these topics in lectures or small-group learning in preclinical years and observe appropriate professional behaviour from their tutors and residents in clinical rotations.
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Acknowledgement I acknowledge all those who made a contribution in the field visits and to those whose dedication have made the teaching programmes successful, especially Rita Giacaman, the founder of the ICPH.
Teaching palliative care to medical students is undoubtedly necessary so that they can achieve educational outcomes and become a ‘five-star doctor’, as defined by the World Health Organization (WHO).
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Examples of changes made to the teaching programmes based on the field visits (1996-2002): • It was noted through the field visits that the issue of hierarchy was prominent in the workplace - especially between doctors and nurses - and can hinder the development of nurses. This issue was addressed in several courses, particularly the Communication Skills class. Gradually, a real difference in the relation between doctors and nurses was noted, both in and out of class, as their respect and appreciation for one another improved. • Small projects were included in most of the course curriculums to help the students incorporate what they have learned in the classroom in more realistic fashion, and to help them look at their work in a more analytical manner, all under the supervision of an academic supervisor. • Management was identified as a real problem - particularly for doctors - and as a result a Management course was introduced to the programmes. • Documentation was problematic in most sectors, so it became a major issue to be addressed in the Community Assessment course, then became part of the Management course when it was introduced.
Attitudes and Confidence in Providing Palliative Care
The results showed acceptable face and content validity. Cronbach’s alpha is 0.85 with high corrected item-total correlation. Factor analysis revealed four themes: confidence in treatment, attitude 21
INTERNATIONAL HEALTH PROFESSIONS EDUCATION LEADERSHIP COLUMN Within The Network: TUFH there is an increased attention for the role of leaders in innovation of education and health services. 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.
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Participatory Leadership is the Best Leadership Ten years ago Rwanda health professions education was restricted to medical school. Other health professionals were not being trained at post-secondary educational level (nurses were trained at secondary school) or not trained at all (e.g. anaesthetists and physiotherapists; the nine physiotherapists working in the country at that time had all been trained abroad). Having just come out of a period of great turmoil - in particular a time of genocide - there was a growing need for all these health professionals to accommodate the large number of traumatised patients. As part of the solution Kigali Health Institute was established; in ten years this institute went from three departments (Nursing, Physiotherapy, and Anaesthesia) to 11 departments. In January 2006 the departments were placed under three Faculties: Nursing, Allied Health Sciences, and Community Health Development. Dr. Dariya Mukamusoni - originally a physiotherapist trained in Congo - witnessed the beginning of the Kigali Health Institute as a teacher at the Department of Physiotherapy. “I knew nothing about education; I started working on the basis of my 15 years of work experience, but after a while I came to the conclusion that teaching is an art, something that you have to learn”. So she went back to school and got her Masters degrees in medical education in Scotland, and her PhD in health sciences in South Africa. Eventually she became the Head of the Department of Physiotherapy, and at present she is the Dean of the Faculty of Allied Health Sciences. In 2006 the institute commenced a curriculum change. “We have been reviewing our curriculum. When we started the institute, our mission was to train people at a threeyear post-secondary school. Now we are 22
moving from the diploma level to the degree level. And as we are developing the curriculum, we are also shifting from a contentbased curriculum to a case-based and community-based curriculum, introducing innovative teaching. With the support from a few people from outside, we have been running many workshops on teaching, trying to introduce a new way of teaching. Most of the time, we have to call experts from outside to come and help. It is always very helpful to examine how other institutions in the world have handled this, and who of them can come in and help, for example, to sell IT or help develop a programme. I think as a leader in education, one should always build partnerships with other institutions. But the first thing to do is define your vision. One should always think “What can we improve in our institution, what do we want exactly?”. Usually, we have the ideas, but not the funds. You have to know how to link these good ideas with fundraising, know where to go for funds and write a fundable project. That is not easy in education, because this is a very competitive business. Fortunately, I know how to do it!
Dr. Dariya Mukamusoni sider them. This is the way to treat academics who are not used to following rules, and who are so swamped with work that they are not very susceptible to new ideas that could mean even more work. If you want to be successful, you have to cooperate with them, so that they buy what you want to introduce, instead of resisting change. If the stakeholders do not accept your views before you start, you are failing even before you have begun.
Having defined your vision, you need to ask yourself “Is it me who wants this, or does everybody want this?”. Always take into account the need of the health and educational systems. As much as yóu might want it, it must fit into the context that you are working in.
I believe that in education we have many intellectual people who have good ideas and who can contribute much. Participatory leadership is the best leadership, especially in an academic environment. The leader must be cooperative as much as he can, but there are also times when he has to put his foot down. Taking a stand, or being flexible; what action to take, depends of the situation, and you have to be sensitive to that. That is what I strive to do”.
Finally you must sell your vision to the stakeholders. Convince them, so that you do not have to walk alone. Involve them, for example in developing a new curriculum. And listen to their concerns; you may not be able to meet all the concerns, but you should con-
This article was based on an interview that Marion Stijnen held with Dariya Mukamusoni (Dean, Faculty of Allied Health Sciences, Kigali Health Institute | dariyakega@yahoo. co.uk) at the Network: TUFH Conference in Ghent, Belgium.
NEW INSTITUTIONS AND PROGRAMMES
UDS Medical School: A Short Story
Introductory PBL workshop in Bolgatanga
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As part of the school’s strategic plan on capacity development, two staff members are currently pursuing a master’s degree programme in Health Professions Education at Maastricht University. Also, four members of staff went on a study tour to Walter Sisulu University in South Africa and the Catholic University of Mozambique, Beira where PBL is being practiced. They had the opportunity to see first hand what a skills laboratory, library, tutorial rooms and even tutorial sessions look like in a PBL setting. At present, a new and modern medical school campus is under construction in Tamale, with an ICT centre, a spacious library and enough spaces for skills laboratory, tutorial rooms, lecture halls and offices for staff.
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For the 1st trimester the students studied in both the traditional method and in PBL approach. Although majority of the staff appreciated the merits and de-merits of the PBL approach, they felt they and the school were not ready to start using the methodology. Students’ assessment became a big question as the students were taught in both methods. In 2001, a PBL/COBES workshop was organised for the staff and students of the school. After having listened to the merits of PBL, students and staff were more satisfied and open to the change. After the workshop, the World Health Organization (WHO) appointed an expert from the then University of Transkei (now Walter Sisulu University) to assist the School develop a PBL/COBES curriculum. The lack of expertise by SMHS to implement this programme prompted the Dutch Government to choose the SMHS as a beneficiary in one of its projects in Ghana.
The project document outlined a series of workshops on curriculum construction, planned to be held in 2006 and 2007. The first workshop was organised in September 2006 in Bolgatanga, north of Tamale; it was an introduction workshop in PBL not only for the staff of SMHS but also for others with political clout.
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The University for Development Studies (UDS) was established in May 1992 as a multi-campus university. In 1996 the School of Medicine and Health Sciences (SMHS) was established to address the health needs and the inadequacy of health professionals in Ghana. The school adopted the Problem-based Learning (PBL) and Community-oriented/Community-based and Extension Services (COBES) methodology to train healthcare professionals.
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Having defined your vision, you need to ask yourself “Is it me who wants this, or does everybody want this?”. Always take into account the need of the health and educational systems. As much as yóu might want it, it must fit into the context that you are working in.
Anthony Amalba and Rowland Otchwemah | Lecturer; Dean | School of Medicine and Health Sciences, University for Development Studies, Ghana Email: aamalba@yahoo.com 23
INTERNATIONAL HEALTH PROFESSIONS EDUCATION MEDICAL EDUCATION
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Longitudinal Integrated Learning: An Approach to Teaching the Population Perspective? A ‘population perspective’ is central to the work of The Network: TUFH to improve the health of the public. As much an attitude as a set of skills and body of knowledge, the population perspective has been programmed into many of the curricular innovations The Network: TUFH has explored and promoted. We attend to non-biological determinants of health, social justice and human rights just as we teach genetics, immunology and neuroscience. These matters, perhaps only as abstractions, motivate some to seek careers as health professionals; others discover the perspective during the course of training. How are these attitudes best reinforced? How are the skills best taught? Problem-based Learning, Community-based Education and Interprofessional Education are a few such curricular models that lend themselves to such a broad clinical education. We put forth ‘longitudinal, integrated clinical learning’, exemplified by our HarvardCambridge Integrated Curriculum (HCIC), as a method to foster deep relationships between students and their patients. And, the population perspective grows naturally from these relationships. Patients at the Centre Our new curriculum changed radically the principal clinical year of medical education, perhaps to a greater extent than has been attempted in the USA since Flexner. Traditionally, this year involves a sequence of one to three month rotations, in seriatim. Students care for acutely ill patients during their brief hospital stays; they are taught primarily by post-graduate residents. In the Cambridge Integrated Clerkship, medical students learn from Harvard faculty mentors in ambulatory settings where they form meaningful, continuous relationships with 75 or more patients and their families over a full year’s time. They follow their patients 24
to any of the necessary loci of care; including diagnostic procedures, emergency and in-patient services, transitional care, nursing homes or their own homes. By placing patients at the centre of their longitudinal experience, students’ learn the challenges of preventing or living with chronic disease, as well as the full course of acute illnesses. They learn about the complexity and liabilities of our health system as they help them navigate the medical care and social service systems while advocating on their behalf. Societal Engagement and Idealism The students integrate seven medical disciplines in parallel: Gynaecology, Medicine, Neurology, Paediatrics, Psychiatry, Radiology, and Surgery. The students make use of advanced information technology, simulations, and teaching portfolios. Finally, the students prepare two weekly case-based seminars, drawing upon their clinical experiences to integrate biological and social sciences with medical practice within the context of a formal structured curriculum. In the social science-clinical practice seminar series, the students grapple with issues as varied as truth telling, end of life decision making, navigating professional boundaries issues, and accessing care in an inequitable health system. Continuities of patient care and faculty mentoring are the curriculum’s structural underpinnings. The students’ intense relationships with their patients invigorate two other continuities: societal engagement and idealism. Several examples are illustrative: after one student’s immigrant patient was denied an organ transplant, he conducted (and submitted for publication) an investigation that demonstrated that immigrants, compared with US born, were more likely to donate than receive organs. Another student explored the effectiveness of high school gay/straight alliances in normalising adolescent’s adjustment to their sexual
identity. Another student discovered that his patient had purchased an FDA outlawed antibiotic at a local bodega. The student sampled other corner stores throughout the city, discovered this to be a common practice, and alerted the press. Another student organised self-help groups for Portuguese speaking patients with diabetes. These students’ motivation grew from their engagement with their patients; the faculty network provided the intellectual support and skills building; the curriculum protected time for these engagements. Basic Premise In comparison with Harvard students taking traditional clerkships, these students consistently equalled or performed better on knowledge-based standardised examinations and skill-based OSCEs. The 16 students during the first two pilot years were significantly (p<.05) more likely to feel they were able: to establish meaningful relationships with patients, to be self-reflective practitioners, to involve patients in decision-making, to feel that they had made differences in their patients health and well being, to deal well with ethical dilemmas, to see how the social context affects patients, and to relate well to a diverse patient population. Our students have taught us a basic premise of medical education: professionalism emerges from deep emotional connections to patients. And out of a deep concern for the one emerges a concern for the many. Time will tell whether these students’ career paths will be illuminated by the population perspective and whether they will dedicate themselves to improving the health of the public. David Bor, David Hirsh, Barbara Ogur | Cambridge Health Alliance and Harvard Medical School, United States of America Email: david_bor@hms.harvard.edu
PROBLEM-BASED LEARNING AND COMMUNITY-BASED EDUCATION
Enhancing Community-Based Education in Vietnam
[ advertisement ]
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Nguyen Thanh Trung | Director Thai Nguyen Medical College, Vietnam Email: nguyenvantuyktn@yahoo.com
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Main Outcomes At the end of the project, TNMC had gained several results: • The CBE curriculum integrated in the available official curriculum at TNMC, including 18 subjects with 38 credits, of which there are 15.5 credits for practicing. That CBE curriculum has been applied in training first- to sixth-year students since 2002. • Criteria and guidance in building a training community were created. There are five necessary criterial groups of one training community and seven steps to develop becoming a training community. • Lecturers’ manuals were written, including 18 teaching plan books according to themes of the curriculum. • Students’ materials were developed, including 18 study books according to themes of the curriculum. • Training materials on community teaching method for health staff were written. The
materials explain the programme, teaching methods, and students’ evaluation at community. • Manuals were written as guidance for implementation of CBE, what is necessary to implement a CBE programme and CBE methods, also introducing the CBE pattern and steps to build the pattern. • Workshops about relevant issues related to public health (such as medical economics, health education, community diagnosis, and project assessment) were organised for TNMC’s lecturers and concurrent teachers in community. Also, workshops were organised in order to share experiences with colleagues of different (medical) colleges and training communities in Vietnam. • Students obtained knowledge, skills and good practice approaches when contacting community residents. They gained enough experience to meet the needs of primary healthcare for people.
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Objectives The overall objective was to build a CBE curriculum based on the six-year medical programme available at TNMC. Specifically, the project aimed: • to develop the curriculum and its material, and to implement the pilot medical training programme for the Northern mountainous provinces (based on the official training programme available at TNMC);
• to strengthen the capacity of CBE for lecturers at TNMC; and • to expand the criteria and guide the building of training communities for TNMC.
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Traditionally, the previous training programme for medical students at Thai Nguyen Medical College (TNMC), Vietnam, mainly concentrated at labs and hospitals. After finishing the course, the health workers were still lacking in work experience in the community, especially in primary healthcare. A medical collaboration programme between Switzerland and Vietnam supported TNMC to build a pilot project called CommunityBased Education Pattern (CBE), from October 1999 to June 2006. This approach in training medical students is new in Vietnam; it focuses on real needs of healthcare, and contributes to meeting the needs of health human resource development in Vietnam.
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The School of Health Professions Education (SHE) offers a variety of courses for all those involved in health professions education. The programme is developed and delivered by expert staff of Maastricht University, which is well-known for its problem-based learning (PBL) curriculum. There is a choice of one- or two-week courses, a two-year distance learning Master of Health Professions Education, and a PhD programme. Topics include PBL, assessment, tutor skills, e-learning, clinical teaching, curriculum design, educational research, ICT, clinical skills training.
Please visit our website at www.she.unimaas.nl 25
PARTNERSHIPS THE LIKE-MINDED WORKING TOGETHER
Natural Allies
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The Foundation for Advancement of International Medical Education and Research (FAIMER), whose goals and activities are described in the Foreword by FAIMER President John Norcini (page 3), is continually interested in meeting others around the world who share our goal of improving the health of communities, in discovering projects we can learn from, and in collaborating with organisations whose activities complement and extend our work. In The Network: TUFH we have found all of these and more.
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Smart Network FAIMER shares with The Network: TUFH a commitment to improving health professions education as a powerful long-term strategy for improving global health. The education route is not given priority right now among funders and others as a strategy to improve global health, because it takes time to effect changes. True, there are actions that need to be taken now. But it is also true that the future will be here before we know it and it is our current students who will make the difference in the future. One of the Network: TUFH’s most powerful models of accomplishment for FAIMER is reflected in its name. FAIMER gives high priority to continuously working to ensure that our fellows and staff operate as a ‘smart network’. The Network: TUFH has been working for years across boundaries of organisations, countries and cultures in ways that show how quickly learning and successes can be shared when motivated ‘network weavers’ communicate with each other. The Network: TUFH’s annual conferences are a key ingredient in sustaining the energy of the global network of those interested in community-based health professions education. FAIMER is excited to be participating in this year’s Conference in Kampala, Uganda by hold-
ing pre-meeting workshops for participants. Sarah Kiguli, 2004 FAIMER Fellow and faculty member in the Department of Paediatrics at Makerere University, has played a role in planning and organising the Conference. Education for Health Another area where FAIMER and The Network: TUFH have a common interest is in promoting and supporting scholarship focused on improving health professions education. The Network: TUFH’s journal Education for Health provides a much needed publishing venue where the data and insights of educators in developing regions can be communicated. In 2006, two papers describing research by a collaboration of FAIMER fellows were published: Research on Medical Migration for Sub-Saharan Medical Schools, Usefulness of a Feasibility Process to Define Barriers to Data Collection and Develop a Practical Study and Accreditation of Undergraduate Medical Training Programs: Practices in Nine Developing Countries as Compared with the United States. FAIMER is proud to be a supporting partner of Education for Health and that two of FAIMER’s staff members, William Burdick and Jack Boulet, serve on its editorial review board. Regional Institutes FAIMER began in 2001. We are still just beginning to learn how we can contribute what we do to address most appropriately and effectively specific local health and education needs in developing regions. One of our strategies is to develop regional institutes, which offer our fellowship programmes. We have started, to date, four regional institutes: three in India and one in Brazil. Three more are in development in Africa, with the expectation that the one in southern Africa will start in 2008 and those in eastern and western Africa in 2009. We hope that over time we will meet
members of The Network: TUFH in these regions and learn more about their local work and discover ways to enrich each other’s activities. We hope all members of The Network: TUFH will consider FAIMER a resource and ally in their work to improve health professions education. As a start we invite you to get to know us better by visiting our website at www.faimer.org Debby Diserens | Director of Development, Education specialist, FAIMER Email: ddiserens@faimer.org
One of the Network: TUFH’s most powerful models of accomplishment for FAIMER is reflected in its name.
INTERNATIONAL DIARY
Diary 2007 Annual International Conference of The Network: Towards Unity for Health 15 - 20 September, 2007, Kampala, Uganda International Conference on Human Resources for Health: Recruitment, Education and Retention. Organised by The Network: TUFH and Faculty of Medicine, Makerere University Post-Conference Excursion to Faculty of Medicine, Mbarara University of Science and Technology 21-23 September, 2007, Mbarara, Uganda
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9 - 12 December, 2007, Ismailia, Egypt 9th Workshop on Human Resource Development in Health Management and Leadership. Organised by Faculty of Medicine, Suez Canal University, Ismailia, Egypt. Further information: fax: 2-64-3209448; email: crdmed@ismailia.ie-eg.com; Internet: http://crdmed.tripod.com
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It is possible to add events to this International Diary from behind your computer. Information inserted in our website database (www.the-networktufh. org) will be automatically included in the International Diary of the Network: TUFH Newsletter.
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17 - 20 October, 2007, Paris, France WONCA Europe 2007 Conference - Rethinking Primary in the European Context: A New Challenge for General Practice. Organised by WONCA, the French National College of Teachers in General Practice and â&#x20AC;&#x2DC;Overcomeâ&#x20AC;&#x2122;. Further information: fax: 33-1-46410521; email: wonca2007@overcome.fr; Internet: www.woncaeurope2007.org
29 October - 9 November, 2007, Maastricht, the Netherlands International Focused Courses on Student Assessment, E-learning, Educational Research, Curriculum Design, Tutor Training, Methodology and Statistics, Skills Training, and (Post-Graduate) Clinical Training. Organised by School of Health Professions Education, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands. Further information: School of Health Professions Education, PO Box 616, 6200 MD Maastricht, the Netherlands; tel: 31-43-3881542; fax: 31-43-3885639; email: she@oifdg.unimaas.nl; Internet: www.she. unimaas.nl
29 - 30 November, 2007, Maastricht, the Netherlands Visitors Workshop: A Primer on the Maastricht Approach to Medical Education. Organised by School of Health Professions Education, Faculty of Medicine, Maastricht University, Maastricht, the Netherlands. Further information: School of Health Professions Education, PO Box 616, 6200 MD Maastricht, the Netherlands; tel: 31-43-3881542; fax: 31-43-3885639; email: she@oifdg.unimaas.nl; Internet: www.she.unimaas.nl
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19 - 21 September, 2007, Poole, UK 33rd Annual Conference of the Transcultural Nursing Society - Human Rights, Migration and Poverty: Their Impact on Transcultural Care. Organised by the Transcultural Nursing Society and the Institute of Health and Community Studies Bournemouth University, Poole, United Kingdom. Further information: Internet: www.bournemouth.ac.uk/ihcs/ tcns07.html
24 - 26 October, 2007, Minneapolis MN, USA International Conference - Collaborating Across Borders: An American-Canadian Dialogue on Interprofessional Health Education. Organised by Academic Health Center, University of Minnesota, Minneapolis, MN, United States of America and the Canadian Interprofessional Health Collaborative. Further information: email: learncom@umn.edu; Internet: www.ipe.umn.edu/
3 - 7 November, 2007, Washington DC, USA APHA annual meeting. Organised by American Public Health Association (APHA). Further information: Internet: www.apha.org/meetings/
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Further information: Network: TUFH Office, PO Box 616, 6200 MD Maastricht, the Netherlands; tel: 31-43-3885638; fax: 31-43-3885639; email: secretariat@network.unimaas.nl; Internet: www.the-networktufh.org/conference
18 - 20 October, 2007, London, UK International Conference: Women Deliver. Organised by Women Deliver Conference Office, London United Kingdom and Family Care International, New York, United States of America. Further information: email: info@womendeliver.org; Internet: www.womendeliver.org
2 - 7 November, 2007, Washington DC, USA AAMC annual meeting. Organised by Association of American Medical Colleges (AAMC). Further information: Internet: www.aamc.org/meetings 27
Member and organisational News Messages from the executive committee
General Meeting 2007 Uganda
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The Network: TUFH will organise its annual international Conference this September in Kampala, Uganda. In conjunction with the Uganda Conference, we will also organise our Biennial General Meeting (GM) for all Network: TUFH members and others interested in our organisation (September 16 and 20, 2007). At this GM Executive Committee (EC) Members will be elected.
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Since both Full and Associate Members have voting rights, the GM and election procedure is an outstanding opportunity for your institution to have a voice in who will become part of the Network: TUFH leadership and other important issues. We therefore encourage our Full and Associate Members to send a delegate or delegates to the GM and International Conference in Kampala, Uganda. Individual and Honorary Members are equally welcome but have no voting rights. Elections Executive Committee • Ian Cameron (Australia): reaches the end of his 1st term of four years. Ian Cameron has informed us that he will stand for re-election. • Harsono Mardiwiyoto (Indonesia): reaches the end of his 1st term of four years. Harsono Mardiwiyoto will not stand for re-election. • David Bor (USA) will end his 2nd and final term of four years. • In 2006 Deyanira González de León Aguire (Mexico) was appointed for one year as Network: TUFH EC Member (representative for Latin America) as replacement for Dr. Laura Feuerwerker, who stepped down. Deyanira González de León Aguire has informed us that she
would like to stand for election for the first official term of four years. • In 2006 Simeon Mining (Kenya) was appointed for one year as Network: TUFH EC Member (representative for Africa) as replacement for Dr. Nosa Orobaton, who stepped down. Simeon Mining has informed us that she would like to stand for election for the first official term of four years. • Jan De Maeseneer (Belgium) and Mohamed Moukhyer (Sudan) are midway their first term of four years.
profile form, indicating that (s)he is willing to stand for the position of Member of the EC. The candidate profile must be signed by the candidate and contain written support from two individuals representing Full or Associate Member institutions, or Individual or Honorary Members.
In Kampala, Uganda, the GM will be split into two sessions, one to be held on Sunday September 16, 2007 and the second on Thursday September 20, 2007. In the first session of the GM an explanation of the election procedure will be given. Thereafter, but only until Tuesday SepJan De Maeseneer is one of the candi- tember 18, 2007 at 1.30 p.m. nominadates for the position of Secretary tions of candidates may still be handed General. A postal ballot has been in. sent to the Network: TUFH Associate and Full Members. In case Jan De In brief, at the second session of the GM Maeseneer will be elected as Secre- the new EC members will be elected from tary General there will also be a va- all those candidates who have been nomcancy for the European seat. If this is inated for that position. This round should the case you will be informed in a yield the new EC members. Updated information about the GM will become separate letter. available at: As a member of The Network: TUFH it www.the-networktufh.org/conferences/ is your prerogative to nominate can- generalmeetings.asp didates for membership of the EC. There will certainly be five vacancies If you consider standing for one of the for EC members, including the Afri- vacancies in the EC specified above, it can, Latin American, North American, may be helpful to know that EC members South-East Asian and Western Pacific receive hotel expenses for the nights reseat. Candidates for election to mem- lated to the EC meetings in order to unbership of the EC must be - or repre- dertake their responsibilities. sent - a Network: TUFH member. Last but not least: in case you would be We encourage you to stand for elec- elected you are expected to attend the tion or to nominate candidates for first session of the new EC on Thursday these vacancies. On Tuesday Septem- September 20 (early evening) in Kampaber 18, 2007 at 1.30 p.m. the latest la, Uganda. nominations must have been submitted to the Network: TUFH Executive Director, Pauline Vluggen. A nomination contains a filled in candidate
TASKFORCES
Nominations for Tamas Fülöp Award At the occasion of the Network: TUFH’s 25th anniversary in 2004, the Executive Committee has called the Tamas Fülöp Award (TFA) into being. The TFA will be handed out once every two years at the General Meeting (GM) to a person, organisation, institution or group for outstanding contributions to The Network: TUFH. This year, at the GM in Uganda, the second TFA will be handed out.
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Weblogs are easy-to-use websites, where anyone easily can post thoughts and information, interact with others, and more. With these new weblogs we encourage Network: TUFH members and others to share news and interesting materials, or to post comments in reaction to what others have written. A weblog can also provide links to other, relevant web pages. With this helpful new way of interacting on the Internet you can reach and learn from many colleagues across the world.
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The Network: TUFH Office will post reports and messages on the Network: TUFH weblogs on regular basis. Please note that everyone is free to add comments in response to these postings without having to sign up first. In case you are interested in posting messages to the Network: TUFH weblogs, or if you have a question, please contact us at secretariat@network.unimaas.nl
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Nominations for the TFA should be accompanied by a letter of support (between 300-350 words) and must be received at the Network: TUFH Office in Maastricht, the Netherlands no later then July 15, 2007.
OUT OF THE SNO PEN: News • The new SNO brochure is now available at the SNO website (www.the-networktufh.org/about_us/ sno.asp). The brochure is designed to easily read on your computer screen but also to print out. Please use this brochure for your SNO PR activities. • In the Network: TUFH Newsletter there is a special section for contributions from students: Students’ Speakers Corner. Every SNO student is invited to write a short article (not more than 650 words) for this section (a photo to go with that article is most welcome as well).You can write about a subject of your own choice. If you are in need of a topic: write about your studying/internship experiences in another country.
A list plus website addresses of the Network: TUFH weblogs is available at: www.the-networktufh.org/publications_ resources/networkweblogs.asp?t=Interactive
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The TFA consist of a certificate, an economy ticket to travel to a future Network: TUFH Conference (to be used within three years from the year of award), space in the Newsletter and a world-wide announcement through the Network: TUFH digital Alert.
Honorary members are exempted from payment of membership fees and enjoy all common assets of membership. Honorary members have no voting rights.
Network: TUFH Weblogs During the past years new communication tools have been invented; one of those are the so-called weblogs or blogs. The Network: TUFH is always exploring innovative ways of communicating with its members and others interested throughout the world. Therefore, we have created a general Network: TUFH weblog, and for each taskforce a separate weblog. All weblogs are connected and give you a platform where you can discuss common tasks and exchange ideas and experiences. J U N E
The following criteria for eligibility of the nominee are: • At least for the last four years the nominee has participated in Network: TUFH activities by being a leader and by giving outstanding contributions. • The nominee has been relevant to the advancement of health in his/her/its community, country or region in any of the different areas that The Network: TUFH considers crucial (education, professional societies, health delivery, health policy, and community work). • The nominee should be an ethical human being, organisation, institution or group who/which has had lasting influence on the domain defined under item two.
Honorary Membership Candidates At the 2007 GM decisions shall be taken to award Honorary membership to individuals who have rendered exceptional service to The Network: TUFH. We would like to draw your attention to the procedure of proposing candidates for Honorary membership of The Network: TUFH. Any Network: TUFH member can suggest candidates for Honorary membership of The Network: TUFH by writing to the Network: TUFH Office in Maastricht, the Netherlands no later then July 15, 2007. With your proposal we would like to receive a letter (between 300 – 350 words) explaining your reasons to propose for Honorary Membership.
We wish you a lot of fun with the new Network: TUFH weblog!
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Member and organisational News REPRESENTED AT INTERNATIONAL MEETINGS/CONFERENCES The Network: TUFH is being represented at meetings and conferences all over the world. Here is a report of one of our representatives.
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A Call to Action: Ensuring Global Human Resources for Health
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Geneva Conference on Health Workforce Migration, Geneva, April 2007 This conference was sponsored by several important agencies, including the Health Research and Educational Trust, the Commonwealth Secretariat, Health Services Research, Academy Health, the Global Health Workforce Alliance, the International Council of Nurses, the International Hospital Federation, and the World Health Organization (WHO). It was a clear echo to the 2006 World Health Report on human resources for health which states that “a clear mandate has emerged for a global plan of bringing forth national leadership backed by global solidarity”. The health workforce is indeed in crisis: it is estimated that four million health workers are currently needed at global scale. The situation in the African continent is dramatic: the shortage of health personnel exists in 38 countries and is estimated to be 0.8 million (doctors, nurses and midwives). Training will be an overwhelming challenge: in the next 20 years, Africa needs to train 2.8 million health workers while the current training output is estimated to 10% of what is needed. Also, projections show that for industrialised countries to remain to their present state of care, an extra 8.5 million of health workers will be needed by the year 2025. That fact represents an increase by 20%, a situation that may worsen the migration trends from emerging countries to richer countries. The conference addressed the following themes: • the health worker: a national and global profile; • strategies to develop, sustain and retain effective health workforce: global and national perspectives; and • ethical hiring practices: a dialogue between nations and health worker professions.
Migration and strategies to overcome the depletion of health personnel from developing countries was a focus of the conference The ‘pull and push’ phenomenon was reviewed by several speakers, pointing out responsibilities of both countries of origin and receiving countries. Compensatory mechanisms should be considered by countries receiving migrants if migration had a negative impact on countries of origin. Also, countries of origin were urged to make the best use of their own workforce through proper human resources planning, training and employment. However, the overarching guiding principle in the conference was that health workers should be available in quantity and quality to meet priority health needs in a country. Migration does indeed exist from poor to rich countries, but also from rural to urban areas, from public to private sectors. As declared by the late Director General of WHO, Dr. Lee, the aim is “to ensure access to a motivated, skilled and supported health worker by every person, in every village, everywhere“. While the conference provided ample evidence of a need for an exceptional worldwide effort to mitigate the crisis, proposed possible solutions have been previously recommended, namely: joint planning of health services and human resources, strengthening information systems on HR, encouraging research on HR, scaling up the production and improving working conditions. Will this international call for action create a greater awareness and stimulate the emergence of innovative approaches to curve the problem? This is still to be seen. In any case, mobilising several international agencies concerned to ensure an adequate health workforce to meet people’s needs and building bridges among them for collaborative relationships is definitively a positive step.
The best word of wisdom was expressed by Dr. Francis Omaswa, the Head of the Global Health Workforce Alliance at the WHO Office in Geneva, indicating that greatest hopes lie in forging a unity of purpose and action among key stakeholders in the health system: policy making bodies, health service organisations, professional associations and educational institutions. This sounds very close to the mission of The Network: TUFH. It is worth noting that the next annual conference of The Network: TUFH (to be held in Kampala, Uganda, 15-20 September 2007) is on target with its general topic on Human Resources for Health: Recruitment, Education and Retention. More information on the Geneva conference - including presentations - can be obtained from the website: www.hret.org/hret/publications/ihwn.html Charles Boelen | International consultant in health systems and personnel; Former coordinator of the WHO programme of human resources for health Email: boelen.charles@wanadoo.fr
The Network: TUFH is being represented at meetings and conferences all over the world: • Geneva Conference on Health Workforce Migration, March 2007, Switzerland. Represented by Charles Boelen. • WHO General Meeting, May 2007, Switzerland. Represented by Perti Kekki. • Global Health Council’s 34th Annual International Conference on Global Health, May/June 2007, Washington DC, USA. Represented by Margaret Gadon. • WONCA Council Meeting, July 2007, Singapore. Represented by Ian Cameron.
RE-ASSESSING FULL MEMBERS Since 1998 Full Member Institutions (FM) are being re-assessed on a regular basis. As part of this re-assessment procedure FM perform a self-evaluation report. In this section you find a summary of a self-evaluation report of an FM that has recently been awarded continuation of its Full Membership.
Fostering the Health of Communities The University of New Mexico Health Sciences Centre (UNM HSC), Albuquerque, USA has structured its activities and programmes to be responsive to the health needs of the Stateâ&#x20AC;&#x2122;s populations. Initiatives in Education, Research, Service and Integrated Community Partnerships align closely with mission, goals and objectives of The Network: TUFH.
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Educational innovations respond to priority health problems: substance abuse, injuries, access issues, cancer, and homicide/suicide. All students complete community projects, and multidisciplinary student teams work together in rural settings.
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Over 25% of the curriculum is communitybased. Students learn in Problem-based Learning (PBL) tutorials and work in community settings from the first year; public health principles are integrated throughout all four years. Graduate programmes incorporate community training; more than 80% of the graduates from three community residencies practice in rural areas.
UNM HSC collaborates with public and private agencies and health systems to improve health status. Its hospital offers financial and management resources, its colleges offer innovative approaches to community-based education, as well as expertise in health policy development. Research initiatives address the priority needs of the state; many programmes are now based in community practice sites. UNM and a state-wide provider network address disease and access issues.
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The UNM HSC offers degree programmes in Medicine, Nursing, Pharmacy, Physician Assistant, Occupational Therapy, Public Health, Laboratory and Radiological Sciences, and the Dental Assistant Programme.
Additionally, the following special centres and programmes offer services and support to providers and populations: the Locum Tenens (Practice Relief) Programme; the state-wide Nurse Advice Line; the Centre for Native American Health; and the Institute for Public Health.
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Thus, educational innovations at UNM HSC have been driven by and remain responsive to the unique needs of the populations and communities in New Mexico. The educational programmes at UNM are increasingly becoming more interdisciplinary and more community-based, focusing on newer skills relevant to population health.
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Yet this state is rich in models of community organisation and self sufficiency. The cultural and ethnic mix of the state features enduring traditions of family support and community mindedness, traditions favouring effective, community-driven health efforts. Fostering the health of communities serves as a unifying mission of the UNM HSC, which sets the HSC apart from other health providers in the community. To achieve this mission, the HSC is increasingly focusing its education, research, and service efforts upon the identified health and service needs of communities in its state.
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New Mexico is the fifth largest state in the USA and has 1.8 million inhabitants. It ranks 47th in per capita income, and has the highest rate of uninsured in the nation. The population suffers from major problems of access to care, limited public transportation, language barriers, and a maldistribution of health providers by specialty and geography. While two-thirds of the population live in rural areas, only a third of the health work force practices there. New Mexico is one of two states whose majority populations are ethnic minority (40% Hispanic, 10% Native American, 2% African American). As a US-Mexico Border state, there is considerable cross-border economic activity and many undocumented workers live in New Mexico and are not eligible for health insurance or social services.
Dr. Arthur Kaufman, the current Secretary General of The Network: TUFH, and a large team of faculty and staff provide resources and consultations for all member institutions. UNM offers annual PBL and community-based training workshops for national and international institutions. UNM is a PAHO/WHO Collaborating Centre, for Partnerships in Health through Education, Service and Research. 31
Member and organisational News ABOUT OUR MEMBERS
It is with pleasure that we would like to inform you that the following Full Members have been awarded (a continuation of their) Full Membership:
Up to 2012: • Faculty of Medicine, Universidade Estadual de Londrina, Londrina, Brazil • Faculty of Medicine, Suez Canal University, Ismailia, Egypt • Division of Biological and Health Sciences, Universidad Autónoma Metropolitana Xochimilco, Mexico City, Mexico
Full Members • Faculty of Medicine, Nursing and Health Sciences, Monash University, Bendigo, Australia • College of Health Sciences, Igbinedion University, Okada, Benin City, Nigeria • Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, United Kingdom • Chainama College of Health Sciences, Lusaka, Zambia
Individual Members • Ms. Kamayani Bali Mahabal, Centere for Enquiry into Health and Allied Themes (CEHAT), Mumbai, India • Dr. Chima Onoka, Teaching Hospital, University of Nigeria, Enugu, Nigeria • Mr. Hassan Mohamed Hassan Saad, Faculty of Medicine and Surgery, Shendi University, Shendi, Sudan • Dr. Sally Bachofor, School of Medicine, University of New Mexico, Albuquerque NM, United States of America
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Up to 2011: • Faculty of Medicine, University of Gezira, Wad Medani, Sudan • School of Medicine, University of New Mexico, Albuquerque NM, United States of America
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New Brochure EfH On the occasion of the new online version of the Network: TUFH journal Education for Health, a new brochure has been printed to be distributed during conferences, workshop et cetera. A copy of this brochure is being sent to you with this Newsletter. Anyone who is interested in marketing the journal can order more copies at: secretariat@network.unimaas.nl or download the brochure from the Network: TUFH website (www.the-networktufh.org/publications_resources/educationforhealth. asp).
Unity of Purpose and Action The fragmentation in the structure, organisation and functioning of health services is a world-wide phenomenon. Major examples include: public vs. private care; individual healthcare vs. population-oriented care; biomedical vs. psychosocial models; services provided by generalists or specialists. As a result of the negative effects of fragmentation, there is an increasing awareness of more and more people involved in health services delivery to act in a constructive way to deal with its effects and to change the situation.
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Tribute to… The College of Medicine & Medical Sciences of the Arabian Gulf University, Bahrain has been awarded the Sheikh Hamdan Bin Rahid Al Maktoum Award - Hamdan Award for the Best Medical College/Institute or Centre in the Arab World.
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INTERESTING INTERNET SITES The Network: TUFH Interactive Recommended Internet sites www.the-networktufh.org/publications_ resources/interactive.asp Racial and Ethnic Approached to Community Health www.cdc.gov/reach/index.htm New Newsletter of the International Center of Nurse Migration www.intlnursemigration.org/default.shtml
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Internally in The Network: TUFH, we have an additional challenge (although much easier to overcome), evidenced by the presence of people, groups and taskforces who are interested and working towards ‘integration-unification-unity’, but in a separated
Jaime Gofin | Chairman Taskforce Integrating Medicine and Public Health Email: jaime@md.huji.ac.il
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The integration has many challenges to achieve its aim, like health policies based on top-down decision lines, rigid structure and organisation of healthcare services, separated funding sources, different focus and orientation in the training of health professionals, medical perceptions by community members of their health needs and the health services role.
This process of combining diverse efforts could be another contribution of The Network: TUFH to its policy of unity of purpose and action.
Moving On: Changes in Institutional Leadership The Secretariat received information about changes in leadership with the following Network: TUFH members. We have listed the names of the former and new (Vice-) Deans/Directors for you: • Dr. John Marley, Faculty of Health, The University of Newcastle, Australia has been replaced by Dr. Mike Calford, mike.calford@newcastle.edu.au • Dr. Alvaro Antonio Vieira de Mello, Faculdade de Ciências Médicinas, Universidade Estadual de Pernambuco, Brazil has been replaced by Marcelo Lins Cirne de Azevedo, cristinamattosconsult@gmail.com • Dr. Loke Bikram Thapa, B.P. Koirala Institute of Health Sciences, Nepal has been replaced by Dr. Purna Chandra Karmacharya, vcbpkihs@yahoo.com • Dr. Cynthia Lazaro Hipol, College of Medicine, De La Salle University, Philippines has been replaced by Dr. Romeo P. Ariniego, vparpa@hsc.dlsu.edu.ph • Dr. Osman Khalafalla Saeed Taha, Faculty of Medicine, University of Gezira, Sudan has been replaced by Dr. Ali Babiker Ali Habour, geziramed@yahoo.com
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The Network: TUFH is not an exception but one illustration of an international health organisation that is actively working towards integrating medicine and public health. Inspired by that goal, expressions of this re-organisation of health services appear under different names that are given to the elements needed to integrate services, e.g. ‘clinical individual care and population health’; ‘primary care and community medicine’, ‘primary healthcare and public health’. The common element in these different denominations is the purpose to combine components of healthcare that could provide a comprehensive approach to individual and population health.
fashion! For that reason the Taskforce on Integrating Medicine and Public Health has recommended to the Executive Committee of The Network: TUFH to work towards, at least, coordination of efforts on this dimension. The investments by different groups have to be unified, while keeping the individual specific characteristics and interest, but simultaneously organising activities and processes to promote the dissemination and awareness of information, education, and practice of integration.
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Member andPROFESSIONS organisational News INTERNATIONAL HEALTH EDUCATION ABOUT OUR MEMBERS Problem-based leArning and community-based education
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Advertising Opportunities With The Network: TUFH With around 250 institutional and individual members and a database of more than 8000 contact addresses around the world, The Network: TUFH offers a unique opportunity to reach individuals and institutions in health professions education, health services and health policy development. The Network: TUFH offers the following advertising opportunities:
the aims of the organisation. Over 350 health leaders from academic, clinical, and community settings from over 45 countries around the globe attend this annual conference. A unique opportunity to expose your organisation and valuable resources for improving health to our participants in the participant’s list and conference programme book.
Advertising on our website: announced on the Network: TUFH website (www.the-networktufh.org) and also included in the Network: TUFH Alert (over 8000 e-mail addresses world-wide).
Advertising in the Network: TUFH Newsletter: the Network: TUFH Newsletter includes interesting reading material concerning health professions education, health services and health policy development, as well as Network: TUFH membership news. The Newsletter is sent to approximately 1200 addresses world-wide twice a year (in June and December) and is available through the Network: TUFH website.
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Advertising in the Hall of Fame: Network: TUFH Full Members catalogue. A hard copy of this catalogue will be sent out to approximately 1.200 addresses world-wide once a year (in June). A regular updated catalogue will also be available at the Network: TUFH website and the Hall of Fame will be announced in the Alert which will be sent over 8000 e-mail addresses worldwide.
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Advertising in Conference Publications: Each year The Network: TUFH organises a conference on current issues relevant to
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Leaflet/flyer inserts: Leaflets and flyers can be inserted in the mailings of the Network: TUFH Newsletter (circulation approximately 1200).
For more information: www.the-networktufh.org
The Network: TUFH Hall of Fame Network: TUFH Full Members strive to achieve the organisation’s objectives through activities in their home settings and in partnership with other stakeholders within the health field and in other sectors of society. Full Membership can be acquired by legally registered institutions, organisations and groups interested in the objectives of The Network: TUFH and the activities that flow from them, and who wish to play an active role in them. One of the assets of Network: TUFH Full Membership is inclusion in the Network: TUFH Hall of Fame - Directory of Accredited and Admitted Full Members. The first edition of the Network: TUFH Hall of Fame is enclosed with this Newsletter. A regular updated catalogue will also become available at our website: www.the-networktufh.org Potential Full Membership status of institutions, organisations and groups is assessed at application by means of a questionnaire. Then, every five years the Full Membership status is reviewed on the basis of a self-evaluation report to be submitted by the Full Member institution, organisation or group. Full Members who have not yet been re-assed are called admitted Full Members. Full Members who have already been re-assessed successfully are called accredited Full Members. To indicate the number of successfully completed re-assessment procedures The Network: TUFH has defined the following Full Membership categories: • Bronze: bronze status will be given to Full Members who have completed their re-assessment procedure successfully for the first time. In 2000 the first Full Members acquired their Bronze status. • Silver: silver Full Members have completed the reassessment procedure successfully for the second time. In 2006 for the first time Silver status was given to Full Members. • Gold: golden Full Members have completed their 3rd and consecutive re-assessment procedure(s) successfully. This 3rd re-assessment round will start in 2011. In the first edition of the Network: TUFH Hall of Fame we have exposed Silver and Bronze Full Members by using a full page per member including general information, a summary of their reassessment report and a quote from the external assessor. The Network: TUFH Hall of Fame also includes a list with admitted Full Members.
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INTERNATIONAL HEALTH PROFESSIONS EDUCATION INTRODUCING MEMBERS Problem-based leArning and community-based education
Monash School of Rural Health
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The School of Rural Health is a multi-site rural campus in regional Victoria, made up of four Regional Clinical Schools at Mildura, Bendigo, Traralgon and Bairnsdale. Each has with their respective affiliated hospitals, teaching general practices and community agencies, and the Monash University Department of Rural and Indigenous Health at Moe. While the regional clinical schools are
As a consequence of a recent expansion of medical school places in Australia, two significant new medical education programmes have been developed in two parts of our School. In the North we have joined with the other major university in Victoria, the University of Melbourne, to develop an expanded rural education programme that places 60 medical students in their clinical years at distributed sites throughout Northern Victoria for five out of six possible clini-
cal semesters. These students are specifically enrolled from communities in Northern Victoria or rural communities elsewhere in the State with the understanding that they will undertake the majority of their clinical training in Northern Victoria. In the South we have established a new regional medical school that will offer a graduate entry medical course and will enrol 60 students in its commencement year in 2008 again with an emphasis on students from rural backgrounds. A distinctive feature of these new programmes will be the further development of a model, piloted in one part of our school over the past three years, in which students are placed for an entire year in general practice and concurrently meet the integrated learning objectives of four disciplines viz. Psychiatry, Obstetrics and Gynaecology, Paediatrics and General Practice itself. This distributed model will be evaluated over the next ten years with a special interest in the following outcomes: clinical competency, professional development, social and population orientation, and finally on decisions to practice in rural areas.
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The Monash School of Rural Health (SRH) is one of nine schools in the Faculty of Medicine, Nursing and Health Sciences at Monash University. Monash is credited with developing the early academic model on which University Departments of Rural Health were established around Australia in 1996. It was involved, with others, in advocating to establish the Rural Clinical Schools programme in Australia in 2000. This programme has created the infrastructure and ongoing funding at all major medical universities in Australia to support the placement of medical students in their clinical years at regional and rural locations throughout the country.
predominantly responsible for rural medical education in years 3 to 5 of the MBBS course they also serve as bases for the implementation of short rural blocks in years 1 and 2 of the MBBS course. Nursing, Allied Health and Indigenous Health education is largely driven from the Department of Rural and Indigenous Health at Moe and implemented, where possible and appropriate, through the regional clinical schools. The Office of Head of School provides an overarching structure that manages and integrates all education, research and operational activity across all sites in Victoria. As a condition of Government funding 25% of all Government supported medical students are required to spend two out of their six clinical semesters in the MBBS course at one or more of our rural campuses.
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Monash University, based in Melbourne, is the largest University in Australia and a member of the Australian Group of eight Universities, all ranked in the top 100 universities in the world by the Times Higher Education Supplement in 2005. Monash prides itself on its tradition of innovation and scholarship in both research and education and has a distinctive interest in consolidating its position as a research-led, truly international university. There is a commitment to encouraging internationalism among our staff and students and within our teaching, learning and research, and to developing significant multi-cultural operations on and off-shore. Monash now has established campuses in Malaysia (including the first Australian accredited off-shore medical school) and South Africa and smaller Centres in Prato, Italy and London, UK.
Geoff Solarsh | Professor and Head, School of Rural Health, Monash University, Australia Email: geoff.solarsh@med.monash.edu.au 5
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Member and organisational News Network: TUFH Conference 2008 in Colombia
The Network towards unity for health Newsletter Volume 26 | no. 1 | June 2007 ISSN 1571-9308 Editors: Marion Stijnen and Pauline Vluggen Language editor: Sandra McCollum The Network: Towards Unity for Health Publications P.O. Box 616 6200 MD Maastricht The Netherlands Tel: 31-43-3885633, Fax: 31-43-3885639 Email: secretariat@network.unimaas.nl www.the-networktufh.org Illustrations on pages 11 and 12 by courtesy
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As one of our Post-Conference Excursions we will visit the Arhuacos
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In the second half of September 2008 The Network: TUFH will organise its international Conference in co-operation with the Facultad de Medicina (FdM), Universidad de La Sabana (ULS), Chía/Bogota, Colombia. With its 15 years the FdM ULS is still a young faculty with sound and robust development that has gained as one of the few medical schools recognition by the national higher education accreditation council of Colombia. It is absolutely worth coming to Chía to see how we are building new ways of training, for example our competency-based programme (developing competences in basic and clinical sciences, public health and primary health care). We would like to show you that Colombia is an exciting country with diverse cultures and regions, and passionate communities looking for innovative ways of reorganising their rights as citizens within a health system searching for creative and better ways to serve and improve the health of their people. We still have a long way to go, but we also understand that opening our frontiers to the global society, sharing our experience beyond our difficulties and learning from others, is the only way to achieve the richness of thought and creativity neces-
sary to build the inclusive ethical society we strive for. It is important to acknowledge the important advances towards building a safer context, not differing from the risks you can find in the modern urban world elsewhere.
of the MUSTANGH Foundation. Lay-out: Graphic Design Agency Emilio Perez Print: Drukkerij Gijsemberg
grating the Western health system and their own system organised around their Mamos (Shamans). The Sierra Nevada de Santa Marta population also connects its health with the surrounding environment; when nature becomes ill (e.g. the Sierra Nevada snow peaks that are melting), both the Arhuacos as ‘elder brothers’ and all of us - who live away from the Sierra Nevada - as their ‘younger brothers’ become ill as well. Universidad de La Sabana, Colombia The local and office organisers have proposed as Conference title: Adapting health services and health professions education to local needs: Partnerships, priorities, and passion. Although the Executive Committee is considering slight modifications of this title, there seems to be adequate support for its spirit. As one of the Post-Conference Excursions we will visit the indigenous people Arhuacos of the Sierra Nevada de Santa Marta. They have a very interesting health model, inte-
For us, the Conferences of The Network: TUFH have offered a wonderful opportunity to share experiences, and even establish partnerships, with other people from all over the world. It empowered us and the students that joined us. We hope we may welcome you in Colombia to experience all of this for yourself. Camilo Osorio Barker (Dean) and Francisco Lamus Lemus (Professor) | Faculty of Medicine, Universidad de La Sabana, Chia, Colombia Email: camilo.osorio@unisabana.edu.co; francisco.lamus@unisabana.edu.co