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November 26, 2001

UCSF Leads Innovators in Global Primary Care Partnership

Around the world, health care providers are struggling to meet even the most basic of needs for their patients. Resources are often inversely proportional to the severity of national or local needs.

In one country, medical schools churn out cardiologists, for example, but do not train general care practitioners. Another country's system involves the constant struggle to meet government-mandated health standards.

With UCSF taking the lead, academic and government leaders from six countries recently came together to share ideas on how to train doctors and nurses in the delivery of efficient, effective and culturally appropriate primary care services.

"This is a way for UCSF to contribute to the health care needs of the developing world," said Haile Debas, dean of the UCSF School of Medicine and vice chancellor for medical affairs. "This is our opportunity to see what we can learn from other countries, it's not about what we can teach them."

Debas and Kathleen Dracup, dean of the UCSF School of Nursing, introduced members of the newly formed "Global Partners for Primary Care Innovation" (GPPCI) at a symposium held Nov. 16 at UCSF. The long-term research and teaching partnership plans to exchange medical, nursing, and academic students and faculty among five countries and UCSF.

The scholars and government officials are leaders in primary care nursing and medical education from China, Cuba, South Africa, Thailand, and the United Kingdom. The partnership has been in the planning stages for 18 months. The group's members met for the first time earlier this month, spending a week in workshops formalizing the partnership among the institutions and government agencies involved.

Examples of innovation

During the Nov. 16 symposium, participants presented examples of innovative interdisciplinary projects in primary care training from their home countries.

Julio Portal Pineda, for example, described the community-based health care system in Cuba, where health care leaders hold dual positions in their regional or local departments of health and government. "Our country is a small one, but it has been able to develop a strong basis for its health care system," said Portal, chief of postgraduate education in Cuba's Ministry of Public Health. According to Portal, Cuba's equivalent of a county health department director also serves as the vice president for the region, or province. The system, Portal said, makes it easier to facilitate change and make health care a priority in the country.

It also means doctors must be trained as community leaders in addition to healers.

This kind of system-driven education and training is also seen in the United Kingdom, where 75 percent of the government's health care budget is allocated to primary care. The government sets outcome requirements for public health trusts. One of these trusts, for instance, might be given the task of reducing the incidence of heart attacks by 20 percent in five years.

"That's a huge challenge," said Elizabeth Murray, a visiting scholar at UCSF and director of undergraduate education in the department of primary care and population sciences at the Royal Free and University College Medical School in London.

To meet the government-issued requirements, nurses are trained to collect and analyze population data and identify high-risk groups in their community on which to focus outreach and prevention services. Murray described a nurse combing through charts by hand to gather data that resulted in a new transportation program for homebound elderly.

Other innovations included a community-driven research agenda in clinics near Durban, South Africa and the use of Buddhist meditation in making attitudinal changes among health care providers in Thailand. Participants expressed their gratitude at being able to come together and explore the diversity of approaches to health care and the education and training of doctors and nurses around the world.

The partnership brings together health care providers from poor countries and rich ones, centralized and community-based systems and those from different cultures with different values systems, said Barry Kistnasamy, dean of the Nelson R. Mendela School of Medicine at the University of Natal in Druban, South Africa.

Despite the differences, Kistnasamy said, "we commit ourselves fully to the goal of this partnership." The global partnership will be administered by the department of family and community medicine and Community Health Systems Nursing. The venture is being developed with support from the deans of medicine and nursing, Steve Barclay, vice chancellor for Administration and Finance, the UC Institute on Global Conflict and Cooperation, the department of anthropology, history, and social medicine, and the Center for the Health Professions.

Those wishing to participate in GPPCI programs at UCSF or abroad should contact Chris Kiefer, PhD, professor of anthropology; Jack Rodnick, chair of family and community medicine; William Holzemer, chair of community health systems nursing; Peter Lovett, assistant professor of family and community medicine; or Jeremiah Mock, assistant research scientist, Center for Health and Community.

Source: Camille Mojica Rey

 

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