WORLD HEALTH ORGANIZATIO N REGIONAL OFFICE FOR THE WESTERN PACIFIC
REPORT MEETING ON UTILIZATION OF GUIDELINES FOR ORIENTING HEALTH PROFESSIONAL EDUCATION TO THE NEW HORIZONS IN HEALTH APPROACH Sydney, Australia 9-13 August 1999
Manila, Philippines October 1999
(WP)HRH/ICP/HRH/002 Report series number: RS/99/GE/07(AUS)
English only
REPORT
MEETING ON UTILIZATION OF GUIDELINES FOR ORIENTING HEALTH PROFESSIONAL EDUCATION TO THE NEW HORIZONS IN HEALTH APPROACH
Convened by:
WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC SYDNEY, AUSTRALIA 9-13 AUGUST 1999
Not for sale Printed and distributed by: World Health Organization Regional Office for the Western Pacific Manila, Philippines October 1999
NOTE
The views expressed in this report are those of the participants in the meeting and do not necessarily reflect the policy of the World Health Organization.
This report has been prepared by the World Health Organization Regional Office in the Western Pacific for governments of Member States in the Region and for those who participated in the Meeting on Utilization of Guidelines for Orienting Health Professional Education to the New Horizons in Health Approach held in Sydney, Australia from 9 to 13 August 1999.
CONTENTS
1.
INTRODUCTION .. ....... ......... .... ......... ....... ... ..... ........................... ............................. ...... 1
1.1 Objectives .... .. ......... ....... ... .............. ... ... .... ..... .... ................ ....... ... .............. .............. 1 1.2 Participants and Secretariat.. ......................................................... .......... .... ........... ... 1 1.3 Organization and outputs ... ...... .. ...... .. - ...... ...................... .. .. .. ................................. .. 2 2. PROCEEDINGS ............... ........ .... .................................... ....... ......... ........... .......... ...... .. .. 2 ANNEXES: ANNEX 1 - LIST OF TEMPORARY ADVISERS, MEETING COORDINATOR .. ...... . 5 AND SECRETARIAT ANNEX 2 - PROGRAMME OF ACTIVITIES .. ... ......................... ....... ........ .................. 9 ANNEX 3 - PROMOTING THE HEALTH OF COMMUNITIES: GUIDELINES ....... 11 FOR HEALTH PROFESSIONAL EDUCATION ANNEX 4 - EXAMPLES OF UTILIZATION OF GUIDELINES ............ ........ .. .. .......... 41
Keywords: Education, Professional I Health occupations- education I Health promotion I Guidelines I Australia
1. INTRODUCTION
The changing contexts of health services resulting from reforms being undertaken in most countries require that health professional education be oriented towards optimizing health of populations through disease prevention, health promotion and health protection. The forty-eighth World Health Assembly recognized the need to orient health professional education and practice, in line with the principles of Health For All, in resolution WHA48 .8. h1 the Western Pacific Region, the policy document, New horizons in health sets out approaches for the achievement of Health For All.
New horizons in health calls for health service delivery which emphasizes health promotion, health protection, multisectoral action and the empowem1ent of individuals and conununities to take more responsibility for their health. For this approach to be successful, health professionals need training that equips them with the knowledge and skills required. In order to encourage and facilitate coordination of regional efforts to refom1 education and practice in line with these principles, a series of meetings have been held at the WHO Regional Training Centre in Sydney, Australia. The 1999 meeting addressed implementation of Promoting the health of communities Guidelines for health professional education developed for use in the revision of health professional education throughout the Region, and monitoring of progress. 1.1
Objectives The objectives of the meeting, as revised on Day 1, were:
( 1) to enhance the capacity of health professional educators to incorporate concepts to promote the health of communities into training of the health professional workforce; (2) to use country experiences to test the utilization of Promoting the health communities: Guidelines for health professional education; and (3) c~f
to develop the capacity for monitoring progress in the implementation of the
Guidelines . 1.2
Participants and Secretariat
Temporary advisers from twelve countries in the Region attended the meeting. This group brought together a wealth of experience and expertise in the area of health professional education in the Western Pacific Region. A list of Temporary Advisers is attached as Annex 1. Dr Jan Ritchie, Director of Academic Services, School of Medical Education, University of New South Wales was the Meeting Coordinator, with support from Ms Bronwyn Hine. Mrs Lorraine Kerse, Regional Adviser in Human Resources for Health, WHO Western Pacific Regional Office, acted as the Secretariat for the meeting.
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1.3
Organization and outputs
The meeting was organized over five days, with discussions based on two draft documents: draft Guidelines for orienting health professional education to the New horizons in health approach ; and the New horizons in health: A teaching guide for educators of health professionals . Temporary advisers reviewed the draft Guidelines in relation to utilization and application, and developed monitoring indicators. They recommended changes to strengthen the Teaching Guide . The programme for the meeting is attached as AJ.mex 2. The final output of the meeting was the fmalization of the draft Guidelines, renamed Promoting the health of communities: Guidelines for health professional education. The Guidelines are attached as AJ.mex 3. The meeting also prepared recommendations for strengthening the Teaching guide.
2. PROCEEDI NGS
The meeting began with introductory activities. Dr Jan Ritchie welcomed participants, Mrs Lorraine Kerse and Professor Arie Rotem presented opening remarks. The meeting's programme and objectives were revised, and participants and resource persons introduced themselves . Following this, a brief overview of the draft Guidelines was presented, highlighting both the purpose and the content ofthe document. Professor S.B. Dowton, Dean ofthe Faculty of Medicine at the University of New South Wales, presented "Dilemmas of a Dean Introducing Curriculum Reform" and answered questions relating to his experience as an agent for change. The meeting then began the process of reviewing the draft Guidelines. The input from Temporary Advisers who had not participated in the development ofthese Guidelines was particularly valuable for clarifying language and meaning. It was agreed that changes were required to make the Guidelines more easil understood by educators and policy/decision makers. The group renamed the Guidelines, choosing the title Promoting the health of communities : Guidelines for health professional education. Discussion regarding the definition and meaning of the term "health promotion" occupied the remainder of the afternoon. A welcome Reception was held for meeting participants and invited guests in the evening. During the second day, participants continued their revision of the draft Guidelines . The glossary in the Guidelines was revised, and definitions added for the tenns health promotion, stakeholder, community and monitoring. The meeting then moved on to review the Teaching guide, and prepared a number of general and specific recommendations related to introduction, educational process, content and assessment. These recommendations were provided to the secretariat for consideration by WHO Western Pacific Regional Office. The third day was dedicated to examination of country experiences in integrating health promotion concepts into health professional education curriculum. The group focused on the lessons learnt through their own experiences, particularly those related to requirements for success and obstacles or barriers encountered, and the importance of addressing these in the Guidelines. In the afternoon, the Temporary Adviser from Cambodia presented a case study of mental health
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training and services, highlighting innovative strategies to address cultural and social aspects important to successful in1plementation ofprogra.trunes . This presentation raised cultural and transcultural issues relevant to the utilization of the Guidelines, and number of changes were made to the draft. During the fourth day, participants prepared action plans for utilization of the Guidelines in a health professional education programme in their own country. These action plans enabled the group to clearly identify implementation issues, and consider how best to secure necessary support and overcome likely obstacles. Drawing from these action plans, a number of generic exan1ples will be prepared to demonstrate potential ways to implement the concepts . These will be attached as an annex to the Guidelines. When preparing plans of action, Temporary Advisers nominated indicators for monitoring progress in implementation. On the final day of the meeting, these specific indicators where used as the basis for the development of general indicators for each component of the Guidelines. These indicators will be included in the Guidelines as examples for institutions or governments to monitor implementation/utilization. The meeting closed with an official lunch for participants and invited guests .
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ANNEX l
WORLD
HEALTH
ORGANISATION MONDIALE DE LA SANTE
ORGANIZATION
REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU REGIONAL DU PACIFIQUE OCCIDENTAL
MEETING ON UTILIZATION OF GUIDELINES FOR ORIENTING HEALTH PROFESSIONAL EDUCATION TO THE NEW HORIZONS IN HEALTH APPROACH Sydney, Australia 9-13 August 1999
WPR/HRH/HRH( l) /99/IB /2 6 August 1999 ENGLISH ONLY
INFORMATION BULLETIN NO.2 PROVISIONAL LIST OF TEMPORARY ADVISERS, MEETING COORDINATOR, AND SECRETARIAT
1. TEMPORARY ADVISERS
1.
Dr Warne Baravilala Dean Fiji School of Medicine Private Mail Bag Suva. Fiji Fax No. (679) 305781 Tel No. (679) 304273, mobile: 920911 E-mail: wame_b@fsm .ac .fj Dr Francis Hombhanje Dean of School of Medicine and Health Sciences University of Papua New Guinea P.O. Box 5623 Boroko Papua New Guinea Fax No. (675) 325 0809 TeL No. (675) 324 3805 Email: hombanfr@upng .ac.pg Dr Dennie Iniakwala Under Secretary Health Improvement Ministry of Health and Medical Services P.O. Box 349 Honiara Solomon Islands Fax No. (677) 20085 TeL No . (677) 23404/23402 Email: smmhms@welkam. solomon.sb
2.
3.
Annex l
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WPR/HRH/HRH(l)/99/IB/ 2 Page 2
4.
Dr Yoon-seong Lee Associate Professor I Associate Dean Department of Forensic Medicine Seoul National University College of Medicine 288 Yongon-dong, Chongro-ku Seoul 110-799 Republic of Korea Fax No. 82-2-764-8340 Tel. No. 82-2-740-8352 E-mail: yoonslee@sny.ac.kr Dr Tserenhuu Lkhagvasuren President National Medical University of Mongolia Janyangunee Str-4 P. 0 . 48 Box - 111 Ulaanbaatar Mongolia Fax No. (976) 1 321249 Tel. No. (976) 1 328670 E-mail: TSLKH@mmu.edu.mn Professor Masaki Moriyama Department of Public Health Fukuoka University School of Medicine 7-45-1 Nanakuma, Jonan-ku Fukuoka City 8140180 Japan Fax No. +81-92-863-8892 Tel. No. +81-92-801-1011 Ext. 3310 E-mail: masakim@fukuoka-u-ac.jp Professor Ren Huimin Former President Xi'an Medical University Vice Director Chinese Higher Medical Education Association 205 Zhuquedajie Xi'an Shaanxi 710061 People's Republic of China Fax No. 86-29-526-7324 Tel. No. 86-29-521-8986 E-mail: Ren@irix.xamu.edu.cn
5.
6.
7.
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Annex l
WPR/HRH/HRH( l)/99/ffi/2 Page 3
8.
Dr Ricardo R. Santi Dean of College of Medicine Director for Academic Services De La Salle University Health Sciences CampU '· Dasmarinas, Cavite Philippines Fax No. +63 (046) 416 0465 Tel. No. +63 (046) 416 0226 E-mail: acarrs@ hsc. dlsu. edu. ph Mrs Pelenatete Stowers Director of Nursing Department of Health Motootua Samoa Fax No. (685) 21440 Tel. No. (685) 21212 Ext. 347 Email: SXIA@LeSamoa.net Dr Ka Sunbaunat Head of Academic Affairs Faculty of Medicine University of Health Sciences Chairman of Mental Health Subcommittee Ministry of Health 73, Monivong Blvd. Phnom Penh Cambodia Fax No. (855-23) 212 859; (855-17) 811939 Tel. No. (855-17) E-mail: IOMPHENPE@world.iom Dr Bounsai Thovisouk Dean of Faculty of Medical Sciences National University of Laos BP; 7444 Vientiane Laos Fax No. (856-21) 214055 Tel. No. (856-21) 214034 E-mail: fms@pan-laos.net.la or planlaos!fms@nitrogen.singnet.com.sg Ms Adeline Welin Principal Nurse Educator Vanuatu Centre for Nursing Education Department of Health Private Mail Bag 009 Port Vila Vanuatu Fax No. (678) 26-204 Tel. No. (678) 22-512
9.
10.
11.
12.
Annex 1
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WPR/HRH/HRH(l)/99/IB/2 Page 4
2. MEETING COORDINATOR Dr Jan Ritchie WHO Regional Training Centi ~. for Health Development School of Medical Education The University ofNew South Wales Sydnev, NSW 2052 Australia Fax No. 61-2-9385 1526 Tel No. 61-2 9385 2445 E-mail: J.Ritchie(q\unsvv.edu.au
Ms Bronwyn Hine World Health Organization PO Box 1217 Phnom Penl1 Cambodia Fax: (855 23) 216211 Ph: (855 23) 216942 Email: hiner2hwho.org.kh
3. SECRETARIAT Mrs Lorraine Kerse Regional Adviser in Human Resources for Health World Health Organization Regional Office for the Western Pacific P.O. Box 2932 United Nations Avenue 1000 Manila Philippines Fax No. (632} 521 1036 Tel No. (632) 528-9957 Dir.; (632) 528 8001 E-mail: kersel@who.org.ph
MEETING ON UTILIZATION OF GUIDELINES FOR ORIENTING HEALTH PROFESSIONAL EDUCATION TO THE NEW HORIZONS IN HEALi~ APPROACH Sydney, Australia 9-13 August 1999
TIMETABLE Classroom MG02 School of Medical Education 9 August, Monday Registration Welcome and official opening Ms L.Kerse Prof A..Rotem Self-introduction of participants Group photo session Classroom MG02 School of Medical Education 10 August, Tuesday SunmlaiJ' of the revision of the draft guidelines for orienting health professional education to the New Horizons in Health approach Classroom MG02 School of Medical Education 11 August, Wednesday Discussion of current country situations Classroom MG02 School of Medical Education 12 August, Thursday Identification of areas where common problems occur Classroom MG02 School of Medical Education 13 August, Friday Future directions -presentation of action plans
Time 8.45am 9.00am
9.30am 10.15am I0.30am ll.OOam
COFFEE BREAK Overview of the meeting Dr J.Ritchie Revision of the draft guidelines for orienting health professional education to the NHIH approach lvfs B. Hine 12.30-2.00pm Lunch and money matters "Dilemmas of a Dean Introducing Curriculum Reform" Prof B. Dowton, Dean Continuation of the revision of the draft guidelines for orienting health professional education to the NHIH approach Discussion on the draft teaching guide for educators of health professionals Continuation of discussion of current country situation Continuation of identification of area.s where common problems occur Continuation of future directions - presentation of action plans 12.00pm Evaluation 1.0
ll.30am
Tues-Thurs 12.30-UOpm 2.00prn
LUNCH BREAK Continuation of the discussion on the draft teaching guide for educators of health professionals Use of case studies to highlight innovative approaches Development of action strategies
12.30-2.00pm Farewell Luncheon and Closing
2.30pm
Tues-Thurs 3.00pm 2.30pm to 3 .45pm 4 .00-6.00plll
COFFEE BREAK Conlinualiou of the revision of the draft guidelines for orienting health profession<Jl education to the NHIH approach Welcome Reception - AGSM Monitoring implementation of guidelines Continuation of the use of case studies to highlight innovative approaches . :UO pnl - Close Continuation of development of action strategies N
4.30pm- Close
4 .JO p l11 - Close
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- 11 ANNEX 3
LL
L_
Protnoting the Health of ComtnunitiesGuidelines for Health Professional Education
Note: This document has been revised. The final version will be distributed soon.
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Annex 3
Promoting the Health of Communities Guidelines for Health Professional Education
Developed over three WHO/WPRO Intercountry Meetings WHO Regional Training Centre, School of Medical Education University of New South Wales Sydney, Australia August 1997, 1998 and 1999
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Annex 3
Contents Executive Summary 1 Introduction 4 Background 6 Why change health professional education? 9 What needs to be changed in Education Programmes? 12 Process and Dynamics of Change 14 Glossary 16 Draft Guidelines 17 Further Reading 26
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Annex 3
Executive Summary The proposed broad policy directions of the Western Pacific Region have recently been outlined in a Position Paper (1999). A major theme of this Paper is Building Healthy Communities and Populations. This theme aims to improve the health of communities and populations through integrated approaches which stress the links between development, the environment and health. The theme reaffirms the previous WHO regional policy document entitled New horizons in health which set out approaches for the achievement of Health For All. To attain this goal, health professionals need education and training which equips them with the knowledge and skills required. These guidelines were developed at the WHO/WPRO Meeting on Guidelines for Orienting Health Professional Education to the New horizons in health (NHIH) Approach, held in Sydney from 10-14 August 1998 and confirmed at the subsequent Meeting on Utilization of Guidelines for Orienting Health Professional Education to the New horizons in health approach, held from 9 to 13 August 1999. They are intended to support educational institutions and governments throughout the Western Pacific Region in reviewing and strengthening health professional education and training (basic and continuing) in order to achieve this orientation. The key areas for action that were identified target educational curricula and the organizational environment in which Promoting the Health of Communities Guidelines for Health Professional Education 1
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Annex 3
education is provided and health services are delivered. The
guidelines are not intended to prescribe a particular course of action, but rather to offer suggestions that countries and institutions may draw on and adapt to suit their unique circumstances and settings. Three key components of a strategy to orient health professional education to promote the health of communities are: the political component, the technical component, and the coordination component. A concerted effort in each or these areas will lead
to comprehensive reform, but action can begin incrementally, and in any area. Action within the political component seeks to secure the active support of political leaders, policy and decision-makers within the health, education and related sectors, through increasing their understanding and appreciation of the value of promoting the health of communities. The technical component addresses institutional capacity in the core areas of health promotion, health protection, multisectoral action, empowerment of individuals and communities, and the need for curricula and research efforts to reflect the institutions' orientation. It targets outcome measures, in particular the attributes of graduates who have participated in education programmes. It also emphasises the need for institutions to develop partnerships with key stakeholders in the health sector, other sectors and in the community.
2
Promoting the Health of CommunitiesGuidelines for Health Professional Education
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Annmex 3
The third component, the coordination component, identifies action to support collaboration between institutions involved .in health professional education at both national and regional levels, to maximize opportunities for learning and reflection.
Promoting the Health of Communities Guidelines for Health Professional Education
3
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Annex 3
Introduction These guidelines were completed at the WHO/WPRO Meeting on Utilization of Guidelines for Orienting Health Professional Education to the New horizons in health Approach, held in Sydney from 9-13 August 1999. The meeting was the third in a series of three addressing this topic, with previous meetings held in 1997 and 1998. The guidelines reflect the fundamental shift that is occurring in both the orientation of health care delivery and the setting of priorities for health care. To achieve the ultimate goal of Health For All, it has become clear that the traditional approaches of disease control, clinical diagnosis, treatment and rehabilitation, while still important, are insufficient in themselves to ensure the health of the population and a good quality of life. The WHO regional Position Paper of February 1999 confirms that new approaches are required for the achievement of Health For All. It seeks to improve the health of communities and populations through integrated approaches which stress the links between development, the environment and health. For this approach to be successful, health professionals need education and training which equips them with the knowledge and skills required for an holistic approach to health care. These guidelines are intended to provide direction and support for 4 Promoting the Health of Communities Guidelines for Health Professional Education
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Annex 3
countries that are reviewing and strengthening their health professional training programmes (basic and continuing) in order to achieve this orientation.
Promot;ing the Health of Communities Guidelines for Health Professional Education
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Annex 3
Background The initiation ofthe global trend towards a focus on health, rather than on disease, occurred with the Declaration of Primary Health Care, proclaimed at Alma-Ata in 1978. This document introduced the notion of attaining Health For All by the year 2000, and included health education as one of the eight essential elements which member states of WHO should consider. The subsequent Global Strategy for Health For All, launched in 1981, encouraged all countries to identify goals and targets to indicate their progress in this direction. The Ottawa Charter for Health Promotion was developed in 1986 to facilitate the implementation of the Health For All strategy, and suggested five areas for action: building healthy public policy, creating supportive environments, strengthening community action, developing personal skills and reorienting health services. In 1995, the Western Pacific region produced a policy document, New horizons in health, which set out new approaches for the achievement of Health For All. The importance of forming broad-based partnerships to work for health was emphasized in the 1997 Jakarta Declaration. Meanwhile, the Pacific Island countries documented their commitment to these principles in the Yanuca Island Declaration (1995), the Raratonga Agreement (1997) and the Palau Action Statement (1999).
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Annex 3
The WPRO Position Paper of February 1999 reaffirmed the values and actions recommended in the "previous documents" with a major theme entitled Building Healthy Communities and Populations (BHC & P).
Building Healthy Communities and Populations Building healthy communities and populations is an important theme of the current Regional Policy. Basically the aim is to foster integrated approaches which stress the link between development, environment and health. The fostering of healthy communities and populations is addressed by creating social and physical environments that are supportive of health, and encouraging healthy lifestyles and living conditions through integrated, intersectoral approaches. A particular focus of the theme is the creation of healthy settings where people live, work and play, such as, for example, healthy cities, healthy villages, healthy schools and healthy marketplaces, among many others. This involves strengthening environmental health and health promotion infrastructures. In addition, the application of the healthy settings approach aims to establish more effective working relationships between the health sector and other sectors to solve problems closer to their source.
New Horizons in Health Essentially, the New horizons in health (NHIH) approach involved:
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Annex 3
_jJ __]
1. Changing directions
• from disease-centred c) people-centred.,. health interventions are people-centred and wellness-centred not disease-focused, with the focus on positive health as part of human development; • from reactive curative c) proactive preventive - a shift in emphasis from the illness itself, to the risk factors which contribute to the problem, and further to factors that will constitute good health; • from health sector alone c) multisectoral shared - the health sector seeks to combine its resources and efforts towards positive health and quality of life with those of other sectors (such as schools, industry, transportation, energy, agriculture and environmental groups) to influence external health related factors. 2. Taking a Lifespan approach
• preparation for life- ensuring that infants and young children not only survive the first years of Life, but are suitably prepared to enable them to realize their health potential throughout their lives; • protection of life- having progressed through childhood and adolescence, individuals are then supported in fully developing and maintaining healthy Lifestyles, and are protected from illnesses caused by a potentially hazardous and degraded environment. The overall aim is to prolong productive, healthy and disabilityfree lives in the most cost-effective and equitable ways possible; • quality of life- enabling all individuals to acquire and maintain the physical, social and mental capabilities required to Lead fully creative, productive and meaningful lives. 8
Promoting the Health of Communities Guidelines for Health Professional Education
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II
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Why change health professional education? With a basic health infrastructure in place in all countries and areas of the Western Pacific region, there is significant concern about how to use this infrastructure more efficiently and effectively. Major health system reforms are being undertaken in many countries in the Region, as nations seek to achieve Health For All within the context of changing health profiles and economic realities. A comprehensive plan to reorient the health workforce is seen as lying at the core of any successful reform in health. 1. New challenges call for new responses
The health profile of the Western Pacific Region reveals a combination of diseases, both those associated with poverty and those associated with affluence. While there has been a general improvement in key health indicators such as infant mortality, adult literacy and life expectancy over recent years, significant inequalities within countries remain. Emerging health issues include those associated with the "ageing" of society, and with socioeconomic development, such as rapid urbanization, changing Lifestyles and environmental degradation. These health issues cannot be effectively addressed through traditional programme-based health sector responses. Health
Promoting the Health of Communities Guidelines for Health Professional Education
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Annex 3
workers must be able to work effectively with non-traditional partners in health and human development, and be willing and interested in finding or creating opportunities to work together in new ways. Tomorrow's doctor (or other health worker) needs to be a care provider, decision-maker, communicator, community leader and manager. 2. Quest for relevance, quality, cost effectiveness and equity
Relevance, quality, cost-effectiveness and equity are four values implicit in the goal of Health For ALL In an "ideal" health system, equal emphasis is given to each of these values. Tensions can and do arise between the four values, in particular between an emphasis on quality and cost effectiveness versus equity and relevance. The World Health Assembly resolution WHA48.8 encourages all countries to undertake activities to reform medical education and practice with a view to increasing relevance, quality, costeffectiveness and equity in health care. Health professionals of all disciplines must be trained to work effectively with a health care system that adopts these values. • Relevance - Are the most important problems tackled first? • Quality - Is health care evidence-based, technologically and
culturally appropriate? • Cost-effectivene ss- Does the system have the greatest impact
on health while making the best use of its resources? • Equity- Is high quality health care available to all people in all areas?
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Annex 3
3. Increasing accountability
The health sector, including planners, funders, educators, researchers and health care providers, are being held increasingly accountable for what they do, and how and why they do it.
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Annex 3
What needs to be changed in education programmes? • Orientation and emphasis - the theme of BHC & P and the NHIH approach to Health For All involve a significant shift in health service delivery, and thus in the knowledge and practice of health professionals. For this to occur, the orientation of health professional education (basic and continuing) must also shift, to reflect a more holistic view of health and the broadest range of health interventions. It will not be sufficient to just add extra topics, such as health
promotion and anagement, to current basic education curricula, or to include these topics in in-service training programmes. The whole orientation and emphasis of training needs to reflect the principles of health promotion and disease prevention. Every aspect of basic and continuing education programmes, including selection of students, the curriculum, student assessment, research and outcomes, must be examined for the extent to which it prepares graduates to adopt an approach that will build healthy communities and populations.
• Foundation skills- all health workers need a solid foundation of cognitive skills if they are to practise effectively within the changing context of health services. In particular, they need Promoting the Health of Communities Guidelines for Health Professional Education
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Annex 3
excellent communication skills, analytical, reasoning and problem solving skills. Education programmes must provide opportunities and support for students to develop and enhance these skills.
Promoting the Health of Communities • Guidelines for Health Professional Education
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Annex 3
Process and dynamics of change If educational institutions are to successfully reform their programmes, they need both a clear idea of what they want to change, and understanding and skills in managing change.
Change is generally viewed as an episodic activity. It starts at some point, moves through a series of steps, then arrives at an outcome that is hoped to be an improvement on the starting point. When moving from the starting point to the changed state, there will be forces within an organization or system that drive the change, and forces that resist it. In today's world, change is an almost continual process, the success of which depends, to a large extent, on motivation, leadership, strategy and energy. • Initiation of change - can come from within an organization
or from outside it. Organizations exist within a changing environment, and in order to "fit in" with that environment, the organization must adapt. The environment in which health services are provided has changed dramatically over the past three decades, with increased expectations from consumers, the aging of the population, and emerging threats to health such as HIV/AIDS and pollution. Variations in funding or passage of new legislation are examples of external factors that could initiate changes in health service 14
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Annex 3
delivery. The release of research findings, or the introduction of new equipment, are examples of internal factors that could initiate change. The "trigger" for change will influence how easily it proceeds, and how well the outcome meets expectations. • Support for change- forces that drive the change can include incentives, such as increased salary or status, or improved conditions. Respected or powerful individuals who favour the change can also act as a driving force. Complementary adjustments to infrastructure within the system will add to the feasibility of the planned change. • Barriers to change - resistance to change can come from many sources. Individuals within an organization may resist change out of habit, fear of Loss of security or income, fear of the unknown, or because they don't fully understand what is planned. The current structure, power relationships, resource allocation, skills and experience within the organization itself may also be barriers to change. Symptoms of resistance to change can include high staff turnover, absenteeism, wastage and errors, etc. • Leadership - if change is to be successful, it must be well managed. Leadership must be provided which wilt drive change and enable barriers to be overcome. The leader/s or change agent/s must have sufficient influence or power to be effective, and must have interest, time and energy to dedicate to supporting the change. Tactics such as education and communication, enlisting greater participation, forming partnerships, providing facilitation and support, negotiating, and even co-opting or coercing may be used to overcome resistance to change.
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Annex 3
Glossary health professional
this term is used in its broadest definition, and refers to all those providing health services recipients of health services in any setting, includes patients in hospitals or clinics strong, formal relationship, developed with equal commitment from each partner around a common goal, the achievement of which will benefit all partners informal, cooperative relationship, developed around a common goal where the outcome may be of greater benefit to one party than to the otherjs, may include one party providing support or assistance to another
clients
partnership
collaboration
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Promoting the Health of Communities Guidelines for Health Professional Education
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Annex 3
Promoting the Health of Communities Guidelines for Health Professional Education These guidelines have been developed to support educational institutions throughout the Western Pacific region in reviewing and strengthening health professional education and training at all Levels - basic, post-basic and continuing. The guidelines are not intended to prescribe a particular course of action, but rather to offer suggestions that countries and institutions may draw on and adapt to suit their unique circumstances and settings.
1.0
The political component
Political leaders, policy and decision-makers within the health, education and related sectors need to understand the challenge of Building Healthy Communities and Populations and the value of seeking to achieve Health For All. Their active support is essential to the successful reform of health professional education and training.
Promoting the Health of Communities Guidelines for Health Professional Education
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Action list • Identify key decision-makers in the government, such as senior officials of Ministry of Health, Ministry of Education, Ministry of Finance and other relevant Ministries; • Identify key stakeholders in nongovernment sectors, such as education institutions, regulatory and advisory bodies, professional associations, funding agencies, nongovernmental organizations, consumer and advocacy groups; • Establish or strengthen mechanisms for government and nongovernment stakeholders to meet and discuss BHC & P and related matters; • Demonstrate to stakeholders (through discussion and dissemination of appropriate information) the benefits of promoting health and the need to orient health professional education in this direction; Examples of Indicators • Develop supportive policy statement!s at Ministry, institutional and programme levels. • Presence of national policies such as supportive sectoral policies in Health, Education, Finance, and/or National Health Promotion Policy. • Allocation ofbudget for implementation of Guidelines at national and/or sectoral level. • Evidence of organizational or structural reforms/changes that support the promotion of health.
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2.0 The technical component
The technical component of these guidelines offers institutions support for action in five key areas: institutional capacity, partnerships, curriculum, graduate attributes and research. 2.1 Institutional capacity In order to undertake the reform and provide the required support for both educators and students, institutions need to develop the necessary technical capacity in the core areas identified in theme component of BHC & P, and in the
management of change. Action List • Identify existing organizational structures, resources and faculty competencies which could be useful for implementing this approach; • Identify relevant professionals or organizations who could help increase the technical capacity of the institution; • Identify and support a focal point/Leader to act as a resource for change and to organize, coordinate and implement the intended activities; • Identify existing programmes and curricula which either reflect the promotion of health or have components relevant to this approach; • Assess the Level of understanding and acceptance of this approach amongst the faculty administrators and educators;
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• Raise the faculty's level of understanding and appreciation of the elements of this theme; • Identify constraints to change within the institution and develop strategies to overcome them; • Identify deficiencies in students' understanding and skills in the area of BHC & P, including communication, analysis and problem-solving; Examples of Indicators • Change in knowledge/awareness/skills/attitudes of teachers; • Curriculum review; • Staff attendance (teachers and clinicians) at briefings/meetings re BHC & P; • Endorsement/acceptance of promotion of health concepts by faculty and administration; • Production and distribution of institutional materials on concepts promoting health. 2.2 Partnerships Institutions must develop working partnerships with key stakeholders in the health sector, other sectors and in the community.
Action list • Identify, inform and orient relevant organizations, institutions, authorities and community groups within and outside the health sector on the principles and benefits of BHC & P; 20
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• Establish or strengthen links with relevant organizations, institutions, authorities, and community groups within and outside the health sector to obtain their active participation and support in implementing this approach; Examples of Indicators • Preparation and dissemination of directory of key stakeholders; • Multisectoral composition of any committee involved in implementation of Guidelines, at any level - national, sectoral, institutional; • Implementation committee/s multi-resourced, with contributions from partners; • Evidence of terms of reference developed by the committee, or partners define/guide/monitor the involvement of partners.
2.3 Curriculum
Institutions must orient basic and continuing education programmes towards BHC & P approach, and emphasise foundation skills such as communication, analysis and problem-solving. Action list • Develop a clear outline of content on the promotion of health · in the curriculum, allocating adequate time for both theory and practice;
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• Include student-centred learning activities in the classroom, community and other health care delivery settings; • Assess students on their understanding and appreciation of BHC & Pas a part of their overall assessment; • Evaluate education programmes regularly to ensure relevance and effectiveness; • Encourage staff to undertake related research and to develop multisectoral contacts; • Incorporate into the existing curriculum, teaching and learning activities to strengthen the understanding and skills of students in areas relevant to the BHC & P approach. • Establish or strengthen links with relevant organizations, institutions; Examples of Indicators • Inclusion of health promotion in course content/curriculum; • Inclusion of health promotion in formal student assessment; • Results of assessment show students understand health promotion; • Inclusion of student-centred Learning activities, including participatory approach; • Organization of community activities of students along concepts of BHC & P.
2.4 Graduate attributes
Graduates of education programmes which incorporate the apprach of BHC & P will appreciate its value, apply the relevant skills and act as advocates for health promotion, health protection, 22
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multisectoral action and empowerment of others in the attainment of Health For All. Action list • Institutions will produce graduates who: 0" Act as role models for healthy and ethical behaviour; 0" Establish partnerships with clients, families and communities, other professionals and organisation s through effective communication, and involve non-traditional partners in addressing health issues as appropriate; O" Demonstrate knowledge, skills and attitudes essential to effective health promotion practice; O" Demonstrate competency in planning, implementing and evaluating health promotion interventions for individuals and groups; O" Evaluate their own performance and show a commitment to life-long professional self-development. Examples of Indicators • Use of participatory approaches by graduates in health service delivery; • Demonstration of BHC & P knowledge by graduates; • Change in attitude to HP among community members.
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2.5 Research
Research increases the understanding of BHC & P approach and the application of relevant principles, and underpins educational reform in this direction. Action list • Encourage and support staff to undertake research in areas relevant to BHC & P; • Allocate resources for research in areas relevant to BHC & P; • Monitor health trends in the community; • Work with the community in setting a research agenda to address Local health needs and issues; Examples of Indicators • Evidence of survey of health needs of the community; • Allocation of funds for research; • Inclusion in curriculum of research methodology appropriate for investigation of HP, such as participatory research; • Evidence of curriculum review informed by results of research.
3.0 The coordination component
Existing and emerging information relevant to health professional education for BCH & P should be disseminated. Collaboration between institutions involved in health professional education at both national and regional Levels should be encouraged to maximise opportunities for learning and reflection. 24 Promoting the Health of Communities Guidelines for Health Professional Education
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Action List • Identify in each country a responsible officer or department to coordinate activities and facilitate information exchange in implementing the reform of health professional education within the context of BHC & P; • Seek support from international development partners to facilitate and support reform of health professional education in the direction of BHC & P ; • Participate in self-evaluation at an institutional and programme level, and share experiences and outcomes nationally and regionally; Examples of Indicators • Presence of focal person or unit with responsibility for coordination of HP integration into health professional education; • Evidence of working/steering group of stakeholders which meet regularly and demonstrates coordination through its meeting minutes; • Evidence of communication re the integration of HP into health professional education between institutio ns, stakeholders, countries through newsletter, homepage or other method.
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Further reading Boelen C. & Heck J.E. 1995, Defining and measuring the social accountability of medical schools, World Health Organization, Geneva. Dunphy D.C. 1991, Organizational Change by Choice, McGraw Hill, Sydney. Hine B. & Ritchie J. (eds.) 1997, Orienting Human Resources to the New Horizons in Health Approach, proceedings of the World Health Organization Intercountry Workshop, University of New South Wales, Sydney. Robbins S.P. 1993, Organizational Behaviour (6th Edition), Prentice Halt International, Englewood Cliff, New Jersey. World Health Organization, 1996, Doctors for health, World Health Organization, Geneva. World Health Organization - Regional Office for the Western Pacific, 1996, Health Promoting Schools , Series 5, World Health Organization, Manila. World Health Organization - Regional Office for the Western Pacific, 1995, New Horizons in Health, World Health Organization, Manila. 25
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3. Develop and Strengthen Coordination and Networking Mechanism
Identify focal person
Focal person in place, facilitate participation in all regional or subregional meeting on concepts Coordination of regular Key Stakeholders meeting Bet ter coordination and improved information sharing
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Review National Health Promotion Policy
Gaps in the policy identified Strategic direction for change in health education and promotion approach developed Cost implications related to the change of policy direction identified
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Health Promotion Policy reflects concepts
Review Current Community Health Promotion Curriculum for nurses
Gaps in the curriculum & potential links identified Costs related to implementation of the curriculum identified Workshop for nurse tutors
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Relevant concepts in Nurses curriculum Nurse Tutors better understand the scr.cepts