Think intersectoral! / by M. A. C. Dowling and Roberta Ritson

One of ten natiqnal ~rojects .in Jhe wHcz!uNoe· Health;Lea~n­ mg . Materials progr~mme, the . c.~nt~(3 ''fqr Edu?ational De- velopment in Heallti inArusha, ~a~za.~i .. ?' is aprimee~a~pl~ (Jf a health project vyhich ~.ngage$ • man'Y.i[ Otper sectors It is usual to think of a health training institute as concerned only with health personnel and medical problems . In fact, in a developing country this is often far from the case. The reality of the daily routine for the director of a health training institute in a country like Tanzania means facing a host of differ- ent practical problems and conflicting priorities. To run a successful training school, you need to look beyond the health care field and "think inter- sectoral ". Dr Ezra Teri is Principal of the Centre for Educational Development in Health in Arusha (CEDHA) , Tan- zania. He first qualified as a doctor at the University of Makerere in Uganda, then studied public health in California, before going on to take his Master's degree in health personnel education at the University of New South Wales. His present job as Principal of the Centre in Arusha involves him in con- tacts with many sectors other than health. He has been obliged to de- velop new skills beyond those for which he was originally qualified. CEDHA is a national training institute of the Tanzanian Ministry of Health. 22 Its aim is to upgrade the health care system by improving the training of health service personnel. A primary activity, therefore , is the teacher training programme of the Centre. The teachers of the future must be good planners and managers, and not just experts in certain specific subjects. So CEDHA trains teachers of health personnel in pedagogic, man- agerial and research skills, as well as in primary health care. This entails close involvement with the Ministry of Edu- cation's institutions , whose teaching staff have the necessary knowledge of educational technology and can help to design and conduct courses for the health sector. These courses are very varied : some of the CEDHA students are just undergoing a complete voca- tional training, while many others are experienced health workers taking " refresher" courses of "in-service" training. Ezra Teri has close contacts with the Institutes of Development Manage- ment in Mzumbe, Morogoro and in Swansea, UK, which run PHC manage- ment courses at CEDHA for managers of district health teams. Dr Teri him- self attended a month's course in Oc- tober 1985 on managerial techniques in training teachers of health sciences, held partly in Moscow and partly in London. The Health Learning Materials pro- ject at CEDHA, Arusha, of which he is project manager, is one of a network of ten national projects in the WHO/ UNDP Interregional Health Learning Materials programme. The aim of this programme is to help developing countries to gain expertise in produc- ing their own teaching and learning materials for local health workers. This demands special skills in manage- ment from the national project leader, unlike most routine health posts. It also requires skills in communication, so that he can cooperate very closely with colleagues in many different sectors. Producing your own materials The production side of the learning materials project obliges the project manager to learn about the practical and technical side of printing, since he has to produce printed texts of manu- als, reference books and teacher guides, as well as other training mate- rials for health care workers. There is W oRLD HEALTH, March 1986 Dr Ezra Teri, manager of the Health Learn- ing Materials project in Arusha, Tanzania . Photo W HO also a heavy demand for health educa- tion materials,. which the health work- ers can use in their contacts with local communities. Since he took up his post as the first Principal of CEDHA in 1982, Dr Teri has recruited a medical illustrator and photographer for the project. He has also engaged an all-round technician to handle the offset printing machin- ery and all the other equipment needed in the illustration, printing and binding of texts . Students and staff at CEDHA carry out their own research into the kind of educational materials needed for the different cadres of health workers in Tanzania, and learn to write, illustrate and produce the finished materials on the spot. None of the medical staff at the Centre previously possessed real skills in writing or editing, let alone the production of materials. So specially- tailored training courses were de- signed for them. For this, the African Medical and Research Foundation W oRLD HEALTH, March 1986 (AMREF) in Nairobi, Kenya , was called in. AMREF is a non-governmental or- ganization which has many years of . experience in producing training materials for health personnel all over Eastern Africa. Dr Joe Popp, head of AMREF's training section, designed a special course at Arusha to provide CEDHA staff with the writing and editing skills they needed to develop their own teaching materials, and travelled to Arusha last March to hold the course. This was reinforced by an editors' course in July, conducted at AMREF in Nairobi, and attended by trainee editors from national projects m Ethiopia, Kenya and the Sudan, as well as from CEDHA . Training the key project staff at CEDHA is, of course, a priority for Ezra Teri. He is constantly on the look-out for appropriate training institutes and opportunities to get training for his staff. He sent Wilson Lendita, the librarian and audio-visual aids special- ist at CEDHA, to London in August 1985 to follow a specially-designed training course, organized by the Blat Centre, on audio-visual aids in the health library. Like AMREF in Nairobi, the Blat Centre (British Life Assurance Trust for Health Educa- tion) works closely with WHO in sup- porting the network of national health learning projects. As a result of this training, Wilson Lendita is now run- ning the library more efficiently and is in the process of developing it into an information resource centre for the health sector. Training and equipment , of course, need to be paid for , which means that another very time-consuming aspect of Ezra Teri's brief is fund-raising and public relations. It soon became obvi- ous that CEDHA needed its own public relations brochure, as well as more well-presented information materials if it could hope to attract funds from major donor agencies. Dr Teri has worked hard to develop public rela- tions skills and an extensive network of personal contacts in donor groups and non-governmental organizations. He has obtained support from a number of Dutch church organiza- tions, as well as the German Founda- tion for International Development based in Berlin. The German Founda- tion is now discussing a proposal with the Ministry of Health in Dar es- Salaam to part-fund a three-year pro- gramme of teacher training at CEDHA. 23 Institution building as one of the objectives of development aid has al- most become a cliche. In the case of the centre in Arusha, it has to be taken literally. Three years ago, CEDHA's premises in Arusha were a jumble of derelict buildings with broken windows, electrical fitments .torn out, and no equipment. Thanks to Dr Teri's fund-raising efforts, the Dutch church groups have now pro- vided the Centre with building mate- rials of all kinds, ranging from electri- cal equipment to cement, most of which are not easily or cheaply obtain- able in Tanzania. With no foreign currency available, the Centre could not have hoped to buy these abroad. Plans are now underway to build staff housing and enlarge the premises of the health learning materials pro- ject. More space has to be found to house the offset printing and binding equipment and printing supplies do- nated by WHO. A local publishing house, Tanzania Litho Arusha, has pledged to help Dr Teri to identify the kind of printing equipment he needs to produce his own health training mate- rials, as well as providing training for CEDHA print-shop staff. To get the Arusha Training Centre 24 operational, he has had to involve himself not only with builders and planners, management trainers and educational technologists, but also with illustrators and technicians re- sponsible for producing printed train- ing materials. He comments, "Inter- sectoral cooperation requires a great deal of public relations work and in- formation flow. It requires dynamism and personal commitment, teamwork and the pooling of human, material and financial resources for a com- mon goal..." As part of his drive to make the Centre better known to the public and the health sector, and in the hope of finding additional support, Dr Teri has built up a good relationship with the local Arusha office of the "Tanzania Daily News" and "Uhuru", a news- paper circulated in Swahili. Through personal contacts in the Shihata news agency, he gets newspaper coverage of the Centre's activities, and Radio Tan- zania has broadcast features on CEDHA's health programmes at least once a year. Dr Teri works in close contact with WHO, UNDP, UNICEF and other agen- cies, as well as with NGOs. WHO gives financial support to CEDHA in the form Both students and staff at the Arusha Centre learn to write, illustrate and produce finished materials on the spot. Photo WHO of equipment and supplies, by under- writing the study travel costs for key staff, and by providing a grant in local currency to cover the costs of work- shops and surveys. WHO also gives technical advice and helps to send suitable consultants to Tanzania with expertise in the areas most needed by CEDHA. The Centre is working very closely with a neighbouring village in training students on primary health care, so Dr Teri has to plan and provide infor- mation sessions for village leaders and their communities. This calls for close involvement with the villagers in order to achieve the objective of producing trained health personnel who will in future serve in the peripheral and rural settings. As Ezra Teri himself says: "All those involved must clearly define the goal of their cooperative venture and show commitment and involvement right from the planning stage through to its successful conclusion." • W oRLD HEALTH, March 1986 J ' '