Report VLIR / Primafamed workshop

Transcription

1 End of August 2010, the VLIR Southern African Family Medicine twinning project partners came together in Ezulwini, Swaziland for the yearly workshop. In this project, funded by the VLIR (Flemish Inter University Council), the South African departments of family medicine are twinning with a partner country in Southern Africa to work as South South cooperation on the development of the family medicine training. The workshop this year had the general theme of research integrated in the family medicine training, as the master thesis is an important part of the training. Research on PHC and family medicine in the African setting is extremely useful for improving the health care for the community and all doctors. To train family physicians and other health care workers to do research in their normal work setting can give a lot of interesting cases and research outcomes. Next to this the workshop gave time for a reflection on the project itself, what has happened in the past year, where do the different partners stand now and what is planned for the coming years.

2 As a general introduction the workshop started on the afternoon of Monday 23 rd August with a reflection of Prof. Jan De Maeseneer on family medicine and its contribution to the realization of the Millennium Development Goals. He pointed out the recommendation of the WHO commission on social determinants of health and the 2008 world health report, PHC now more than ever. Community oriented primary care and patient-centered care play an important role in reaching the MDG s. After this introduction the status of PHC and the family medicine training in the different countries was discussed. Prof. Jan Heyrman chaired this session with a questionnaire that was sent to all partners as the starting point of the discussion. The discussion was very broad and rich. The main topics that came up, can be summarised as follows: local context is very different e.g. if you compare the situation in Namibia with Swaziland or Zimbabwe. So, the most urgent needs have to be addressed first: when there is only a starting undergraduate curriculum, the contribution of family medicine to that curriculum, may be an urgent issue. Community exposure during the undergraduate curriculum in different forms (attachment to communities, to families), is of utmost importance. Moreover, there is a need for increasing the social accountability of undergraduate medical curricula. primary health care is based on the team-concept: family physicians, nurses, nurse practitioners, clinical associates, In some regions, the family physician is mainly positioned in the district hospital, in others in the primary health care centers. Cooperation with nurses in the clinics is of extremely importance, with regular outreach of family physicians to support the work in the clinics as an

3 appropriate strategy. The question is: how are we going to prepare practitioners, for the team concept (inter-professional education?). quality is an important issue: guidelines should be present and updated, an essential drug list is an important tool underpinning the therapeutic quality. There is a need for capacity building: how to find and to train tutors for family medicine trainees? How to deal with building capacity, in a context where you have doctors from different origin (e.g. situation in Botswana)? Scaling up is necessary, and lessons can be learned from the experiences within South-Africa e.g. in orientating undergraduate students towards primary health care, out of the hospitals. There is political goodwill and support, but this does not always translate in policy and funding. Positive evolutions of official recognition of the discipline of family medicine are present in more and more countries. It will be important to take the population on board, in the profiling of primary health care as the point of first contact of the people in the health care system. The attractivity of "technology" (in secondary and tertiary care), remains an issue. So advocacy is important, as is the demonstration of the performance of primary health care. Family medicine should be orientated towards integration, comprehensiveness, embracing complexity. The twinning project facilitates the actions of the departments of family medicine in South-Africa to strengthen their "twinning-partners". This very fruitful discussion took most of the afternoon of day one and the morning of the second day. In between a few speakers gave a presentation on linked topics. Dr. Lilo Du Toit did a literature review on South-South cooperation in medical education as a part of the work plan of the twinning project. She presented her findings in a very interesting talk. What is South-South cooperation (SCC), history of SCC and different models of SCC, with a focus on health care and health education.

4 Prof. Ian Couper discussed the global policy recommendations of the World Health Organization on Increasing access to health workers in remote and rural areas through improved retention. The report gives advice divided into four areas: education, regulatory, financial incentives and personal/ professional recommendations. Next to this he gave a session on teaching and assessing the consultation. With juggling balls he explained that a consultation is more than asking questions to the patient. It is an ongoing process of facilitation, clinical reasoning, collaboration to get to a synergy of the expectations of the doctor and the patient. WHO Global Policy Recommendations on Access to Health Workers After a 2 year process, WHO has recently published Global Policy Recommendations on Increasing Access to Health Workers in Rural and Remote Areas through Improved Retention. These guidelines are based on the best available international evidence. They recommend strategies for attracting, recruiting and retaining health works in rural and remote areas through educational, regulatory, financial, and personal and professional support approaches. These need to be relevant and affordable in the local context, and should not be implemented piecemeal but ideally as a package, as part of an overall national health plan. The guidelines are particularly important to us as educationists (the most evidence is available for the educational recommendations) and as health professionals working in primary care in Africa, where we have such critical shortages of skilled health workers. Teaching and Assessing the Consultation The juggler model is an approach developed by Ian Couper and Jannie Hugo to assist teaching and assessing the consultation. It defines 3 groups of skills which can be taught, practiced and assessed separately, and which need to be at play throughout the consultation: facilitation, clinical reasoning and collaboration. They

5 offer a method of putting together the many models and stages of the consultation in a cross-cutting way. A final element is integration of the processes into a logical, orderly whole within the available time. Record-keeping is important; here the SOA 3 P 4 approach is useful subjective, objective, 3-stage or biopsychosocial assessment and a 4-part plan which incorporates the 4 tasks defined by Stott. Registrars can be assessed on these groups of skills separately and together in observed consultations. Dr. Mergan Naidoo presented Using experiential learning to enhance patient centered clinical method. The learning process in adults is more significant when it refers to applied knowledge (experiential learning), the principles as stated by Rogers and the Kolb cycle were discussed. How to use the experiential cycle in teaching students. With reflecting ourselves we can improve our skills. Prof. Bob Mash opened the thematic part of the workshop on research. With his presentation Integrating research into family medicine training: Educational design he gave an introduction on the different aspects of research. With the analysis of family medicine in Sub Sahara Africa in several studies he set the example of how to look at research. The ADDIE model; analysis evaluation implementation development design was discussed.

6 Prof. Jan De Maeseneer, Prof. Jimmy Chandia and Lynn Ryssaert started with the First important session; Learning to choose and refine a research question. With the good characteristics of research (FINER) list of Huley examples of research questions from the participants were discussed; Is the research question feasible, interesting, novel, ethical and relevant? To have a good objective is the basis of good research. Prof. Graham Bresick and Prof. Alison Pollock gave a workshop on Learning to work with different research paradigms and study designs. Prof. John Ndimande and Prof. Jan Kartounian gave a session on Learning to facilitate an action research project and Learning to do a quality improvement project. Dr. Kristin Hendrickx gave an introduction on Data analysis of qualitative research. After some theory on how to collect and analyze data by coding, the participants were asked to do an exercise, with this as example she continued the workshop, explaining the pitfalls. Computer programs can be very useful in analyzing qualitative data, but also has some negative aspects. At last she gave a brief explanation of framework analysis. Last but not least Prof. Pierre de Villiers gave a presentation on Learning to write a research article. Collecting data and findings is useful, though it is important to know how to disseminate these data to the outside world. Questions like why to publish, how to write a readable/ structured manuscript, which journal to publish in, were discussed. Important tips were given on how to increase the chance to have your article published in the chosen journal.

7 Several posters were made by the partners on the status of the family medicine training in the different universities/ countries, these were discussed in between the sessions. The last day the partners had time to sit together with their twinning partner to discuss their status and the strategy they will follow in the coming year. For some partners it was the first time to sit together and discuss the possible plans and the work together. Prof. Jimmy Chandia from Walter Sisulu University tried to connect with Zambia in the past year, without result, but as representatives from the College of Primary Care of Physicians of Zimbabwe, Dr. Muriel Fallala and Dr. Godfrey Mungwadzi have shown great interest in this cooperation. Also for Dr. Mergan Naidoo from the University of Kwa Zulu Natal it was the first time to sit together with the representatives from Catholic University of Beira, Dr. Mario Antunes, and Universidade Eduardo Mondlane, Dr. Alfeu Passanduca, in Mozambique. The possibility to work together in the development of a community health program in the undergraduate curricula was discussed as it is too early to start a postgraduate family medicine training in Mozambique. Stellenbosch University (Prof. Bob Mash) and the University of Botswana (Dr. Sunanda Ray and Dr. Taatske Rijken) on the other hand have been intensively working together the past year and the first registrars in the new Botswanean family medicine training will start in January Prof. Ian Couper from Witwatersrand University and Dr. Luckson Dullie from Malawi discussed the possibilities for training in Malawi. Dr. Fola Tiamiyu from the University of Pretoria and Dr. Francis Aimuan from Swaziland talked about how Pretoria could assist in training family physicians in/ from Swaziland. Prof. Graham Bresick from the University of Capetown and Dr. Marcus Goraseb and Dr. Milly Morkel from the University of Namibia have been working together in the past year in the twinning and discussed

8 the plans for the coming year on how to integrate the family medicine in the PHC strategy of Namibia. Prof. Cecil Boltman, Free State University, twinning with Lesotho will continue the communication in the coming year with the representatives. Limpopo University (Prof John Ndimande) is working out the possibility to twin with the University of Goma (DR Congo). In the evening meetings the work plan, all activities, administrative issues and the budget were discussed. Not only partners in the VLIR-project were present during these three days, partners in a new, EU-FP7 funded project, were also present to discuss the HURAPRIM (Human Resources for Primary Care in Africa) project, which will start in This project focuses on research around human resources in primary health care in the African setting. Ghent University works together in this project with Witswaterrand, Botswana, Mbarara, Ahfad, Mali, Vienna and Oxford University. During the workshop, in between sessions, several of the participants were interviewed by Selwa Othman, a family medicine registrar at Ghent University. For her master thesis she was very interested in the medical training in Sub Saharan Africa, how PHC is integrated in the undergraduate medical training and the reason why students decide (or not) to work as a doctor in PHC and do the family medicine training. For her research proposal she developed a questionnaire for a qualitative research with interviews from doctors from the different countries and universities involved in the Primafamed/ VLIR workshop.

9 With the hard work of all partners in the different countries, family medicine is growing. Slowly but steadily, family medicine is starting to make a difference in the health care in Southern Africa. With South South cooperation and sharing knowledge and skills we are learning from each other and we can build a strong network that will be heard by policymakers. By working together with local communities, health care workers and policymakers on all levels and with partners and stakeholders on international level, we can make PHC and family medicine the starting point of health care for all again. Accessible, affordable, equitable quality health care for the community is feasible. Together we can do this. All my thanks to all the VLIR for funding this project and making the workshop possible and all my thanks to all the partners in the project. Maaike Flinkenflögel Workshop organizer

10 Ministry of Health and Social Welfare Swaziland Rural Doctors Association of Southern Africa 14 th Annual Conference on Rural Health August 2010 The Royal Villas, Ezulwini Valley, Swaziland The 14 th Rural Health conference was an unqualified success: Over 250 Health Professionals from all parts of Africa registered, making it our largest conference to date. Swaziland played a magnificent host on the occasion of this first conference outside RSA. Our theme was Inspiration without Borders and by all accounts, we succeeded in this! In keeping with the RuDASA spirit, the programme was highly varied and covered many issues around Rural Health. We were privileged to have high quality international speakers and at our plenary talks we learned of the history of MSF, were welcomed by Hon. Minister Benedict Xaba (MOH), heard perspectives on HIV in Swaziland, Swaziland health care and then other wider issues around HIV in Southern Africa. We ran 5 concurrent venues including: New Ideas in Rural Health, Primary Health Care, Clinical Skills, Human Resources, Advocacy, Research, HIV prevention and Management, Medical Students, Task Shifting, Chronic Care, The Rural Health Specialist, Snakes and Snakebites. Our venue, Royal Villa s, met our every expectation and produced an efficient conference service as well as being a luxurious venue for our guests. On reviewing our feedback questionnaire, we received overwhelmingly positive responses from our delegates: We believe we ve succeeded in our mandate to Inspire for Rural Health! Thank you assisting so many Primafamed delegates to attend. A precedent has been set for a great working relationship between RuDASA and Primafamed! We wish you every success in the expanded scope of your work struggling for health provision in Africa. We look forward to partnering with you again in Rural Health! Dr Jonathan Pons Convener jono@goodshepherdhosp.org