|Year : 2011 | Volume
| Issue : 2 | Page : 704
Continuing Progress in Primary Healthcare Education
M Glasser1, S Cristancho2, RM Borrell3, D Pathman1
1 Co-Editor, Education for Health
2 National Center for Rural Health Professions, University of Illinois College of Medicine at Rockford, USA and Facultad Nacional de Salud Pública, Universidad de Antioquia, Antioquia, Colombia
3 Regional Associate for Education in the Health Sciences, PAHO
|Date of Submission||03-Aug-2011|
|Date of Web Publication||10-Aug-2011|
1601 Parkview Ave., Rockford, IL 61107, USA
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Glasser M, Cristancho S, Borrell R M, Pathman D. Continuing Progress in Primary Healthcare Education. Educ Health 2011;24:704
Two years ago, we reported in this column on the importance of the World Health Organization’s renewed focus on primary healthcare – EFH, 2009:22(3)1. Primary healthcare (PHC) continues to be a high priority of the Pan American Health Organization (PAHO) and its Human Resources for Health group specifically as it relates to medical and health professions education programs for Central and South America. This past June, PAHO, in cooperation with PALTEX—a technical cooperation program of PAHO to increase the quality of health sciences education in Latin America by distributing textbooks and instructional materials in Spanish—convened a conference in Cartagena, Colombia entitled 'La Educacion en Ciencias de la Salud Hacia la Atencion Primaria de la Salud (APS) y los Libros de Textos.' The conference’s 40 participants, from nine countries, including Argentina, Brazil, Canada, Chile, Colombia, Mexico, and the United States, came to share their efforts related to PHC education. The objectives of the meeting were to:
- Analyze health sciences education strategies in the Americas and share experiences that have used a primary healthcare (PHC) perspective, as defined by WHO.
- Provide recommendations through regional guidelines and strategies in order to move health sciences education forward towards PHC.
- Suggest textbooks that would support renewed PHC learning and examine the possibility for PALTEX to develop a series of textbooks on this topic.
- Promote the development of an interprofessional regional network aimed at discussing, recreating, promoting and developing knowledge, as well as strengthening the PHC approach in health sciences education.
Four presentations reflect the type of information shared on PHC. The experience of the Universidad Nacional de Tucuman in Argentina, presented by Dr. Demetrio Martinez, Dean of Medicine, highlighted the importance of political commitment to including PHC in the medical curriculum. Dr. Martinez’s talk also emphasized that PHC should be a longitudinal component of the curriculum, expressed in a series of curricular axes that include bioethics, mental health, public health, emergency care and research methods. He emphasized the importance of developing and sustaining partnerships with communities and gradually shifting learning settings through the course of study from lab and clinically-based to community-based venues. The Tucuman experience is grounded in an ethical principle of commitment to service, where academic excellence is not the main goal but instead a means to achieve excellence in service.
In a second presentation, Dr. Clarice Aparecida Ferraz explained that in Brazil, the Ministry of Health works within a unified healthcare system that has been grounded in PHC principles since the country’s constitutional reform in 1988. The Brazilian government developed several strategies as part of its human resource training reorientation policy. These policies include a national program for the reorientation of professional education in health (PRO-SAUDE). PRO-SAUDE has transformed and integrated knowledge generation, teaching, learning and service provision processes using an integral perspective of the health-illness continuum with an emphasis on PHC. As a result, a total of 354 courses have been taught with this approach to 97,000 students of the various health professions including medicine, nursing, dentistry, physical therapy, nutrition and psychology. Other strategies that are part of the national policy for permanent education in health include the program of education for healthcare workers (PET-SAUDE) and the medical and multi-professional residency both of which are based on a preceptorship model for students and professionals at healthcare providing institutions. These preceptorships are aimed at teaching and reinforcing PHC concepts in daily practice.
Dr. Eduardo Hebel, Dean of Medicine at the Universidad de La Frontera in Temuco, Chile, presented the work taking place in surrounding La Araucania, a region where almost one-fourth of the population is indigenous, mostly Mapuche. The school’s curriculum is student-centered and teaching is guided by a problem-based learning (PBL) approach. Through interdisciplinary centers for local development as part of a rural internship program, the school has been able to implement a PHC model based on service-learning. The program is grounded in principles and strategies that include acknowledgment and respect for local cultures, community participation in the definition of needs and interventions, interdisciplinary teamwork, and taking the neighborhood as the territorial focus and the family as the main unit of intervention. This experience emphasizes for students the importance of healthcare working hand-by-hand with education, of balancing care and prevention, of recovering the 'popular knowledge' or local and traditional views on health and illness and of using art as a key communication and learning method between students and communities.
Dr. Alvaro Cardona, Dean of the National School of Public Health in Colombia, presented a historical analysis of healthcare policy and PHC trends in Colombia and in the region of Antioquia. The School has historically responded to policy changes by generating new knowledge and training a public health workforce under a PHC approach both at the undergraduate level (in health services administration, environmental health administration and health systems information management) and at the graduate level (for masters in public health, epidemiology, mental health and occupational health and doctorates in public health and epidemiology). Furthermore, the School has adopted a critical position in advocating for the PHC approach in the difficult context of a neoliberal national social security system that has operated in Colombia since 1993 and that is mostly market-oriented.
Overall, recurring themes related to primary healthcare that emerged at the Cartagena meeting were: interdisciplinary approaches; integration of service and learning; balancing care and prevention; political commitment to PHC; PHC-oriented health policy at the national level and advocacy for PHC policy; strong community trust and participation through the development of partnerships; and strong leadership in higher education institutions as well as in communities.
These same themes are reflected in several articles in this and recent issues of Education for Health. In this issue, Lee and colleagues, in 'Value of a Health Behavior Change Reflection Assignment for Health Promotion Learning Participants,’ reported that students discovered the complexity of health amidst socio-environmental influences, and critically assessed the environmental risks in familial and social contexts influencing their behavior2. From this reflection exercise, students described increased motivation, confidence and belief in their ability to successfully pursue a health behavior change, setting the stage for working with communities in long-term, health promotion interventions. Also in this issue of EfH, Solomon and Salfi describe the results of an interprofesional education program that provides students with the opportunity to interact with colleagues from other professions in an intensive yet realistic educational event3. In the process, students built confidence through their interactions and learned about others' scope of practice, helping to prepare them for a team approach to healthcare delivery. One student summarized 'It was really great to see how all the professions did overlap; like you were saying, with a holistic view and that you're not just focused on one thing, you're kind of looking at the whole person.' In a similar vein, a letter to the editor by Svan Åström in our previous issue of EfH, entitled 'Teamwork: A Graduating Medical Student’s Perspective' points to the importance of learning to be a part of the healthcare team4.
Other papers addressing PHC from the perspectives of education, providers and communities from this and recent EfH issues include: 'A Community Health Worker Program for the Prevention of Malaria in Eastern Kenya' (Stromberg et al.)5; 'Changes in Healthcare Workers’ Knowledge about Tuberculosis Following a Tuberculosis Training Programme' (Naidoo et al.)6; 'General Population and Medical Student Perceptions of Good and Bad Doctors in Mozambique' (Pfeiffer et al.)7; 'Inspiring Health Advocacy in Family Medicine: A Qualitative Study' (Mu et al.)8; and 'Developing Culturally-oriented Strategies for Communicating Women’s Health Issues: A Church-based Intervention' (Aja et al.)9.
These papers and the PAHO meeting reinforce the importance of the need for healthcare institutions developing strategies to provide services with a PHC approach. This includes increasing the PHC-trained workforce, hiring and training a staff that is sensitive to local needs, promoting interdisciplinary work and taking a health promotion and disease prevention perspective. Service staff needs infrastructure and resources to adequately implement PHC strategies, programs and plans. Healthcare institutions need to develop partnerships with the communities they serve.
Communities, in turn, need to build their capacity to articulate and address their priority health issues. Initially this could be accomplished through partnerships with health sciences education institutions and healthcare providers. In the long term, however, communities need to develop more leadership, take ownership and feel empowered to actively and more independently accomplish transformations, participate, advocate, negotiate and set the priorities for external actors to make significant contributions to their well-being.
The need for PHC remains a topic of global importance. It is our hope that Education for Health and The Network: Towards Unity for Health can continue to work with agencies like PAHO and others in seeking opportunities to enhance PHC education and extend PHC delivery at multiple levels including the community, regionally and nationally.
Michael Glasser, PhD
Co-Editor, Education for Health
Sergio Cristancho, PhD
Research Assistant Professor, National Center for Rural Health Professions, University of Illinois College of Medicine at Rockford, and Coordinador Grupo de Investigación en Salud Mental, Facultad Nacional de Salud Pública, Universidad de Antioquia
Rosa Maria Borrell, MD
Regional Associate for Education in the Health Sciences, PAHO
Donald Pathman, MD, MPH
Co-Editor, Education for Health
1. Glasser M, Pathman D. Renewed Focus on Primary Health Care (PHC). Education for Health, 2009; 22(3).
2. Lee BK, Yanicki SM, Solowoniuk J. Value of a Health Behavior Change Reflection Assignment for Health Promotion Learning. Education for Health. 2011; 24(2).
3. Solomon P, Salfi J. Evaluation of an interprofessional education communication skills initiative. Education for Health. 2011; 24(2).
4. Svan Åström T. Teamwork: A Graduating Medical Student’s Perspective. Education for Health. 2011; 24(1).
5. Stromberg DG, Frederiksen J, Hruschka J , Tomedi A, Mwanthi M. A community health worker program for the prevention of malaria in Eastern Kenya. Education for Health. 2011; 24(2).
6. Naidoo S, Taylor M, Esterhuizen TM, Nordstrom DL, Mohamed O, Knight SE, Jinabhai CC. Changes in healthcare workers’ knowledge about tuberculosis following a tuberculosis training programme. Education for Health. 2011; 24(2).
7. Mu L, Shroff F, Dharamsi S. Inspiring health advocacy in family medicine: A qualitative study. Education for Health. 2011; 24(2).
8. Pfeiffer A, Noden BH, Walker ZA, Aarts R, Ferro J. General population and medical student perceptions of good and bad doctors in Mozambique. Education for Health. 2011; 24(1).
9. Aja GN, Umahi EN, Allen-Alebiosu OI. Developing culturally-oriented strategies for communicating women’s health issues: A church-based Intervention. Education for Health. 2011; 24(1).