Primary Health Care Management
Content
GRADUATE SCHOOL OF HEALTH AGO MEDICAL AND EDUCATIONAL CENTER BICOL CHRISTIAN COLLEGE OF MEDICINE MODULE GUIDE
COURSE NUMBER COURSE TITLE CREDIT UNITS ALLOTED TIME PROFESSOR:
EPDM 450 PRIMARY HEALTH CARE MANAGEMENT 3 UNITS 54 HOURS/18 MEETINGS
COURSE DESCRIPTION Introduces students to the origins, concepts and development of community-based primary health care through case studies from both developing and developed countries. Like clinical bedside teaching, the course uses real cases to help students develop problem-solving skills in practical situations. Participatory approaches in the organization and management of health services and other factors such as equity, socio-cultural change and environmental protection are discussed.
LEARNING OBJECTIVES: Upon completion of this course, students will: 1) be able to describe the key concepts of the SEED-SCALE and illustrate their use in a description of a plan for implementing Community Based Primary Health Care; 2) learn and demonstrate practical methods of promoting participatory activities in communities and action groups; 3) comprehend the methods for examining the conditions and practical techniques for developing partnerships to improve bottom-up participation of communities, top-down support by officials and outside-in stimulation by experts; 4) explore in depth and be able to describe concepts of equity, justice, sustainability, scaling up, the tilting point in community empowerment and challenges in promoting changes in behaviors and social norms; 5) describe strategies of multisectoral collaboration and integration within health services and demonstrate the methods for analysis of these strategies; 6) identify successes and failures or weaknesses of each case study and describe the lessons learned from them. Overall objectives of this course are: 1) to help students clarify their own values and attitudes in developing partnership relationships with communities and colleagues; 2) to facilitate students' ability to understand participatory methods in building community capacity to solve priority problems in varied health care settings; 1
3) to build on students' prior experiences and help them develop skills in learning how to use case studies in their own work and teaching; and 4) to facilitate students' ability to scale up community-based succeses from a local situation to general extension. Additional Course Objective(s): 1. To understand the key concepts of the SEED-SCALE. Paradigm for implementing Community Based Primary Health Care 2. To learn practical methods of promoting participatory activities in communities and action groups 3. To critically examine the conditions and practical techniques for developing partnerships to improve: bottom-up participation of communities, top-down support by officials and outside-in stimulation by change agents 4. To explore in depth some concepts of equity, justice, sustainability, scaling up. the tilting-point in community empowerment, and challenges in promoting changes in behaviors and social norms 5. To analyze strategies of multisectoral collaboration and integration within health services 6. To critically identify successes and failures or weaknesses of each case study and lessons learned LEARNING STRATEGY The learning methods include didactics, discussions, internet based approach, and workshops. The learners will work on their own modules topics and develop this into a full-blown module output. By the end of the course, each learner is expected to come up with final module output.
GUIDELINES FOR PREPARATION OF MODULE OUTPUT A. How it should be done: 1. TYPEWRITTEN – DOUBLE SPACE EXCEPT: DIRECT QUOTATIONS CITATIONS Other key Statements as directed by importance, ex. Vision and Mission Statements 2. MAKE THREE COPIES: One for the Mentor One for Dean One for Yourself 3. Use any of either the following documentation style: APA Manual or Turabian (Latest Edition) 4. Use formal and accepted English for your written module reports. 5. Submit report mounted in a decent folder.
REQUIREMENTS: Presentations of Module Mode Throughout this course there will be a series of modules assigned with the intent being to represent miniature research reports. In most instances, you should craft your 2
reports to closely parallel the abstract of the research article that you have been assigned to summarize. However, to satisfactorily complete these assignments, it will probably be necessary to supply additional methodological details beyond those appearing in the source paper's abstract. During selected class meetings one or more students will be asked to make 3-5 minute presentation of their most recent short paper. Similar to the modules they represent, these presentations will need to follow a specific format and will serve as preparation for your second modules presentation. Mid-term Exam The mid-term exam will be the presentation of modules outputs. It is highly probable that some of the content of the modules will be derived from reading material not covered in class discussion. There will be NO make-up module outputs. Final Exam This module culminates with a Final Output. This outputs will be based on your preparation of an original full-length module capsule and an oral presentation of your work. Although you may select the topic area of your module report from the entire field of health and health promotion issues, you will need to obtain approval on your topic. To gain approval you will need to submit a proposed topic prior to the final written examination. Although your proposed topic will constitute one of your weekly assignments, it would be a good idea not to wait until this deadline to start thinking about your options. Attendance Although attendance will be taken for every class, your presence is NOT required except for the examinations and module outputs. Since there are NO make-ups, for any exam or modules outputs, one's grade could be substantially affected by absence coincidental with one or more tests. Moreover, if you have been absent and feel the need to determine what you have missed, I hope that you will understand that I may not be full of zeal to re-cover class content with you. Plagiarism Unfortunately some, but very few learners in past semesters have not adequately acquainted themselves with the Academic Integrity Code of AMEC Graduate School of Health and/or have either naively or perhaps intentionally submitted work which blatantly violates one or more elements of this code. For many graded components in this course, I allow, and even encourage a great deal of freedom of access to reference materials, to problem solutions, to student collaboration, to computer programs, and to my private tutorials. In contrast, on examinations, module outputs, and especially for proper technical paper citations and referencing, I very strictly adhere to the AMEC Graduate School of Health integrity code. MODULES OUTLINES Module #1 What have we learned in 88 years as Community Based Primary Health Care has evolved? Required Reading - Alma Ata Declaration (1978). Available on-line: http://www.who.int/hpr/NPH/docs/declaration_almaata.pdf - Taylor, C. (1993) Overview: Primary Health Care Before and After Alma-Ata (p. 8-10) in WHO. Primary Health Care and Health Sector Reform: 15 Years After Alma Ata. WHO/ARA/97.4 p. 8-10 & p. 26-28 Optional Reading
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- Primary Health Care – Now More Than Ever. World Health Report 2008. Available online: http://www.who.int/whr/2008/en/ - Primary health care comes full circle – an interview with Halfdan Mahler http://www.who.int/bulletin/volumes/86/10/08-041008/en/index.html - Link about the structure and governance of WHO and the World Health Assembly http://www.who.int/governance/en/ - Taylor, C. (1988) The Straw Men of Primary Health Care. Soc Sci Med, 26, 9: 971-977 - Hayford, Charles Wishart. 1990. To the People: James Yen and Village China. ColumbiaUniversity Press. 1990. 304 pp. ISBN 023107204X, 9780231072045 Web Links: • • • • • • • • • • • • • • • • PAHO link with interesting graphics and history about Alma Ata -- Important Halfdan Mahler Interview Alma Ata Declaration Group_Project_Assignment.pdf (26k) World_Health_Report_2008_PHC.pdf (3216k) (Litsios_2004)Draft_on_CMC_and_WHO.pdf (68k) (Litsios_2004)CMC_and_WHO.pdf (2736k) Syllabus_CSPHC_2009-01-20.pdf (61k) 01--Introduction+Alma_Ata+Pioneers.pdf (574k) Alma Ata Declaration 1978.pdf (13k) Jimmy_Yen_Bio.doc (40k) (Litsios_2002)Road_to_Alma_Ata.pdf (108k) (Litsios_2004)PHC_WHO+NGO.pdf (158k) Taylor Jolly 1988 The Straw Men of Primary Health Care.pdf (715k) Session 01_Intro.pdf (8k) Taylor Overview Primary Health Care Before and After Alma Ata.pdf (3217k)
Online Library Files:
Module #2 What have we learned from the Legacy of the Gadchiroli SEARCH projects as a model f or establishing a field research campus and pioneering Longitudinal Community Based Trials? Required Readings: -Chapter 13: Gadchiroli, India - Addiction as a Barrier to Development - Bang, AT, Bang RA, Reddy, HM (2005). Home-based Neonatal Care: Summary and Applications of the Field Trial in Rural Gadchiroli, India (1993 to 2003). Journal of Perinatology, 25:S108-S122 Journal available online via Welch Library Full Text ejournals link: http://www.nature.com/jp/journal/v25/n1s/pdf/7211278a.pdf Form Groups – In group, discuss topic and ways to do final presentation Web Links: • • • • • Society for Education, Action and Research in Community Health - Website Group_Project_Assignment.pdf (26k) (Taylor_2008)IJME_Response.pdf (66k) lec04_Guide_Jamkhed+Gadchiroli.doc (41k) Bang 2005 Home Based Neonatal Care Summary and Applications.pdf (228k) 4 Online Library Files:
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PHC-13-A-IJME_First_Packet.pdf (226k) Syllabus_CSPHC_2009-01-20.pdf (61k)
Module #3 What have we learned about Women's Empowerment...and what is the field reality of Required Readings: - Rosenberg, Tina (2008). Necessary Angels. National Geographic, Dec 2008: 66-85. Available online at http://ngm.nationalgeographic.com/2008/12/communitydoctors/rosenberg-text - Chapter from new book on Arunachal Pradesh and women of Palin - Chapter 12: Jamkhed, India - The Evolution of a World Training Center Optional Readings: - Arole & Arole (1994). Jamkhed – A Comprehensive Rural Health Project. London: MacMillan Press and Jamkhed Foundation in North Carolina http://www.jamkhed.org/ - Video of “Necessary Angels” http://ngm.nationalgeographic.com/video/player? titleID=1873043134 Written Assignment #1 Assignment due at the beginning of the session (Hardcopy) - Please read the Indian Journal of Medical Ethics case study. http://www.ijme.in/issue152.html - Please read the response by the Hopkins investigators. http://www.ijme.in/154cr196.html 1) Give us your frank opinion about the implications of this kind of criticism of International Research in a developing country such as India. 2) Then read the Hopkins response and write about whether you would recommend changes to the response. Web Links: • • • • • • • • • National Geographic Article "Necessary Angels" about Jamkhed Comprehensive Rural Health Project-Jamkhed Website (Taylor_2008)IJME_Response.pdf (66k) PHC-13-B-Cochrane_Response.pdf (5337k) (Briggs_2008)Cochrane_review_on_service_integration.pdf (275k) PHC-13-A-IJME_First_Packet.pdf (226k) Syllabus_CSPHC_2009-01-20.pdf (61k) 03a-Women's_Empowerment.pdf (911k) Newbook_Arunachal.doc (88k)
Online Library Files:
Module #4 Just and Lasting Change: When Communities Own Their Own Futures Required Readings: - Chapter 1: Getting Started – Positive Change is Possible, pages 20-21 - Chapter 2: Synopsis of SEED-SCALE, pages 34-44 - Chapter 3: Alternative Approaches in Making a Large and Lasting Impact, pages 51-61 Web Links: • Arole and Arole Online Library Files: 5
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Group_Project_Assignment.pdf (26k) lec03_Guide_SEED.doc (37k) Syllabus_CSPHC_2009-01-20.pdf (61k) 04-Seed-Scale.pdf (87k)
Module #5 What have we learned from Pholela and U.S.primary care regarding Community Orientation versus Community Ownership? Required Readings: - Yach D and Tollman SM. Public Health Initiatives in South Africa in the 1940s and 1950s: Lessons for a Post-Apartheid Era. Am J Public Health. 1993; 83:1043-1050. - Susser M. Pioneering Community-Oriented Primary Care. Bulletin of WHO. 1999; 77:436-438. Optional Readings: - Multiple articles in on-line library - Video about Mound Bayou http://www.motionbox.com/videos/4a9cdabf101dc4 22 min Web Links: • • • • • • • • • • • • • • • • Historic Video about Mound Bayou - Original Footage -- Important lec10_Guide_Pholela.doc (36k) (Yach+Tollman_1993)Public_Health_Lessons_for_Post-Apartheid.pdf (4381k) (Mullan+Epstein_2002)COPC_in_Changing_world.pdf (404k) (Susser_1999)bulletin_77(5)_436-438.pdf (160k) (Kark+Cassel_1999)bulletin_77(5)_439-447.pdf (895k) Brown_2002Sidney_Kark_and_John_Cassel.pdf (444k) Geiger_2005_The_First_Community_Health_Centers.pdf (645k) Gofin_2006Summary_of_Practice_of_Social_Medicine.pdf (642k) Kark_1952Pholela_Health_Centre_Progress_Report.pdf (895k) Kark_2003Sidney_Karks_Contributions.pdf (109k) AJPH Editorial 4-9-03 about community research.pdf (88k) Syllabus_CSPHC_2009-01-20.pdf (61k) Assignment_2-Narangwal_Revisited[1].doc (31k) Pholela.pdf (282k) COPC.pdf (513k) Online Library Files:
Module #6 What have we learned from Narangwal about Community Based Trials of Integrated Services in a developing country? Required Readings: - Chapter 10: Narangwal: The Role of Conceptual and Cultural Breakthroughs - Taylor, CE, Parker, RL (1987) Integrating PHC Services: Evidence from Narangwal, India. Health Policy and Planning, 2(2):150-161 - Cochrane Review of Strategies for integrating primary health services in middle- and low-income countries at the point of delivery. Briggs, C. J. and P. Garner (2006). "Strategies for integrating primary health services in middle- and low-income countries at the point of delivery." Cochrane Database Syst Rev(2): CD003318. 6
Assignment Written #2 Assignment due at the beginning of the session (Hardcopy) - Please read the Cochrane Review of Strategies for integrating primary health services in middle- and low-income countries at the point of delivery. (Briggs and Garner, 2008) - Please read the Hopkin’s researcher’s response, Answer two questions : 1. What were the real reasons behind the decision that the Narangwal project did not meet the stated criteria for the Cochrane Review? 2. Is the response of the Narangwal team adequate? How could it be improved? Online Library Files: • • • • • • • • • PHC-13-B-Cochrane_Response.pdf (5337k) (Briggs_2008)Cochrane_review_on_service_integration.pdf (275k) lec02b_Guide_Narangwal.doc (38k) lec02a_Guide_Narangwal.doc (38k) Taylor Parker Integrating PHC Services Evidence from Narangwal India.pdf (1556k) Syllabus_CSPHC_2009-01-20.pdf (61k) Assignment_2-Narangwal_Revisited[1].doc (31k) 06-Narangwal.pdf (1261k) Group Assignment.ppt (18k)
Module #7 What have we learned from Tibet and China about Healthy People in a Healthy Environment as a development objective? Required Readings: -Chapter 7: Ding Xian - The First Example of Community-Based Development -Chapter 18: Tibet, China – Integrating Conservation with Development Optional Reading: -Chapter 19: China Model Counties – Going to Scale with Health Care Group Project Online Library Files: • • • • lec06_Tibet.doc (35k) Syllabus_CSPHC_2009-01-20.pdf (61k) Group Assignment.ppt (18k) 07-Tibet+China.ppt (26665k)
Module #8 What have we learned from The White Mountain Apache about the Disempowerment of Indigenous People? Required Reading: - Chapter 15: The White Mountain Apache, United States - Reclaiming Self Determination Group Project Online Library Files: • Syllabus_CSPHC_2009-01-20.pdf (61k) 7
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Group Assignment.ppt (18k) Apache_Carl.pptx (6309k) Apache_Allison Barlow.ppt (13736k)
Module #9 What have we learned from CLAS in Peru about Community Committees taking responsibility for their primary health centers? Required Reading: - Chapter 17: Peru - Communities and Government Learning to Work Together Group Project Submit "Unanswered Questions" for class on 2/19/09 to Shan by e-mail. Web Links: • • • • • • Video about CLAS Peru lec08_Guide_Peru.doc (34k) WHO Case Study - Peru CLAS 21 December 2007.pdf (286k) Syllabus_CSPHC_2009-01-20.pdf (61k) Group Assignment.ppt (18k) Peru3[1].pdf (1064k) Online Library Files:
Module #10 What have we learned from Afghanstan about the community's role in the search for Peace during time of war? Required Readings: - Chapter 6: A Crisis Can Become An Opportunity (especially the concluding 5 pages Future Opportunities) - Chapter on Afghanistan excerpt posted in Online Library Unanswered questions about community-based primary health care Online Library Files: • • • • • lec13_Guide_Afghanistan.doc (38k) Syllabus_CSPHC_2009-01-20.pdf (61k) Group Assignment.ppt (18k) New book_Afghanistan_seven_tasks.doc (96k) Scaling_Up_CORE_Background_Paper_7-13.pdf (124k)
Module #11 What have we learned from Mozambique about validating reductions in child mortality using Retrospective Pregnancy Histories? Required Reading: Edward, Anbarasi et al. (2007). Examing the evidence of under-five mortality reduction in a community –based programme in Gaza, Mozambique. Transaction of the Royal Society of Tropical Medicine and Hygiene, 101:814-822. Group Project Web Links: • • the Calleson's article Freudenberg's article 8
Online Library Files: • • • • • lec07_Guide_Mozambique.doc (33k) Syllabus_CSPHC_2009-01-20.pdf (61k) Reading_MozMort_Transactions.pdf (349k) Group Assignment.ppt (18k) Case_Studies_Moz_022409_HO.pdf (230k)
Module #12 What have we learned from East Baltimore about the relationship between Academic Health Centers and their Neighbors? Required Readings: - Levine DL, Becker D, Bone LR, Hill MN, Tuggle MB, and Zeger SL (1994). Community-Academic Health Center Partnerships for Undeserved Minority Populations. JAMA, Vol 272, 4: 309-311. - Calleson DC, Seifer SD, Maurana C (2002). Forces affecting community involvement of AHCs: perspectives of institutional and faculty leaders. Acad Med 2002 Jan; 77(1):7281. Available on-line:http://www.academicmedicine.org/cgi/reprint/77/1/72.pdf Optional Readings: - Freudenberg, N (2000) Health Promotion in the city: A review of current practice and future prospects in the United States. Annual Rev Public Health, 21: 473-503.Journal available online via Welch Library Full Text e-journals link:http://www.welch.jhu.edu/eresources/ejournals_alpha.cfm?title=A Group Project Online Library Files: • • • • • • • Community-Academic Health Center Pa...Undeserved Minority Populations.pdf (807k) Syllabus_CSPHC_2009-01-20.pdf (61k) Group Assignment.ppt (18k) East_Baltimore_B.mp3 (10047k) East_Baltimore_B.pdf (135k) East_Baltimore_A.pdf (140k) East_Baltimore_A.mp3 (16342k)
Module #13 Effectiveness of Primary Health Care-What have we learned about demonstrating results to the scientific community and how to improve the statistical power of trail methodology? Group Project Referenced Paper Due at the begining of sessoin (Hardcopy)! Web Links: • • • • • Halfdan Mahler Interview Alma Ata Declaration Microsoft PowerPoint - Presentation to CTaylor Class-3March2009f.pdf (1300k) World_Health_Report_2008_PHC.pdf (3216k) (Litsios_2004)CMC_and_WHO.pdf (2736k) 9
Online Library Files:
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Issues Raised in Response to CT's M...nsolidation-3 March 2008 Update.doc (84k) Syllabus_CSPHC_2009-01-20.pdf (61k) (Litsios_2004)PHC_WHO+NGO.pdf (158k) Systematical review_Effectiveness_CBPHC.doc (50k) (Manandhar 2004)_RCT_Nepal.pdf (545k) Group Assignment.ppt (18k) Projahnmo_Lancet_6_Jun08[1] copy.pdf (312k) CARE_Eval_paper_WHO_Bull_Oct_2008.pdf (606k)
Module #14 Evolution of SEED-SCALE Web Links: • • • • • • • • Halfdan Mahler Interview Alma Ata Declaration World_Health_Report_2008_PHC.pdf (3216k) (Polak_2008)Out_of_Poverty.pdf (893k) (Litsios_2004)CMC_and_WHO.pdf (2736k) Syllabus_CSPHC_2009-01-20.pdf (61k) (Litsios_2004)PHC_WHO+NGO.pdf (158k) Group Assignment.ppt (18k)
Online Library Files:
Module #15 Group Presentation (A& B) Description: All students are expected to attend and ask challenging questions of their classmates you'd want them to do the same for you! Online Library Files: • • • Group_Project_Assignment.pdf (26k) Syllabus_CSPHC_2009-01-20.pdf (61k) Group Assignment.ppt (18k)
Module #16 Group Presentation (C & D) All students are expected to attend and ask challenging questions of their classmates and faculty - you'd want them to do the same for you! Celebration! Online Library Files: • • • Group_Project_Assignment.pdf (26k) Syllabus_CSPHC_2009-01-20.pdf (61k) Group Assignment.ppt (18k)
EVALUATION METHOD: Breakdown of the Evaluation Process Monthly/Weekly modules output
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A. Concept Paper B. Module Outputs C. Final Written Exam
20% 55% 25% 100%
REFERENCES: Internet based learning.
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COURSE NUMBER COURSE TITLE CREDIT UNITS ALLOTED TIME PROFESSOR:
EPDM 450 PRIMARY HEALTH CARE MANAGEMENT 3 UNITS 54 HOURS/18 MEETINGS
COURSE DESCRIPTION Introduces students to the origins, concepts and development of community-based primary health care through case studies from both developing and developed countries. Like clinical bedside teaching, the course uses real cases to help students develop problem-solving skills in practical situations. Participatory approaches in the organization and management of health services and other factors such as equity, socio-cultural change and environmental protection are discussed.
LEARNING OBJECTIVES: Upon completion of this course, students will: 1) be able to describe the key concepts of the SEED-SCALE and illustrate their use in a description of a plan for implementing Community Based Primary Health Care; 2) learn and demonstrate practical methods of promoting participatory activities in communities and action groups; 3) comprehend the methods for examining the conditions and practical techniques for developing partnerships to improve bottom-up participation of communities, top-down support by officials and outside-in stimulation by experts; 4) explore in depth and be able to describe concepts of equity, justice, sustainability, scaling up, the tilting point in community empowerment and challenges in promoting changes in behaviors and social norms; 5) describe strategies of multisectoral collaboration and integration within health services and demonstrate the methods for analysis of these strategies; 6) identify successes and failures or weaknesses of each case study and describe the lessons learned from them. Overall objectives of this course are: 1) to help students clarify their own values and attitudes in developing partnership relationships with communities and colleagues; 2) to facilitate students' ability to understand participatory methods in building community capacity to solve priority problems in varied health care settings; 1
3) to build on students' prior experiences and help them develop skills in learning how to use case studies in their own work and teaching; and 4) to facilitate students' ability to scale up community-based succeses from a local situation to general extension. Additional Course Objective(s): 1. To understand the key concepts of the SEED-SCALE. Paradigm for implementing Community Based Primary Health Care 2. To learn practical methods of promoting participatory activities in communities and action groups 3. To critically examine the conditions and practical techniques for developing partnerships to improve: bottom-up participation of communities, top-down support by officials and outside-in stimulation by change agents 4. To explore in depth some concepts of equity, justice, sustainability, scaling up. the tilting-point in community empowerment, and challenges in promoting changes in behaviors and social norms 5. To analyze strategies of multisectoral collaboration and integration within health services 6. To critically identify successes and failures or weaknesses of each case study and lessons learned LEARNING STRATEGY The learning methods include didactics, discussions, internet based approach, and workshops. The learners will work on their own modules topics and develop this into a full-blown module output. By the end of the course, each learner is expected to come up with final module output.
GUIDELINES FOR PREPARATION OF MODULE OUTPUT A. How it should be done: 1. TYPEWRITTEN – DOUBLE SPACE EXCEPT: DIRECT QUOTATIONS CITATIONS Other key Statements as directed by importance, ex. Vision and Mission Statements 2. MAKE THREE COPIES: One for the Mentor One for Dean One for Yourself 3. Use any of either the following documentation style: APA Manual or Turabian (Latest Edition) 4. Use formal and accepted English for your written module reports. 5. Submit report mounted in a decent folder.
REQUIREMENTS: Presentations of Module Mode Throughout this course there will be a series of modules assigned with the intent being to represent miniature research reports. In most instances, you should craft your 2
reports to closely parallel the abstract of the research article that you have been assigned to summarize. However, to satisfactorily complete these assignments, it will probably be necessary to supply additional methodological details beyond those appearing in the source paper's abstract. During selected class meetings one or more students will be asked to make 3-5 minute presentation of their most recent short paper. Similar to the modules they represent, these presentations will need to follow a specific format and will serve as preparation for your second modules presentation. Mid-term Exam The mid-term exam will be the presentation of modules outputs. It is highly probable that some of the content of the modules will be derived from reading material not covered in class discussion. There will be NO make-up module outputs. Final Exam This module culminates with a Final Output. This outputs will be based on your preparation of an original full-length module capsule and an oral presentation of your work. Although you may select the topic area of your module report from the entire field of health and health promotion issues, you will need to obtain approval on your topic. To gain approval you will need to submit a proposed topic prior to the final written examination. Although your proposed topic will constitute one of your weekly assignments, it would be a good idea not to wait until this deadline to start thinking about your options. Attendance Although attendance will be taken for every class, your presence is NOT required except for the examinations and module outputs. Since there are NO make-ups, for any exam or modules outputs, one's grade could be substantially affected by absence coincidental with one or more tests. Moreover, if you have been absent and feel the need to determine what you have missed, I hope that you will understand that I may not be full of zeal to re-cover class content with you. Plagiarism Unfortunately some, but very few learners in past semesters have not adequately acquainted themselves with the Academic Integrity Code of AMEC Graduate School of Health and/or have either naively or perhaps intentionally submitted work which blatantly violates one or more elements of this code. For many graded components in this course, I allow, and even encourage a great deal of freedom of access to reference materials, to problem solutions, to student collaboration, to computer programs, and to my private tutorials. In contrast, on examinations, module outputs, and especially for proper technical paper citations and referencing, I very strictly adhere to the AMEC Graduate School of Health integrity code. MODULES OUTLINES Module #1 What have we learned in 88 years as Community Based Primary Health Care has evolved? Required Reading - Alma Ata Declaration (1978). Available on-line: http://www.who.int/hpr/NPH/docs/declaration_almaata.pdf - Taylor, C. (1993) Overview: Primary Health Care Before and After Alma-Ata (p. 8-10) in WHO. Primary Health Care and Health Sector Reform: 15 Years After Alma Ata. WHO/ARA/97.4 p. 8-10 & p. 26-28 Optional Reading
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- Primary Health Care – Now More Than Ever. World Health Report 2008. Available online: http://www.who.int/whr/2008/en/ - Primary health care comes full circle – an interview with Halfdan Mahler http://www.who.int/bulletin/volumes/86/10/08-041008/en/index.html - Link about the structure and governance of WHO and the World Health Assembly http://www.who.int/governance/en/ - Taylor, C. (1988) The Straw Men of Primary Health Care. Soc Sci Med, 26, 9: 971-977 - Hayford, Charles Wishart. 1990. To the People: James Yen and Village China. ColumbiaUniversity Press. 1990. 304 pp. ISBN 023107204X, 9780231072045 Web Links: • • • • • • • • • • • • • • • • PAHO link with interesting graphics and history about Alma Ata -- Important Halfdan Mahler Interview Alma Ata Declaration Group_Project_Assignment.pdf (26k) World_Health_Report_2008_PHC.pdf (3216k) (Litsios_2004)Draft_on_CMC_and_WHO.pdf (68k) (Litsios_2004)CMC_and_WHO.pdf (2736k) Syllabus_CSPHC_2009-01-20.pdf (61k) 01--Introduction+Alma_Ata+Pioneers.pdf (574k) Alma Ata Declaration 1978.pdf (13k) Jimmy_Yen_Bio.doc (40k) (Litsios_2002)Road_to_Alma_Ata.pdf (108k) (Litsios_2004)PHC_WHO+NGO.pdf (158k) Taylor Jolly 1988 The Straw Men of Primary Health Care.pdf (715k) Session 01_Intro.pdf (8k) Taylor Overview Primary Health Care Before and After Alma Ata.pdf (3217k)
Online Library Files:
Module #2 What have we learned from the Legacy of the Gadchiroli SEARCH projects as a model f or establishing a field research campus and pioneering Longitudinal Community Based Trials? Required Readings: -Chapter 13: Gadchiroli, India - Addiction as a Barrier to Development - Bang, AT, Bang RA, Reddy, HM (2005). Home-based Neonatal Care: Summary and Applications of the Field Trial in Rural Gadchiroli, India (1993 to 2003). Journal of Perinatology, 25:S108-S122 Journal available online via Welch Library Full Text ejournals link: http://www.nature.com/jp/journal/v25/n1s/pdf/7211278a.pdf Form Groups – In group, discuss topic and ways to do final presentation Web Links: • • • • • Society for Education, Action and Research in Community Health - Website Group_Project_Assignment.pdf (26k) (Taylor_2008)IJME_Response.pdf (66k) lec04_Guide_Jamkhed+Gadchiroli.doc (41k) Bang 2005 Home Based Neonatal Care Summary and Applications.pdf (228k) 4 Online Library Files:
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PHC-13-A-IJME_First_Packet.pdf (226k) Syllabus_CSPHC_2009-01-20.pdf (61k)
Module #3 What have we learned about Women's Empowerment...and what is the field reality of Required Readings: - Rosenberg, Tina (2008). Necessary Angels. National Geographic, Dec 2008: 66-85. Available online at http://ngm.nationalgeographic.com/2008/12/communitydoctors/rosenberg-text - Chapter from new book on Arunachal Pradesh and women of Palin - Chapter 12: Jamkhed, India - The Evolution of a World Training Center Optional Readings: - Arole & Arole (1994). Jamkhed – A Comprehensive Rural Health Project. London: MacMillan Press and Jamkhed Foundation in North Carolina http://www.jamkhed.org/ - Video of “Necessary Angels” http://ngm.nationalgeographic.com/video/player? titleID=1873043134 Written Assignment #1 Assignment due at the beginning of the session (Hardcopy) - Please read the Indian Journal of Medical Ethics case study. http://www.ijme.in/issue152.html - Please read the response by the Hopkins investigators. http://www.ijme.in/154cr196.html 1) Give us your frank opinion about the implications of this kind of criticism of International Research in a developing country such as India. 2) Then read the Hopkins response and write about whether you would recommend changes to the response. Web Links: • • • • • • • • • National Geographic Article "Necessary Angels" about Jamkhed Comprehensive Rural Health Project-Jamkhed Website (Taylor_2008)IJME_Response.pdf (66k) PHC-13-B-Cochrane_Response.pdf (5337k) (Briggs_2008)Cochrane_review_on_service_integration.pdf (275k) PHC-13-A-IJME_First_Packet.pdf (226k) Syllabus_CSPHC_2009-01-20.pdf (61k) 03a-Women's_Empowerment.pdf (911k) Newbook_Arunachal.doc (88k)
Online Library Files:
Module #4 Just and Lasting Change: When Communities Own Their Own Futures Required Readings: - Chapter 1: Getting Started – Positive Change is Possible, pages 20-21 - Chapter 2: Synopsis of SEED-SCALE, pages 34-44 - Chapter 3: Alternative Approaches in Making a Large and Lasting Impact, pages 51-61 Web Links: • Arole and Arole Online Library Files: 5
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Group_Project_Assignment.pdf (26k) lec03_Guide_SEED.doc (37k) Syllabus_CSPHC_2009-01-20.pdf (61k) 04-Seed-Scale.pdf (87k)
Module #5 What have we learned from Pholela and U.S.primary care regarding Community Orientation versus Community Ownership? Required Readings: - Yach D and Tollman SM. Public Health Initiatives in South Africa in the 1940s and 1950s: Lessons for a Post-Apartheid Era. Am J Public Health. 1993; 83:1043-1050. - Susser M. Pioneering Community-Oriented Primary Care. Bulletin of WHO. 1999; 77:436-438. Optional Readings: - Multiple articles in on-line library - Video about Mound Bayou http://www.motionbox.com/videos/4a9cdabf101dc4 22 min Web Links: • • • • • • • • • • • • • • • • Historic Video about Mound Bayou - Original Footage -- Important lec10_Guide_Pholela.doc (36k) (Yach+Tollman_1993)Public_Health_Lessons_for_Post-Apartheid.pdf (4381k) (Mullan+Epstein_2002)COPC_in_Changing_world.pdf (404k) (Susser_1999)bulletin_77(5)_436-438.pdf (160k) (Kark+Cassel_1999)bulletin_77(5)_439-447.pdf (895k) Brown_2002Sidney_Kark_and_John_Cassel.pdf (444k) Geiger_2005_The_First_Community_Health_Centers.pdf (645k) Gofin_2006Summary_of_Practice_of_Social_Medicine.pdf (642k) Kark_1952Pholela_Health_Centre_Progress_Report.pdf (895k) Kark_2003Sidney_Karks_Contributions.pdf (109k) AJPH Editorial 4-9-03 about community research.pdf (88k) Syllabus_CSPHC_2009-01-20.pdf (61k) Assignment_2-Narangwal_Revisited[1].doc (31k) Pholela.pdf (282k) COPC.pdf (513k) Online Library Files:
Module #6 What have we learned from Narangwal about Community Based Trials of Integrated Services in a developing country? Required Readings: - Chapter 10: Narangwal: The Role of Conceptual and Cultural Breakthroughs - Taylor, CE, Parker, RL (1987) Integrating PHC Services: Evidence from Narangwal, India. Health Policy and Planning, 2(2):150-161 - Cochrane Review of Strategies for integrating primary health services in middle- and low-income countries at the point of delivery. Briggs, C. J. and P. Garner (2006). "Strategies for integrating primary health services in middle- and low-income countries at the point of delivery." Cochrane Database Syst Rev(2): CD003318. 6
Assignment Written #2 Assignment due at the beginning of the session (Hardcopy) - Please read the Cochrane Review of Strategies for integrating primary health services in middle- and low-income countries at the point of delivery. (Briggs and Garner, 2008) - Please read the Hopkin’s researcher’s response, Answer two questions : 1. What were the real reasons behind the decision that the Narangwal project did not meet the stated criteria for the Cochrane Review? 2. Is the response of the Narangwal team adequate? How could it be improved? Online Library Files: • • • • • • • • • PHC-13-B-Cochrane_Response.pdf (5337k) (Briggs_2008)Cochrane_review_on_service_integration.pdf (275k) lec02b_Guide_Narangwal.doc (38k) lec02a_Guide_Narangwal.doc (38k) Taylor Parker Integrating PHC Services Evidence from Narangwal India.pdf (1556k) Syllabus_CSPHC_2009-01-20.pdf (61k) Assignment_2-Narangwal_Revisited[1].doc (31k) 06-Narangwal.pdf (1261k) Group Assignment.ppt (18k)
Module #7 What have we learned from Tibet and China about Healthy People in a Healthy Environment as a development objective? Required Readings: -Chapter 7: Ding Xian - The First Example of Community-Based Development -Chapter 18: Tibet, China – Integrating Conservation with Development Optional Reading: -Chapter 19: China Model Counties – Going to Scale with Health Care Group Project Online Library Files: • • • • lec06_Tibet.doc (35k) Syllabus_CSPHC_2009-01-20.pdf (61k) Group Assignment.ppt (18k) 07-Tibet+China.ppt (26665k)
Module #8 What have we learned from The White Mountain Apache about the Disempowerment of Indigenous People? Required Reading: - Chapter 15: The White Mountain Apache, United States - Reclaiming Self Determination Group Project Online Library Files: • Syllabus_CSPHC_2009-01-20.pdf (61k) 7
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Group Assignment.ppt (18k) Apache_Carl.pptx (6309k) Apache_Allison Barlow.ppt (13736k)
Module #9 What have we learned from CLAS in Peru about Community Committees taking responsibility for their primary health centers? Required Reading: - Chapter 17: Peru - Communities and Government Learning to Work Together Group Project Submit "Unanswered Questions" for class on 2/19/09 to Shan by e-mail. Web Links: • • • • • • Video about CLAS Peru lec08_Guide_Peru.doc (34k) WHO Case Study - Peru CLAS 21 December 2007.pdf (286k) Syllabus_CSPHC_2009-01-20.pdf (61k) Group Assignment.ppt (18k) Peru3[1].pdf (1064k) Online Library Files:
Module #10 What have we learned from Afghanstan about the community's role in the search for Peace during time of war? Required Readings: - Chapter 6: A Crisis Can Become An Opportunity (especially the concluding 5 pages Future Opportunities) - Chapter on Afghanistan excerpt posted in Online Library Unanswered questions about community-based primary health care Online Library Files: • • • • • lec13_Guide_Afghanistan.doc (38k) Syllabus_CSPHC_2009-01-20.pdf (61k) Group Assignment.ppt (18k) New book_Afghanistan_seven_tasks.doc (96k) Scaling_Up_CORE_Background_Paper_7-13.pdf (124k)
Module #11 What have we learned from Mozambique about validating reductions in child mortality using Retrospective Pregnancy Histories? Required Reading: Edward, Anbarasi et al. (2007). Examing the evidence of under-five mortality reduction in a community –based programme in Gaza, Mozambique. Transaction of the Royal Society of Tropical Medicine and Hygiene, 101:814-822. Group Project Web Links: • • the Calleson's article Freudenberg's article 8
Online Library Files: • • • • • lec07_Guide_Mozambique.doc (33k) Syllabus_CSPHC_2009-01-20.pdf (61k) Reading_MozMort_Transactions.pdf (349k) Group Assignment.ppt (18k) Case_Studies_Moz_022409_HO.pdf (230k)
Module #12 What have we learned from East Baltimore about the relationship between Academic Health Centers and their Neighbors? Required Readings: - Levine DL, Becker D, Bone LR, Hill MN, Tuggle MB, and Zeger SL (1994). Community-Academic Health Center Partnerships for Undeserved Minority Populations. JAMA, Vol 272, 4: 309-311. - Calleson DC, Seifer SD, Maurana C (2002). Forces affecting community involvement of AHCs: perspectives of institutional and faculty leaders. Acad Med 2002 Jan; 77(1):7281. Available on-line:http://www.academicmedicine.org/cgi/reprint/77/1/72.pdf Optional Readings: - Freudenberg, N (2000) Health Promotion in the city: A review of current practice and future prospects in the United States. Annual Rev Public Health, 21: 473-503.Journal available online via Welch Library Full Text e-journals link:http://www.welch.jhu.edu/eresources/ejournals_alpha.cfm?title=A Group Project Online Library Files: • • • • • • • Community-Academic Health Center Pa...Undeserved Minority Populations.pdf (807k) Syllabus_CSPHC_2009-01-20.pdf (61k) Group Assignment.ppt (18k) East_Baltimore_B.mp3 (10047k) East_Baltimore_B.pdf (135k) East_Baltimore_A.pdf (140k) East_Baltimore_A.mp3 (16342k)
Module #13 Effectiveness of Primary Health Care-What have we learned about demonstrating results to the scientific community and how to improve the statistical power of trail methodology? Group Project Referenced Paper Due at the begining of sessoin (Hardcopy)! Web Links: • • • • • Halfdan Mahler Interview Alma Ata Declaration Microsoft PowerPoint - Presentation to CTaylor Class-3March2009f.pdf (1300k) World_Health_Report_2008_PHC.pdf (3216k) (Litsios_2004)CMC_and_WHO.pdf (2736k) 9
Online Library Files:
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Issues Raised in Response to CT's M...nsolidation-3 March 2008 Update.doc (84k) Syllabus_CSPHC_2009-01-20.pdf (61k) (Litsios_2004)PHC_WHO+NGO.pdf (158k) Systematical review_Effectiveness_CBPHC.doc (50k) (Manandhar 2004)_RCT_Nepal.pdf (545k) Group Assignment.ppt (18k) Projahnmo_Lancet_6_Jun08[1] copy.pdf (312k) CARE_Eval_paper_WHO_Bull_Oct_2008.pdf (606k)
Module #14 Evolution of SEED-SCALE Web Links: • • • • • • • • Halfdan Mahler Interview Alma Ata Declaration World_Health_Report_2008_PHC.pdf (3216k) (Polak_2008)Out_of_Poverty.pdf (893k) (Litsios_2004)CMC_and_WHO.pdf (2736k) Syllabus_CSPHC_2009-01-20.pdf (61k) (Litsios_2004)PHC_WHO+NGO.pdf (158k) Group Assignment.ppt (18k)
Online Library Files:
Module #15 Group Presentation (A& B) Description: All students are expected to attend and ask challenging questions of their classmates you'd want them to do the same for you! Online Library Files: • • • Group_Project_Assignment.pdf (26k) Syllabus_CSPHC_2009-01-20.pdf (61k) Group Assignment.ppt (18k)
Module #16 Group Presentation (C & D) All students are expected to attend and ask challenging questions of their classmates and faculty - you'd want them to do the same for you! Celebration! Online Library Files: • • • Group_Project_Assignment.pdf (26k) Syllabus_CSPHC_2009-01-20.pdf (61k) Group Assignment.ppt (18k)
EVALUATION METHOD: Breakdown of the Evaluation Process Monthly/Weekly modules output
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A. Concept Paper B. Module Outputs C. Final Written Exam
20% 55% 25% 100%
REFERENCES: Internet based learning.
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