Partnering with Academia: Visioning Church Hospitals

Towards Educational ExcellenceBruce Dahlman MD Director, Institute of Family Medicine (INFA-MED)

African Christian Health Association Conference Kampala, Uganda

25 February 2009

Objectives1. One human resource challenge: physician

leadership retention in your hospitals

2. Discuss the strengths and issues of forming partnerships between universities and faith-based health institutions towards Family Medicine development in Africa

Medical Leadership: Is it a Crisis in Your

Hospitals?

Who is the leader of the medical staff at your 70 – 150 bed hospital(s)?

How long do they serve?

Specialization?

Think of yourself as a new Medical Officer

Your Career ladder:

Internship – 1 year Assigned Government service in rural

District Hospital – or your smaller church hospital which often:– Is in the Remotest place– Has Poorest working environments– Little or no clinical back-up– Poor professional advancement

opportunities

Meanwhile . . .

Your medical school classmates . . .

Who landed at larger hospitals have been working under a surgeon/ obs-gynae/ paediatrician for 2-3 years

They have their referee letter to apply for speciality training

Look forward to consultancy position; university lecturer post; secure future

What would you do? Ask for sponsorship for speciality

training from your church hospital?

Join the PEPFAR project in your area?

Join a friend’s private practice?

Continue serving joyfully year after year in the lowest paid Medical Officer cadre with no professional rank?

Family Medicine Training: Who is a Family Physician?

Definition from Kenya Ministry of Health Family Medicine Policy (2007):“A family physician is a medical doctor

– providing competent and comprehensive clinical care (usually in a primary care consultancy role)

– over a wide range of patient conditions – considering the person’s physiologic, psychological,

socio-economic, cultural and spiritual dimensions – within the context of their family and community and – not limited by the person’s age, gender, organ

system or disease entity.”

Roles of a Family Physician

Provide continuous, comprehensive, cost-effective and coordinated care to individuals, families and communities; primary care consultant

Engage in life-long learning to improve health care delivery

Teach effectively members of the health care team, the patient and the community

Act as a team player and a leader Manage health care resources

Why Family Physicians?

“Given the need to provide primary care services to the entire population, as well as the family doctor’s ability to manage most medical problems, it makes sense that a majority of physicians should be trained to practice as family doctors. This may be even more important in developing countries, where it may be prudent to limit the utilization of costly hospital-based technology” (WHO, 1994).

Why are Family Physicians Needed?

National Health Strategic Plan (2005-2009)

“To contribute to the reduction of health inequalities and to reverse the downward trend in the health related impact and outcome indicators,

“To achieve Millennium Development Goals to reduce child mortality, improve maternal health and reduce communicable diseases like malaria, HIV/AIDS & TB,

“Medical Officers are currently not sufficiently trained to provide general, comprehensive care to the Kenyan people.”

Family Medicine:Especially important to

achieve improvement in equity of access

The Family Physician will: “Improve quality of care, particularly for

the underserved Kenyans “Improve patient satisfaction

and continuity of care “Provide comprehensive specialist care

at District and Sub-district levels “Improve preventive care”

From Kenya Ministry of Health Family Medicine Policy Document (2007)

Kenya MoH Family Medicine Policy:

(Echoing WHO)

“The MoH recognizes that the Family Physician is the most appropriate person to respond to the challenges of the Kenyan health care delivery system.”

The African Family Doctor: A summary

Clinical specialist in Primary Care; leader of the medical team

3-4 year Master of Medicine training Competent emergency surgeon “Bridge” to the primary care team Gains the professional respect of peers

as the primary care consultant specialist Equipped to stay & “build” your hospital

Where Is This Doctor Mentored?

Probably will not do this training in the National Referral Hospitals

Because they will need mentoring by dedicated doctors who have the same call to service and in a place where the greatest needs are

That place would be?

Your rural church hospital!

Why Does Your Hospital Need to be a Teaching Hospital?

Because these hospitals are serving in the places where Family Medicine training needs to exist – in the rural areas

Because they contribute a significant portion of the clinical care in most sub-Saharan African countries – and will continue to do so

Because they are often already well-respected by patients

Church Hospitals: Role in Education

Your church hospitals likely already have a nursing school to meet the needs of nursing staffing . . .

Can there be a corollary in the medical education realm?

Church Hospitals:Are You Ready for “Prime Time”?

Objections . . .– “We’re not big enough”

– “They don’t need us . . .”

– “What would we have to offer?”

– “We couldn’t pay for it”

But what if . . .

You step

outside . . .

of the box

Africa Inland ChurchKijabe Hospital - 265 beds outside view of inpatient wards

Educational Resource From Rural Church Hospitals:

Example of AIC Kijabe Hospital

1916 - Hospital started as infirmary to a boarding school for missionary kids

1959 – Separate facility built to serve the community – 30 beds; 1 doctor

1970s – Expanded to 120 beds; 2 doctors; Expatriate medical student rotations

1980 – 210 beds, 3 doctors; KECHN nursing school; Kenyan medical student electives

AIC Kijabe Hospital:Becoming Part of the Answer

1995 – Medical staff of 7; No Kenyans – Gov’t medical internship started

2005 – Medical staff of 16; 2 Kenyan – Family Medicine residency started with Moi University

2006 - Agreements with Pan-African Academy of Christian Surgeons and University of

Nairobi - general and paediatric surgery externships

2008 – COSECSA orthopaedic residency 2009 – Medical staff of 27; 11 Kenyan

But How to Begin?

“Take First Steps . . .

The Kenyan Case Towards Family Medicine Training

March 1995 – MAP Int’l. consultation with hospitals from Kenya and Zaire resolves to start family medicine post-grad. programme

1996 – 2000: Kijabe, Chogoria and Tenwek Hospitals begin College of Family Medicine (COFAMED) and pursue accreditation with Commission for Higher Education

But . . . in most sub-Saharan contexts:

The model for post-graduate education requires partnership with a medical degree-granting academic institution

Master of Medicine Degree

Includes Master’s research thesis

Kenyan Family Medicine Development

Sept. 2003: Moi University Senate approves the curriculum that had been through numerous revisions over 3 years.

January 2005: Moi University Family Medicine begins with three registrars

July 2008: First class graduates; all take teaching positions

Your Partner is: TheUniversity Medical

School

You need to partner with your University that does medical training – Dean, Comm. Med. department

You may be suggesting something new to them

You may need to engage Ministry of Health, Professional Boards

Resource on how to engage the process:

Improving Health Systems: the Contribution of Family Medicine –

A Guidebook

WONCA – World Org. of Family Doctors

www.globalfamilydoctor.org

Africa Christian Health Associations

African Family MedicineExpansion

1980s - Nigeria and South Africa 1988 – Uganda 1996 – DR Congo 2004? – Ghana 2005 - Kenya, Tanzania 2009 - Rwanda, Lesotho Investigating - Ethiopia, S. Sudan Interest – Malawi, Mozambique

Institute of Family Medicine (INFA-MED)

Support and assistance organisation to assist the development of the community-based church hospital teaching sites for the Moi programme

Faculty development Integrating continuing medical

education with post-graduate needs Scholarship support

Institute of Family Medicine:Mission

INFA-MED is committed to advancing family medicine in the developing world by training and mentoring doctors to be clinicians, teachers, leaders and life-long learners, who will provide comprehensive and wholistic health care, relevant to community needs

Institute of Family Medicine:

Strategic Goals

1. To establish and expand family medical education in developing countries

2. To facilitate the sharing of evidence-based, relevant primary health care information

3. To actively engage church congregations to become healing communities

4. To promote and support continuing professional development and life-long learning

5. To build the capacity of INFA-MED as an institution, and mobilize resources for the advancement

of family medicine in developing countries

Institute of Family Medicine:

Accomplishments in Kenya 2000 – Assist Moi University to start Kenya’s first

Family Medicine program 2002 – Helped launch KAFP 2003 – Brought Advanced Life Support in

Obstetrics course (ALSO) to Kenya; contributing to Global ALSO refinements

2005 – Assist with initial Moi Univ. lecturer salaries 2006 – Began small group CPD courses with KAFP 2009 - Adapting Comprehensive Advanced Life

Support (AfriCALS) to East Africa 2010 – Digital African Health Library – Health

information tools to use at the point of care

Questions and comments?

Bruce Dahlman MDInstitute of Family Medicine (INFA-MED)bdahlman@aimint.net

+254-736-450-915

Pan-African College of Christian Surgeons

Dr. Bruce Steffes

bruce@brucesteffes.net

Kenya: The People