Health personnel training in the Nicaraguan health system

The "Unified National Health System" of Nicaragua was established in 1979, in an attempt to transform some of Latin America's worst health indices. This system, based on the stated principles of planning, regionalization, public participation, and primary care, has prioritized the development of health professions training programs appropriate to its special needs and principles. Public Health and Epidemiology training was inaugurated in 1982. A new campus of the School of Medicine was opened in 1981, increasing the number of medical students by a factor of five. Formal residency training (never before available within the country) in primary care specialties has been established. Training for allied health personnel has been formalized in several fields, with the establishment of the Polytechnical Institute of Health. The rapid increase in number and size of training programs has created a tremendous need for educational resources both human and material. This article reviews the status of health personnel training in Nicaragua today, the integration of these programs into planning for the health system, and problems arising from their rapid appearance.     

Cuba's international cooperation in health: an overview.

In the first years after Cuba's 1959 revolution, the island's new government provided international medical assistance to countries affected by natural disasters or armed conflicts. Step by step, a more structural complementary program for international collaboration was put in place. The relief operations after Hurricane Mitch, which struck Central America in 1998, were pivotal. From November 1998 onward, the "Integrated Health Program" was the cornerstone of Cuba's international cooperation. The intense cooperation with Hugo Chávez's Venezuela became another cornerstone. Complementary to the health programs abroad, Cuba also set up international programs at home, benefiting tens of thousands of foreign patients and disaster victims. In a parallel program, medical training is offered to international students in the Latin American Medical School in Cuba and, increasingly, also in their home countries. The importance and impact of these initiatives, however, cannot and should not be analyzed solely in public health terms.     

Health for all through research.

John F. Kennedy's vision of man on the moon by the year 1970 set a goal for technological research and development. The World Health Organization's vision of health for all by the year 2000 set a similar goal not only for health policy but also for health research. Drawing on the analogy between these goals, this paper first explores what health for all means as a policy goal. It calls for changes in most aspects of the health care system. In the European Region of the World Health Organization, 38 specific targets show how approaches to health problems, lifestyles, environment, health care and various support measures (e.g., planning, management and training) should be changed to reach the over-all goal. These changes should be based on sound scientific knowledge. Health for all therefore also calls for a health research policy and reorientation of research. The second part of the paper looks at the research implications of health for all. Assisted by the Regional Office of the World Health Organization, the European Advisory Committee for Health Research analysed the 38 targets to see what kind of research would help to achieve them. The result of this analysis were two publications: "Research Policies for Health for All" and "Priority Research for Health for All". The first volume explains why a country needs a health research policy. The second one identifies, target by target, research necessary to reach them. Translated into several languages, they have begun to influence national research policies. The third section of the paper describes the research priorities identified in the two research for health for all volumes. It also aims at showing their relevance for the European health research community. It finally discusses the prerequisites that the countries have to set up to make research for health for all possible. They include changes in the incentives for and financing of research, personnel development, research organization and communication between the researchers and decision-makers.     

国外健康素养型医疗机构建设与评价及对我国的启示

介绍了美国医学研究所(Institute of Medicine,IOM)发布《健康素养型医疗机构的10个特征(Ten Attributes of Health Literate Health Care Organizations,HLHO 10个特征)》文件的背景及健康素养型医疗机构(health literate health care organization,HLHO)概念,并以Donabedian的理论为指导综述了HLHO的特征和建设措施及HLHO评价的研究进展。提出了我国医疗机构可借鉴《HLHO 10个特征》文件与国外HLHO评价现状,从人员培训、文化、制度、物理和信息环境建设,要求员工应用健康素养策略,促进服务对象参与健康材料的开发及医务人员健康教育工作的考核等措施入手,践行《健康中国行动(2019—2030年)》提出的“医务人员在诊疗过程中主动提供健康指导”和“建立医务人员开展健康教育绩效考核机制”两项指标。     

Health action alliance: a consumer approach to improving ambulatory care in a family practice residency clinic.

"The Health Action Alliance for Family Practice Clinic--St. Marys" is a group of physicians, patients, and clinic personnel who meet regularly for the purpose of providing a forum for interaction between health care personnel and patients. The group deals with patient training for effective participation in general clinic activities, participation in decision making processes of the clinic, health education, and other topics as the group decides. This paper discusses the formation of the group, its purposes, accomplishments, and plans for the future.     

昆山市卫生监督人员教育培训情况分析

目的:了解昆山市卫生监督机构人员教育和培训的现状。方法:设计卫生监督机构人员调查表,对2006~2012年昆山市卫生监督机构从业人员教育和培训情况进行调查。结果:昆山市卫生监督人员人均培训31.91学时/年,其中2011年人均培训最多,为54.33学时;在培训内容上,综合性培训和法律法规知识等执法基础培训学时数最多,分别占49.03%和28.92%;培训形式以本单位培训为主,培训人次和培训学时分别占87.69%和48.81%。结论:2006~2012年昆山市卫生监督人员培训力度不断加强,培训学时呈逐年递增趋势。培训内容和形式灵活多样,全面提升监督员综合素质。建议进一步加大卫生监督人员培训力度,增加专业知识培训学时数,全面提高卫生监督员执法能力和综合素质水平。     

深圳市卫生监督人才培养现状的分析与建议

卫生监督人才是基层卫生监督机构推进公共卫生服务均等化、维护人民群众健康权益的重要保障。本文分析了深圳市卫生监督人才培养方面的现状与不足,认为存在人才准入被动接受、人才培养系统性不足、职称缺失导致专业性不强、职级晋升与业务技能不挂钩等存在问题。建议加快卫生监督人才培养,恢复专业技术职务考评、设立首席监督员制度、市区卫生监督骨干交流挂职、加强卫生监督专业化系统化培养,以期达到提升卫生监督水平、巩固行政执法成效的目的。     

Strengthening local health care management in Bolivian districts through participatory operational research

The purpose of this article is to demonstrate how the use of a participatory health care management and problem-related research methodology may help strengthen health service management and the capacities of local health care personnel. The text refers to five studies carried out in three Bolivian health districts from 1993-1995, in an Operational Research Project, conducted by an Italian N.G.O. (Cooperazione Internazionale) in agreement with the local Ministry of Health and P.A.H.O./W.H.O. The object of these studies was to assess the main problems in health care delivery and to define and implement appropriate solutions. The studies utilized a methodology based on the principles of operational research and continuous quality improvement. During the process some positive aspects and difficulties were met. The positive aspects were: the applied character of the research focused on the solution of a problem; the study of a problem related to health service management; the use of modern and simple techniques adapted to local knowledge; on-the-job training of health care personnel during the research process. Lack of a generic 'culture of research' and poor health personnel training were the main difficulties encountered. National health authorities should take these points into account to define or readjust policies on health service research, health workers' academic education and in-service training. Insisting on developing human resources and allowing them to achieve and expand their potential is the key factor for getting developing countries out of their current crisis and toward reaching a truly human and sustainable development.     

医疗模式转变与人才建设的重要性——澳洲医疗考察、培训有感

目的探讨新时期下医疗模式的转换与人才建设。方法赴澳考察参观了三所不同层次的医院,接受了墨尔本大学公共卫生学院、卫生政策与经济研究中心承办的专项培训。结果医疗机构建设关键在人才,更新医学模式迫在眉睫,医院有创新、有特色,才有生机和出路。结论人才建设与医疗创新是医疗模式更新的要求。     

Action-oriented participant research as a strategy for training and evaluation in health education

In this article we present the results of a study on educational practices at the "Escuela de Malariología y Saneamiento Ambiental 'Dr. Arnoldo Gabaldón'" (EMSA), a pioneering institution in training health personnel, pertaining to the Ministry of Health and Social Assistance in Venezuela. This study was developed as an experiment in action-oriented participant research, i. e. authorities, teachers, and students were committed to an evaluation of the educational practices in which they were involved. The main results of this cooperative inquiry were: a theoretical reconstruction of the models of health education employed by EMSA; a critical analysis of those models; and the design and testing of an alternative model centered on community participation.     

浅谈中医护理在基层医疗卫生服务中的应用

中医护理在基层医疗卫生服务中的应用前景广阔。应加强中医护理人力资源投入,强化人员培训和科学研究,提高中医护理的竞争力;加强宣传,提高公众对中医护理的认可度;在中医护理中融入健康教育理念以促进护理人员和护理对象的沟通交流;最终利用中医护理有效改善基层医疗卫生服务质量,提高护理对象的健康水平和健康知识。     

对2003年全国健康教育机构业务工作现况调查的分析

目的通过对2003年全国各级健康教育所（中心）上报的《健康教育所（中心）业务工作调查表（卫统43表）》结果进行分析,为制定全国健康教育工作规划及相关政策提供依据。方法以《健康教育所（中心）业务工作调查表（卫统43表）》统计结果为数据来源,对健康教育／健康促进活动的成果、健康教育形式、大众媒体宣传、人员培训、健康教育专业人员构成、统计报表问题等方面进行研究与分析。结果2003年全国共有2748家单位上报调查表,上报率为85．0％,比2002年提高16．0％。全国开展各种形式的健康教育活动16．1万次,制作发放文字材料近4．6亿份,主办报纸杂志或与报刊合作开办栏目831个,举办各类培训近10万次。54．9％的各级健康教育单位积极开展了抗击传染性非典型肺炎（SARS）等突发公共卫生事件的宣传教育工作,累计受益人数2．9亿人次。结论健康教育在公共卫生建设、疾病预防控制、健康促进等方面起到了重要作用。其投入少,社会效益显著,非常适合我国国情。建议各级政府加大支持力度,以推动我国健康教育与健康促进事业的全面、快速发展,为提高人民的健康水平服务。     

Inequidades en salud entre países de Latinoamérica y el Caribe (2005-2010)

Objective

To identify health inequalities among Latin American and Caribbean countries in recent years (2005-2010), based on the view that measurement of inequalities is the first step in identifying health inequities.

Method

We performed an ecological study, whose units of analysis were 20 Latin American and Caribbean countries. These units were used to build the Inequalities in Health Index. This index summarizes, in a value ranging from 0 to 1, a set of socio-economic and health indicators, developed by international organizations. These indicators are considered as proximal and contextual determinants of health.

Results

According to the index calculated, the five countries with the worst health status were Haiti, Guatemala, Bolivia, Venezuela and Honduras. In contrast, the five countries with the most favorable health status were Cuba, Argentina, Uruguay, Chile and Mexico.

Conclusion

Even today, there are wide health inequalities in Latin America and the Caribbean. The country with the most favorable health indicators was Cuba and that with the least favorable was Haiti. We recommend systematic evaluation of health inequalities in Latin America and the Caribbean through the Inequalities in Health Index and other indices, in order to analyze actions, policies and programs to reduce inequities in this region.     

Training initiatives within the AFHSC-Global Emerging Infections Surveillance and Response System: support for IHR (2005)

Training is a key component of building capacity for public health surveillance and response, but has often been difficult to quantify. During fiscal 2009, the Armed Forces Health Surveillance Center, Division of Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) supported 18 partner organizations in conducting 123 training initiatives in 40 countries for 3,130 U.S. military, civilian and host-country personnel. The training assisted with supporting compliance with International Health Regulations, IHR (2005). Training activities in pandemic preparedness, outbreak investigation and response, emerging infectious disease (EID) surveillance and pathogen diagnostic techniques were expanded significantly. By engaging local health and other government officials and civilian institutions, the U.S. military's role as a key stakeholder in global public health has been strengthened and has contributed to EID-related surveillance, research and capacity-building initiatives specified elsewhere in this issue. Public health and emerging infections surveillance training accomplished by AFHSC-GEIS and its Department of Defense (DoD) partners during fiscal 2009 will be tabulated and described.     

Are Michigan hospitals facing a shortage of trained personnel?

The 1990 MHA Health Personnel Shortage Survey requested information on 31 personnel positions to determine the extent of personnel shortages, the sources of replacement personnel, the positions for which it is most difficult to recruit applicants, and the positions for which it is most difficult to retain personnel. In addition, hospitals were asked about the impact of personnel shortages on hospital services, the strategies they had implemented to alleviate the problems caused by shortages, and their commitment to, and involvement in, training and educational programs to increase the availability of health care personnel in Michigan. A total of 77 Michigan hospitals and health care institutions responded to the survey. Analyses were performed on a sample of 69 community hospitals distributed similarly, with respect to hospital bed size category and geographic location, to the state total of 176 Michigan community hospitals. For more information, or for a copy of the complete 1990 MHA Health Personnel Shortage Survey report, contact the MHCI Health Policy Analysis Department.     

我国卫生管理教育的现状与发展对策

卫生管理教育是职业化卫生管理队伍建设的基本途径,因此我国卫生管理教育发展的战略选择是：近期对现职业卫生管理人员进行岗位培训,和萁要通过高等教育培养未来卫生吉业发展所需管理人才。本文通过对我国23所卫生管理教育机构的调查,从我国的实际情况出发,提出了发展我国卫生管理教育的主要对策建议。     

Occupational medicine in European countries and in Yugoslavia

A recent publication on occupational health services in European countries prepared by the World Health Organization is reviewed. On the basis of guidance by the international organizations, the overall objectives of occupational health services are embodied in principles which are implemented in various ways in the practical activities undertaken in each country. The functions of occupational health services, organizational models, coverage, personnel, support systems (industrial hygiene, ergonomics, psychology, clinical occupational medicine) as well as research, training and funding are discussed. Comparison is made with the actual situation and development of occupational health service in Croatia with special reference to the conclusions drawn at a round table discussion organized by the Association of Occupational Health of the Croatian Medical Society in Pazin, in April 1991.     

慕课——公共卫生硕士培养的新模式

摘要:公共卫生硕士教育承担了为国家的卫生事业培养高层次人才的重任,未来的公共卫生硕士需要具备科研和解决实际问题的能力。为了培养有竞争力的公共卫生人才,需运用现代科学技术开创新的教育培养模式。本文基于国外慕课的发展和使用情况,探讨如何在公共卫生硕士培养中应用慕课解决现阶段其存在的问题,结合成人教育学说明慕课的重要性。     

The health status of Cuba: recommendations for epidemiologic investigation and public health policy

The health status of Cuba is described in comparison with Costa Rica and, in some instances, the United States. Recommendations are made for epidemiologic studies and for specific health policies to lower death rates from diarrhea and enteritis, cardiovascular disease, cancer, and injuries. Rapid expansion of training and research in epidemiology and biostatistics is emphasized, and specific goals for health outcomes for the year 2000 are suggested.     

成都和沈阳社区卫生服务能力及条件建设评价研究

目的了解成都和沈阳两市UHPP项目区社区卫生服务提供能力及条件建设状况，为各级政府和卫生行政部门完善社区卫生服务提供客观依据。方法利用现有资料及定性和定量调查资料，对UHPP项目区的社区卫生服务能力进行评价。结果UHPP项目通过开展一系列针对社区卫生人员能力建设的培训活动，提高了社区卫生人才队伍的整体素质和服务水平，促进了社区卫生服务培训规范化模式的形成，提高了卫生行政和有关部门组织社区卫生服务培训的能力。结论成都和沈阳两市社区卫生服务机构人员素质得到提高，工作条件得到改善。