Initial proposition
UNI-UNAN, Leon is an inter-institutional, transectoral project, of academic character which intends to introduce changes in health professionals education through interaction and cooperation among universities, services and communities.
The Project takes place in the Municipality of Leon, Nicaragua, located in the occidental region of the country some 90 km from the capital city. Its area is 1,114 km2 and it has a population of 172,010 inhabitants (80% of which are urban). Health services consist of a general hospital, a pediatric clinic, a chronic diseases hospital and a primary care service. This PHC service is divided into three territories with 27 units: 3 health centers and 14 medical stations (13 are teaching-care units) in the urban area, and 10 health posts in the rural area.
The project has six objectives as follows:
1. To develop a way for the University, the Ministry of Health, Municipality and community to work together through motivation seminars, inter-institutional cooperation agreements and the creation of organizational structures suited for the Project.
2. To develop competence among teaching-service and administrative personnel, through workshops on innovative learning methodologies, visits to other teaching-service programs (based on involvement of the community, family approach, strategic plans for training nursing professionals), and through coursework in epidemiology, community diagnosis, and primary care management.
3. To strengthen present resources to improve operational efficiency and to ensure the development of teaching-service activities.
4. To plan and organize the activities of teaching-services and the Local Health System by situational analysis of the municipality's health status and health manpower resources (location, demands, abilities etc.). To design strategic plans for the creation of additional health resources and intervention in: area health issues, changes in professional curricula, and reorganization efforts regarding study-work activities and participatory research.
5. To strengthen social participation in health planning at local and district levels. This will be accomplished through motivational and training workshops, participatory research, the design of new educational materials, and community-assisted analysis of health status in the area.
6. To provide an adequate monitoring and evaluation system.
Achievements
At the beginning of the Project, two essential strategies were defined which have produced the following results thus far:
1. Definition of an organizational model for conducting the Project and the development of a teaching-service model for the community. This model incorporates the creation of 117 active multiprofessional student pyramids in 41 locations (47,142 inhabitants) with the participation of 1,033 students (coming from 5 health careers), 45 teachers (tutors), 119 health "brigadiers" and 19 community leaders. Through this structure, the premises, objectives and pragmatic concerns relating to student work in the community were defined. In addition, the Introductory Module was implemented for Tutors, with the aim of standardizing familiarization and use of epidemiological, technical and conceptual guidelines of the project, and to promote the joint identification of priority populations (based on epidemiologic data). An instrument was designed to evaluate student performance in community work, and, finally, a methodological process was initiated to monitor and evaluate the integration in regards to the process of project development.
2. Definition of organizational structures for guiding the Project, including organizational arrangements for management and the administration of financial and material resources. Also defined were the organizational structures needed for implementation, with the Expanded Executive Committee serving as "the engine of the Project". Ad hoc commissions for overseeing various components of the Project were created, and the functions and responsibilities of territorial administrative staff were defined. Finally, modifications were made in service infrastructure, and some of the materials needed for Project activities were obtained.