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UNI Project - Temuco

Dr. Oscar Morales Project Sub-Director - University of the Frontier, Chile
Dr. Daniel Marcones Dental Coordinator - University of the Frontier, Chile
General Information

Chile is divided, administratively, into 13 regions, which have relative autonomy in decision-making. The IX Region of Araucania has approximately 750,000 inhabitants, with a rural population of 40% due to its agricultural character. The Mapuche, the most important ethnic minority in the country, are native to the area and comprise 30% of the region's population.

Socioeconomic indices of our region indicate it to be the poorest in the country, with 60% of the population living in poverty. Temuco is the capital city of the region and is the geographical area in which the UNI Project takes place. Its 250,000 inhabitants are essentially distributed throughout the urban districts (83%); however, demand for health care also extends well into neighboring rural areas.

In Chile, the state has traditionally been responsible for health care. There are 26 health services that correspond to geographical areas defined by criteria such as accessibility, population and administration. Private medicine is only beginning to develop.

Each of these services is responsible for a network of hospitals providing different levels of care; a tertiary care referral center functions as the base for each local system. Temuco's urban area has a tertiary level regional hospital and six primary level facilities which provide only a limited range of services. This structure generates an immense system overload.

Professional training is fundamentally based on regional universities which are financed by the central government. The University of the Frontier is the only higher education center that has four schools: Medicine, Education, Agriculture and Engineering.

Professions within the Medical School which take part in the UNI Project are: nursing, obstetrics, kinesiology, medicine, nutrition and medical technology. The newly created career of dentistry started just this year (1993). The dental component does not receive funds from the Temuco UNI Project because it did not exist at the time the project was prepared. With many points in common, however, a natural integration with the other careers should be achieved. Characteristics in common might include: teaching-services integration, problem-solving based learning, epidemiological orientation, and an emphasis on prevention.

Since its beginning our school has been closely integrated with Araucania's Health Systems, largely because of a teaching-service covenant. The city administration is based on a municipality model, the mayor being the chief executive. The municipality is responsible for education and primary health services (in five urban offices), and it maintains close coordination with a host of community organizations.

Despite the influence of local district associations (territorial organizations), the community organizational system has no defined role in relation to health services. Thus community participation in this sector is generally restricted to collaboration in most municipal and urban health centers.

Problem

From the previous discussion we can identify the following problem areas:

1. Insufficient problem-solving capabilities in dealing with ambulatory care; no secondary level of care, nor system for referral;

2. Traditional education for both undergraduate and graduate students, with practices almost exclusively at the Regional Hospital, a tertiary level center.

3. Community participation restricted to a collaborative role, one of passive reception of the activities of the health services and University.

Objectives

The primary objective is to create an integrated health care system in which future professionals would be trained in concert with cooperation from health services and genuine community input.

Health services will develop suitable levels of coordinated care and be supported with the provision of personnel trained in these regards, along with suitable infrastructure to provide optimal diagnostic, therapeutic, and rehabilitation services. Programs will be tailored for innovative services and prevention activities, especially in regards to personal care and family health, with appropriate community participation.

The University will gradually integrate activities that fall outside the range of services covered in traditional hospitals, starting with epidemiology and administrative areas. It will also look for new areas for integration among participating disciplines and health careers. The University will develop a trained teaching staff that can utilize original techniques in teaching, evaluation, and research and that possesses sufficient motivation to integrate teaching at different levels of the health care system. Together with adequate community involvement, this strategy will enable the University to prepare its graduates with the skills necessary to positively influence the health status of their communities.

Advances

In this first year, most Project activities have involved preparation for clinical programs outside of the hospital. These efforts include teaching-assistance training, enlargement of physical workspaces and supplying resources for diagnostic support for the six offices.

Integrated activities are also being conducted by several participating health professions (nursing, medicine, nutrition and physical therapy) in an attempt to develop the secondary level health care. At the community level, various work groups are being structured to focus on activities taking place in the establishments of participating communities.

This health system will be the basis for field-based clinical training for each of the health occupations. The system will constitute an educational model which is totally integrated with service delivery and community participation. It is this last element which we feel is most important, for the community is the ultimate beneficiary of improved education for our future health professionals.


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