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UNI Program-Tucuman, Tucuman National University

Dr. Rita Waserman de CunioTucuman UNI Project Executive Director
Program Identification

In the past, Tucuman has been plagued with problems in personnel training, health care delivery, and inadequate community participation in health services - the basic scenario responsible for the Conceptual and Operational Guidelines of the W. K. Kellogg Foundation's UNI Program. Accordingly, Tucuman's UNI Project was developed jointly by the Schools of Medicine, Dentistry, Nursing and Social Services of Tucuman National University, the Health Provincial System, San Miguel Tucuman City Council and selected community leaders of the capital city.

Purpose and Objectives

The purpose of the program is to improve health and living conditions in communities of SILOS territory (Southwest Operative Area, 116,000 inhabitants) by facilitating needed changes in the training of health professionals, the availability of health services, and the level of community participation. General program objectives emphasize leadership development and innovation in creating new models for academia, services, and community participation.

The Academic Model seeks to improve the training of health personnel by encouraging suitable revisions in the curriculum. Proposed changes include the development of greater extramural and multidisciplinary work opportunities and various research activities in clinical dentistry, epidemiology, management, and education.

The SILOS Model aims to improve services by utilizing multidisciplinary staff to enhance the availability of integrated comprehensive health care; the focus is on family health services.

The Community Participation Model is intended to increase citizen input in SILOS management issues and to strengthen the promotion of self-care preventive practices.

All three models stress leadership development. For each of the general objectives a series of specific objectives were proposed.

Strategies

To facilitate a close working relationship between the three components of the UNI Program, plans were developed in relation to two strategic themes:

1. Power

2. Process

In the former, information sharing is emphasized to encourage community participation in resource management and technical assistance for decision-making. Plans for training include: educational methods for teachers and health professionals; interdisciplinary seminars in primary health care; training of community voluntary workers and health promoters; promotion of health self-assessments; training for students with independent (self) study and group work, and continuing education for health personnel. All planned activities will be carried out with an interdisciplinary focus, employing elements of public health, epidemiology, research, and participatory local programming.

The second theme, related to process, includes various research activities designed to promote inter-institutional collaboration in areas of teaching, research, and service. Moreover, the local participatory programming should enhance the problem-solving capacity of teachers and students from the four professional schools, expanding the scope of primary prevention capabilities of local health services. Additional benefits could be found in regards to supervision and improved operations of service facilities.

Activities and Improvements Achieved as of September 1993

By far the most significant achievement to date has been the harmonious integration of diverse participating groups. Specific improvements realized at present are in sound agreement with stated objectives of the project.

Some specific project objectives:

To expand academic training opportunities for health service personnel.

Improvements:

· Positive response from professional disciplines in regards to teacher training, with course enrollees surpassing expected numbers;

· Joint development by academic and service personnel of diagnostic criteria and treatment guidelines, including referrals, for use in primary health care centers;

· Considerable input from services and, especially, academic personnel in the First Integration Seminar;

· Contribution of service and academic proposals to work groups, leading to satisfactory evaluations by assistants.

To train academic and service personnel, as well as community members, in PHC, emphasizing community participation.

Improvement:

· Presentation of seminar for assistants, evaluated by attendees as "satisfactory";

To innovate educational methods to improve academic performance.

Improvements:

· Incorporation of an introductory course in learning methodology, in the first curricular year for participating health professions;

· Incorporation of teachers (professional educators) in the faculty of nursing and social work, currently in an advanced stage of development;

· Assignment of additional time for the units on educational methodology for medicine and dentistry.

To create a model for teaching health professions utilizing the community primary care settings, with appropriate community participation, in adequate learning environments.

Improvements:

· Participating schools currently holding teachers meetings for scheduling interdisciplinary group educational activities for students. On-going activities include problem-solving learning in both conventional and non-conventional centers (e.g. provincial, municipal, and community centers);

· Academic and service personnel take part in teaching/learning processes, based on group planning;

· Newly incorporated medical school faculty must work in the services of primary care level;

· University faculty and service professionals currently enrolled in the first General Epidemiology course, with demand outnumbering the available vacancies.

To promote community participation in order to empower their own organization, enhancing problem-solving in primary health care services and to support the training of health manpower resources.

Improvements:

· Community participation in diagnosis and organization efforts throughout a 22 block area of the "Ejercito Argentino" neighborhood;

· Organization of neighborhood community centers and legal establishment of the Neighborhood Centers Council;

· Establishment of UNI work groups, with community representatives participating in decision making;

· Scheduled weekly meetings, regularly held and well attended;

· Active community participation in seminars, such as: Small Businesses, Exchange and Improvement of Community Leadership, Project Development.

To improve the problem solving capacity of the primary health care services.

Improvements:

· Facility improvements for two municipal and two provincial health care centers, using local labor and municipal engineering expertise (first of three stages);

· Additional equipment and supplies bought for the four care centers being remodeled in the first stage, as determined by a special commission;

· Acquisition of two service vehicles;

· Initial work on defining diagnostic and treatment criteria for two specialties;

· Meetings among health services staff, pharmacology faculty, SIPROSA Official Pharmacy, and Municipal Pharmacy are currently being held to create a common basic vademecum;

· Organizational manuals covering responsibilities and work activities currently being written in accordance with present municipal and provincial legislation.

To carry out integrated activities of all Project components in community problem-solving, with universities, services, and communities participating in local programming.

Improvements:

· University, services and community members have worked together in a Participatory Methodology Workshop, with technical support from experts;

· A document on Participatory Local Programming is being prepared by a team integrated by representatives from the three components of the project.


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