Rural and Remote Public Health Training in Disease Control by wuy61796

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									   Rural and Remote Public Health Training in Disease Control for
                            District Communicable Disease
                                Control Coordinators




                            THIRD REPORT

                                      3 May, 1998


School of Public Health &        Department of Community       Ministry of Health,
Tropical Medicine,               Health, University of the     Mpumalanga Province,
James Cook University,           Witwatersrand, Johannesburg   Nelspruit 1200,
Townsville, 4811,                2193,                         South Africa
Queensland, Australia            South Africa
TABLE OF CONTENTS


1.INTRODUCTION ................................................................................................................. 2


2.SUMMARY REVIEW OF PROGRAM .............................................................................. 2
     2.1Objectives ................................................................................................................. 3
     2.2Activities ................................................................................................................... 3


3.ACHIEVEMENTS................................................................................................................. 3


4. ADDITIONAL OUTCOMES .............................................................................................. 8
      4.1 Joint Publications .................................................................................................... 8
      4.2 Joint Teaching ......................................................................................................... 8


5. CONCLUSIONS ................................................................................................................... 8




1.INTRODUCTION

The SA Links project to train Communicable Disease Control Coordinators in Mpumulanga
Province, South Africa will provide a cadre of highly skilled and knowledgeable health professionals
to oversee disease control in the Province. In addition, the project will also serve as a model which
can be replicated in other priority health program areas and in other provinces in South Africa and
possibly the region.

The partners in this project are the School of Public Health and Tropical Medicine, James Cook
University, Townsville, Australia, the Department of Community Medicine, University of the
Witwatersrand, Johannesburg 2193, South Africa, and the Ministry of Health, Mpumalanga
Province, Nelspruit 1200, South Africa. James Cook University has a contractual arrangement
with the University of Witwatersrand, and the latter has a contractual arrangement with the
Department of Health, Mpumalanga Province. The Department of Health plays the major role in
implementation of the project with lesser input from the other partners. The School of Public Health
plays the major role in interactions with IDP.


2.SUMMARY REVIEW OF PROGRAM

The project has achieved all goals in relation to the workplan, and additional activities in the areas of
health policy development, joint publications, research collaboration, and joint teaching have been
undertaken between the School of Public Health and Tropical Medicine and the Ministry of Health,
Mpumulanga Province, and the Department of Community Health, University of Witwatersrand.

The objectives and activities are given below. Since the project has progressed well according to



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the original plan, these do not differ from those originally proposed.

2.1Objectives

1.To develop the capacity of districts to plan and evaluate infectious disease programs.
2. To enable district staff to appropriately respond to outbreaks of infectious disease.
3. To strengthen the surveillance system in Mpumalanga Province.
4.    To develop a provincial team, comprised of district Communicable Disease Control
                       Coordinators (CDCCs), who understand and optimise the use of available
                       data sources.
5. To pilot this model for potential expansion to other district programs and provinces.
6.To work towards establishing a training course of sufficient academic standard to enable the
                       course to be accredited towards partial fulfilment of a higher degree(s) in
                       public health at the two participating academic institutions; and to negotiate
                       with these institutions to have the course recognised academically.


2.2Activities

1.  Design a curriculum for a training course in public health for remote and rural areas with a focus
                       on disease control for the district CDCCs of Mpumalanga.
2. Develop course materials, including a reference manual
3. Conduct the training of the CDCCs using course modules
4. Production of a manual for disease outbreak response for clinic and hospital staff
5. Monitoring and evaluation of the model.
6.Negotiations with University of Witwatersrand and James Cook University about academic
                       recognition of the training course as a contribution to higher degrees in
                       public health at either institution, and implementation of this.


3.ACHIEVEMENTS

The activities in South Africa have progressed according to schedule (Table 1). In summary, this
project has been very successful with 5 of the 6 objectives achieved.




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Table 1: Proposed activities and achievements.

          Objectives                                        Achievements to date                                          Final outcome


  1.      To develop the capacity of districts to plan                                                                    Objective 1 achieved.
          and evaluate infectious disease programs.


  1.1     Design a curriculum for a training course in      Curriculum content, sequence of delivery, dates, and          Task achieved
          public health for remote and rural areas with a   suitable lecturers finalised
          focus on disease control for the district
          Communicable Disease Control Coordinators
          of Mpumalanga Province.


  1.2     Develop course materials, including a reference   15 modules completed                                          Task achieved
          manual


  1.3     Conduct the training of the CDCCs using           Training sessions held in 1997 and 4 sessions in 1998.        Progressing to schedule
          course modules


  1.4     Production of a manual for disease outbreak       1. Manual has been completed, and approved by South           Funds are being
          response for clinic and hospital staff            African experts and by experts at the Centers for Disease     transferred for the
                                                            Control and Prevention, Atlanta, USA.                         manual to be printed and
                                                            2. All hospital infection control nurses already trained on   distributed throughout




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                                                       the draft manual.                                      South Africa.


2.    To enable district staff to appropriately                                                               Objective 2 achieved.
      respond to outbreaks of infectious disease.



2.1   Activities listed above under Objective 1 have   See activities listed under Objective 1.               Task achieved.
-2.   enabled this objective to be achieved            In addition permission has been granted by General
4                                                      Cloete for 24 hour manned line in military Operation
                                                       Room to enable a rapid mobilisation in response to
                                                       outbreaks.


3.    To strengthen the surveillance system in                                                                Objective 3 achieved.
      Mpumalanga Province.


3.1   All activities listed in Objective 1 also have   See activities listed under Objective 1.               Task achieved.
-3.   enabled this objective to be achieved.
4


4.    To develop a provincial team, comprised of                                                              Objective 4 achieved.
      district Communicable Disease Control
      Coordinators (CDCCs), who understand
      and optimise the use of available data
      sources.




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4.1   All activities listed in Objective 1 have enabled   See activities listed under Objective 1. In 1998 the        Task achieved.
-4.   this objective to be achieved.                      CDCC were employed on permanent contracts by the
4                                                         Mpumulanga Ministry of Health. Prior to this, the CDCC
                                                          had been in temporary positions.


5.    To pilot this model for potential expansion         The CDCC model and their training program is now            Objective 5 achieved.
      to other district programs and provinces.           being referred to in South Africa as the "demonstration
                                                          project" for communicable disease control at the district
                                                          level.


5.1   Monitoring and evaluation of the model.             Discussion is on-going about best tools for evaluation of   Task in progress, and
                                                          model.                                                      still to be completed


6.    To work towards establishing a training                                                                         Objective 6 partly
      course of sufficient academic standard to                                                                       achieved.
      enable the course to be accredited towards
      partial fulfilment of a higher degree(s) in
      public health at the two participating
      academic institutions; and to negotiate
      with these institutions to have the course
      recognised academically.



6.1   Monitoring and evaluation of the model              Discussion is on-going about best tools for evaluation of   Task in progress, and
                                                          model.                                                      still to be completed




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6.2   Negotiations with Uni of Witwatersrand and   1. Evaluation of standard of training has been done by        Agreement by both
      James Cook Uni about academic recognition    examination, review of content of course by outside           institutions to issue
      of the training course                       experts, and assessment of assignments by external            certificates for training is
                                                   examiners.                                                    possible. Further
                                                   2. Possibility of academic recognition by Uni of              negotiations are in
                                                   Witwatersrand has been discussed                              progress.
                                                   3. Recognition by JCU has been discussed, and criteria to
                                                   be met determined in principle. JCU Overseas Student
                                                   Office interested in providing assistance in accreditation.




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4.    ADDITIONAL OUTCOMES

4.1   Joint Publications

      David Durrheim and John Govere from Ministry of Health, Mpumulanga Province, South
      Africa and Rick Speare from James Cook University, Australia have published two chapters
      in a new textbook for southern Africa. The book, The Ecology of Environmental Hygiene
      and Occupational Health edited by Werner Coetzer is part of the Public Health Series.
      Chapters are:

      Durrheim, D.D., Govere, R.J. and Speare, R. 1997. Chapter 8: The ecology of malaria and
             other mosquito-borne diseases in southern Africa. In: The Ecology of Environmental
             Hygiene and Occupational Health. Ed. Werner Coetzer. Public Health Series:
             Easilearn CC: Sinoville. pp. 246-306.
      Durrheim, D.D., Speare, R. and Govere, R.J. 1997. Chapter 9: The ecology of
             schistosomiasis in southern Africa. In: The Ecology of Environmental Hygiene and
             Occupational Health. Ed. Werner Coetzer. Public Health Series: Easilearn CC:
             Sinoville. pp. 307-350.

      A joint publication on travel medicine is currently being negotiated between Dr Peter Leggat
      of School of Public Health and Tropical Medicine, James Cook University, and Dr David
      Durrheim.


4.2   Joint Teaching

      Dr Mary Edginton of the Department of Community Health, University of Witwatersrand,
      conducted a session on the "Control of tuberculosis in rural South Africa: a model for
      developing countries" in the Disease Control course held in Townsville for health
      professionals in the public health and tropical medicine program of the School of Public
      Health and Tropical Medicine, James Cook University. This session was held on 29 April
      1998 by videoconference link between Townsville and Johannesburg. Twenty four health
      professionals from Queensland, New South Wales, Northern Territory, Victoria,
      Switzerland and USA participated in this videoconference. The session was very
      successful, and all aims were achieved.


5.    CONCLUSIONS

      This project has been highly successful and will achieve all objectives. The working
      relationship between the South African organisations and the Australian organisation has
      been of significant benefit in terms of interchange of knowledge and skills on both sides. A
      major benefit for the Australian partner has been the opportunity to participate in health
      policy formulation, and research planning in South Africa. The project is training a very
      effective cadre of disease control professionals, who are playing a significant role in
      improving health in rural South Africa. In addition the Australian partner has used the project
      to establish professional links with other health professionals and organisations in South



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Africa. These are quite strong positives, and most of the outcomes for all three
organisations would not have occurred without this project.

In addition to the link between the two academic institutions, James Cook University in
Australia and University of Witwatersrand in South Africa, the implementation by the
Ministry of Health in Mpumulanga Province has extended the impact of the project
enormously. The activities of David Durrheim and his team of CDCC are now recognised
as a potentially highly effective model for control of communicable diseases in South Africa.
The national distribution of outbreak manuals throughout South Africa will ensure that
outbreak activity is standardised and coordinated.




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