URC Develops Tuberculosis Training CD-ROM in Spanish
by Cynthia F. Young
A newly completed Spanish version of the Quality Assurance Project's Tuberculosis Case Management CD-ROM was officially launched at the Third STOP TB in the Americas meeting in Santa Cruz, Bolivia, on April 22, 2002. The conference was organized by the Pan American Health Organization (PAHO) and attended by delegates from Bolivia, Peru, Brazil, Mexico, the Dominican Republic, Haiti, Honduras, Nicaragua, and Ecuador. The purpose of the meeting was to examine key issues in the regional control of tuberculosis (TB) and discuss measures that are being taken worldwide to effectively treat TB, including the World Health Organization's Directly Observed Treatment Short Course (DOTS) strategy.
The Spanish TB Case Management CD-ROM is part of the Bolivia Ministry of Health's overall strategy to optimize in-service training for health professionals. The interactive TB Case Management program trains health workers, nurses, and physicians in prevention, diagnosis, and treatment of tuberculosis, which is a major health problem in Bolivia. The CD-ROM is based on the World Health Organization's DOTS strategy.
Dr. Marina Budeyeva, Senior Advisor on URC's Quality Assurance (QA) Project, led the development of the computer-based training (CBT) program, which was produced jointly with the Bolivian Ministry of Health's National Tuberculosis Control Program. The QA Project country coordinator for Bolivia, Dr. Bernarda Salas, facilitated the final stages of the CD-ROM's development with the Ministry of Health. Funding for the development of the Tuberculosis CD-ROM in Spanish was provided by the U.S. Agency for International Development (USAID) through its Mission in Bolivia.
The CD-ROM's national launch, part of the Bolivian Ministry of Health's Information, Education, and Communication strategy, included presentations by Dr. Mirtha Del Granado, Chief of the National Tuberculosis Control Program; Ms. Luisa Mendizábal, national program TB specialist; and Dr. Charles Oliver, USAID/Bolivia Health Officer.
All STOP TB conference participants received a copy of the Spanish version of the TB Case Management CD-ROM. Delegates from several countries expressed great enthusiasm and interest in the self-paced tutorial. They also discussed the possibility of producing and adapting the CD-ROM for the unique needs of differing countries, such as Brazil.
For more information on URC's CBT products and e-Learning services, contact Dr. Marina Budeyeva.
Scaling Up Quality Improvements in Russia
by Lani Marquez
Quality improvement and evidence-based medicine are finding fertile ground in Russia, thanks in part to U.S. Agency for International Development support under the Health Committee activities of the U.S.-Russia Joint Commission on Technological and Economic Cooperation. URC, one of several cooperating agencies supporting the Commission's health agenda, is leading efforts to improve the quality of women's and infant's health services and institutionalize quality assurance in the Russian health care system through our Quality Assurance (QA) Project.
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The head Neonatologist at Torzhok Maternity Hospital in Tver checking on a new mother and baby.
Photo by Kim Ethier |
URC began work in Russia in 1998, developing demonstration projects to improve quality and outcomes for three priority health problems: hypertension, pregnancy-induced hypertension, and neonatal respiratory distress syndrome. The highly successful demonstration projects, which were conducted in Tula and Tver oblasts and completed in early 2000, developed and implemented evidence-based clinical guidelines for the management of each condition. The pilot efforts resulted in significantly improved health outcomes, as well as cost reductions from decreases in hospitalization.
An evaluation of the pilot projects showed that their impact went beyond the dramatic clinical improvements. Learning quality improvement has changed the way that physicians and oblast leaders approach their work and relate to one another. Those involved in the projects have become empowered to make changes. One physician in Tula said, "I now know that I can do something about my own situation. Before, I would wait for Moscow [Ministry of Health] to tell us what we should do." Other physicians and nurses expressed their feeling of empowerment and increased confidence with comments such as, "You pulled us from a swamp" and "I now feel like a person."
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Leaders from the pilot project in Tver oblast and Dr. Rashad Massoud teaching facility head physicians at a quality improvement awareness workshop. |
Many physicians and nurses interviewed for the evaluation said that they now have better, more open relationships with their colleagues and a greater understanding of each person's value in the process of health care delivery after working more intensively together on the improvement efforts. Some even went as far as to say that their new way of working and thinking led to improvements in their family situations.
The larger success story has been, however, the scale-up of the new processes of care beyond the pilot sites and the speed with which Russian health professionals have embraced evidence-based practices. Based on quality management and diffusion of innovation principles adapted to the Russian organizational culture, the improved process for hypertension care has been introduced in just under 500 practitioner offices in Tula (covering the total population of 2 million). The new system of care for pregnancy-induced hypertension (PIH) developed in three pilot hospitals in Tver is currently being expanded to all 42 hospitals in the oblast (covering approximately 1.6 million people). The neonatal respiratory distress syndrome (NRDS) demonstration project developed in 5 pilot hospitals in Tver has also been expanded to the 42 hospitals covering Tver Oblast.
As part of the large-scale implementation process, oblast leaders, physicians, and nurses from the pilot project are now the trainers for the new facilities. The trainers report that many facilities are eager to begin the quality improvement process after hearing about the results and success of the pilot projects. One trainer said that the process of teaching others has deepened her knowledge about the new clinical practices and given her more self-confidence.
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Dr. Massoud working with general practioners in Tula |
In addition to supporting the large-scale implementation of successful pilot demonstrations in Tver and Tula, URC is supporting oblast authorities in applying the process improvement and system redesign approaches to other health problems, including improving care for breast cancer, gastro-intestinal bleeding, tuberculosis in children, infant care program, and depression. We are also working with health leaders in Tula and Tver to spread quality assurance approaches to four other oblasts in the Russian Federation: Samara, Saratov, Novgorod, and Perm.
Along with the large-scale implementation of improved processes of care in Tula and Tver, URC is working jointly with the Ministry of Health (MOH) on developing the Russian National Quality Assurance Program. The MOH of the Russian Federation has formed a working group to develop the National Quality Assurance Program. The experiences from Tula and Tver will be used as a basis for work throughout the country.
For more information on URC's work to improve the quality of health services in Russia, contact Dr. M. Rashad Massoud, Associate Project Director, Quality Assurance Project, at rmassoud@urc-chs.com.
New Contract Award: Bangladesh
URC will lead the Quality Assurance Component of the new USAID-funded Non-Governmental Organization Service Delivery Program (NSDP), which was awarded in April to Pathfinder International. In addition to URC, the Pathfinder-led consortium includes CARE, Save the Children, INTRAH, Research Triangle Institute, Deloitte Touch Tohmatsu International, and the Bangladesh Center for Communication Programs. The 53-month program will assist non-governmental organizations (NGOs) in Bangladesh to improve and expand their delivery of essential health services in both rural and urban areas. URC will provide six staff members for the program and short-term technical assistance from our Bethesda office.
As part of the program, URC will be responsible for assisting NGOs to implement a quality monitoring and supervision (QMS) system that has already been field tested in Bangladesh under our QA Project. The NSDP will expand the use of QMS quality assessment tools and strengthen the capacity of NGO supervisors in working with facility teams to identify and address quality gaps in clinical areas.
Bilingual Education Project Website Launched
The Bilingual Education: Training for All Teachers Project is pleased to announce the launch of its website at: http://wwwfac.wmdc.edu/BilingualEducation. The website provides information on the courses and unique professional development opportunities being offered to teachers and administrators enrolled in the Bilingual Education and English for Speakers of Other Languages (ESOL) Program at Western Maryland College.
The following sections are currently featured on the website:
- Course offerings in the Intensive Summer Teacher Training Program in ESOL/Bilingual Education (July 20-August 9)
- Course descriptions for Graduate Training in Teaching ESOL
- Notes from Professional Symposia on Language Minority Issues
- Summer Seminar on Transformative Literacy in Oaxaca, Mexico (June 22- July 6)
- Links to Online Resources in ESOL/Bilingual Education
Bilingual Education: Training for All Teachers —a five-year joint project between Western Maryland College and University Research Co., LLC/Center for Human Services and funded by the U.S. Department of Education—was launched in March 2002. Project staff are developing a high quality program to provide teachers with research-based tools to ensure that English Learner students in K-12 schools reach high levels of literacy and have access to core curriculum.
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