Title: Community Oriented Primary Care
Keywords: Primary Health Care
Measuring health status
Health systems
Health promotion
Disease prevention, control and elimination
Country: Germany
Institution: Germany - Institute of Tropical Medicine and International Health, Berlin
Course coordinator: Dr Hans-Friedemann Kinkel
Date start: 2019-05-13
Date end: 2019-05-24
About duration and dates: 2 weeks
Classification: advanced optional
Mode of delivery: Face to face
Course location: Institute of Tropical Medicine and International Health
Charité - Universitätsmedizin Berlin
Augustenburger Platz 1
D-13353 Berlin,Germany
ECTS credit points: 3 ECTS credits
SIT: 90 hours SIT:
• Contact (in-class: lectures and group work): 60h
• Self-directed learning: 30h
Week 1: 45h (9h per day)
Contact (lectures): 30h (6h p.d.)
Self-directed learning: 15h (3h p.d.)
Week 2: 45h (9h p.d.)
Contact (in-class: lectures and group work): 30h (6h p.d.)
Self-directed learning: 15h (3h p.d.)
Language: English
Description:
At the end of the module the student should be able to:
1. Propose an intervention/ programme/ service for a common health problem, disease or condition for a community health team
2. Discuss and debate interventions/ programmes/ services rendered by a community health team for common health problems, diseases or conditions
3. Explain the principles of Community Oriented Primary Care (COPC)
4. Describe the role and function of a community health team (“outreach team”)
Assessment Procedures:
1. A 1.5 hour closed book exam (accounting 50% to the overall mark) and
2. An assessment of a 20-30 min oral presentation of a group work (ca. 4-5 people per group) (accounting 50% to the overall mark)
Exam:
The exam will cover theoretical aspects of the module. The student passes the exam if 60% or more of the achievable points are gained.
Exams will be marked before the course ends and communicated to the students at the end of the last day.
If the student fails he/she can re-sit (up to 2 times) on a date agreed on with the module coordinator (preferably within 4 weeks after the module).
Presentation of group work:
The group work is a proposal for an intervention/ programme/ service for a community health team dealing with a specific health problem, disease or condition of choice in a setting of choice in a low or middle income country (LMIC). The proposal will be presented orally (ca. 20-30 minutes) in front of the class and marked by the module coordinator and one representative from the ITMIH. The proposal will be marked for content (80%) and presentation (20%) (the marking grid is still to be defined by the module coordinator). The presentation is passed if 60% or more of the achievable points are gained.
The presentations will be marked immediately after the presentation and communicated to the students together with the exam marks at the end of the last day.
If a group fails, each group member has to do an individual assignment (ca. 1500-2000 words) that needs to be submitted within 4 weeks after the module. The assignment will be the same task as the presentation, but each student can decide individually about the specific health problem, disease or condition and the setting he/she wants to work on. The assignment will be marked for content (80%) and layout (20%) by the coordinator (the marking grid is still to be defined by the module coordinator). The assignment is passed if 60% or more of the achievable points are gained.
Content:
Please see also the course schedule attached
• Introduction, Expectations & Course outline (1slot)
• History of COPC (1). The origins of Community Oriented Primary Care (COPC) with an emphasis on South Africa; How COPC evolved in other parts of the world; Influence of COPC on PHC/Alma Ata; The development of Community Health Worker (CHW) programmes and COPC in recent years
• The health team (HT) (4). The composition of a HT (“outreach team”); Definitions of “community”; the role of a HT in the health system and the community; the role and mandate of the members of the HT;
• Implementation of COPC (2). 10 steps of implementing COPC (based on the South African experience)
• Principles of COPC (Marcus, 2013) - Information (3). The role of information about (i) the community (e.g. local demographic differences and implications on health services), (ii) the household (i.e. socioeconomic context and risk factors at household level) and (iii) the individuals (i.e. individual demographic and health related information and risk factors) in order to provide services that are equitable, comprehensive, information/evidence based and person centered; Information management (e.g. data collection; e-/m-health solutions in COPC; access to information; confidentiality; data safety; personalised and aggregated data); M&E; reporting.
• Principles of COPC - Equity (1) Definitions of Equality and Equity (Whitehead, 1992); Health disparity (referring to the concept of social determinants of health)
• Principles of COPC - Comprehensive Care (3). The spectrum of health care from promotion, prevention, treatment and care, rehabilitation and palliation; prevention concepts (primary, secondary, tertiary); screening strategies (opportunistic/ systematic); high risk based (individual) prevention and population based prevention (Rose, 1985);
• Principles of COPC – Practice with Science (2). Emphasising principles of diagnostic & screening research (Sackett & Haynes, 2002); limits of diagnostics & screening; the role of research in COPC; “big data”-approach (Krumholz, 2014)
• Principles of COPC - Person centered care (1). Opportunities and limitations of personalised care (evidence/algorithm based care); Person centered care (holistic approach) (Ekman et al. 2011)
• The household assessment (2). Definition of “household”. Opportunities and challenges assessing common variables of a household (e.g. composition; dependency; relation of members; “vulnerability”; headship; dwelling type, access to water/ electricity/ sanitation etc.; exposure to air/ water/ land/ pest/ noise pollution; income etc.)
• Health status assessment and community based interventions (total 21): The potential of COPC, especially when combined with e-/m-health solutions is not yet uncovered in most health systems. One of many reasons is that COPC differs conceptually from the “traditional” (facility based) approach in health care: COPC is focussed on health (instead of disease), health promotion and prevention (instead of treatment) and it pro-actively approaches people in their communities and homes (instead of providing demand driven services in a health facility). Thus the challenges as well as the opportunities of a health team dealing with common health problems, disease or conditions in the community/ the home of the person differ from the ones health professionals face in a clinic or hospital setting. The sessions in this block will introduce to programmes/ interventions/ services a HT could offer addressing nine common fields (see below). A few specific health problems, disease or conditions in each will be chosen for deeper learning: Through interactive lectures and guided small group work the students will develop and debate programmes/ interventions/ services a HT could provide for the selected health problems, disease or conditions taking the role and function of a health team and the principles of COPC into consideration:
• General Health & Lifestyle (2): Functionality, sensory, body mass, nutrition, exercising, smoking etc.
• Child health (3): Child development, infant feeding, Vitamin A, immunization, deworming
• HIV (2): Education, prevention/ community based testing, treatment support, “90-90-90” strategy
• TB (2): Education, prevention/ community based screening, treatment support, “90-90-90” strategy
• Reproductive Health (3): Ante-, post- and neonatal care, sexual health/STI, “men’s health”, contraception use, family planning, adolescent health
• Chronic/ Non-communicable diseases (3): Education, prevention/screening, “5C” approach (clinical symptoms, control and monitoring of disease, care and treatment, compliance to treatment, complications) concept; examples: art. hypertension, diabetes mellitus, chronic lung diseases etc.
• Mental health (3): Education/ prevention/ screening, examples: dementia, depression, psychiatric disorders
• Cancer (2): Examples: cervix, breast, prostate, colon cancer
• Physical & Sexual assault (1): Education, prevention/screening
• Group work (total 13):Introduction of the topic (1 slot) The session includes the formation of the groups and the decision about the topic/ setting each group will work on. The students will receive a checklist about what is expected to be covered in the proposal/ presentation and how it will be evaluated. Practice (12 slots) The groups will work independently but under the supervision/ facilitation of the module coordinator.
• Exam (2): Written exam
• Presentation (3): The groups will present their work to their peers, and the two examiners.
• Reflection & Closeout (1): Reflections; Closeout
• Self-directed learning (30): Students are expected to reinforce learning contents through self-directed learning (e.g. reading, discussions etc.)
Methods:
The learning method during the first three days of teaching is more teacher centered and lecture based. This is considered adequate to acquire basic knowledge and understanding about COPC, its history, practice and guiding principles (introduction [1 slot], history [2], the health team [4], implementation of COPC [2], and principles of COPC [10]).
The learning method during the following six teaching days is more learner centered, firstly with interactive lectures and small group work during lectures discussing and debating possible interventions/ programmes/ services a health team could provide for common health problems, diseases or conditions [23]. Eventually participants will work independently in (supervised/ facilitated) groups demonstrating their ability to apply newly gained knowledge and insights to a specific and complex environment: Students will develop a proposal for an intervention/ programme/ service a community health team could provide for a specific health problem, disease or condition of their choice in a setting of their choice [13].
Throughout the module, students are expected to reinforce learning contents through self-directed learning (e.g. reading, discussions etc.) [30]
Prerequisites:
Successful completion of the core course (basic knowledge about PHC and health systems in LMIC, good understanding of primary care principles, good understanding of common health problems in LMIC, ability to critically review and appraise literature/ guidelines, basic project management and planning skills).
No further or specific subject areas have to be completed before the module can be started.
If not a native English speaker: Internationally recognised English proficiency certificate equivalent to a TOEFL score of 550 paper/213 internet/80 online, or IELTS score 6, or DAAD (A or B in all categories). TropEd students need to provide proof of registration as tropEd student at their home institution only.
Attendance:
Max. 30 students (unlimited tropEd students)
Selection:
Places are allocated on a “first-come, first-served” basis.
COPC module:
• Application deadline: 10 weeks before module start (18 March 2018).
• Payment deadline: 8 weeks before module start (02 April 2018).
• Confirmation of participation by ITMIH: 6 weeks before module start latest (16 April 2018), subject to a sufficient number of applications.
• Late applications will be considered as long as places are available.
Fees:
750.00 € TropEd MScIH students and alumni
937.50 € DIPH and DTMPH students
1125.00 € Other students (e.g. short course students)
Scholarships:
Not available
tropEd accreditation:
Accredited in December 2017. This accreditation is valid until December 2022.
Remarks:
Key literature
1. Marcus T. Community Oriented Primary care. COPC Principles, the Individual, the Family and the Social Structure of Society. 2013, Cape Town, South Africa: Pearson Education South Africa (Pty) Ltd.
2. Whitehead M. The concepts and principles of equity in health. Health promotion international 1992;6(3):217-228
3. Sackett DL and Haynes RB. The architecture of diagnostic research. BMJ 2002;324:539-541.
4. Krumholz HM. Big data and new knowledge in medicine: the thinking, training, and tools needed for a learning health system. Health Aff (Millwood) 2014;33(7):1163-1170
5. Rose G. Sick individuals and sick populations. Int J Epidemiology 1985;14:32-38
6. Ekman I, Swedberg K, et al. Person-centered care--ready for prime time. Eur J Cardiovasc Nurs 2011;10(4)248-251

Course application form
Email Address: mscih-student@charite.de
Date Of Record Creation: 2017-12-17 15:42:23 (W3C-DTF)
Date Of Record Release: 2017-12-17 20:57:35 (W3C-DTF)
Date Record Checked: 2018-06-27 (W3C-DTF)
Date Last Modified: 2018-06-27 13:18:15 (W3C-DTF)

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