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GHF2014 – PS03 – Primary Health Care Reforms and Family Medicine

PS03 TUESDAY, 15 APRIL 2014 ROOM: 15 ICON_Fishbowl
Primary Health Care Reforms and Family Medicine
Prof. Jan De Maeseneer
Head of the Department of Family Medicine and Primary Health Care of Ghent University, Belgium
Identifying and Addressing Structural Quality Gaps in Primary Health Care in Tanzania
Dr. Dominick Mboya
Research Scientist, Research Department, Ifakara Health Institute, Tanzania
Medical Student and Clinical Teaching Staff Attitudes and Perception of Family Medicine: Tajikistan
Prof. Dilrabo Kadirova
Professor of Family Medicine, Chair of Family Medicine Nb. 1, Tajik State Medical University, Tajikistan
The Impact of the Family Health Team (FHT) model on UNRWA PHC clinic: a success story in a resource-limited and refugee setting
Dr. Ali Khader
Family Health Team Coordinator, Health Department, United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), Jordan
Making the Profession of Family Doctors Attractive for Future Doctors: Kyrgyzstan
Dr. Salima Sydykova
Teacher, Kyrgyz State Medical Academy I.K. Akhunbaev, Kyrgyzstan
Dr. Flora Lucas Kessy
Senior Lecturer in Development Studies, Mzumbe University, Dar es Salaam Campus College, Tanzania

JanDeMaeseneerProf. Jan De Maeseneer

Professor Jan De Maeseneer is a family physician and Head of the Department of Family Medicine and Primary Health Care of Ghent University. His research at the university focuses on Education, Health Promotion, Health inequity, Health Services Research and Global Health. He published more than 100 articles in scientific journals.

In 2013 Jan De Maeseneer was appointed to the Expert Panel on effective ways of investing in health of the European Commission. In 2012 Jan De Maeseneer became a member of the Global Forum on Innovation in Health Professional Education at the Institute of Medicine in Washington. (Read more…)


PS03_Mboya_squareDr. Dominick Mboya

Dominick Mboya has over 25 years experience as medical practice and teaching, currently employed as a research scientist at Ifakara Health Institute in Tanzania, responsible for coordinating Health System Quality Improvement initiatives implemented by Ifakara Health Institute through Initiative to Strengthen Affordability and Quality of Health Care (ISAQH). The initiative is funded by Novartis Foundation for Sustainable Development. Apart from that he is the Intervention coordinator for the Connect project designed to test the model of trained and paid Community Health Workers to accelerate achievement of MDG 4 & 5, the project is funded by Doris Duke Foundation and Comic Relief. (Read more)

Kadirova PhotoProf. Dilrabo Kadirova

Prof. Dilrabo Kadirova is the Head of the Family Medicine Department No.1 of the Tajik State Medical University (TSMU) named after Abu Ali ibn Sino, MD, Professor. She has over 25 years of teaching experience.

Prof. Kadirova received her candidate of science and doctorate degrees studying at the Medical University in Moscow. Her research focuses on cardiology, in particular hypertension and its prevalence, diagnosis and treatment of different age groups: women, youth, elderly and senile, as well as the development of family medicine in the Republic of Tajikistan (RT). (Read more)

Dr. Khadrer_squareDr. Ali Khader

Worked as medical doctor in different clinics and hospitals in Jordan and Saudi Arabia, worked at different managerial and technical levels with the United Nations Relief and Works Agency (UNRWA). Developed guidelines, training materials, assessment tools, project and research proposals, developed PHC interventions, conducted scientific and operational research, published papers in the fields of maternal and child health, NCDs, Tobacco, school health, micronutrient deficiencies, family medicine…..  provided guidance and mentoring to staff and junior researcher. Represented UNRWA health department in regional and international meetings.

Kessey Profile PhotoDr. Flora Lucas Kessy

Flora Lucas Kessy, a Senior Lecturer in Development Studies at Mzumbe University, Morogoro Tanzania holds a PhD in Agricultural and Consumer Economics with a major in Family and Consumer Economics and a minor in Women and Gender in Global Perspective from University of Illinois at Urbana Champaign, USA. Dr. Kessy has researched and published on issues related to income and non-income poverty, social sectors development and good governance. In particular, she has researched on poverty reduction strategies in Eastern and Southern Africa, poverty escape routes, covariate and idiosyncratic shocks affecting households in Tanzania and social protection. In the area of governance, she is involved in public expenditure studies for the health sector and water sector and the use of evidence for actions to improve maternal and newborn health. (Read more)


Recep Akdag

RecepAkdagSquareRecep Akdag

Minister of Health of Turkey 2002 - 2013

Recep Akdag was born in Erzurum, Turkey in 1960. As a pediatrician, he has been holding a professor title from the Ataturk University School of Medicine since 1999. During his career as a medical specialist and academician, he had been involved in a number of administrative tasks. Between 1994 and 1998, he worked as the Deputy Chief Medical Director, Chairman of the Procurement Commission and Deputy Editor of the Medical Bulletin in the Research Hospital of the Medical Faculty of Ataturk University. He also co-founded the Biotechnology Research Center of the University and served as the Deputy Head of the Center from 1997 to 2000.

After being elected as a Member of Parliament from the Province of Erzurum, he had served as the Minister of Health of Turkey between 2002 and 2013. During his tenure, he has been the key figure for the implementation of the influential Health Transformation Program (HTP) in Turkey. This comprehensive program brought a people-oriented approach to healthcare service delivery and strengthened the health system with successful implementation of universal health coverage. Major aspects of this health system reform included integration of public hospitals, increased patient access to medical services and prescription drugs, invigorated primary healthcare delivery with the implementation of family medicine, improved maternal and childhood healthcare services, better quality and reach of emergency services, and establishment of a national medical rescue team.

HTP generated high access rate for essential services thru the adequate healthcare supply and universal health insurance covering the poorest. Infant mortality rate, maternal mortality ratio and catastrophic health expenditures decreased dramatically. Public satisfaction with health services increased from 39% in 2002 to 75% in 2012. Apart from leading this influential program, Prof. Akdag has edited a number of reports and contributed/co-authored academic articles about HTP. He has addressed, directed and moderated in many international conferences including of those the WHO and UNICEF. He has received the WHO’s “World No Tobacco Day” Award as a recognition of his efforts in the fight against the global tobacco epidemic and in the promotion of tobacco control initiatives and policies. He has been an advisory board member of the Ministerial Leadership in Health (MLIH) Program at Harvard University since 2012.

Prof. Akdag still serves as an MP in the Grand National Assembly of Turkey for his third consecutive term. He also is a Richard L. and Ronay A. Menschel Senior Leadership Fellow, Harvard School of Public Health.


Dr. Suzanne Suggs

Professor Suggs is an Assistant Professor of Social Marketing and Head of the BeCHANGE Research Group in the Institute for Public Communication, Faculty of Communication Sciences, at the Università della Svizzera italiana (USI), in Lugano Switzerland. She is also Director of the USI Sustainability Incubator (USI-SINC). She received a BBA in Marketing at University of North Texas (USA), a MSc and PhD in Health Studies at Texas Woman’s University (USA), and a Post-doctoral fellowship at McMaster University (Canada).

Suzanne’s research focuses on behavior change communication through information and communication technologies. She examines the determinants of behavior and tests innovative digital communication strategies, delivered through ICT, and the influence on health behaviors. The majority of her work focuses on eating and physical activity behaviors, but also does research on alcohol, tobacco, decision-making, vaccination uptake, hand washing, HIV testing, medication compliance, self-management of conditions and therapy, and consumption behaviors.

Prior to joining the faculty in Lugano, she was Assistant Professor of Health Communication, Department of Marketing Communication, at Emerson College and Adjunct Assistant Clinical Professor in the Department of Public Health and Family Medicine at Tufts University School of Medicine (Boston, Massachusetts, USA). She has a wealth of industry experience, working with pharmaceutical companies, health insurers, foundations, organizations, and multi-media communication companies. She is a Co-Founder and on the Executive Board of the European Social Marketing Association and is on the Editorial Board for the Journal of Health Communication: International Perspectives. She teaches graduate level courses in Social Marketing, Focus Group Methods, Research Methods, and Media Skills. And for the second year in a row, Suzanne will teach a course on ” m-Health: Mobile Communication for Public Health”, in the Swiss School of Public Health+ Summer School this August in Lugano.

Securing WHO FCTC Article 11 Compliance Through Legislative Advocacy: the Philippines

Author(s) Patricia Miranda1, Diana Cecilia Trivino2, Karla Mae Rocas3, Evita Mariz Ricafort4.
Affiliation(s) 1Legal Team, HealthJustice Philippines, Antipolo City, Philippines, 2Legal Team, HealthJustice, Quezon City, Philippines, 3Legal Team, HealthJustice Philippines, Quezon City, Philippines, 4Legal Team, HealthJustice Philippines, Quezon City,Philippines.
Country - ies of focus Philippines
Relevant to the conference tracks Governance and Policies
Summary Under the WHO FCTC, the Philippines obligated itself to require effective health warnings on cigarette packs by 2008. That deadline has long passed. Thus, HealthJustice Philippines (HJ) and Social Weather Stations (SWS) conducted a nationwide survey entitled "Usage and Attitudes of Filipino Youth Towards Tobacco" to gauge the behavioral response of Filipino youth towards graphic health information (GHI) on cigarette packages. The results show, among others, that 82% of current smokers believe that GHI shall be effective in preventing the increase of smokers. The survey is one of the launching points of HJ's legislative advocacy to ensure the passage of a GHI law in the 16th Congress.
What challenges does your project address and why is it of importance? The biggest challenge to the GHI legislative advocacy plan is the strong pro-tobacco lobby of the Northern Luzon Alliance (NLA), a legislative bloc composed mostly of representatives of tobacco-growing districts in Northern Luzon. The NLA has been known to deliver a "solid vote" against tobacco control measures in the Philippines. Currently, the Philippines is implementing Republic Act No. 9211, otherwise known as the Tobacco Regulation Act of 2003 (RA 9211), which provides for text-only warnings at the bottom portion of only one side of the pack. The contents of the warnings have not changed since the enactment of RA 9211 in 2003. Notably, RA 9211 does not comply with Philippine obligations under the WHO FCTC. Under this treaty, the Philippines is obligated enact effective measures requiring the placement of GHI on tobacco product packages by 2008. Thus, the Philippines has breached its international obligations when it missed its deadline to comply with the WHO FCTC. As a member of the family of nations, the Philippines agreed to be bound by generally accepted rules for the conduct of its international relations.
How have you addressed these challenges? Do you see a solution? It is urgent and necessary that Congress pass a law or laws guaranteeing that all our policies are in compliance with the WHO FCTC. One such legislative measure is the passage of a law requiring the placement of graphic health GHI on tobacco product packages, and banning the use of misleading descriptors thereon.HJ is currently with individual lawmakers and lawmaking bodies to gain support for GHI. As part of its legislative advocacy plan, HJ has prepared the following documents:
(a) brief on implementing Article 11 of the WHO FCTC in the Philippines;
(b) draft model bill incorporating the requirements of the WHO FCTC and its Implementing Guidelines;
(c) legislator's toolkit containing reports, surveys and studies relating to the effectivity of GHI in other countries; and
(d) presentation containing data which includes the results of the HJ-SWS nationwide survey entitled "Usage and Attitudes of Filipino Youth Towards Tobacco."At the time of this writing, there are currently seven Graphic Health Information bills. In the Senate, there are two bills filed by Senate President Franklin Drilon and Senator Pia Cayetano. In the House of Representatives, there are currently five bills on GHI, filed by Representatives Marcelino Teodoro of Marikina City, Niel Tupas of Iloilo, Joseph Violago of Nueva Ecija, Leah Paquiz of Ang Nars Party List, and Eric Singson of Ilocos Sur. All of these bills have been read on First Reading and are pending in their respective committees on health and/or trade. It should be noted that Eric Singson is a member of the Northern Luzon Alliance (NLA), a legislative bloc composed mostly of representatives of tobacco-growing districts in Northern Luzon. This may prove to be a sign that there is public clamor for more health promotive policies, particularly one requiring the placement of graphic health GHI on tobacco product packages. Hence, the solution lies in pushing for the passage of a law requiring GHI, particularly because of the presence and commitment of dedicated champions, the recent re-filing of the bills in both Houses of Congress, and the filing of a bill from a member of the NLA.
How do you know whether you have made a difference? One can only hope to make a difference, since the passage of any tobacco control measure in the Philippines entails coordination and teamwork between public health advocates. This is because the Philippines has the strongest tobacco lobby in Asia. Thus, one crucial gauge to determine if tobacco control advocates have made a difference in pushing for WHO FCTC compliant measures is to determine the number of tobacco control measures passed.
Have you or the project mobilized others and if so, who, why and how? The HJ Project Team is still currently mobilizing legislators and government agencies. Hence, the results of the "Usage and Attitudes of Filipino Youth Towards Tobacco," as well as the contents of the draft WHO FCTC-compliant bill, is being made available to the public.
When your donor funding runs out how will your idea continue to live? While donor funding may have been useful in drafting the documents submitted to the legislators in the Senate and Congress, these documents are also made available to the public. Hence, even if donor funding runs out, the documents meant to promote standardized tobacco product packaging and labeling in accordance with the Article 11 Guidelines would still be available to other tobacco control advocates, both public and private partners, to use and disseminate as they fit. The end goal would be amending RA 9211 to ensure its compliance with the WHO FCTC. The Department of Health, the Civil Service Commission, and the Metropolitan Manila Development Authority are government agency partners of HJ. These agencies have shown a strong support for the implementation of tobacco control policies in the Philippines.

Chronic disease risk factor and physical activity patterns: Findings from Sri Lanka

Author(s) Shreenika DE Silva Weliange1, Dulitha Fernando2, Jagath Gunathilake3.
Affiliation(s) Community Medicine, University of Colombo, Colombo, Sri Lanka, Department of Community Medicine- retired, University of Colombo, Colombo, Sri Lanka, 3Department of Geology, University of Peradeniya, Kandy, Sri Lanka.
Country - ies of focus Sri Lanka
Relevant to the conference tracks Chronic Diseases
Summary There is a tremendous increase in chronic diseases worldwide. A similar pattern is observed in Sri Lanka. Physical inactivity contributes to 6% of deaths globally and is identified as the fourth leading risk factor for mortality due to chronic diseases. There is sparse knowledge of the profile of the risk factors of chronic diseases as well as inadequate knowledge of the pattern of physical activity in Sri Lanka. The objective of this study was to assess the risk factors of chronic disease and the association with physical activity for adults in the Colombo Municipal Council (CMC) area.
Background 'The Global Strategy on Diet, Physical Activity and Health' endorsed at the 57th World Health Assembly states that a “profound shift in the balance of the major causes of morbidity and mortality has already occurred in the developed countries and is underway in many developing countries”. The World Health Report 2002, 'Reducing Risks, Promoting Healthy Life', shows that few risks are responsible for a large number of premature deaths and account for a big share of the global burden of disease. The immediate risk factors for chronic diseases are raised blood glucose, high blood pressure, high concentrations of cholesterol in the blood and overweight or obesity. Physical inactivity and tobacco use, along with poor diet, are the common modifiable risk factors. In Sri Lanka a changing trend in the pattern of disease burden is observed. Trend analysis using Registrar General’s data shows that chronic disease mortality rates are increasing rapidly during the past decades. In 2001, 71% of all deaths in Sri Lanka were due to chronic diseases. Chronic disease mortality is reported to be 20-30% higher in Sri Lanka than in many developed countries. According to the Annual Health statistics, coronary heart disease was the leading cause of hospital deaths in Sri Lanka since 1997.
Objectives Urbanisation and other socio economic changes have led to changes in individuals’ lifestyle thereby causing an increase in the intermediate risk factors of chronic diseases, such as raised blood pressure, raised blood glucose, abnormal blood lipids and overweight/obesity. However, to further understand the problem it is necessary to study these intermediate risk factors and the common modifiable risk factors in the most urbanized part of Sri Lanka namely the CMC area. This study aims to assess these risk factors and the association of physical activity for adults in the CMC area.
Methodology Study design and area: This was a cross sectional study of a representative sample of adults aged 20-59 (both inclusive) years living in the CMC area in which has the highest population density, and covers most of the metropolitan and the economic area in Sri Lanka. Study population: All adults living in the area for a continued period of not less than six months were the study population. The exclusion criteria were: institutionalised adults, adult visitors to the study area, pregnant females up to postpartum period of 3 months, adults with severe psychiatric illness and those not providing consent. Sampling: Four hundred adults were selected using a probability proportionate to size cluster sampling method. The Primary Sampling Unit was a ward in the CMC area which is similar to a village structure. The Grama Niladhari (village headman) in each ward helped the data collectors to locate the selected houses. Within the household an adult was selected using a random procedure. Only one eligible individual was selected from a household so as to minimize cluster effect, as members of the same household share similar life styles. Recruitment was done irrespective of the availability of the study participants in the house at the time of the first visit to the households. The cluster was considered as complete when 40 consenting eligible people were identified and interviewed.Measurements: An interviewer administered questionnaire consisting of socio-demographic, economic characteristics was used to collect data. Medically trained officers interviewed individuals and assessed the disease status by questioning and going through medical records. Physical activity was assessed using the validated long version of the international physical activity questionnaire and individuals were classified into ‘sufficient activity’ and ‘insufficient activity. Trained personnel took anthropometric measures of height and weight from all participants.Ethics: All participants received an information sheet about the study and signed a consent form if they agreed to participate. Ethical clearance was obtained from the Ethics Review Board of the Faculty of Medicine, University of Colombo. The provincial and the district government authorities gave permission to carry out the study in their area.

Statistical analysis: Descriptive analysis was done using chi square tests. All analysis were conducted using SPSS software version 17.

Results Out of the 400 participants 43% (n=172) were males and 57% (n=228) were females. Only 46% (n=184) had a G.C.E. ordinary level education or more and 86.3% (n=345) had an income of less than Rupees 30,000. Fifty four percent were between 40-59 years of age while the rest (46%) were between 20-49 years of age.
The self-reported prevalence of type 2 diabetes mellitus was 12.3% (n=49) while the prevalence of raised blood pressure and abnormal lipds were 13.3% (n=53) and 5.5% (n=22) respectively. The majority (60.5%, n=242) were overweight while another 7% (n=28) were underweight. More than half (64.5%, n=258) of the participants had at least one immediate risk factor for NCD, and out of them 110 (27.5%) were 40 years or less. Of the sample 11.8% were current smokers and 14.5% were previous smokers.
Seventy two precent (n=288) of the participants were in the ‘sufficiently active’ category, with activity accumulated mainly through household, travel and job related behaviours. However, 85.8% (n=343) reported no leisure-time PA, and 21.3% (n=85) reported that they did not walk either for travel or leisure for more than 10 minutes a week. No active transport (walking/cycling) methods were used by 23.5 % (n=94). Of those who were had at least one immediate risk factor 85.6% (n=221) had no leisure activity while 21.3% (n=55) and 93.4% (n=240) reported no walking or cycling during the previous week.
Having an immediate risk factor for chronic disease was not statistically significantly associated with socioeconomic or demographic characteristics of the individuals. This study also did not find a strong evidence of association between the presence of at least one immediate risk factor and physical activity.
Conclusion An alarming percentage of immediate risk factors were observed in the CMC area although no particular socioeconomic and demographic group was more affected than the others. The major contributors to energy expenditure in the local setting according to this study were housework, transportation and job related activities. This is different to the pattern seen in the developed countries. Being active while attending to day to day chores should be encouraged and promoted in the developing countries since it is already their habitual practice. Special concern is necessary due to the counteracting forces of rapid urbanisation taking place in Sri Lanka which makes it more convenient and fashionable for people to use mechanical equipment for housework, to seek sedentary jobs and use motorised vehicles for transport. Since it is seen that most of the participants in the present study enacted their activity from transportation it is necessary to promote active transportation. Thus the importance of an activity friendly physical environment with good street structure to facilitate walking and cycling, traffic and general safety, access and connectivity needs to be highlighted.
Strength and limitations: This study explored the burden of risk factors in the most urban part of Sri Lanka and its association with physical activity. Physical activity measurement, although validated for Sri Lanka, was carried out through self-reports. Thus there was a possibility for recall bias and for over-reporting or under-reporting the number of occasions and time spent on physical activity in different domains. This is due to various reasons such as social norms determining socially acceptable answers. A cross sectional study design had to be used. Therefore causal interferences cannot be made because of the inability to determine the temporal sequence.

Finding an integrated solution for tobacco use prevention: Kyrgyzstan.

Author(s) Anara Kalieva1, Salima Sydykova2, Nurlan Brimkulov3, Asel Burzhubaeva 4
Affiliation(s) 1Project "Community-based action against smoking in Chui Oblast KR 2011-2013", Project "Community-based action against smoking in Chui Oblast KR 2011-2013", Bishkek, Kyrgyzstan, 2Department of Hospital Therapy, Kyrgyz State Medical Academy I.K. Akhunbaev, Bishkek, Kyrgyzstan, 3Department of Hospital Therapy, Kyrgyz State Medical Academy I.K. Akhunbaev, Bishkek, Kyrgyzstan, 4Department of Hospital Therapy, Kyrgyz State Medical Academy I.K. Akhunbaev, Bishkek, Kyrgyzstan.
Country - ies of focus Kyrgyzstan
Relevant to the conference tracks Advocacy and Communication
Summary The current escalation in tobacco use and tobacco-related death and disease can be reversed only by integrated tobacco control strategies. Like other low-income countries Kyrgyzstan is facing massive challenges in this respect. The main idea of this project is to integrate a public health and health systems approach in tobacco control by implementing intensified community-based actions in one of the seven regions of the country in 2011-2013. Through activation of village health committees, primary health care, schools, medical schools and mass media the project strives to reach better understanding of the health hazards of smoking, and make changes in social norms of the community.
What challenges does your project address and why is it of importance? Kyrgyz Republic (KR) is a developing country in phase II of the tobacco epidemic, with a very high and growing prevalence of smoking in males and less in females. One of the dramatic facts that confirm the urgency of the tobacco use problem is high mortality from chronic respiratory diseases which is the highest among Eurasian countries. The problem requires integration of the various layers of the community, and active actions to build of supportive environments for the non-initiation and cessation of smoking.
One of the problems is the lack of data including data about actual smoking and attitude of the different layers of society towards smoking. Up to 80% of smokers acquire tobacco dependence before the age of 18. That is why it is so important to conduct intervention activities before this age when they are young and not dependent. Unfortunately our country does not have up-to-date and detailed data on the prevalence of active and passive smoking in various age groups. This deficiency of information hampers tobacco control, in particularly prevention activities for the reduction of smoking prevalence. The data available is not complete, but even this confirms the importance and urgency of the tobacco problem in our country.
How have you addressed these challenges? Do you see a solution? We see the solution in integration. If we want to change social norms, change the behavior and mentality of the community, the only way to go is integration of the players, because only the combination of all the available forces can beat the tobacco monster.
The pilot phase of the project was conducted during 2011-2013 in Chui Oblast. In 2015 monitoring will be conducted for the evaluation of the long-term effects of the activities.
The project combines efforts of the Ministry of Education, Ministry of Health and Republican Health Promotion Center to coordinate the integration process and enforce the project. The project integrates Village Health Committees, local authorities, school teachers, primary care professionals, health curriculum developers and mass media. They, in their turn work with various layers of the community: adult village population (smoking and non-smoking), drivers of public transport, school children, households, patients (smoking and non-smoking), medical students and interns, doctors, and newspaper readers.
VHC is a union of volunteer members who are active villagers wanting to advocate healthier lives and raise awareness of the community on various health issues. VHCs are trained by the Health Promotion Unit (HPU) specialists of the Family Medicine Centers (FMC).
The main components of our pilot project include: 1) Building the capacity of VHC in tobacco use prevention and activization and empowerment of local authorities; 2) Implementation of the modern teaching modules on healthy life style into school curriculum; 3) Systematization of the activity of the primary health organizations in tobacco use prevention; 4) Development and implementation of anti-smoking programs in the health curriculum at undergraduate and post-graduate levels.
Indicators were developed for each component and regular monitoring of the qualitative and quantitative indicators was performed.
We expected to reach the following outcomes:
• Increase awareness of the community in the health area.
• Establish skills on tobacco use prevention at a personal and community levels.
• Increase the number of patients visiting doctors for tobacco cessation.
• Establish healthy life-style behavior and tobacco-free attitude in children.
• Reinforce inter-sectoral cooperation at regional and smaller levels on tobacco use prevention.
• Elaborate of the model of the program on tobacco use prevention among the general population.
How do you know whether you have made a difference? The pilot phase of the project was conducted during 2011-2013 in Chui Oblast.
First of all a communication strategy was developed for community involvement in tobacco prevention activity in the Chui region and implementation of guidelines for the members of the VHC and HPU specialists. Authorities of the villages of Chui region approved the campaign and showed commitment to providing support to the village health committees.
The central part of the campaign are VHC members who are coordinated by the HPU specialists of the FMC. The project ensured the training of the HPU specialists and VHC members.
HPU specialists ensured that the local newspapers publish success stories and other positive information on tobacco use prevention.
The first task of the VHC members and schools was to increase awareness of the community about harmful effects of active and passive smoking on human body, especially in children. The second task of the VHC members and schools was the establishment of the negative attitude to tobacco smoking.
The survey of the Chui population shows that in 2011 34% of the population in Chui Oblast regarded smoking as very harmful to health whereas in 2013 the result was 49% (+15% increase). The awareness of impact of passive smoking on health increased from 29% to 49% (+20% increase).
In 2011 66% of the population was aware of the existence of national tobacco legislation. In 2013 this number was 85% (+19% increase). The number of smokers indicating that they would like to quit increased from 33% to 72% during the project (+39% increase).
600 teachers from the 296 schools in the Oblast have been trained during the project resulting in improved knowledge (37% -> 91%) about tobacco control issues by the teachers.
The teachers were provided with hand-outs containing description of lessons plans on smoking prevention for their students, text of the tobacco control law and the video “Tobacco or health!”.
Selective interviews of the family doctors within the report period revealed improvement of the situation in providing support to those who are willing to quit. Elements of anti-smoking programs are included in the curriculum of under-graduate and post-graduate levels in the training programs of Kyrgyz State Medical Academy.
Have you or the project mobilized others and if so, who, why and how? The project is realized by the partners: Finnish Lung Health Association (FILHA), Finnish ASH and Republican Health Promotion Center of the Ministry of Health of Kyrgyz Republic (KR), training center of Practical Approach to Lung Health Strategy under the Kyrgyz State Medical Institution of Continuous Medical Education and Ministry of Education of KR.
The partners have signed an agreement that was signed and approved by the Ministry of Health of KR and Ministry of Health and Education of KR.
The key partners were identified because of the expertise they have in the field of tobacco control, or the role they play in public health and the communication of the health messages with the community, or their role in coordination and reinforcement of the orders and regulations related to tobacco use prevention. All of the partners have past experience in tobacco control activities and showed their commitment through the whole period of project realization.
When your donor funding runs out how will your idea continue to live? From the very beginning of the project the project team was employed sustainable ideas that would survive long after the funding runs out. The key authority partners, such as Ministry of Health and Ministry of Education, were involved for the sake of sustainability. The project made sure that all the documents and orders that legalized project activities (such as including lessons into school curriculum for the 5-7 form school students, including the tobacco problem into the agenda of village authority meetings, the inclusion of tobacco control problems into the curriculum of KSMA at undergraduate and post-graduate levels and the systematizing of the tobacco prevention activities in the Family Medicine Centers) would be sustainable and institutionalized.

Comprehensive Assessment and Management of Hypertensive Patients in Primary Healthcare Facilities of Guatemala

Author(s): C. Mendoza Montano*1, P. Orellana2, A. de Arroyo3, M. Ramirez Zea4
Affiliation(s): 1Health Promotion, 2Medicine, 3Epidemiology, Guatemalan Association for the Prevention of Heart Diseases-APRECOR, 4Chronic Diseases, Institute of Nutrition of Central America and Panama CAP, Guatemala, Guatemala
Keywords: Chronic diseases, cardiovascular diseases, risk factors, hypertension, health system interventions.

In Guatemala, cardiovascular diseases (CVD) are becoming the leading cause of mortality and disability. The rising burden of these diseases makes it imperative to formulate effective community and health system-based interventions. Currently, the primary healthcare (PHC) system in Guatemala is mostly oriented to communicable diseases and maternal/child health so public PHC centres lack adequate programmes to cope with the increasing demand of CVD.


The objective of the study was to assess the feasibility and effectiveness of a comprehensive CVD risk reduction programme targeting patients with hypertension that could be integrated into the PHC facilities of Guatemala. The programme was designed for assessment, CVD risk stratification and management of adult individuals detected to have hypertension through opportunistic screening. Patients were stratified at low, medium and high risk based on the level of blood pressure and the presence or absence of other simple, non-invasive variables such as age, personal and family history of CVD, waist circumference (WC) and tobacco use. All patients received lifestyle counselling including smoking cessation, promotion of healthy diet and physical activity. Drug therapy with an antihypertensive medication was restricted to patients at high cardiovascular risk.


A total of 114 patients (54 ± 13 years old, 74% women and 26% men) were enrolled during a 6 months period at the public PHC clinic of the community of Villa Nueva. Seventy patients were followed up with a second visit to the clinic, and 43 with a third visit. Significant reductions were observed during the first follow up (36 ± 18 days later) in the group mean systolic blood pressure (from 164.9 ± 27.7 to 150.0 ± 21.0, p < 0.01 mmHg) and was even higher during the second follow up (168.0 ± 27.0 to 138.1 ± 17.3, p < 0.01). WC did not change during the first follow up (97.1 ± 8.4 to 95.2 ± 8.8cm, p = 0.14); however, a significant reductions were achieved (from 97.1 ± 8.4 to 93.2 ± 6.9, p=0.04) in patients (N=40) who had 3 visits to the clinic (71±20 days later). Of the 13 tobacco users, 7 discontinued use (53%).

Lessons learned:

This pilot study provides preliminary evidence of the effectiveness and feasibility of incorporating a CVD risk reduction programme into the limited healthcare infrastructure of Guatemala and probably applies to other developing countries.

Community Health through Health Education: The Zimpeto Community Health Promotion Experience

Author(s): F. V. Cabo1
Affiliation(s): 1Mozambican Public Health Association, Maputo, Mozambique

Health education, community health, partnerships for action, health promotion, public health, community health promotion agents, civil society


The Associação Moçambicana de Saúde Pública (AMOSAPU), founded in 1991, is the only national, non-governmental, not-for-profit, voluntary membership association representing the public health community in Mozambique. Mozambique as elsewhere has been impacted by the public health human resource crisis. Since 2000 AMOSAPU has been proactive in Maputo’s peri-urban communities implementing health education activities through the training of local community health promotion agents, in collaboration with the Ministry of Health. AMOSAPU’s work was initially carried out in the district of Zimpeto, home to 20,000 inhabitants who fled their homes from rural areas because of war and natural disaster. Community health promotion agents sensitized and improved the knowledge of community residents about public health issues such as basic sanitation, nutrition, tobacco control, malaria and HIV/STD prevention.


The Zimpeto project is now self-sufficient and serves as a model for similar initiatives throughout the country and region. Building on this success, AMOSAPU through the Canadian Public Health Association’s SOPHA programme continues this work in the region of Inhambane to extend the Zimpeto model to train and support 150 Community health promotion agents.


Over the next three years this strategy seeks to mobilize the Community Health Promotion Agents (CHPA) to actively participate and help take ownership of the health of their communities. The following results are expected: (1) The CHPAs will have received training in basic disease prevention and surveillance techniques, and health education training on a broad number of topics from sanitation, nutrition to communicable and non-communicable diseases. (2) They will have acquired the capacity and skills to plan, programme, monitor and evaluate the progress of their community health interventions. (3) The CHPAs will compliment basic government health services in the communities where human health resource shortage is critical.

Lessons learned:

This presentation will present some of the key successes, challenges and important lessons learned that AMOSAPU has experienced through its work in Mozambique.

Immigration, Mental Health and Access to Healthcare: 566 Eastern European Immigrants Residing in Portugal

Author(s): A. P. T. A. Monteiro1
Affiliation(s): 1UCPE Saúde mental comunitária, de família, Nursing School of Coimbra, Coimbra, Portugal
Keywords: Migrations, Eastern Europe, mental health, access of migrant populations to healthcare

In the last years of the 90s of the 20th century, the geography of the immigration to Portugal has suffered very deep transformations, both in the areas of recruiting and in the geographic fixation patterns of immigrants in Portugal, with rising and exponential flow of new groups of immigrants from Eastern Europe. The literature about this subject and the analysis of some indicators that focus on the access to healthcare by the main immigrant communities residing in Portugal, shows that despite significant legislative advances were recorded and an effort for the prosecution of good practices at the level of immigrant welcoming exists, there are not still the necessary studies to make a detailed and established assessment of the immigrants’ health conditions and practices, as well as the quality and suitability of care provided by the Portuguese Health Service to these populations.


This study aims to perform a socio-demographic characterization, identify the main health problems and health surveillance patterns of the Russian speaking immigrant population, coming from Eastern Europe countries residing in Portugal. It also aimed to assess the mental health status of this population and it’s vulnerability to stress, relating them with the migratory process, access to health services and social support. The study was conducted in immigrant support community centres from January 31st 2005 to March 31st 2006 and focused on 566 Eastern Europe immigrants residing in several regions of Portugal, 296 males and 270 females, with an age average of 36.3 years old. In this study one used the 23 QVS (Vaz Serra, 2000); GHQ-28 (Goldberg & Hillier, 1979); SSQ6 (Saranson, Saranson & Pierce, 1987) and a socio-demographic questionnaire.


From the 566 individuals sample one, we conclude that this population is predominantly from the male gender, in active young age, characteristic of an economic migration, with high academic qualifications, but that does not perform work tasks that demand similar qualifications. 81.8% of the inquired immigrants already had access to the Portuguese National Health Service, being the main reasons for the use of the health services situations of acute illness or work accidents. A significant percentage of the inquired refers consumption of alcoholic drinks and tobacco, have risk work tasks and presents reduced health surveillance behaviours. Regarding the mental health status, 10.4% of the inquired immigrants presented psychiatric pathology assessed by the cutting point of GHQ-28 and 54.9% of the inquired presented stress vulnerability determined by the cutting point of 23QVS. The statistic analysis revealed the existence of statistically relevant relations between social support understood as available (both in its dimension number and in the dimension satisfaction with the social support), and mental health. In this study one verified a statistically relevant correlation between access to health services and the levels of mental health of the inquired population. Several factors related to health vulnerability or bigger incidence of stress, namely the rupture with family support networks, unfavourable lodging conditions, unfamiliarity with the Portuguese language were identified.

Lessons learned:

Eastern European immigrant populations are a recent migratory flow in Portugal, with socio-demographic, cultural, linguistic specificities in face of the Portuguese population that represent a new challenge to structured health services in Portugal. This study revealed that Russian-speaking immigrants present high vulnerability to stress, low social support and that the mental health of this population is directly influenced by structural factors inherent to the migratory process and the welcoming society, as the working situation and access to healthcare in Portugal.