Development cooperation in
healthcare…
What about the patients
perspective?
Overview of content
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Introduction
Healthcare needs in developing countries
The concept of Patient-centred Care
The Lucoma Project
Communication skills course for rural
healthcare workers
Introduction:
Does developmental aid meet the
needs?
Development cooperation: what are
the needs?
… And what is in the (Belgian) offer?
(Source: http://diplomatie.belgium.be/en/policy/policy_areas/index.jsp)
Gouvernmental cooperation
BTC, Lowns, acquitation of debts,…
291.514.950€
Non-Gouvernmental cooperation
VVOB, VLIR, Scientific institutions, local NGO's,…
233.032.467€
Multilateral cooperation
UN-contributions, World Bank, …
442.193.581€
Others
Humanitary aid, sensibilisation, support private sector
313.925.930€
Foreign Affairs
B-Fast, humanitary aid, conflict prevention & diplomacy,…
Total Belgian budget 2008:
97.802.431€
1.378.469.359€
(Source: DGOS year report 2008)
Match or mismatch?
• Not everything that counts can be counted and…
• Healthcare is only one part in a complex web of
interrelated needs
• Equally complex landscape of development cooperation
organisations
• Acute vs. long term needs
• This seminar focuses on “efficient cooperation for long
term needs in healthcare”
Healthcare needs in developing
countries
Ranking of selected risk factors: 10 leading risk
factor causes of death by income group, 2004
Source: GLOBAL HEALTH RISKS, Mortality and burden of disease attributable to selected major risks. WHO, 2009.
Chronic and complex health problems
• Growing incidence in both high and low
income countries
• Have significant influence on healthy
life expectancy and quality of life
• Are not cured by standard procedures
• Any cure:
– Is mostly focussed on keeping the
situation stabile rather tan on healing
– Risk for noncompliance
– Success is related to integration in
patients life (motivation!)
Healthcare in Western vs. developing
countries
Core Health Indicators (WHO, 2004-2006)
Belgium France
UK
Burkina
DR
USA
Faso Mali Ethiopia Congo
Life expectancy m/f
77/82
77/84
77/81
75/80
46/49 45/48
55/58
46/49
Healthy Life expectancy m/f
69/73
69/75
69/72
67/71
35/36 37/38
41/42
35/39
Per capita gouvernment expenditure on
healthcare (Intl$)
2194
2646
2261
2862
51
31
12
6
Per capita total expenditure on healthcare
(Intl$)
3071
3314
2597
6350
86
60
20
17
Per capita gouvernment expenditure on
healthcare (%)
0,71
0,79
0,87
0,45
0,59
0,51
0,6
0,35
42
34
23
26
?
<1
<1
1
142
80
128
94
?
6
2
5
Physicians (/10000 population)
Nurses & midwifes (/10000 population)
Criteria for effective rural healthcare
– Availability (distance, time)
– Regional spreading
– Regional cooperation & referral
– Low cost – Government support
– Healthcare staff skills
– Integration of prevention in socio-cultural life
(Source: Immpact, 2008)
In reality: if you get sick in rural
Africa...
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See the village responsible or local healer
Can you afford professional healthcare?
Organise family and housekeeping
Travel to the nearest health facility
(community care centre)
• See the nurse for clinical examination and
standard cure
• Travel home
Health risks
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Traditional medicine
Lack of financial means
Loss of time
Limited & strongly standardised basic care:
– Lack of physicians
– Anamnesis & clinical examination based on algorithms
– Treatment based on standard cures
• Noncompliance
Some examples: CMA Houndé (Burkina Faso)
Some examples: Dispensary just outside Houndé
(Burkina Faso)
Some examples: CSCOM Koutienso, Mali
First conclusions so far...
Healthcare needs:
• Mainly chronic diseases
• Multi-problem
situations
Healthcare system:
• Limited budget
• Limited development
aid
• Limited Infrastructure
• Limited skills
• Traditional medicine
Patient centered care
What patients really want...
(Stewart, 2001)
1.
Explore the patients' main reason for the visit, concerns and need
for information
2.
Seek an integrated understanding of the patients' world—that is,
their whole person, emotional needs, and life issues
3.
Find common ground on what the problem is and mutually agrees
on management
4.
Enhance prevention and health promotion
5.
Enhance the continuing relationship between the patient and the
doctor
Why Patient-centred care?
• Biomedical model does not satisfy patients needs in complex and/or
chronic diseases
-> Quality of life
• Investigate and treat the patient, not the disease!
-> “shared decision making”
• Compliance with therapy:
– Patients knowledge & motivation
– Integration in patients life style and family life
– Thrust in medical staff & therapy
(Stewart, 2001; Pruitt, 2005; Dolan, 2008)
• Efficient healthcare
– Outcomes
– Settings
(Bradley, 2005, Inui, 2007)
PCC and the millennium development goals
•Social promotion
•Family planning
•Female circumcision
•Immunisation
•Neonatal care
•Child nutrition
•Primary health care
•Substance abuse
•Child labour
•Perinatal follow-up
•Skilled birth attendance
•Prevention from
domestic violence
•Prevention from
arranged marriage and
pregnancy in young age
•HIV
•Malaria
•TBC
•Safe drinking water
How to achieve patient-centred care?
• Skilled health-care provider:
– Medical knowledge & skills
– Family & life style anamnesis
– Communication skills
• Time & motivation
– Team support & counselling
(Source: Dunn, 2003)
The Lucoma project
Houndé, Burkina Faso
Communication skills course
Houndé, April 2009
Course content
• Part 1: General communication theory and skills
training
– Schröder model
• Part 2: patient anamnesis
– Conversation structure
– Gordon’s 11 Health patterns
• Part 3: Health education
– Goals & means
– Procedures
The model
1.
Health perception &
management pattern
2. Nutritional-metabolical pattern
3. Elimination Pattern
4. Activity-exercise pattern
5. Sleep-rest pattern
6. Cognitive-Perceptual pattern
7. Self-perception/self-concept
pattern
8. Role-relationship pattern
9. Sexuality-reproductive pattern
10. Coping-Stress tolerance pattern
11. Value-Belief pattern
Pedagogic considerations
• Theoretical part:
– Limited and understandable
– Lectures and literature review
– Local situation as a starting point
• Focus on applicability
• Interactive sessions:
Presentations, discussions,
role-plays, exercises and
try-outs
Presentations & discussions
Role-play
Results of the pilot
PCC and the holistic model
Methods of communication and
positive influences
New, difficult and important?
Discussion and conclusions
• Small survey
• Social desired answering
• Limited knowledge on PCC
• Training is important, but only 1 aspect of a
complex situation (time & motivation)
• Additive & continued support:
– Procedures and posters
– Expert group
– Coaching