Developmentcooperation in healthcare… Whatabout the patientsperspective?
Overview of content • Introduction • Healthcare needs in developing countries • The concept of Patient-centred Care • The Lucoma Project • Communication skills course for rural healthcare workers
Introduction: Does developmentalaid meet the needs?
… And what is in the (Belgian) offer? (Source: http://diplomatie.belgium.be/en/policy/policy_areas/index.jsp) (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”
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!)
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... • 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 • 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
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
What patients really want... (Stewart, 2001) • Explore the patients' main reason for the visit, concerns and need for information • Seek an integrated understanding of the patients' world—that is, their whole person, emotional needs, and life issues • Find common ground on what the problem is and mutually agrees on management • Enhance prevention and health promotion • 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)
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 • Health perception & management pattern • Nutritional-metabolical pattern • Elimination Pattern • Activity-exercise pattern • Sleep-rest pattern • Cognitive-Perceptual pattern • Self-perception/self-concept pattern • Role-relationship pattern • Sexuality-reproductive pattern • Coping-Stress tolerance pattern • 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
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