Message of the Vice Chancellor RMU                           

Working for better health of the people who are apparently normal and are at homes is itself a great challenge for healthcare professionals.  It needs one’s high intellect, professionalism and exceptional endeavor for the purpose. This program has a great cause of human service beyond responsibility. I trust Rawalpindi Medical University Community health transformation program (CHTP) will deliver a multidisciplinary effort under umbrella of department of Community Medicine & public health. This model would set new trend in practice of public health in teaching medical institutions and hence would play an effective role in health development of people of Pakistan after its country wide extrapolation in future.

 

Prof. Muhammad Umar (SI)

Vice Chancellor & CEO

Rawalpindi Medical University

& Allied Hospitals

Background:

Rawalpindi Medical University community health transformation program was undertaken to pursue the moral responsibility of the institution after its inception as Rawalpindi Medical University to identify its role in health betterment of the people of the region. Prof. Dr. Muham

mad Omar vice chancellor RMU realized that public sector health institutions are run by the public-resources, so the people have full right and be benefited in matters of health in all possible ways traditional & extra-traditional. In response a novel concept was shared to invest capacity of public health and other relevant departments of the University for th

eir an exceptional & effective role in health development of the people of the area beyond their traditional work range.

The vision is based on philosophy of shifting the notion of “healthcare for the peoples” to the “healthcare by the people” i.e. by placing people’s health in their own hands (1). Its approach is participatory and spirit is missionary. Here it is right to recall the words of Henry Sigerist, the great medical historian that” the people’s health ought to be the concern of the people themselves. They must struggle for it and plan for it. The war against disease and for health cannot be fought by the physicians alone. It is a people’s war in which entire population must be mobilized permanently”(1). This program intends to combine university intellect and community strengths under a meaningful mechanism for a visible health gain. This Program would provide opportunity for the health scientists to work directly in community perspectives and to closely examine interdependence of individual’s characteristics, prevailing cultural values & believes, environmental conditions and customary attribute of healthcare delivery system in determining real health needs of the people. Close work with highly disease-susceptible population would open many avenues for epidemiological research. Community based evidence would add better to improve healthcare philosophies. The program engages the faculty & students RMU in corrective health work in the service of the community.

This is beyond debate that health scene of our population is full of disease and wide social & behavioral malfunctioning in matters of health exists in the society. The dearth of adequate health pertinent knowledge, enough absence of health supportive attitudes and practices in the community is our real backwardness in health. This exist as a big challenge for public health profession. This might be considered as a primary scope of our program. Following discussion would further explain the underlying concepts and objectives of RMU Community health development initiative. .

Firstly, it is well established that substantial health problems of the community are due to people’s inadequate attitudes & behaviors in health matters and hence are amenable to change (2).  CDC estimates that 15-43% deaths from 5 leading causes were preventable.

Based on relevant statistics WHO stresses member countries for strong will for vigorous programs to encourage lifestyles & behaviors which would  help prevent these illnesses(3).  Secondly, University is a highest resource of knowledge, skills and other medical capabilities. It would be highly justified to utilize Public health & other potential medical disciplines of the university for this purpose and to place them directly in the service of the community outside the hospitals settings. Thirdly, Health education is the time tested and cost effective mean to avert people’s health status. Information-education communication (IEC) – is a universally accepted strategy for this purpose (4). Fourthly, this program offers an opportunity to the university students and postgraduate trainees of “community based learning” and “epidemiological research”. The faculty of community medicine & public health is on board on this new concept & required missionary work. A core component of this initiative “Communication for Health Awareness Program” under “Center for Health Communication (CHC)” Department of Community Medicine & Public Health RMU is operational since year 2018.

Prof. Dr Syed Arshad Sabir

Organizational structure of CHTP & CHC RMU

Pattern in chief

Prof Dr. Muhammad Umar (SI)

Vice Chancellor RMU

Lead                 

CHTP/ CHC

Prof Dr Syed Arshad Sabir

Dean Community Medicine & Public  Health RMU

Co-Lead

CHTP/ CHC

Dr Sana Bilal

Assistant Prof Com-Med

Coordinator CHTP / CHC

Dr Nargis Zaidi

Senior Demo Com-Med

Co-Lead  VC Hep-C Free Rawalpindi initiative 

Dr Afifa Kulsoom

Assistant Prof Com-Med

Team CHTP / CHC

Faculty & Staff of department of community medicine & public Health RMU

Introduction

The RMU Community health transformation program (CHTI) comprises three inter-related  work circles as briefed below;

  1. Rawalpindi Medical University Community Health Transformation Program (CHTP)” This is community outreach component of RMU Community Health Development initiative. It aims to improve the health status of people of a selected community in close vicinity of the University (a union council) primarily through communication for desired behavior change in matters of health at individual & communal level. Other than community based training of the future doctors it is determined to employ all workable public health interventions to promote people’s health within means of university. Its agenda is to transform the targeted community in a time frame into a community which would be healthier & performing better in matters of health than before. The selected community will serve as a site for community learning as well as of community serving.
  2. “RMU Communication for Health Awareness Program”. This aims to promote “health literacy*” in the population of the region through all possible channels. Its mission is to improve health through information & education. This program has been initiated since August 2018 The people are accessed through high school students, teachers (preferably of govt. schools) and other community groups. Peoples are communicated on health issue of immediate relevance. Health education material is home-grown & tailored to community needs (developed in CHC RMU). Its strategy is to inform & educate people in scientifically identified areas of health needs in local community context**. It is empowering peoples with knowledge needed to modify their attitudes and behaviors in matters of their individual and communal health. It is to remove barriers of ignorance to good health.  It is to abandon risky behaviors and exposures to reduce preventable disease and death.  
  • “Center for Health Communication” (CHC)

CHC is more a concept than a physical place. This is an institution based workstation in the department of community medicine & public health, NTB RMU. It serves as work place for planning & homework for first and second initiatives other than training of undergraduates, PGTs & community health workers in health communication, coordinating center, development of community need based IEC material & other tools for public health work. It also works as office of “Public Health Advisory” generation board and “Outbreak investigation cell”. CHC serves as base of CHTP and RMU-Communication for Health Awareness Program

Introduction

The RMU Community health transformation program (CHTI) comprises three inter-related  work circles as briefed below;

  1. Rawalpindi Medical University Community Health Transformation Program (CHTP)” This is community outreach component of RMU Community Health Development initiative. It aims to improve the health status of people of a selected community in close vicinity of the University (a union council) primarily through communication for desired behavior change in matters of health at individual & communal level. Other than community based training of the future doctors it is determined to employ all workable public health interventions to promote people’s health within means of university. Its agenda is to transform the targeted community in a time frame into a community which would be healthier & performing better in matters of health than before. The selected community will serve as a site for community learning as well as of community serving.
  2. “RMU Communication for Health Awareness Program”. This aims to promote “health literacy*” in the population of the region through all possible channels. Its mission is to improve health through information & education. This program has been initiated since August 2018 The people are accessed through high school students, teachers (preferably of govt. schools) and other community groups. Peoples are communicated on health issue of immediate relevance. Health education material is home-grown & tailored to community needs (developed in CHC RMU). Its strategy is to inform & educate people in scientifically identified areas of health needs in local community context**. It is empowering peoples with knowledge needed to modify their attitudes and behaviors in matters of their individual and communal health. It is to remove barriers of ignorance to good health.  It is to abandon risky behaviors and exposures to reduce preventable disease and death.  
  • “Center for Health Communication” (CHC)

CHC is more a concept than a physical place. This is an institution based workstation in the department of community medicine & public health, NTB RMU. It serves as work place for planning & homework for first and second initiatives other than training of undergraduates, PGTs & community health workers in health communication, coordinating center, development of community need based IEC material & other tools for public health work. It also works as office of

“Public Health Advisory” generation board and “Outbreak investigation cell”. CHC serves as base of CHTP and RMU-Communication for Health Awareness Program.

RMU “Community Health Transformation Program”

(CHTP)

 A commitment of Rawalpindi Medical University Rawalpindi for health development of the people of the region.  

 

COMMUNITY HEALTH TRANSFORMATION PROGRAM (CHTP)

Health is fundamental to quality & quantity of human life but mostly it is attended after it is impaired.  Common man in our society understands health in terms of freedom from apparent illness and demands health in term of free medicines & treatment facilities (felt health needs).  But as a medical fact, health is beyond “no illness” concept and that it is a state of complete physical, mental & social wellbeing, and not merely the absence of disease or infirmity. Disease prevention and health promotion are the real approaches to decrease human sufferings and improve wellbeing of the people. Health education aimed at inducing health generating and health promoting attitudes and behaviors is time tested and most cost-effective approach to uplift the health status of the people.

According to US Department of Health and Human Services Report about half of deaths in USA could be attributed to a limited number of largely preventable behaviors and exposures (5).  Health scene of our nation reflects that diseases are very frequent across all ages & gender groups, in all sections of the community, and at the same time majority of our population is ignorant to their preventive and promotive health needs.  Health statistics of the population rank it below many countries of the region. Recently Pakistan is reported to be highest in new borne mortality in the region (6). As a matter of fact despite great expansions in preventive medical knowledge & technologies, the people are not being benefited at large. Their capacity in protecting & promoting health has not been prioritized for effective interventions. Most budgetary provisions made by the Govt. in health sector go to curative sector without impacting real health solutions of the population. War against people’s health adversities cannot be fought by the traditional health means alone. Albert Einstein said “the solutions of the problems we are facing today cannot be found by the same level of thinking which have created these problems”. We have to think and act different, and better. People may not know their actual health needs but the health scientist. University is place of highest medical wisdom in the area and has liability to serve health needs of people on more scientific & innovative way.

People’s health issues cannot be adequately solved by the health sector without active involvement of the individuals and communities whose health is at stake. Health promotion demands coordinated efforts from all sectors of the society and the people are central to it. Universally, the people have been admitted as the most powerful resource in protecting, maintaining and promoting their health. Earlier the people were considered as just a target for preventive and therapeutic services. Current trend is to demedicalize the health and involve the people in meaningful ways. This implies active involvement of the families and the communities in matters of health. People should take charge of their own health. It is a scientific fact that people’s health cannot be improved unless the factors which determine their health are improved. Though biologic, economic and environmental conditions are fundamental to health but in the face of resource scarcity, attitude & behavioral aspects of our people towards health have big space for change and would produce immediate benefits if addressed adequately. here is a big list of areas which carry great potential for behavior change &health development.                                  

Practice of modern medicine has become a joint venture of many groups both from medical to non medical settings extending from physicians, nurses, paramedics to community health workers. People’s core abilities itself are an effective & immediate resource to their own health and health of the peoples around. Formal literacy standards should not bar to their involvement in health development process. Use of multidisciplinary public health approach, involvement of all stakeholders of community health and employing community real health needs based interventions is the philosophy behind this (CHTP) initiative.

Our idea of community preventive care while working within community is not a newer one but CHTP is comprehensive and a measureable initiative. Such concepts have been practiced in developed world like “Healthy people-2010” in United States. While such projects are part of many renowned health institutions of the country including AGA KHAN University, Baqai Medical University Karachi and of ShifaTameer-e-Millat University Islamabad etc. This initiative is taken by department of community medicine & public health but it is proposed for joint efforts of all the relevant departments of the university. Its spirit is missionary, beyond official liability. Work outline of RMU CHTP is projected by work-matrix (Fig.I)

It is also visualized that after the laid down objectives of CHTP for a give area (Union council l) are achieved (5years) we would move to next community (UC) of the region to benefit other population of the region.  After the first success this program may be proposed to be replicated by each Govt. Medical and Private Medical College in its relevant community around hence the mission of total community health transformation would be achieved.    Current status: Program is in process

 

“Rawalpindi Medical University “Communication for Health Awareness Program”.

In spite of huge investments and reforms people health and people’s satisfaction with healthcare system are showing adverse trends.  Our health system is elite oriented and inclined towards diagnostic & curative medicine. Quality doctors and modern medical technology is available only to small affordable class.  Historical Public Health Document “Ottawa Charter (1986) on Health promotion states that health promotion action aims at reducing differences in current health status and ensuring equal opportunities and resources to enable all people to achieve their fullest health potential. Health promotion supports personal and social development through providing information, education for health, and enhancing life skills. By so doing, it increases the options available to people to exercise more control over their own health and over their environments, and to make choices conducive to health.  (http://www.who.int/healthpromotion/conferences/previous/ottawa/en/)

According to US Department of Health and Human Services Report 2017, more than 50% mortality & morbidities in the population have been attributed to preventable behaviors & exposures . such behaviors & exposures in our population may be equated and added with more primitive & inadequate behaviors in matters of health like personal hygiene & self-care, vaccinations, self medications & delays in seeking healthcare or not following a doctor’s advice, the list is endless.  

Coming to our health scene it is observed that most of the population perceives health in terms of “No illness state” and demands health in terms of free medications and treatment facilities. Following health statistics rank the country in lower grades for the region and at the same time indicate need for behavior change communication.

·Pakistan is ranked 6thamongst 22 high disease burden countries (WHO) with 40 percent of the BOD is in the form of preventable communicable diseases such as Malaria and TB.

·Maternal mortality ratio 276, Under-five mortality rate 89 , IMR= 61.8 / 1000 LBs Neonatal mortality rate 55 .

· Only 47%  women of reproductive age (aged 15-49 years) have their need satisfied with modern FP-methods. Mothering in Adolescent & teen age is 44%.

·Poverty incidence according to Govt. estimate is 24.3% (2016).

·In SDG-13 it is stressed to raise awareness in population about climate change related hazards and counteracting measures. 

 [Based Economic Survey of Pakistan report (2017  (http://www.finance.gov.pk/survey_1718.html].

·Vaccination coverage still ranges 70-80% (90% international Target) indicates need to improve  the people’s attitude towards vaccination.

·NCDs accounts for 50% of total deaths and probability of premature death in ages 30-70Y due to 4major NCDs is 21%.  (WHO).

·Prevalence of Cigarette smoking in >15Y is 28.6% (male) and 2.6% in female. 2016 estimate. 

(http://www.who.int/tobacco/surveillance/policy/country_profile/pak.pdf?ua=1)

(http://www.who.int/countries/pak/en/)

Health education is time tested and most cost-effective approach to modify people’s attitudes & behaviors. CDC defines health communication as a “multidisciplinary, theory-based practice designed to influence the knowledge, attitudes, beliefs, and behaviors of individuals and communities” (Roper, 1993). An operational definition of “IEC (Information, education & communication)” refers to a public health approach aiming at changing or reinforcing health-related behaviors in a target audience, concerning a specific problem and within a pre-defined period of time, through communication methods and principles. With this background, it was proposed to launch a Health awareness program to communicate with people of the region in all matters pertinent to their individual and communal health. Promotion of “health literacy” (Health-literacy is classified as “Information & skills which are minimally considered necessary for a person to enable him/her to prevent disease, maintain, protect & promote health and restore health when impaired in individual, family & communal capacity” : Maxy-Rasonu 15th Edition) among population with commencement of move in short time and with no involvement of financial resource is central theme and objective of this program. Its purpose is to empowering people with right knowledge ,attitude& behaviors  so they could make right choices in matters of health. It will primarily hit social determinants of people’s health which is ignorance. It will help people to overcome those barriers to their health which are in their personal domain. It will add to interactive, functional and critical health literacy of the people. Health education can also raise awareness about social, economic and environmental determinants of health, and make people inclined towards development of desired individual and collective actions which eventually may change the health scene.

In addition to well known areas of deficiencies we intend to work on immediate relevancies of the population. In principle the topics of communication may be any relevant area but health message will be developed by the competent resource in the university (CHC) keeping in view targeted population needs. Moreover Health Message type would not be restricted to print message but we intend to use audio, video and other channels and tools too.

100 Community Touch Point Project:

CHC is committed to communicate for preventive health awareness in more than 100 areas identified based on our local & regional community need. Currently CHC has touched 25 points ( Feb 2020)

The target recipient would be any appropriate group but the senior students and teachers of government schools will be first considered as priority. Teachers may act as a permanent resource for spread of information & education communicated to them and students are specifically supposed to spread the information to their family & contacts. Other the high risk groups would also be served in the spirit of their visible need and urgency. Objective is to make people health literate as wide and as much as possible, expecting a positive behavior change, decrease in risky exposures and eventually better health outcomes. 

Sources:

I.J Parks Text of Preventive & Social Medicine 24th Edition

II.Text Book of Preventive Medicine by Muhammad Illyas & Ansari  13th Edit. ion

III.Oregon State Health Dept (USA) web

IV.CDC Atlanta USA web

 

Rawalpindi Medical University, Center for Health Communication (CHC) is simply a workplace but in actuality it would be a competent University resource for development and execution for various pre-identified public health interventions to prevent the disease and promote the health & well being of the people of the region. It’s more a mental capacity than a physical place for continuous thought generation and materialization in the spirit of service of the community.  Another underlying concept is that how best intellectual and professional abilities of Public Health and all other relevant specialties of Rawalpindi Medical University & Allied Hospitals can be used in a unified way in the health interest of the population. I believe this concept will set new standards of work for public health profession.

It will serve as base for Rawalpindi Medical University Community Health Transformation Program (CHTP)  and ““Rawalpindi Medical University Communication for Health Awareness Program”.

Moto & mission of CHC is to improve Health of our community through behavior modification, precisely “Improving Health through Behavior Modification.

CHC is a workstation for;

  1. Debate & decision making place (meetings & conferences) on the relevant subjects.
  2. The development of community based health communication material (flyer, leaflet, a document, video or audio messages etc ) prepared by university resource.
  • Capacity building wok: Faculty, undergraduates & PGTs capacity building in IEC science & other public health works like outbreak investigation and other epidemiological work  and also training of community leaders & workers.
  1. Base office for epidemiological research.
  2. Public Health Advisory (PHA) Generation. PHA- Board office. For our practical purposes PHA may  defined as “a scientific statement issued by a technically competent body to timely alert the susceptible population of the region against some existing or impending health threat. It essentially contains information about workable and doable actions required to undertake so as to prevent the hazardous health outcomes”. It may also serve for a alert call and guiding document to the relevant authorities, institutions or organizations to initiate their assigned roles related to people’s health protection. Successful experiences of PHA may contribute in local Public Policy.

This center will also provide an opportunity to the public health persons and medical professionals of all relevant fields to make collaborative effort and contribute their expertise for the health protection & promotion of the people living around this institution.  

{it will be a extended Public Health Advisory- which will not only a timely health Alert &Advice but CHC will take possible measures to ensure its effective delivery to population at risk. We intend to develop a mechanism of information which would be useable to target community in the region in real time. So called Extended PHA).* work plan of PHA is given  Fig.II (Currently not functional)

  1. Base office for outbreak investigation unit.
  • Record keeping.

References

  1. J Park text book of Preventive & social medicine page-22
  2. Power of Prevention-CDC-2009.
  3. WHO Facts Sheet 24th May 2018) http://www.who.int/en/news-room/afact-sheets/detail/the-top-10-causes-of-death).
  4. (http://www.emro.who.int/child-health/community-information/information/All-Pages.html)
  5. (UNICEF Report 2018). (UNICEF Report 2