INTER- PROFESSIONAL EDUCATION FOR COLLABORATIVE HEALTH CARE IN SOUTH AFRICA.

1. INTER- PROFESSIONAL EDUCATION FOR COLLABORATIVE HEALTH CARE IN SOUTH AFRICA. Presented by Prof Ratie Mpofu Emeritus Professor : University of the Western Cape At SACOHSD Workshop , 3 July 2012 UKZN

2. OBJECTIVE OF PRESENTATION • To draw attention to the growing concepts of Interprofessional education (IPE) towards collaborative practice Globally and Nationally • To give an example of how some Health Sciences Faculties attempt to incorporate IPE in curricula for Health Sciences and what limits these attempts • To link IPE to the reengineering of Primary Health care in SA

3. What is IPE? In the context of health professions education, IPE refers to……… • “... occasions when two or more professions learn together with the object of cultivating collaborative practice.”(CAIPE, 1997) “Interprofessionaleducation... is an opportunity to not only change the way that we think about educating future health workers, but is an opportunity to step back and reconsider the traditional means of healthcare delivery. ... what we’re talking about is not just a change in educational practices, but a change in the culture of medicine and health-care.” Student Leader (quoted in WHO Framework of Action 2008)

4. Why IPE ? – current problems • History of Silo mentality among disciplines • Professionals do not keep pace with health changes • Outdated and static curricula that produce ill-equipped graduates • Mismatch of competencies to patient and population needs • Lack of team spirit among professionals (tribalism) • Pre determined teams for specific tasks – professions working in competition with each other • Health systems are often organised around certain disciplines (Drs, Nurses, Dentists etc.)

5. WHY IPE?- Isidingo (the need) Call for: • education for health professionals for the 21st Century • transformative education to strengthen health systems in an interdependent world • redesigning of education for health professionals to allow for mutual learning and joint solutions • interprofessional and transprofessional education that breaks down professional silos while enhancing collaborative and non-hierarchical relationships in effective teams. ( Lancet Commission,2010)

6. Why IPE in South Africa • There has been a mind shift in Health Professions Education which allows for innovative teaching and learning approaches e.g. field education, community-based learning, and service-learning; • Recognition that effective and sustainable improvements in health and health services require a deeper understanding of local, historical and cultural contexts and circumstances. • Working with rural or underserved communities require knowledge of social development. • Social Accountability by professionals

9. QUESTIONS OFTEN ASKED IN IPE • How can students be prepared for IPE? • Is the workplace ready for IPE? • Which are the main drivers for Collaborative Practice and How do we collaborate? • How do we get rid of the silo mentality? • How do we make professional boards and employers aware of the need for collaborative practice?

10. ATTEMPTS BY FACULTIES OF HEALTH SCIENCES IN SA • A move away from discipline related faculties to faculties of health sciences (FHS) • FHS Include : Medicine, Dentistry, Pharmacy, Nursing, Public Health, Physiotherapy, Occupational Therapy; Nutrition and Dietetics, Speech Audiology etc. • Attempts at collaborative learning eg core courses developed often around PHC, prevention and promotion, social accountability • Attempts to move clinical education and practice to all levels of health care including communities. In other words moving away from the teaching hospital to the teaching platform which include hospitals, clinics and communities ( District health system) • Also attempts to collaborate among faculties in provinces where there are more than one faculty especially where clinical platforms are shared, in collaboration with provincial health authorities

11. Interprofessional Education IPE driven through different approaches: • Early yrs-Interdisciplinary core courses (primary health care; philosophy of care; health promotion). Community projects • Senior yrs - Service learning and practice (same sites but may be discipline specific) • Interdisciplinary Community Based Practice module (UWC), Rural Ward (US) SHAWCO (UCT) and others

12. OBJECTIVES OF IPE To facilitate: • Openness in communication across and within disciplines . • Understanding of perspectives of other professionals • Increased knowledge of the range of skills of others • Self-questioning of personal prejudice and stereotyped views • Positive sensitivity towards other professionals and their values • Teamwork skills needed for problem solving • Opportunities to meet others not normally part of clinical placements • Awareness of areas of crossover and overlap in knowledge and skills • Understanding of differences in professional language • Understanding community needs and different cultures • Understanding leadership skills required for collaborative practice. (Adapted from: Parsell and Bligh, Educational principles underpinning successful shared learning. Medical Teacher, 1998.)

13. PREPARING STUDENTS FOR COLLABORATIVE HEALTH CARE • Orientation (local professionals, community members) • Needs analysis (understanding the context Challenges, the issue/s, assets/resources, methods: interviews, observations, focus group discussions, surveys • Reflection(reflect, share & record findings) • Develop Objectives & Indicators • Implement Projects together with other professional • Learn to record Interventions • Evaluate programmes • Feedback (Noting Issues/challenges ) All this often takes place at PHC and community level and at schools

14. Reengineering of PHC Four Main Outputs: • Increasing life expectancy • Decreasing maternal and child mortality • Combating HIV & AIDS and decreasing the burden of disease from TB. • Strengthening Health Systems and Effectiveness

16. The ward based PHC teams Should be aware: • that interprofessional health profession students go beyond the designated PHC disciplines • All health professions are already taught to provide home and community based health services and also how to work with CHWs, community members and families. • All health professionals are trained to provide health promotion, prevention of health risks and to promote healthy life styles. • They often act as support for CHWs

17. School Health Services PHC leaders : • the suggested packages should not limit IPE as all health students require knowledge to learn to screen learners for all health risks including lifestyle risks such as lack of exercises, recreation facilities , nutritional needs , obesity as well as hearing and vision impairments.

18. District Based Health Specialists • The term often referring to Doctors and could be termed trans-disciplinary resulting in other professions being sidelined and driven to private practice. • Students often find less collaboration among professions at this level • Need to be aware of the IPE initiatives.

19. RECOMMENDATIONS A strong political framework that encourages interprofessional education and team working is essential, Shared governance models and enabling legislation are required. Important to develop health care leaders who will ensure appropriate models are put in place, functioning teamwork and interprofessional education in health care services. To find ways of distributing budgets so as to promote team work. The Link between IPE and PHC to be explored particularly in SA where there are more professions than the currently designated disciplines and a real positive shift towards collaborative practice. Faculties of Health Sciences to work closely with the District health and PHC teams to promote IPE and collaborative practice.