Iraq-U.S. Physician Partnership Program
     Health Resources and Services
          Administration’s Role


         RADM...
Map of Iraq
Background
• Iraq’s health care system once regarded as one
  of the best in the region
• Over the last 25 years, the heal...
Physicians in Iraq
• Iraqi Physicians Registered
  Before 2003 - 34,000
• Iraqi Physicians Who Have Left
  Iraq Since 2003...
HHS Initiative
• In May 2008, Department of Health
  and Human Services Secretary
  meeting with Iraqi Minister of Health
...
Goals of the HHS Initiative
• Promote Health Diplomacy and
  provide hope and inspiration to the
  Iraqi people;
• Educate...
Iraqi Physician Training:
     Goals and Objectives
• To build upon current Iraqi health care promotion
  activities in Ir...
Iraq-U.S. Physician
     Partnership Program
• HHS Coordination through Office of Global
  Health Affairs (Jaime Burke and...
Iraq-U.S. Physician
 Partnership Program (cont’d)
• Host Training Sites:
  – Children’s Hospital, Washington, DC;
  – Heal...
Iraq-U.S. Physician
 Partnership Program (cont’d)
• HRSA Sites:
  – Community Health Centers (CHC): Two
    sites selected...
Physician Training Schedule
• All physicians attended 2-day HHS
  orientation
• Physicians assigned to HRSA
  received add...
HRSA: Physician Training
         Schedule
• HRSA Orientation, Day 1
  – Prevention and Primary Care Expert Panel:
    • O...
HRSA: Physician Training
     Schedule (cont’d)
• HRSA Orientation, Day 2
  – Site Visit to Rural CHC- Eastern Panhandle o...
HHS Debriefing
• One day debriefing in Washington
  DC
  – Overall the physicians were very satisfied with their
    exper...
HHS Debriefing (cont’d)
• The breakout group discussed several issues
  related to the effectiveness of the current
  Iraq...
Alternate Models for the
Physician Partnership Program
• Bring teams of U.S. physicians to
  Iraq
• Implement the model de...
Application of Lessons Learned in
                Iraq
• Develop a clear strategy for delivery of
  health care (e.g., fin...
Application of Lessons Learned in
          Iraq (cont’d)
• Facilitate the adoption of evidence-based
  practices;
• Devel...
Maintaining Links and
     Sustaining Partnerships
• Participants exchanged e-mail addresses
  with their U.S. colleagues ...
Follow-up
• Several follow-up items are being
  coordinated by HHS, including issues of
  connectivity between the host-si...
Acknowledgements
The individuals below contributed to the success of the Iraq-U.S. Physician
Partnership Program for HRSA
...
Iraq- U.S.
Physician Partnership Program

        Contact Information
     RADM Kerry Paige Nesseler
          CAPT Nita S...
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  1. 1. Iraq-U.S. Physician Partnership Program Health Resources and Services Administration’s Role RADM Kerry Paige Nesseler CAPT Nita Sood Office of International Health Affairs June 1, 2009
  2. 2. Map of Iraq
  3. 3. Background • Iraq’s health care system once regarded as one of the best in the region • Over the last 25 years, the health care infrastructure has deteriorated due to neglect and war • Violence and emigration have decreased the number of physicians • Physicians that remain are not up to date on the latest evidence-based medicine and technologies necessary to provide high-quality care
  4. 4. Physicians in Iraq • Iraqi Physicians Registered Before 2003 - 34,000 • Iraqi Physicians Who Have Left Iraq Since 2003 - 18,000 (est.) • Annual Graduates from Iraqi Medical Schools - 1,800 • Percentage of Work Outside of Iraq- -higher than 20%, many still leave the country to get specialized training • Average Salary of an Iraqi physician- $12,000 per year, higher for specialists
  5. 5. HHS Initiative • In May 2008, Department of Health and Human Services Secretary meeting with Iraqi Minister of Health (MOH) • MOH requested a physician training program in order to understand the U.S. primary healthcare model
  6. 6. Goals of the HHS Initiative • Promote Health Diplomacy and provide hope and inspiration to the Iraqi people; • Educate the Iraqi physicians on the U.S. primary health care system and strengthen their ability to provide quality care; • Learn from the Iraqi people; and • Enhance the cultural competencies of the U.S. physicians.
  7. 7. Iraqi Physician Training: Goals and Objectives • To build upon current Iraqi health care promotion activities in Iraq- Centers for Disease Control and Prevention (CDC) partnership with non- governmental organization, International Medical Corps (IMC) to develop the Centers of Excellence; • The Iraqi Government had already invested $8 million dollars on physician training; • The Basra Children’s Hospital was under construction with health emphasis on pediatric oncology; • 134 renovated Primary care facilities in Iraq needed healthcare provider staffing.
  8. 8. Iraq-U.S. Physician Partnership Program • HHS Coordination through Office of Global Health Affairs (Jaime Burke and CDR Dan Singer) and U.S. Embassy in Iraq (Dr. Terry Cline, Health Attaché); • Iraqi physicians were selected by the MOH • Out of 41 physicians, 27 were able to participate; • 6 physicians were slated for HRSA; 3 were able to participate; • Observership training- no patient contact; • 4-week timeframe.
  9. 9. Iraq-U.S. Physician Partnership Program (cont’d) • Host Training Sites: – Children’s Hospital, Washington, DC; – Health Resources and Services Administration (HRSA); – Henry Ford Hospital, Detroit, Michigan; – Indian Health Service, Arizona; – Johns Hopkins Hospital, Baltimore, Maryland.
  10. 10. Iraq-U.S. Physician Partnership Program (cont’d) • HRSA Sites: – Community Health Centers (CHC): Two sites selected; rural and urban sites affiliated with teaching universities – The CHC sites: • Sunset Park Medical Center, Brooklyn, New York • Greene County Health Care Inc., Snow Hill, North Carolina
  11. 11. Physician Training Schedule • All physicians attended 2-day HHS orientation • Physicians assigned to HRSA received additional 2-day HRSA orientation on Prevention, Primary Health Care and Chronic Disease Management • Remaining time (~ 3 weeks) spent at CHC sites
  12. 12. HRSA: Physician Training Schedule • HRSA Orientation, Day 1 – Prevention and Primary Care Expert Panel: • Oral Health • Maternal & Child Health and Children with Special Health Care Needs • Cancer Prevention and Anti-Smoking Campaign – Chronic Disease Management Expert Panel: • Diabetes Control • Hypertension and Cardiovascular Disease Control • HIV/AIDS Care and Treatment • Quality and Evidence Based Care – Site Visit to Urban CHC: • Unity Health Care, Washington D.C.
  13. 13. HRSA: Physician Training Schedule (cont’d) • HRSA Orientation, Day 2 – Site Visit to Rural CHC- Eastern Panhandle of West Virginia: • Shenandoah Valley Medical System, Martinsburg, WV • War Memorial Hospital (critical access hospital), Berkeley Springs, WV • Then to Observership Training Sites – Two Iraqi physicians (pediatrician and general practitioner) at Brooklyn, New York – One physician (orthopedics) at Snow Hill, North Carolina
  14. 14. HHS Debriefing • One day debriefing in Washington DC – Overall the physicians were very satisfied with their experience and would like to see this happen again in the future – Breakout Group Sessions discussed 3 topics: – Alternate Models for the Physician Partnership Program – Application of Lessons Learned in Iraq – Maintaining Links and Sustaining Partnerships
  15. 15. HHS Debriefing (cont’d) • The breakout group discussed several issues related to the effectiveness of the current Iraqi model – There are two specific needs that must be addressed: • improving provision of care (training, access to new technology), and • improving the overall health care system – Improve the health care infrastructure; – Improve the ability of health care providers to function as a team; interdisciplinary model – Enhance the relationship between the health care system and the community; – Improve the skills of individual practitioners (practitioners must be motivated to change and seek out opportunities); – Enhanced involvement of planners and policymakers.
  16. 16. Alternate Models for the Physician Partnership Program • Bring teams of U.S. physicians to Iraq • Implement the model described above in a site outside of Iraq • Train Iraqi physicians in the United States; extend to 6-8 weeks
  17. 17. Application of Lessons Learned in Iraq • Develop a clear strategy for delivery of health care (e.g., financing); • Establish short-, middle-, and long-term strategies for managing challenges; • Address the technology gap - Incorporate the use of information technology; • Improve the level of nursing care; • Adopt electronic medical records; • Establish an independent regulatory authority for the health care system, medical societies, licensing, and continuing medical education.
  18. 18. Application of Lessons Learned in Iraq (cont’d) • Facilitate the adoption of evidence-based practices; • Develop a system for the referral of patients; • Focus on primary health care to reduce the burden on hospitals; • Rehabilitate sub-specialty centers; • Control medicine management and use; • Improve patient management systems; • Improve communication (within service settings).
  19. 19. Maintaining Links and Sustaining Partnerships • Participants exchanged e-mail addresses with their U.S. colleagues and will remain in contact via e-mail; • Webcams and telemedicine provide opportunities for communication; • HHS to explore ways to conduct long-term follow up with participants; • HHS learn how participants disseminate what they have learned in the United States to their Iraqi colleagues.
  20. 20. Follow-up • Several follow-up items are being coordinated by HHS, including issues of connectivity between the host-sites and their respective participants; • Information from this pilot will be used to evaluate this particular model and to formulate next steps to continue collaborative relationships between the two countries.
  21. 21. Acknowledgements The individuals below contributed to the success of the Iraq-U.S. Physician Partnership Program for HRSA • Anthony Achampong • Dr. Therese Hughes • Dr. Jay Anderson • CAPT Donna Hutten • Tara Balsley • Jim Macrae • Dr. Marcia Brand • Dr. Daniel Mareck • Jaime Burke • Tim Montgomery • John Cafazza • Tom Morris • Gina Capra • Shawir Nawruz • Tina Cheatham • Dr. Tanya Pagán Raggio-Ashley • CAPT Gail Cherry-Peppers • RADM Deborah Parham Hopson • Dr. Terry Cline • Sara Rue • Tom Coughlin • Richard Sayre • Loretta Ellison • Leslie Shah • Diana Espinoza • CDR Dan Singer • Dr. Kaytura Felix • Dr. Peter van Dyck • LT Ulgen Fideli • RADM Donald Weaver • Tanya Gadzik • Maureen Williams • Kate Guzzone • Sunset Park Medical Center, Brooklyn, NY • Sandy Harris • Greene County Health Care, Snow Hill, NC • Joanne Howard
  22. 22. Iraq- U.S. Physician Partnership Program Contact Information RADM Kerry Paige Nesseler CAPT Nita Sood 301-443-2741 KNesseler@hrsa.gov NSood@hrsa.gov

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