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Capacity building


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Capacity building

  1. 1. CAPACITY BUILDING FOR DIABETES PREVENTION IN JAMAICA Mark Pereira, Ph.D.Associate Professor & Director of Public Health Nutrition Division of Epidemiology & Community Health Petrona Lee, Ph.D. Postdocoral Fellow School of Public Health University of Minnesota
  2. 2. Introduction to Capacity Building2 Two phases of capacity building described by Hawe, 2000  Specific Capacity Building  Delivery of specified, high quality services or responses to particular situations or problems, such kidney dialysis.  Generalized Capacity Building  System-wide solutions to new problems and responses to unfamiliar situations, such as public health prevention and control of chronic diseases in developing countries
  3. 3. Introduction to Capacity Building3  Generalized capacity building for public health problems requires a diffused and complex set of criteria, including:  Characteristics of the work environment  Nature of team interactions  Quality of leadership  Structure of health organizations 2/1/2013
  4. 4. Generalized Capacity Building4  System approach to public health  Efficacy of resources directed at prevention and treatment  Comprehensive structure reassessment  Developing a vision and mission, articulation to stakeholders  Short, intermediate, and longterm goal setting with buy- in throughout  Facilitate creative and strategic thinking at all levels  Garnering and maintaining resources system-wide  Persistent dedication to funding via local, national, and international source 2/1/2013
  5. 5. Generalized Capacity Building5  Political Process -- direct, facilitate, and continually refine mission-driven strategy  Parish and parliamentary (central) levels, etc…  Negotiation -- mediate resolutions, stakeholders and resources, public health and medical providers, employers, funding sources, etc… 2/1/2013
  6. 6. Generalized Capacity Building6  Social forecasting and marketing  Identify and interpret emerging trends  Create predictions and build scenarios  Media communications, health communications, risk communications, community relations 2/1/2013
  7. 7. Generalized Capacity Building7 Team-building competencies Develop team-oriented structures and Systems, e.g. service, entrepreneurial spirit, organizational learning, etc. Facilitate development of team and work groups Shared mission, vision, and values Clear goals and objectives Facilitation and mediation roles Listening, dialogue, negotiating, rewarding, encouraging, motivating, modeling integrity, credibility, enthusiasm, commitment, honesty, caring, and trust
  8. 8. Moving out of the silo
  9. 9. First Steps Towards Capacity Building:A Vision Diabetes Prevention in Jamaica Introduction to the problem of diabetes in Jamaica by Dr. Petrona Lee, a Jamaican-American at the UMN who had a successful career in medical technology, and recently obtained her PhD in environmental health sciences. Dr. Lee was passionate about spending the rest of her career addressing diabetes prevention through community-based programs starting in the area she was raised in, Trelawny. 2/1/2013
  10. 10. Type 2 Diabetes: Integration of Biology & Environment G G Polygenic G Economics & Culture g g ??? g ???DietaryEpistasis Physical inactivity Intrauterine effects ??? Body Composition Lean mass Intramusc. fat Visceral fat Insulin Economic Factors Resistance β-cell deficiency β-cell insufficiency Diabetes
  11. 11. Societal policies and processes influencing the population prevalence of diabetes INTERNATIONAL NATIONAL/ COMMUNITY WORK/SCHOOL/ INDIVIDUAL POPULATION FACTORS REGIONAL LOCALITY HOME Public Leisure Transport Transport Activity/ Facilities Globalization Energy Urbanization Public Expenditure of Safety Labour markets Health Infections Diabetes Health Care & Development Worksite Social security Food & Obesity Sanitation Activity Food intake : Media Media & Nutrient programs Culture Manufactured/ Family & density & advertising Imported Home Food Education School Food & Agriculture/ Food & Nutrition Gardens/ Activity Local markets National perspective Modified from Ritenbaugh C, Kumanyika S, Morabia A, Jeffery R, Antipathies V. IOTF website 1999:
  12. 12. Short Term Goals14  1. Determining the extent of diabetes in Jamaica  The School of Public Health has diaspora agreement with the Organization of Strategic Development in Jamaica (OSDJ).  Through our contacts with OSDJ, we were able to obtain health data on diabetes in Jamaica. 2/1/2013
  13. 13. 15 2/1/2013
  14. 14. 16 2/1/2013
  15. 15. 17 “It is expected that these data will continue to inform health policy in the coming years, including the implementation of multi-faceted effective interventions to tackle the NCD epidemic beyond the mere health provider based approach.” 2/1/2013
  16. 16. Short term goals18  2. Identifying and involving stakeholders  Medical providers, politicians, clinics, youths, adults, schools, churches, local communities, persons with diabetes and their families, etc.  3. Obtaining funding  Modest-sized grants for Dr. Lee’s continued mentoring and activities on site in Trelawny.  United States Department of Agriculture National Institute of Food and Agriculture – grant application 2/1/2013
  17. 17. Intermediate Goals19  1. Facilities and infrastructure  Community-Based Trelawny Diabetes Center.  A Wakefield church offered office space for a temporary location.  Staffing with trained personnel for administration and protocol development  Linkage to UMN  2. Surveys of youth and adult obesity and diabetes in Wakefield-Bunker‟s Hill-Deeside area. 2/1/2013
  18. 18. Intermediate Goals20 3. Develop working relationships with area colleges/universities, schools, medical personnel, parish councilors, community leaders and lay persons.  Last spring Dr. Lee visited with representatives from several of the schools, churches and other community leaders. The response was very positive.  We submitted a proposal as part of a health assessment package that was delivered by OSDJ to the Jamaican Government.. 2/1/2013
  19. 19. Intermediate Goals, cont.21 4. Focus Groups and Pilot Studies with Jamaicans  Filling gaps in translational nutrition research for diabetes prevention and treatment  Effects on glucose control, palatability, and satiety of foods and meals prepared in culturally appropriate ways  Breadfruit case-study  Physical activity perceptions and opportunities  The vast gender gap  Blood glucose screening and monitoring  Education, awareness  Cultural barriers to checking blood sugar 2/1/2013
  20. 20. Intermediate / Long Term Goals22 4. Long-terms substantial funding for training and infrastructure  National Institutes of Health Fogarty Training Grant for Predocs and Postdocs  Capacity building for non-communicable disease prevention in lower and middle income countries  Permanent infrastructure grants  USAID 2/1/2013
  21. 21. Breadfruit as a Model for Translational Research and Capacity BuildingThe Breadfruit Project  Contribute to science (antidiabetic properties?)  Build collaborations across disciplines between the U.S. and Jamaica  Microeconomics, with long term potential for broader economics  Serve as a model for other projects with Jamaican traditions
  22. 22. Health effects? Effects on blood sugar, etc.Breadfruit flour as a gluten-free substitute for wheat flour.
  23. 23.
  24. 24. Trees That Feed Foundation Trees to Feed People, Create Jobs and Benefit the Environment Helping local communities in developing countries achieve sustainable food supplies, accessible markets, jobs, and reforested environment Planting trees, educating, supplying equipment, fostering small farmers and cooperatives, enabling commercial ventures  Shade tolerant trees under canopies of larger trees, all bearing fruit  E.g., cocoa &coffee growing under breadfruit trees. Improving diets, independence from imported foods & chemicals Collaborating with government, NGOs, co-ops, service clubs, churches, schools and community associations.
  25. 25. Beyond breadfruit, of course!
  26. 26. Jamaican Foods I’ve eaten this week Grains  Rice and peas, Bun and cheese Vegetables  Bammy, Renta yam… Fruits  Mangoes (no. 11, etc.), Naseberry, Sweet Sop, Ackees, Breadfruit, Bananas, Watermelon, Grapes, Jamaican apple (Othaiete), Jamaican plum, Sugar cane Maybe it could be easy to be vegetarian in Jamaica, but… 2/1/2013
  27. 27. Jamaican Foods I’ve eaten this week! Grains  Rice and peas, Bun and cheese Vegetables  Bammy, Renta yam… Fruits  Mangoes (no. 11, etc.), Naseberry, Sweet Sop, Ackees, Breadfruit, Bananas, Watermelon, Grapes, Jamaican apple (Othaiete), Jamaican plum, Sugar cane Meat and fish  Cod (with ackees), Cod fried, Snapper (steamed)  Curry goat, stewed pork, jerk pork, jerk chicken 2/1/2013
  28. 28. Long Term Goals 1. Develop a permanent Diabetes Prevention and Management Center.  A permanent site has been identified and committed to the project.  It‟s location is adjacent to the Wakefield Elementary School with direct access from the main road.  Preliminary architectural plans are being developed by a Jamaican American in Minnesota and will be submitted to the proper authorities in Trelawny. 2/1/2013
  29. 29. Goals of the Diabetes Prevention Center31  A) Partner with the community to develop sustainable strategies for preventing and managing diabetes  B) Outreach with elementary schools and churches for educating youths and families in optimal lifestyles  C) Collaboration with area colleges and universities in program development, education, research, and trainng.  D) Research on diabetes surveillance as it relates specifically to Jamaicans  E) Education center for youths an adults  F) Provision of basic clinical needs and screenings  G) Support groups for diabetes prevention education  H) Venue for „town hall‟ meetings and seminars 2/1/2013
  30. 30. Strategies for Long Term Goals32  Microeconomic programs  Stakeholders form collaborative groups determine which enterprises are best needed for each community.  Real-estate, apartment rental, „bed-and-breakfasts‟  Environmental activities that have synergistic benefits  Gardening, landscaping, as a benefit to the environment, to the local residents, and as added attraction for tourism. 2/1/2013
  31. 31. Long Term Goals33 Expand the project island-wide  Networks and satellite offices, expanding technological capacity and infrastructure  Local control of the centers – BY Jamaicans FOR Jamaicans  Directors, coordinators, nurses, laboratory technicians, endocrinologists, dietitians, administrator s, office workers, grounds keepers, and community entrepreneurs, etc. 2/1/2013
  32. 32. Summary34  Using Capacity Building as a guide for diabetes prevention, we are…  Identifying needs for diabetes prevention, a community that wants the service, potential stakeholders.  Developing a working model and designing pilot projects.  Exploring capabilities for receiving input from users, medical professionals, academia and focus groups.  Seeking financial and human resources to develop programs, leadership, political competencies and encourage local entrepreneurship.  Planning sustainability through economic components and capability for academic preparation of future professional expertise 2/1/2013
  33. 33. Acknowledgements35  UWI and conference organizers  Dr. John Finnegan, Dean, School of Public Health, University of Minnesota  Dr. Elizabeth Vernig, Associate Dean, School of Public Health, University of Minnesota 2/1/2013
  34. 34. Thank you36 As for me, all I know is that I know nothing. - Socrates 2/1/2013