LETTER OF INTENT

The development of a health care model, which will provide highly efficient health care with minimal cost, is an important issue for both political leaders and medical specialists in most world countries. Several aspects can be considered. The fast development of medical technologies has lead to an increase in health care expenditure. In turn, the high cost of individual procedures decreases availability of health care resources for the general population. Typically, in most countries the aging population increases pressure on health care resources. Importantly, an increase in expenditure on in-patient treatment does not result in a dramatic improvement in the nation's health. Reform of health care system is characteristic of many Western countries. The main areas for health system development have been changes in health administration, development of health technology assessment (HTA) approach, evidence-based medicine, analysis of epidemiological data for improved planning and decision-making as well as highlighting preventive measures and healthy life style information.

Russian health care, a legacy of the Soviet system, has both positive and negative aspects. The main drawback of the system was the high cost of maintenance due to the declared availability and free-of-charge for all. The present changes in economical situation both within the country and on the international markets means that conserving the present system is impossible. There is currently budget deficit, aging equipment and an impossibility of renewing the technical base. This, in turn, influences the health situation in the country. The reform of health care has become an imperative for the all levels of health care administrators, but in doing this it is necessary to take into account our own experiences, the results of scientific investigations and the Western experience. Previous reforms of the health care structure, adoption of population wide preventive programs and health technology assessment programs have shown that it is possible to increase quality of health care with concomitant stabilization of health care costs. These lessons from United Kingdom, Finland and Sweden are to be built upon.

The aim of the project is to develop Public Health in Russia and the short-term goal in this direction will be development of the School of Public Health.

To achieve this goal it is necessary to achive the progress in several fields

1. Curriculum development, which needs to include several components, namely health promotion and disease prevention, health system development, application of modern technologies in health care administration as well as basic public health training. The curriculum should undergo external review and quality of training should be regulary checked in cooperation with Nordic Country Institutes.

2. Development of specific pedagogic models. Taking into account huge distances covered by North-West Region of Russia and difficulties of traveling to St.Petersburg for many physicians it is necessary to develop pedagogical model relaying on distance education, compulsory and elective courses as well as orientiating Summer Schools. Also it is advisable to use in-place courses during which personnell of the School will visit towns of the North-West Russia. The help would be needed in evaluating effectivenes of the various pedagogic models and in setting up teams for visit

3. Establishment of libraries. To facilitate learning at the School it is necessary to give faculty and students access to the latest publications on the Public Health as well as basic books on the subject. The library should also contain information center which will provide access to the electronic publiations as well as bibliographical data bases. It should be equippped enough to conduct studies in Health Technology Assessment. Creation of the library with significant number of volumes on Public Health could be one of the most expensive parts of the project

4. Learning materials. To ensure widest possible coverage of the pupils at the School, teaching should be done in Russian. This calls for creation and dissemination of the learning materials in Russian. Those could include, but not limited to, books on Public Health translated from foreign languages, books on Public Health written by Russian authors (which give more precise picture of the Russian Health Care), printed leecture materials, journal-style publications. This work will need the support in publishing materials and selection, adaptation and translation of foreign materials.

5. Teaching. While the competence of the Russian teacher is very high, some of the emerging fields in the Public Health demand international cooperation in teaching. From the very beginning it is agreed, that being Russian undertaking, the School will employ maximum 50% of the foreign teachers in the any given course. In the same time training in the aforementioned emerging fields will call for necessity to involve foreign faculty in teaching process at the School

6. Training of trainers. To make in the end School independent, it is necessary to prpepare Russian faculty staff. This will be done by "training the trainer" approach with short- and long-term fellowships in the Universities and Public Health organizations in the Nordic Countries for those who eventually will become teacher at the School of Public Health.

7. Research cooperation to generate materials fo the teaching in the school and stimulate research in the area. It is clear from the very beginning that involvment of the students could be guaranteed only if material taught is based on real problems of modern Russia. This calls for organization of the international collaboration in the research field between the School of Public Health and Research Institutes of Nordic Countries by particiation of Nordic Institutes in the research work at the School of Public Health and researcher exchanges.

To further develop the School of Public Health tight cooperation between all involved parties is necessary.

This cooperation shoud include involvment of the different organiztions inside Russia, among them Health Committees of St.Petersburg and Leningrad Oblast, MAPS, Nort-West Branch of the Russian Academy of Medical Sciencies, Medical Association of the North-West Russia, Health Committees of the regions to name a few.

On the other side tight cooperation between Nordic countries is also necessary with coordination of the activity between different institutes invloved in the project.

For the coordination of the work it would be necssary to create project management commttee which will include limited number of participants charged with implementation of the development strategy. It will rely upon recommendations of the advisory board which include representatives from all actively involved sides.

To be successful the project should have clearly defined time-frame.

The official opening of the School should take place in the year 2000. The whole project should run for 3 years with one additional year necessary for evaluation of the results and preparing future collaboration in the field. Evaluation should be based on quality of training, nuber of people trained and amount and quality of research work

At present MAPS and partners already started work along the lines of the creation of the School. MAPS has provided working force for the school, financing their salary. It also provided School with offices for which renovation has been conducted. With the help of Open Society Institute MAPS has started work on creating and equipping informtion center.

Sweden has provided felowship stipends for the future teachers of the School and first trainee are already started their raining cycle. It also, together with Finland (and Nordic School of Public Health) took major participation in the Summer School of the year 1999.

This is to name a few activities that already has started. Active participation of other Nordic Countries is expected very soon.

Development in the near future

Academic year 2000-2001

School starts to operate and prepares several deep courses. This year will be dedicated to introduction of the concept of Evidence-Based Medicine and Health Technology Assessment. The first deep courses that should be organized are Basics of EBM (October 2000). Then Winter school should be organized which will be dedicated to Research design and Methodology. Also during this year it is necessary to prepare several courses like Scientific Writing, Medical Decision-Making, Meta-Analysis in Medicine, Clinical Epidemiology and Basic Epidemiology. Also teaching on already prepared cources in the MAPS Departments will commence. In the research field this year wil be dedicated to the startnng HTA studies (see Development of HTA plan)

In this year it is also necessary to provide external control of the program and courses quality. This should lead to the analysis and comparison of the program of Public Health School with analogous programs in Nordic countries and the programs should be made comparable.

Academic year 2001-2002

Summer school 2001 should be dedicated to the questions of biostatistics and how it is helping managers in their work, as well as marketig research and strategy in medicine. During the year the rest of compulsory courses should be prepared and tested in operation. Research activity should be directed to the questions of chronic disease epidemiology

Academic year 2002-2003

Program should be finalized. All elective courses should be prepared and tested. First students could be expected to start course work.

Academic year 2004

Evaluation of the school activity