Empowering communities through university partnerships in public health: a pilot project in Nepal and the Philippines

在尼泊尔和菲律宾，社区在公共卫生行动中几乎没有发言权。卫生服务提供者往往采取自上而下的方法，向家庭“说教”他们应该如何过更健康的生活，而忽视他们的日常现实。然而，有效的健康促进取决于承认当地卫生知识和信念，并以现有社区资产（包括工作人员和基础设施）为基础的办法。大学在教育未来的卫生工作者方面发挥着关键作用，可以直接促进转变对边缘化社区的态度。该项目汇集了尼泊尔Tribhuvan大学和菲律宾圣托马斯大学的两个医学研究所，旨在促进对公共卫生课程中社区学习的范围、范围和看法的理解。我们将把我们小组已确立的以社区为基础的学习方法扩展到公共卫生和我们关于土著/代际学习的研究，并在大学和地方社区之间试行一种新的伙伴关系。目前，医疗机构的社区学习可以是单向的，主要目的是向学生介绍社区面临的健康问题，以便他们根据自己的医学知识提供建议。这类举措也常常以“服务”目标为框架，而不是以相互学习关于健康和福祉的不同观点为出发点。该项目旨在建立大学医疗机构和当地社区之间的学习伙伴关系，尊重他们不同的健康信仰和做法。我们的首要研究问题是：大学如何才能最好地与社区建立相互尊重和平等的伙伴关系，以推进公共卫生教育？研究将从访谈、焦点小组讨论和文献分析开始，以探索各医学院目前以社区为基础的学习方法。然后将与每个国家的一个社区共同进行一项关于食物和营养的研究。通过关于食物信仰和做法的非正式对话，我们将与社区团体合作，发展他们在这一领域进行公共卫生干预的想法。社区成员、公共卫生专业学生和大学研究人员将聚集在一起，制定共同调查当地和土著卫生知识的方法。参与性研究的方法学专门知识将由东安格利亚大学教科文组织成人扫盲和学习促进社会转型教席提供，这是我们三所大学六年前建立的伙伴关系。基于社区的公共卫生学习方法截然不同，合作的医疗机构提供了有价值的比较维度。该项目包括通过互访和研讨会获得对彼此大学公共卫生课程的第一手见解的机会。通过对干预过程的比较分析，该项目也将探讨其对其他国家背景的相关性。项目产出包括指导大学、公共卫生工作者和学生如何利用当地卫生知识，以及医学院如何在实践中应用这一模式。主要受益者将是尼泊尔和菲律宾的社区，迄今为止，这两个社区在公共卫生行动中几乎没有什么机构。通过在现有公共卫生和医科大学课程的框架内设置和建设干预措施，该项目力求确保长期的可持续性、可负担性和可行性。

In Nepal and the Philippines, communities have had little voice in public health initiatives. Health providers often take a top-down approach, 'preaching' to families about how they should live more healthy lives and ignoring their everyday realities. Effective health promotion is however dependent on approaches that recognise local health knowledge and beliefs, and build on existing community assets, including staff and infrastructure. With their key role in educating future health workers, universities can contribute directly to transforming attitudes towards marginalised communities. Bringing together two institutes of medicine - at Tribhuvan University in Nepal and University of Santo Tomas in the Philippines - the project aims to contribute understanding of the range, scope and perceptions of community-based learning in public health courses. Extending our team's established community-based learning approach to public health and our research on indigenous/intergenerational learning, we will pilot a new kind of partnership between universities and local communities. Currently, community-based learning in medical institutes can be unidirectional, with the main intention of introducing students to health issues faced by communities so that they can offer advice based on their medical knowledge. Such initiatives have also often been framed in terms of a 'service' objective, rather than setting out to engage in mutual learning about different perspectives on health and wellbeing. This project aims to develop a learning partnership between university medical institutions and local communities which is framed around a relationship of respect for their differing health beliefs and practices. Our overarching research question is: How best can universities engage communities in a mutually respectful and equal partnership to advance public health education? The research will begin with interviews, focus group discussions and documentary analysis to explore current approaches to community-based learning in each medical school. A co-produced study into food and nutrition will then be conducted with one community in each country. Through informal conversations about food beliefs and practices, we will work with community groups to develop their ideas for a public health intervention in this area. Community members, public health students and university researchers will come together to develop methods for co-investigating local and indigenous health knowledge. Methodological expertise in participatory research will be provided by the UEA UNESCO Chair in Adult Literacy and Learning for Social Transformation, a partnership established between our three universities over six years ago. With strikingly different approaches to community-based learning in public health, the collaborating medical institutions offer a valuable comparative dimension. The project includes opportunities to gain first-hand insights into each other's university public health courses through exchange visits and workshops. Through comparative analysis of the intervention process, the project will explore the relevance for other country contexts too. Project outputs include guidelines for universities, public health workers and students on how to build on local health knowledge, as well as how medical schools could apply this model in practice. The major benefit will be to communities in Nepal and the Philippines, who until now have had little agency in public health initiatives. By situating and building the intervention within the framework of existing public health and medical university courses, the project seeks to ensure longer term sustainability, affordability and feasibility.