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

在尼泊尔和菲律宾，社区在公共卫生倡议方面几乎没有发言权。医疗服务提供者通常采取自上而下的方法，向家庭“宣讲”他们应该如何过上更健康的生活，而忽视了他们的日常生活现实。然而，有效的健康促进依赖于承认当地健康知识和信念的方法，并建立在现有社区资产的基础上，包括工作人员和基础设施。大学在教育未来的卫生工作者方面发挥着关键作用，可以直接为改变人们对边缘化社区的态度做出贡献。该项目将尼泊尔特里布万大学和菲律宾圣托马斯大学的两个医学研究所结合在一起，旨在促进对公共卫生课程中以社区为基础的学习的范围、范围和看法的理解。将我们团队已建立的以社区为基础的学习方法推广到公共卫生领域，以及我们对土著/代际学习的研究，我们将在大学和当地社区之间试行一种新型的伙伴关系。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，以便他们能够根据自己的医学知识提供建议。此类倡议也常常以“服务”目标为框架，而不是着手于就健康和福祉的不同观点进行相互学习。该项目旨在发展大学医疗机构和当地社区之间的学习伙伴关系，这种伙伴关系的框架是尊重他们不同的健康信仰和做法的关系。我们的首要研究问题是：大学如何在相互尊重和平等的伙伴关系中最好地让社区参与到促进公共健康教育的工作中来？这项研究将从访谈、焦点小组讨论和文献分析开始，以探索目前每个医学院基于社区的学习方法。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联合研究。通过关于饮食信仰和实践的非正式对话，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、公共卫生学生和大学研究人员将共同制定方法，共同调查当地和土著卫生知识。UEA教科文组织成人扫盲和学习促进社会变革教席将提供参与性研究的方法论专业知识，这是我们三所大学六年多前建立的伙伴关系。由于以社区为基础的公共卫生学习方法截然不同，合作的医疗机构提供了一个有价值的比较维度。该项目包括通过交流访问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。通过对干预进程的比较分析，该项目还将探讨与其他国家情况的相关性。项目成果包括指导大学、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。主要的好处将是尼泊尔和菲律宾的社区，到目前为止，他们在公共卫生倡议方面几乎没有什么机构。通过在现有公共卫生和医学大学课程的框架内定位和建立干预措施，该项目力求确保较长期的可持续性、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.