Annual Program Report 2004 - American International Health Alliance

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Annual Program Report 2004 - American International Health Alliance

Mission Statement

To advance global health through volunteer-driven partnerships that mobilize communities

to better address healthcare priorities while improving productivity and quality of care

AIHA History

Founded in 1992 by a consortium of American associations of healthcare providers and of health

professions education, the American International Health Alliance (AIHA) is a nonprofit organization

that facilitates and manages twinning partnerships between institutions in the United States and their

counterparts overseas. Since 1992, AIHA has established and managed partnerships and programs

that improve the health status of individuals in Eurasia.

AIHA has supported to date 116 partnerships linking American volunteers with communities, institutions

and colleagues in 22 countries in a concerted effort to improve healthcare services. Operating

with funding from the United States Agency for International Development (USAID), the Health

Resources and Services Administration (HRSA) of the US Department of Health and Human

Services, the Library of Congress, the Susan G. Komen Breast Cancer Foundation, and other organizations,

AIHA’s programs represent one of the US health sector’s most coordinated responses to

global health concerns.

AIHA has developed and refined a voluntary, partnership model in which a US community’s healthrelated

institutions are paired with community institutions in developing and transitional countries.

The partnerships embrace city, county and statewide relationships. Through peer-to-peer exchanges,

these partnerships develop practical solutions to problems, create model programs, disseminate lessons

learned, and effect broad, systemic change during and after the AIHA-funded partnership period.


TABLE OF

CONTENTS

From the Executive Director . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

AIHA Partnership Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Where We Work 2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

HIV/AIDS and Tuberculosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Healthcare Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Health Professions Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Healthy Communities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Information and Communication Technology . . . . . . . . . . . . . . . . . 23

Active Partnerships and Projects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

The Year in Numbers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Partner Profiles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Funders and Strategic Partners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Board of Directors and Staff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

Photo: Anne Maynard

During a professional exchange in Tampa, Uzbek CLDP

delegates teach their US hosts a national dance.

Annual Program Report 2004


FROM THE EXECUTIVE

DIRECTOR

AIHA’s unique partnership “twinning” model continued to flourish and

make important contributions to improving health and healthcare

throughout the world during 2004, particularly through human and organizational

capacity-building efforts. This report seeks to capture the growing

range of AIHA programs and activities that reflect a dynamic and

responsive organization capable of adapting to meet the changing needs of

partner countries.

The year 2004 was one of transition, consolidation and expansion. Several

long-running primary healthcare partnerships ended and programs to

address HIV/AIDS increasingly took center stage. Other programs continued

to build on past partnership successes and new partnerships and programs

were added to AIHA’s portfolio.

Representative of the transition was bidding farewell to 27 partnerships in

nine countries, as well as closing AIHA’s office in Armenia and scaling back

the office in Ukraine as the USAID-funded programs in those countries

were significantly reduced after more than 12 fruitful years. While individual

partnerships graduated, in Georgia, Russia and elsewhere, new activities

were funded and initiated in these countries. AIHA is proud of its graduated

partnerships and the many accomplishments that encompass significant and

sustainable improvements in the provision of healthcare services and health

professions training and education.

The year also saw the consolidation and institutionalization of successes

achieved by past partnerships and programs. A stellar example is the

hospital nursing excellence awards received by four hospitals in Armenia

and Russia that had participated in AIHA partnerships in the 1990s. Many

graduated partners now serve as mentors to new partners and provide

training and other assistance sharing what they have learned through their

own partnership experience. In one example, the current project on

Strengthening Tuberculosis Control in Moldova is collaborating with the

University Primary Healthcare Center in Chisinau and the TB Center of

Excellence in Latvia, both AIHA partner institutions, and benefiting from

their training capacities.

Annual Program Report 2004 1


Program expansion was reflected in the establishment

of 11 USAID-funded partnerships this year:

three in Azerbaijan and Georgia that continue to

focus on primary healthcare; two in Russia that

focus on family planning and reproductive health;

four in Russia that reflect a growing emphasis on

HIV/AIDS; and two regional health professions

partnerships in Central Asia. In keeping with

efforts to expand the contributions of the partnership

model to meet emerging challenges, AIHA

received new funding for programs outside

Eurasia. In one of the most exciting developments,

HRSA awarded AIHA a five-year project to establish

a Twinning Center for HIV/AIDS in support

of the President’s Emergency Plan for AIDS Relief,

which currently targets 12 African countries, two

Caribbean countries and Vietnam. The project has

the potential for establishing as many as 100 new

twinning partnerships over the next five years.

Reflecting a widening funding base, AIHA

implemented projects in 2004 with grants from

the Library of Congress and the Susan G. Komen

Breast Cancer Foundation. These projects, which

support community leadership development and

breast health respectively, also contribute to

capacity building efforts for ongoing healthcare

improvements within the target countries by

nurturing leaders and providing them with

knowledge and practical skills to address priority

health problems.

Program expansion also entailed new and

strengthened collaborative relationships, notably

with the World Health Organization. While partnerships

remain the core of our work, AIHA

increased its capacity to directly implement projects,

continuing to draw and engage volunteers,

including our former partners.

AIHA and its partners can point to numerous

achievements in 17 countries during 2004. These

achievements are organized and described in this

report within five broad areas of AIHA programs:

HIV/AIDS and tuberculosis; healthcare services;

health professions education; healthy communities;

and information and communications technology.

Our work was made possible by the dedicated team

of professionals who make up our staff in

Washington, DC, and AIHA offices in eight countries,

by the invaluable participation of legions of

US healthcare professionals from 28 cities who last

year provided more than 3,400 days of volunteer

service, by the hundreds of counterpart health professionals

and others who demonstrated leadership

and courage to implement change in their countries,

and by the many organizations and donors

that provided critical collaboration and support.

We hope this report provides some insights into

AIHA’s programmatic activities. We welcome your

inquiries and encourage you to visit us on the Web

at www.aiha.com for more information.

James P. Smith

2 American International Health Alliance


AIHA PARTNERSHIP

MODEL

Key Elements

Voluntarism: significant in-kind contributions of human, material and

financial resources

Institution-based partnering for capacity-building and systematic change

Peer-to-peer collaborative relationships that build trust and respect

Transfer of knowledge, ideas and skills through professional exchanges

and mentoring

Benefits flowing in both directions

Replication and scaling-up of successful models

Sustainability of achievements and relationships

“Partnership of partnerships” for networking, sharing and common

approaches and solutions

Photo: Barry Kinsella

Since 1992, AIHA partnerships have helped practitioners in low-resource countries bring

high-quality healthcare services to people in their communities.

Annual Program Report 2004 3


WHERE WE WORK 2004

Eurasia

Caucasus: 1 Armenia, Azerbaijan, Georgia










Graduation of 10 partnerships

Dissemination conference for Armenian partnerships marking end of a decade of collaboration

Two Armenian hospitals receive “Journey to Excellence” award from the American Nurses Credentialing Center in

recognition of improvements in quality of nursing care

Initiation of 2 new partnerships in Georgia and 1 in Azerbaijan

Opening of primary healthcare clinic in Narimanov District in Baku, Azerbaijan

Opening of emergency pediatric center at Iashvili Children’s Central Hospital in Tbilisi, Georgia

Opening of Learning Resource Centers in Ganja, Azerbaijan, and in Gori and Guria District, Georgia

Certification of 19 trainers from the Mtshkheta Family Medicine and Regional Training Center in Georgia

Georgian textbook on health management education published; health management education toolkit in Russian prepared

Central and Eastern Europe: 2 Albania, Croatia, Hungary, Kosovo, Latvia, Romania

■ Dissemination conference on health management at conclusion of the Tirana, Albania/Bucharest, Romania partnership

(the first AIHA partnership not involving a US partner)

■ Opening of the “Town Health Center,” a model primary healthcare clinic in Lezha, Albania

■ Opening of women’s health information and resource center, 2 satellite centers, 8 health information kiosks in Gyo ″ r,

Hungary

■ Enhancement of family medicine antenatal care skills in Kosovo

International Training Centre at the State Centre of Tuberculosis and Lung Diseases of Latvia officially designated as a World

Health Organization Collaborating Centre for Research and Training in Management of Multidrug-Resistant Tuberculosis

■ Roundtable on HIV/AIDS stigma and discrimination and publication of handbook in Croatia

■ Romanian Society for Breast Imaging formed and radiology quality assurance initiated at 5 pilot sites

Central Asia: 3 Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, Uzbekistan










Launch of 2 new regional partnerships: on medical education and for nursing education and leadership

Manual on Family Nursing finalized and the draft requirements for nursing registration approved by the Central Asia

Nursing Council

Review of accreditation process for medical schools in collaboration with the Central Asia Council of Rectors

Initiation of health management course for undergraduate medical students in Uzbekistan

Expanded support to Family Medicine Training Center in Turkmenistan for primary healthcare

Funding of 10 projects designed by nurses to promote early detection and awareness of breast cancer

Prevention of Mother-to-Child Transmission of HIV training provided for professionals from 3 replication sites in Kazakhstan:

Pavlodar, Temirtau, Karaganda

Visits of 15 Uzbek delegates through the Community Leadership Development Program to learn about community-based

healthcare delivery, rural health, and tuberculosis treatment and prevention services in the United States

First alumni meeting of the Uzbek Community Leadership Development Program delegation held in Tashkent, with

delegates reporting on progress of their projects

Moldova 4








Renovation of the National TB Reference Laboratory and 2 regional TB laboratories

Approval of revised laboratory guidelines and environmental mitigation and infection control plan

Enhancement of TB diagnosis and treatment skills of 350 primary care physicians and nurses

Baseline survey of public’s knowledge, attitudes and practices regarding TB

Distribution of TB information to practitioners and journalists

Development of public awareness campaigns

Integrated platform for TB and HIV/AIDs surveillance system agreed to with Ministry of Health and UNAIDS

4 American International Health Alliance


Latvia 2 Russia 5 Kazakhstan 3 Kyrgyzstan 3

Hungary 2 Ukraine 6

Moldova 4

Romania

Croatia 2 2

Kosovo 2 Georgia 1

Albania 2

Armenia 1

Uzbekistan 3

Azerbaijan 1

Turkmenistan 3 Tajikistan 3

Eritrea 7

Russia 5









Graduation of 4 primary healthcare partnerships with subsequent replication of 2 successful programs at other sites

Launch of 4 comprehensive HIV/AIDS care, treatment and support partnerships

Launch of family planning/reproductive health partnerships in Moscow Oblast/Dubna and Volgograd

Two Russian hospitals receive “Journey to Excellence” award from the American Nurses Credentialing Center in

recognition of improvements in quality of nursing care

Visits of 57 Russian delegates through the Community Leadership Development Program to learn about HIV/AIDS

services in the United States

Youth AIDS prevention and health promotion programs initiated by networks of alumni from Community Leadership

Development Program

Model Prevention of Mother-to-Child Transmission of HIV program established in Samara and Togliatti

Training in Prevention of Mother-to-Child Transmission of HIV for more than 40 policymakers and administrators from

5 oblasts (regions) of Russia

Ukraine 6









Graduation of 6 primary healthcare partnerships, concluding with a regional conference on sustainability

Odessa program on Prevention of Mother-to-Child Transmission of HIV recognized as model in region; Training Center

established to facilitate regional scale-up and recognized as center of excellence

Inauguration of Regional Knowledge Hub for the Care and Treatment of HIV/AIDS in Eurasia; training implemented for

Ukrainian care teams responsible for providing antiretroviral therapy in the country

All-Ukrainian conference on standardized patient approach to medical education

Teen counseling center opened at University Primary Healthcare Center in Kharkiv

Nursing conference for 500 primary healthcare nurses sponsored by Kharkiv Primary Healthcare Center

Opening of 2 dental clinics at University Family Medicine Training Center in Uzhgorod

Translation into Ukrainian and distribution of manual on neonatal resuscitation

Africa

Award of new 5-year cooperative agreement by the US Department of Health and Human Services, Health Resources and

Services Administration to establish an HIV/AIDS Twinning Center to serve 15 focus countries (including 12 in Africa:

Botswana, Cote d’Ivoire, Ethiopia, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda

and Zambia, plus Guyana, Haiti and Vietnam); initial consultations with US government country teams in focus countries

on HIV/AIDS plans and twinning opportunities

Eritrea 7

■ Award of new USAID Health Professions Education Partnership Program in Eritrea (began in 2005)

Annual Program Report 2004 5


HIV/AIDS AND

TUBERCULOSIS

“Before the campaign,

we struggled to find

ways to get

information about our

programs and

tuberculosis on

television, but now

several channels have

come to us with

proposals for

broadcasts on the

fight against TB. Print

and broadcast

journalists have been

calling our offices to

ask for help preparing

materials because

they are being

bombarded by

readers and listeners

who have questions

about the disease.”

– Irina Zatusevski,

AIHA’s senior health

communications specialist

in Moldova

As HIV/AIDS and other infectious diseases, notably tuberculosis, have

increasingly become urgent healthcare issues in Eurasia (where the world’s

fastest growing HIV epidemics can be found) as well as in other parts of

the world, AIHA is devoting greater resources to the control of these diseases.

From interventions to prevent transmission to diagnosis, care and

treatment, AIHA partnerships and projects support efforts to combat

HIV/AIDS and TB by strengthening services for persons living with

HIV/AIDS and TB and increasing human and knowledge resources to

institute and replicate effective models of care. AIHA’s focus is on regional

capacity-building, as well as piloting new programs and establishing centers

of excellence.

HIV/AIDS Regional Capacity-building

(Eurasia)

On March 11, AIHA opened the Regional

Knowledge Hub for the Care and Treatment of

HIV/AIDS in Eurasia (Knowledge Hub) in collaboration

with the World Health Organization

(WHO) and Deutsche Gesellschaft für

Technische Zusammenarbeit (GTZ). Based in

Kiev, Ukraine, the Knowledge Hub’s principal

objective is to create human resources to

care for people living with HIV/AIDS

(PLWHA) by developing the expertise of

healthcare professionals, strengthening the

training capacity for passing on knowledge

and skills, and compiling a body of

evidence-based resources and informational

materials. The Knowledge Hub is

collaborating with international experts

and educational institutions in the

region on training workshops and

online resources for practitioners.

In 2004, with funding from the Global Fund to Fight AIDS,

Tuberculosis and Malaria, didactic and clinical training in antiretroviral

Annual Program Report 2004 7


therapy (ART) was conducted for

multidisciplinary care teams from six

priority oblasts in Ukraine. This was

followed by on-site mentoring on ART

for pediatric, adolescent and adult

patients. By the end of the year, the

Knowledge Hub had trained and

mentored 66 ART caregivers.

EurasiaHealth AIDS

Knowledge Library

In support of capacity-building efforts

throughout the region, the

EurasiaHealth AIDS Knowledge

Library (www.eurasiahealth.org) gives

practitioners in Eurasia access to current

guidelines and research. Along

with strategic partners active in the

region, AIHA is building the Library to serve as the

primary source of Russian-language information

on HIV/AIDS care and treatment and the foundation

for the Knowledge Hub’s Internet-based

resources. AIHA supports identification, collection,

adaptation and translation of new HIV/AIDS

research and guidelines. Other HIV/AIDS care,

treatment and prevention materials for which limited

information is available in Russian are being

translated. The Library contains more than 250

documents, including full-text articles and

abstracts. During 2004, 10 key resource documents

were translated and posted, including: 2003

Medical Management of HIV Infection (J. Bartlett,

J. Gallant, eds.); WHO HIV/AIDS Treatment and

Care Protocols for Countries of the Commonwealth of

Independent States; HIV Medicine 2003 (H. Albrecht,

C. Hoffmann and B.S. Kamps, eds.); Antiretroviral

Therapy in Resource-Limited Settings (GALEN

Module No. 9); Palliative Care in HIV Management

(GALEN Module No. 15); and WHO/CDC PMTCT

Generic Training Package, August 2004.

Prevention of Mother-to-Child

Transmission of HIV:

Replication and Scale-up

(Ukraine, Russia, Kazakhstan)

Since 2001, the United States Agency for International

Development (USAID) has supported AIHA’s

project to develop and disseminate a model for

Prevention of Mother-to-Child Transmission of

The ribbon commemorating the official opening of the Knowledge Hub is cut

by Peter Weis, scientist in the HIV/AIDS Care and Support Department at

WHO/Geneva; Michael Adelhardt, head of the Initiatives Support Project,

GTZ; James Smith, AIHA executive director; and Vladimir Zagorodniy, deputy

minister, Ministry of Health of Ukraine.

HIV (PMTCT) in Eurasia. Initially implemented in

Odessa, Ukraine, the project introduced systemic

and institutional changes in HIV/AIDS prevention

and treatment. Its objectives are to ensure PMTCT

integration in primary care; the use of evidencebased

treatment protocols; the development of

appropriate training materials and curricula; and

the creation of local capacity for training healthcare

workers and trainers to replicate the model. The

project led to a 75 percent reduction in the rate of

vertical HIV transmission from 24 to 6 percent in

the Odessa catchment area (2 million people) and

the PMTCT model was endorsed by the Ukrainian

Ministry of Health for nationwide replication. A

case management monitoring database was developed

as an integral part of the project to document

baseline data and results and to serve as a quality

improvement tool. Internationally accepted

PMTCT indicators were reviewed and adapted to

the Ukrainian situation. As a result of its demonstrated

effectiveness, the Odessa database is being

used as the basis for a national PMTCT monitoring

system in Ukraine and is being adapted for use in

other countries. The Odessa PMTCT model was

presented at poster sessions at the XV International

AIDS Conference in Bangkok in July and at the

October conference of the International Society for

Quality in Health Care in Amsterdam.

USAID funding supported replication of the Odessa

model at five sites outside Ukraine that were selected

Photo: Vira Illiash

8 American International Health Alliance


for their high HIV/AIDS prevalence: two in Russia

and three in Kazakhstan. Professionals from these

sites are receiving practical, skills-based training in

PMTCT-related topics from partners at Odessa’s

Southern Ukraine AIDS Education Center, which is

recognized as a center of excellence in the region.

AIHA, with USAID support, took the lead in adapting

the Centers for Disease Control and Prevention/

World Health Organization (CDC/WHO) PMTCT

Generic Training Curriculum for use in the region.

AIHA also initiated the adaptation as part of a twoyear

effort to adapt, pilot and begin the certification

process for trainers in PMTCT.

HIV/AIDS Care and Treatment

Partnerships

(Russia)

In collaboration with the Ministry of Health, four

new partnerships were formed in July to assist

Russia in curbing the world’s fastest growing

HIV/AIDS epidemic. With USAID funding, the

Orenburg/New York, Samara/Providence,

Saratov/Bemidji and St. Petersburg/New Haven

partnerships are creating comprehensive models

for care, treatment and social support for people

living with HIV/AIDS. The partnerships extend

beyond medical care to social services, NGOs,

communities and the patients themselves. Models

developed by the partnerships will be used by the

Ministry of Health to scale up efforts to provide

services along the continuum of care for PLWHA.

During 2004, the partners conducted initial assessments,

collected demographic data and information

on health and social services, and identified

the principal community concerns for each region.

AIHA is collaborating closely with the University

Research Corporation’s Quality Assurance Project

at the four partnership sites.

confidentiality of medical records. Participants

formulated plans to review proposed improvements

to the existing legal and regulatory framework,

school-based sex education and public

awareness efforts. One concrete result is the

HIV/AIDS Stigma and Discrimination Handbook

designed to promote non-discriminatory discussion

in the media and public. The Handbook was

launched in December at the Stampar School with

the US Ambassador to Croatia attending the event.

HIV/AIDS Twinning Center

(Africa, Caribbean, Vietnam)

In September, AIHA was awarded a cooperative

agreement from the US Department of Health and

Human Services, Health Resources and Services

Administration (HRSA), to create an HIV/AIDS

Twinning Center in support of the President’s

Emergency Plan for AIDS Relief in Botswana, Cote

d’Ivoire, Ethiopia, Guyana, Haiti, Kenya,

Mozambique, Namibia, Nigeria, Rwanda, South

Africa, Tanzania, Uganda, Vietnam and Zambia.

AIHA leads a consortium that includes the

International Training and Education Center on

HIV (I-TECH) and the Futures Group.

The Twinning Center will establish twinning partnerships

and a Volunteer Healthcare Corps to support

capacity-building in the 15 focus countries to

institutionalize HIV/AIDS care and treatment

models and allow for rapid scale-up. The

Twinning Center began operating toward the end

of 2004 with staff conducting strategic planning

Reducing Stigma and Discrimination

(Croatia)

In April, AIHA and the Stampar School of Public

Health in Zagreb jointly organized a workshop

and roundtable on HIV/AIDS stigma and discrimination,

the first such event in Croatia. More than

50 attendees representing physicians, law professors,

media, legislators, AIDS organizations, NGOs

and USAID discussed causes of discrimination,

misconceptions about transmission, and lack of

AIHA partnerships work to improve diagnostic capabilities

at host institutions through hands-on training.

Photo: AIHA archives

Annual Program Report 2004 9


Photo: Dmitrii Volkov

meetings and initiating consultations with HRSA

and country teams on incorporating partnerships

and volunteers into the HIV/AIDS plans of the

focus countries.

National Tuberculosis Control

(Moldova)

With USAID funding, AIHA is implementing a comprehensive

project, Strengthening Tuberculosis

Control in Moldova, in support of WHO’s Directly

Observed Therapy-Short Course (DOTS) strategy.

The four-year project, begun in 2003, is upgrading

laboratories; enhancing skills in detection, treatment

and follow-up; improving TB surveillance; and

increasing awareness of symptoms and treatment.

The renovated National TB Reference Laboratory

and two Regional Reference Laboratories reopened

in March 2005 for World TB Day, with equipment

provided by the Global Fund to Fight AIDS,

Tuberculosis and Malaria. An environmental mitigation

and infection control plan and revised guidelines

for laboratory procedures were approved. A

total of 15 laboratory staff, TB specialists, PHC

physicians and nurses, and medical professors

received instructor training at the International

Training Center at the State Center of Tuberculosis

and Lung Diseases of Latvia. These individuals subsequently

trained 350 PHC practitioners in cooperation

with the World Bank and the State Medical and

Pharmaceutical University “Nicolae Testemitanu.”

Providers now have the information and skills to

better communicate with TB patients.

Results of a baseline knowledge, attitudes and practices

survey were used to design a public awareness

Culture method room in the newly-reopened National TB

Reference Laboratory in Chisinau.

campaign, “TB can be treated! See the doctor!”, that

was launched in 2004 and continued in 2005. The

campaign addresses a stark result of the survey –

nearly one-fourth of respondents believed TB cannot

be cured completely. Awareness raising activities

included press briefings and providing interview

opportunities for journalists. A series of televised TB

roundtables included AIHA’s Project Director, representatives

from the Ministry of Health, Institute of

Phthisiopneumology, Municipal TB Clinic, National

TB Control Programme and The Global Fund to

Fight AIDS, Tuberculosis and Malaria.

Design and indicators for a TB surveillance system

were agreed upon with the Ministry of

Health. The software is being developed in collaboration

with the Scientific-Practical Center for

Sanitary Management. AIHA joined forces with

UNAIDS on a common surveillance system platform,

with AIHA developing the TB component

and UNAIDS developing the HIV/AIDS component.

This interagency cooperation facilitated

achievement of an agreement by authorities of the

breakaway Transnistria region to carry out TB

control activities consistent with DOTS within the

framework of the Moldovan National

Tuberculosis Program.

Center of Excellence for

Multidrug-resistant TB

(Latvia)

In November, the International Training Center at

the State Center of Tuberculosis and Lung Diseases

of Latvia was designated officially as a WHO

Collaborating Center for Research and Training in

Management of Multidrug-resistant TB (MDR-TB).

At the opening ceremonies in Riga, the Latvian

Minister of Health presented an award to the US

coordinator of the Riga/Little Rock partnership in

recognition of the role the University of Arkansas

for Medical Sciences (UAMS) played in the certification

of the Center. With USAID funding, UAMS

assisted the Center during 2002-2004 in enhancing

teaching methodologies and management skills and

instituting a business plan for financial stability. The

Center is recognized for its world-class training in

diagnosis, treatment and management of MDR-TB

and has trained trainers for the Moldova TB project.

10 American International Health Alliance


HEALTHCARE

SERVICES

“AIHA programs are

valuable not only for

promoting changes in

the NIS healthcare

infrastructure, but also

for fundamentally

changing the thinking

of the people involved

in the programs, who

are enriched with the

knowledge and

resources needed for

successful reforms.”

– US Ambassador to

Ukraine John Herbst

Improving access to quality healthcare services – from primary to tertiary levels

– is a cornerstone of AIHA programs. AIHA and its partners have helped

to establish models of healthcare, introduce new or improved services and

strengthen the human and organizational capacity to deliver quality care.

Program focus areas including family medicine nursing, women’s wellness,

hospital management, emergency medicine and breast health have made substantial

contributions to improving standards of healthcare across Eurasia.

Primary Healthcare

(Albania, Armenia, Azerbaijan, Georgia, Kazakhstan, Kosovo,

Russia, Turkmenistan, Ukraine)

Primary care has been the central focus of partnerships since 1999 in

response to priorities in the targeted countries to transform healthcare

delivery from specialized services to a patient- and family-centered primary

care approach. During 2004, 22

USAID-funded primary healthcare

(PHC) partnerships graduated and

four were initiated or remained

active. The graduated partnerships

have left a legacy of model clinics

and trained providers offering new

or improved services to hundreds of

thousands throughout the nine

Eurasian countries.

Albania

The Lezha/Pittsburgh partnership

graduated in March after opening

the Lezha Town Health Center the

previous month. The Center, a

model primary healthcare clinic for

the country, serves 86,000 people

and provides women’s and children’s

consultations, family planning,

obstetrical care, laboratory services,

Primary care partners focus on providing a

wide range of diagnostic, treatment and

prevention services to ensure the well-being

of patients of all ages.

Photo: Kathryn Utan

Annual Program Report 2004 11


patient information, community health education

classes and a Learning Resource Center. Weekly

education programs are held for pregnant women,

new parents and adolescents.

Armenia

Five PHC partnerships graduated in September

and a dissemination conference marked the culmination

of AIHA’s 12-year program in Armenia,

which also encompassed hospital partnerships and

programs in women’s health, emergency medical

services, infection control, neonatal resuscitation

and nursing. The PHC partnerships leave behind

five model clinics that continue to offer quality

primary care services in their communities.

During 2004, continued training and public health

outreach at Sevan Polyclinic in the Gegarkunik

region and Vanadzor Polyclinic No. 5 in the Lori

region expanded diagnosis, screening and disease

management services in rural areas. At the Health

Training Center at Vanadzor Polyclinic No. 5, five

new modules were developed for the PHC curriculum.

A total of 11 modules were adapted in compliance

with the country’s “unified curriculum”

and presented to the Ministry of Health. In addition

to women’s health services, Yerevan’s

Armenian American Wellness Center began offering

primary care for the entire community and

instituted a patient survey to collect information

for improving services.

Clinicians at the Armenian American Wellness Center in

Yerevan review the results of a mammogram before consulting

with a patient.

Azerbaijan

The new Ganja/Livermore PHC partnership

opened a Learning Resource Center and three partnerships

graduated in 2004. Established in 2002

under the Baku/Houston partnership, the Mir

Kasimov Women’s Wellness Center continued to

provide education on childbirth, family planning,

STDs, and breast and cervical cancer screening. In

Baku’s Narimanov District, a model PHC clinic,

which serves as a site for the new family medicine

training course at the Institute of Postgraduate

Medical Education, opened as a result of the partnership

with Portland, Oregon. A mental health

component was introduced and 740 patients were

registered for mental health services. Through the

Baku/Richmond partnership, the Binagadi District

Health Department improved collection and analysis

of health data and conducted 88 health education

sessions on infectious disease prevention,

healthy lifestyles and substance abuse. A total of

1,662 people, including 353 internally-displaced

persons, attended the sessions in 2004.

Georgia

One primary healthcare partnership graduated,

having established a sustainable model PHC center

that serves approximately 10,000 people in the

Mtshkheta-Mtianeti region. The partnership’s

Family Medicine and Regional Training Center formally

opened this year and Georgian authorities

licensed and certified 19 trainers who provided 940

hours of family medicine training in the region.

Building on the partnership’s success, the Center

for International Health in Milwaukee is engaged

in a new partnership in the adjacent Shida Kartli

Region to improve the clinical skills of primary

care physicians and nurses at ambulatory health

centers. Another new PHC partnership began in

the Guria region with La Crosse, Wisconsin, and

the Guria District Health Administration established

a Learning Resource Center in October.

Kazakhstan

After the Demeu Family Medicine Center opened

in 2000, improvements in the delivery of health

services in the Kazakh capital city of Astana convinced

the Ministry of Health and the Ministry of

Labor and Social Welfare to replicate the PHC

model introduced by the Astana/Pittsburgh partnership.

Following the signing of a memorandum

of understanding between AIHA and the two ministries

in 2004, three family group practices in

Photo: AIHA Archives

12 American International Health Alliance


Photo: Courtesy of Sabirabad Regional Hospital

In Azerbaijan, AIHA partners are bringing much-needed primary

care services to the nation's many internally displaced persons.

other regions of Kazakhstan were selected to participate

in implementing the model of integrated

primary care and social services. Volunteer

Services Overseas and Columbia University’s

School of Social Work are collaborating with

AIHA to develop and implement the social services

components of the project.

Kosovo

A reproductive health partnership between

Dartmouth Medical School and the municipality

of Gjakova in Kosovo is strengthening family medicine-based

antenatal care. Training materials and

patient forms in Albanian and English were developed

based on WHO’s Antenatal Care Model. In

November, a US antenatal care specialist facilitated

the first full antenatal care training in Gjakova. Ten

of the 11 participants passed the post-training

knowledge and skills tests and were certified.

Earlier in the year, a PHC partnership between

Gjilan and Dartmouth wrapped up a highly successful

three-year project that improved the quality

of family medicine practice by implementing new

patient management systems, institutionalizing

continuous quality improvement processes, and

establishing community-based health programs.

Russia

Four primary healthcare partnerships graduated

during 2004, having established three PHC centers,

two Women’s Wellness Centers and two

community health education centers, along with

numerous new models of primary care services,

including for the management of chronic diseases

such as asthma and hypertension. Each partnership

received additional funding to replicate successful

programs at other sites. These replications

included the Tomsk community health education

centers, the Samara asthma management and

nursing management programs, the Sarov hypertension

management program and the Kurgan

neonatal program. The partnerships held a joint

best practices dissemination conference for 535

professionals and provided training and technical

assistance at the replication sites. More than 1,300

professionals attended training and specialized

dissemination conferences and 5,000 people participated

in health promotion and disease management

programs during the year.

Two additional primary healthcare partnerships –

Sakhalin/Houston and Volgograd/Little Rock –

successfully completed their projects during 2004.

In Sakhalin, a Teen Health Education Center and a

Mayoral Health Council are now actively engaged

in community-based health promotion activities.

In Volgograd, partners established a family medicine

clinic that serves as a residency training site.

The two partnerships received new funding for

HIV/AIDS prevention and family planning/reproductive

health, respectively.

Turkmenistan

An additional project was initiated in Ashgabat to

build on the work of the Ashgabat/North Dakota

partnership (1999-2003). The project focuses on

further strengthening PHC capacity building at

the Family Medicine Training Center, opened in

2000. Curriculum and training needs were

assessed to develop a women’s health module in

family medicine.

Ukraine

Six PHC partnerships graduated, ending the

USAID-funded partnership program and leaving a

legacy of 12 sustainable model PHC centers and

numerous PHC physicians and nurses trained at the

five skills-based training centers established by the

partnerships. The PHC centers provide high-quality

care to a population of approximately 75,000

people. The Donetsk and Kramatorsk/Pittsburgh

partners trained 65 practitioners from 22 women’s

health centers as Lamaze instructors and introduced

treatment protocols for cervical erosion, bronchitis,

Annual Program Report 2004 13


hypertension and pneumonia at the Kramatorsk

Women’s Wellness Center and the Kramatorsk

Family Medicine Department. A pediatric and an

adult dental clinic opened at the Uzhgorod

University Family Medicine Training Clinic. At the

Velykiy Berezny Family Medicine Center, referrals to

specialists decreased to 27 percent by mid-2004

from 53 percent at its opening in 2000. The

Kiev/Philadelphia partnership held a conference for

100 participants from 18 oblasts to review clinical

skills and assessment using standardized patient

methodology. A teen counseling center was opened

and a PHC nursing conference was held in Kharkiv.

A new nursing curriculum developed by the partnership

with LaCrosse was introduced at the

Kharkiv Post-Graduate Medical Academy as the

basis for a new four-year nursing degree program.

New Family Planning/Reproductive

Health Partnerships

(Russia)

In response to one of Russia’s continuing national

health priorities – improving reproductive health to

reverse negative population growth – USAID provided

funding in July for two new partnerships

aimed at enhancing primary care providers’ ability to

meet family planning needs and integrating reproductive

health and patient education into primary

care in two oblasts. The Moscow Oblast-Dubna/

La Crosse and Volgograd/Little Rock partnerships are

providing training in reproductive health and effective

patient education and outreach techniques. The

objectives of these partnerships are to increase access

to family planning services, to train additional family

planning practitioners, to expand use of family planning

services by women and couples at PHC facilities

and to raise contraceptive prevalence rates in underserved

communities.

Breast Health

(Central Asia and Romania)

The Susan G. Komen Breast Cancer Foundation

funded two AIHA projects to improve skills and services

related to breast cancer detection and treatment.

The Romanian project is co-funded by USAID.

Radiology Quality Assurance in Romania

With support from US volunteer specialists recruited

by AIHA, the Romanian Society for Breast Imaging

A nurse at Yerevan’s St. Grigor Lusavorich Medical Center receives

a “Journey to Nursing Excellence” ribbon from Mary Ann Anderson

of Wake Forest University’s Baptist Medical Center.

was formed to organize training and to serve as a

liaison with the Ministry of Health for radiology

quality assurance. At five pilot sites, 20 radiology

technicians, radiologists and physicists were trained

and quality assurance testing equipment and supplies

were purchased and installed. The newlyintroduced

quality assurance processes greatly

improved mammography procedures and patient

positioning, resulting in improved quality of breast

x-ray images. USAID is selecting five additional sites

at which Romanian trainers will provide training.

The quality assurance manual of the American

College of Radiology was adapted and translated into

Romanian to serve as a procedure manual.

Central Asia Nursing and Breast Health

The project’s long-term goal is to improve breast

health by upgrading nurses’ roles and skills in

detection and treatment of breast cancer in

Kazakhstan, Kyrgyzstan, Tajikistan and Uzbekistan.

At the initial workshop in May, 40 nurses were

trained as breast health educators and invited to

submit proposals for community-based breast

health projects. The 14 nurses who submitted proposals

attended a second workshop in November

where participants discussed their proposed projects

and received training in advocacy and adult education

techniques. Ten of the projects (totaling $5,000)

were subsequently selected for funding. The projects

range from training nurses in clinical and breast

self-exam to raising community awareness to promote

early detection.

Photo: Courtesy of Linda Aiken

14 American International Health Alliance


Hospital Nursing Quality Improvement

A three-year pilot program for nurses to improve

the quality of hospital care culminated in 2004

with the prestigious “Journey to Excellence” award

by the American Nurses Credentialing Center

(ANCC) given to four hospitals that had participated

in now-graduated partnerships, two in Russia

and two in Armenia. The USAID-supported program

introduced evidence-based standards of professional

nursing based on ANCC’s accreditation

program for nursing care excellence, which recognizes

excellence in hospitals in its “Magnet”

Program. Each hospital was assisted by US experts

in nursing standards and a partnership with a US

hospital that had achieved ANCC Magnet status.

Teams of nurses and physicians were formed to

implement standards, which led to substantial

improvements in quality of care and patient satisfaction.

These hospitals now serve as national

models of excellence in healthcare quality.

Women’s Wellness Centers

AIHA produced a report on an assessment conducted

in late-2003 of the network of Women’s

Wellness Centers established by AIHA between

1997 and 2003. These Women’s Wellness Centers

(WWCs) represent model comprehensive outpatient

centers serving women of all ages. The selfassessment

questionnaires, completed by 29 of the

32 established WWCs, revealed that more than 90

percent are continuing to provide services within

the five core service categories of the WWC

model – prenatal and perinatal care, family planning,

sexually-transmitted diseases, cancer screening

and diagnosis, and services to elderly women.

The Centers also reported improved implementation

of clinical guidelines and protocols

as a result of training and information

resources made available through the program,

as well as improved physical facilities and availability

of equipment, leading to better patient

care and outcomes.

tailored to the region. Based on the US Department

of Transportation’s national standard curriculum,

the workshop was held in Tbilisi in April and used

trainers affiliated with Harvard Medical School.

Each center received hard copies and CD-ROMs of

the instructor and student manuals. The centers,

while no longer receiving direct AIHA support,

have continued to flourish. Since the centers were

established beginning in 1994, they have trained

more than 50,000 healthcare professionals and first

responders in topics from first aid to medical

emergencies and disaster management.

Georgian Hospital Improvement

On June 1, an emergency pediatric center was

opened at the Iashvili Children’s Central Hospital

(CCH) in Tbilisi. An emergency specialist from

Atlanta assisted in the start-up under the USAIDfunded

Tbilisi/Atlanta partnership. More than

7,000 critically injured children received state-ofthe-art

emergency care at the center since its opening.

The partnership is also creating a professional

nursing model and improving hospital management

at CCH and Gudushauri Hospital (National

Medical Center-NMC). In-service nurses’ training

courses in pain management, infection control,

surgical peri-operative techniques, intubation

techniques, and treatment of acute and chronic

ostheomielitis were held at the hospitals. The

finances and administration of CCH and NMC

were reviewed, training was provided on budgeting

and monitoring, and recommendations are

being implemented to improve fiscal management

and performance indicators.

Emergency Medical Response

Trainers from AIHA’s network of 14

Emergency Medical Services Training Centers

located in nine countries received a week-long

skills-based training on a new curriculum for

non-medical personnel (first responders)

Healthcare professionals, police, firefighters and other first responders learn

critical life-saving skills at AIHA’s network of EMS Training Centers.

Photo: AIHA archives

Annual Program Report 2004 15


HEALTH PROFESSIONS

EDUCATION

“The success of

healthcare reform in a

country is directly

related to its ability to

develop a cadre of

high-quality

professionals capable

of working within the

new system. The

partnership allows

medical schools to

exchange ideas and

enhance the

professional skills of

faculty, as well as help

promote the

development of

medical education

reform in the Central

Asian Republics.”

– Professor Talgat

Muminov, rector of the

Kazakh State Medical

University, Almaty,

Kazakhstan

Building human and institutional capacity through health professions

education is a key component of healthcare reform and integral to AIHA’s

efforts to contribute to improved healthcare. Since 1996, AIHA has been

supporting educational partnerships and programs that seek to strengthen

formal education and professional training for physicians, nurses and

healthcare managers.

Medical Education Reform Underway in Central Asia

In partnership with University of

South Florida (USF), seven medical

education institutions from

Kazakhstan, Kyrgyzstan, Tajikistan

and Uzbekistan are piloting reforms

in the region. The partnership focuses

on establishing regional standards

and accreditation, improving administrative

capacity for planning and

monitoring, enhancing the ability of

faculty to design appropriate curricula,

enhancing institutional capacity

to conduct research, and promoting

student development activities.

During 2004, links were established

with US and European medical education

organizations for pilot projects,

accreditation processes and data

By improving medical education and professional

development opportunities, partners are also improving

institutional efficiency and the quality of

patient care.

requirements were studied, and research standards and grant-writing were

reviewed. The partners and the region’s Council of Rectors agreed to develop

a Central Asian Medical Education Database to track information on institutions,

curriculum and quality indicators to support regional accreditation.

Central Asia Council of Rectors

The Council of Rectors is spearheading unified approaches among Central

Asian countries in admission standards, graduate qualifications, standardized

examinations, professional licensure, accreditation and workforce

planning to support health system reforms. The Council, established in 2000

Photo: Barry Kinsella

Annual Program Report 2004 17


Photo: John Capati

The concept that we can accomplish more through collaboration

than working alone is a cornerstone of AIHA's twinning

model. Team-building exercises such as this one encourage

physicians, nurses and other care providers to work together to

provide comprehensive, integrated healthcare services.

with support from AIHA and Abt Associates with

USAID funding, has broad representation of medical

education institutions in Central Asia, with 10

from Kazakhstan, eight from Kyrgyzstan, two from

Tajikistan, 10 from Uzbekistan and one from

Turkmenistan. In 2004, its activities were tied

closely to the medical education partnership’s

activities. The Council discussed regional standards

of medical education and uniform qualifications

for graduates. The rectors have agreed to begin

drafting accreditation standards using guidelines of

the World Federation for Medical Education.

Strengthening Nursing Education and

Leadership in Central Asia

The first multi-institutional and multi-country

partnership on nursing education and leadership

was initiated in Kazakhstan, Kyrgyzstan and

Uzbekistan with the University of Minnesota’s

School of Nursing (UMN). The partnership is

strengthening nursing curricula, teaching strategies,

practice standards and professional independence.

Nurse educators from UMN assessed implementation

of the existing nursing curricula and

recommended a phased approach for basic and

advanced curriculum models. In June, the partners

held a planning workshop in Bishkek in conjunction

with the Central Asia Nursing Council and

formulated partnership priorities and objectives.

Central Asia Nursing Council

Created in 1999, with support from AIHA and

USAID, the Central Asia Nursing Council’s principal

goal is to promote collaboration in nursing

education, practice, specialty training, research,

management, regulations and associations in the

five countries of the region. During 2004, the

Council finalized the Manual on Family Nursing

for distribution, approved the draft Regulations on

Nurse Registration System, and revised model

clinical practice guidelines on malaria, tuberculosis

and diabetes.

Health Management Education in

Uzbekistan

In 2004, the Tashkent/Lexington, Kentucky, health

management education partnership focused on

developing the undergraduate health management

curriculum, with graduate and continuing education

courses to be developed in later years. In May,

a training-of-trainers (ToT) workshop in the new

curriculum was given to 15 faculty members and

administrators at the First and Second Tashkent

State Medical Institutes. University of Kentucky

faculty assisted in the first 36-hour course taught

to medical students and the Uzbek faculty has

since taught the course to 470 students.

Support for Healthcare Policy

Development and Health Management

in Turkmenistan

At the request of Turkmenistan’s Ministry of

Health and Medical Industry, AIHA initiated a

new project with USAID support to develop a

Health Management Training Center at the

Ashgabat Medical Institute. The Kazakhstan

School of Public Health and Virginia

Commonwealth University, formerly of the

Almaty/Richmond health management education

partnership, provided health management ToT

training as part of the new project. In addition,

AIHA organized a study tour for five health and

finance ministry officials to learn about different

approaches to healthcare financing in the United

States and Canada. The group visited private

health insurance companies, government-financed

programs and universities.

18 American International Health Alliance


Photo: Barry Kinsella

Health Management Training in

Georgia

The Tbilisi/Scranton, Pennsylvania, partnership

wrapped up nearly five years of USAID-funded

collaboration in September. The National Health

Management Center in Tbilisi and its satellites in

Batumi, Kutaisi and Telavi are continuing to provide

courses developed by the partners to hospital

managers, physicians and nurses. The partners

published the quarterly, interdisciplinary Journal

of Health Services Management and Public Health

and a textbook in Georgian titled, Public Health

and Management. In collaboration with the

National Institutes of Health, partners also prepared

a toolkit in Russian titled, Health Care

Management Guidelines.

Nursing Distance Education in

Armenia

Under the USAID-funded Nursing Distance

Education Project, graduate nursing students at

Erebouni Medical College in Yerevan participated in

on-line courses with counterparts at the University

of Nebraska Medical Center’s School of Nursing to

strengthen advanced nursing education in Armenia.

The project also demonstrated the use of distance

learning technology for developing nursing education

in a resource-poor country. During 2004, 10

students from Erebouni completed Internet-based

courses on curriculum design and research in nursing.

Four courses were completed during the twoyear

project. The project was interrupted with the

end of funding for AIHA programs in Armenia.

AIHA partnerships have helped create a new generation of

highly-skilled nurses by improving opportunties for their education

and professional development.

Theoretical lessons combined with hands-on clinical training

help partners hone their skills.

Public Health and Health Management in

Albania

In January, the Tirana/Bucharest, Romania, partnership

(the first not involving a US partner) held

a dissemination conference to share their experiences

and outcomes and to market the primary

care management course developed through the

partnership. The partners presented processes for

identifying training needs for health professions

and developing the training-of-trainers course in

Albania. Given the similarities in healthcare

reforms in Albania and Romania, the capacity

building for public health and health management

served both partners. The partnership graduated

in March.

New Eritrea Award

In December, USAID awarded AIHA the Health

Professions Education Partnership Program

designed to build a foundation for meeting urgent

health workforce education needs in Eritrea. In

view of the critical role of physicians and the

diminished size of Eritrea’s medical workforce, the

program will emphasize the strengthening of medical

education through support to Eritrea’s new

academic health center, comprising the recentlyestablished

Orotta School of Medicine, related

nursing and allied health professions schools, and

affiliated teaching hospitals. The project, closely

coordinated with the Ministry of Health’s workforce

plans and policies, began in 2005.

Photo: Barry Kinsella

Annual Program Report 2004 19


HEALTHY

COMMUNITIES

“Resources are

limited, but

our creativity

is unlimited.”

– Tashkent,

Uzbek meeting participant

Since its inception, AIHA has encouraged and supported community-based

approaches to addressing priority health problems. In 1996, with USAID

funding, AIHA adapted and began employing the healthy communities

model, which defines health broadly as not merely the absence of disease

but the well-being of the population as a whole. The model, related to the

World Health Organization’s Healthy Cities movement, is based on engaging

citizens and public and private entities in promoting healthy behaviors

and improving quality of life. AIHA has established six healthy communities

partnerships to date, two of which were active in 2004 in Hungary.

More recently AIHA integrated the healthy communities model into the

Community Leadership Development Program (CLDP) which, with funding

from the Library of Congress’ Open World Leadership Center, has

brought civic and healthcare leaders from more than 40 communities in

Russia and Uzbekistan to the United States. Participants are hosted within

US communities and gain knowledge and skills to better enable them to

mobilize their own communities to address priority health and social issues.

Promoting Healthy Communities in Hungary

Two healthy communities partnerships in Hungary graduated in 2004. The

Pécs/Harrisburg partnership brought together business and arts leaders to

encourage their involvement in promoting women’s health through arts and

cultural programs in the 23 member

communities of the Hungarian

Association of Healthy Cities. The

Gyo″r/Pittsburgh partnership conducted

an adolescent pregnancy prevention

campaign in February targeting girls

between the ages of 14–18 at schools

and gathering places for youth. The

campaign concluded with a disco and

discussion attended by 90 teens and

supported by $15,000 in donated media

time. A women’s health and information

resource center, “For Women’s

Health,” was opened in Gyo″r in March

Partners work to prevent chronic diseases by

educating the public at health fairs and other

outreach events.

Photo: Courtesy of Laura Faulconer

Annual Program Report 2004 21


and during the year held 54 classes attended by

1,146 people and distributed 10,900 leaflets on

health topics. Two satellite centers and eight information

kiosks were set up at healthcare sites, a

pharmacy, a cultural center, a shopping mall, a

business park, the public library, and the Family

and Marriage Institute. Both partnerships graduated

in September.

Russian and Uzbek Civic and Healthcare

Leaders Visit the United States

With the third year of funding from the Library of

Congress, AIHA continued to engender mutual

understanding and healthy communities through the

Community Leadership Development Program.

During October and November, three groups comprising

69 leaders from Russia and Uzbekistan visited

Florida, Iowa and Minnesota. The Russian delegates

came from 12 communities with active AIHA programs:

13 from Orenburg, 18 from St. Petersburg,

12 from Samara, and 14 from Saratov. Participants

learned how to integrate medical services with social

services provided by community organizations for

comprehensive HIV/AIDS care. The Uzbek delegation

to Minnesota saw TB treatment in prisons and

laboratory diagnostics. The Uzbek delegation to

Florida observed community health workers reaching

underserved populations and preventive health

services funded through dedicated sales taxes. These

professionals are now part of the CLDP alumni network

that is actively spearheading community action

plans to promote health in their communities.

Russian CLDP Alumni Lead Local

Efforts to Improve Health

AIHA sponsored a Russia-wide leadership meeting

in Moscow for the Community Leadership

Development Program/Russia alumni. At the May

meeting, CLDP alumni reported on successful follow-on

programs, including the formation of five

regional networks of healthy communities representing

25 cities, towns and districts in

Chelyabinsk, Kurgan, Sakhalin, Samara and Tomsk

oblasts. CLDP participants from Yuzhnouralsk

gained wide support for a drug abuse and

HIV/AIDS program, receiving city council

approval and funding through 2005. Alumni from

Novokuibyshevsk formed a healthy community

program committee headed by the deputy mayor

Through AIHA's CLDP exchanges, delegates get a first-hand

look at community-based health programs in action.

and decided to focus on prevention of HIV/AIDS

and drug abuse in youth. Working with local agencies

and NGOs, activities included distributing

3,000 AIDS prevention booklets, holding a music

festival, training school staff in prevention and

conducting stakeholder roundtables. Samara

alumni promoted healthy lifestyles among youth

with three awareness and training projects. The

“Take it with you!” project conducted 20 training

courses on AIDS prevention in local schools in

cooperation with the Center for Social

Development and Information Foundation.

Alumni and specialists from the Samara

Pedagogical University trained 60 specialists from

family medical centers to assist parents on the project,

“Preserving children’s and adolescents’ health

in the Samara region.” Alumni and members of the

health and education departments sponsored the

Health-aware Teenagers” program, which trained

30 physicians, 25 teachers and parents.

Uzbek CLDP Alumni Convene for

Follow-up Meeting

In April, eight alumni of the first Uzbek Community

Leadership Development Program delegation met in

Tashkent along with representatives of the Tashkent

State Medical Institutes, the Open World project,

USAID and AIHA. Among other topics, the participants

discussed relevant health programs and

resources available in Uzbekistan, communityoriented

interventions and delegates’ CLDP experiences.

Alumni reported that since returning from

the United States, they had initiated programs to

expand services for drug abuse and HIV/AIDS,

increase use of information technology, improve

management of hospital beds and introduce healthy

community principles in family medicine.

Photo: Anne Maynard

22 American International Health Alliance


INFORMATION AND

COMMUNICATION

TECHNOLOGY

“The LRC is a very

important tool for

changing the way

people who work in

healthcare think

because it gives them

an opportunity to

learn to make the

maximum use of

existing information

resources, both for

themselves and for the

people around them.”

– Yuri Vorokhta,

information coordinator

for the Odessa State

Medical University LRC

AIHA’s Information and Communication Technology (ICT) programs

focus on improving access to reliable health and medical information for

health professionals worldwide, as well as developing the capacity for health

professionals to interpret and apply this information using the principles of

evidence-based practice. With greater access to information, physicians,

nurses, educators, policymakers, and other health professionals are

equipped with greater capability to improve the quality and effectiveness of

the healthcare they deliver. AIHA’s ICT programs strive to both improve

the availability of appropriate native-language health information resources

and build upon the infrastructure and capacity of healthcare institutions to

access and use these resources.

Learning Resource Center Project Selected as Stockholm

Challenge Finalist

AIHA’s Learning Resource Center (LRC) Project was a finalist in the 2003-

2004 Stockholm Challenge, a prestigious award for innovative ICT programs

in international development. The Stockholm Challenge is a nonprofit

initiative of the City of Stockholm that focuses on the benefits of ICT for

people and society. The LRC Project was selected from a field of nearly 900

entries from 107 countries. Finalists were invited to attend a conference and

ceremony held in Stockholm in May. An international jury of 28 experts

selected finalists in six categories – e-government, culture, health, education,

e-business and environment – based on innovation, user need, accessibility

and transferability.

Sixteen New LRCs Established

AIHA established 16 new Learning Resource Centers in the Caucasus,

Central Asia, Kosovo and Russia to support AIHA partnerships in primary

care, medical and nursing education, HIV/AIDS and reproductive health.

These centers joined the network of 130 LRCs established in the region since

1995. During 2004, the LRC project provided information and communication

services to 75,000 health professionals and fulfilled 8,500 information

requests. The LRCs trained 2,400 health professionals on the use of computers

and the Internet and opened their doors to nearly 21,000 visitors.

Annual Program Report 2004 23


LRCs Contribute to Evidence-based

Decision-making: An Example from

Moldova

Learning Resource Centers play an important role

in improving healthcare quality by supporting evidence-based

decision-making. In 2004, in an effort

to overcome the old scourge of overmedication, the

staff of the Cardiosurgery Center at the Republican

Clinical Hospital in Chisinau, Moldova, evaluated

patterns of drug usage for surgical and post-surgical

prophylaxis. After reviewing the evidence-based

literature, clinicians reduced the number of antibiotics

used in routine surgical procedures from three

to one. They standardized the culture and sensitivity

tests for determining appropriate drug treatment

for postoperative complications. In the six

months following the implementation of the new

procedure, the Center observed a noticeable

decrease in the number of complications and a

reduction in the average hospital length of stay. In

addition to better patient care, the changes resulted

in cost savings for the hospital.

EurasiaHealth Knowledge Network

Usage Doubles in 2004

Use of the EurasiaHealth Knowledge Network, a

Web-based clearinghouse of health and medical

information in Russian and other Eurasian languages,

more than doubled during 2004, from

4,200 to 10,700 visits per month. The increase is

due in part to the visibility generated by information

bulletins EurasiaHealth began producing this

year. These include the “Free Resources Bulletin”

and the “Guide to Electronic Libraries,” which

inform health professionals in developing countries

how to obtain free books, CD-ROMs and

access to on-line health and medical journals.

Several Web sites and print journals reprinted

issues of these bulletins. Activities of the specialized

EurasiaHealth HIV/AIDS Knowledge Library

are described in the section on HIV/AIDS.

Evidence-based Medicine Distance

Learning Course

In April, AIHA conducted the first of three iterations

of a new distance learning course on the

basics of evidence-based medicine and critical

appraisal of scientific literature. The course is

designed to teach participants how to formulate

“answerable” clinical questions, identify the best

sources of evidence for each type of question, and

appraise publications on validity, reliability and

applicability. The four-week course was offered

twice in Russian and once in English. Altogether,

135 individuals from Eurasia and Africa attended

the course. In the post-test self-assessments, participants

showed increased knowledge in identifying

relevant sources of evidence, devising search strategies,

using critical appraisal tools and introducing

evidence-based principles in their area of practice.

Books, electronic databases and computer software are a part of the Standard Learning Resource Center Equipment and

Resources package.

Photo: Frances Greene

24 American International Health Alliance


ACTIVE PARTNERSHIPS

AND PROJECTS

Caucasus

Armenia

Armavir/Galveston, Texas

Caucasus Partners: Armavir Regional Health Care Administration, Armavir

Polyclinic

US Partners: University of Texas Medical Branch at Galveston, Galveston

Partnership for Better Living, JesseTree

Gegarkunik/Providence, Rhode Island

Caucasus Partners: Gegarkunik Regional Health Care Management

Department, Sevan Polyclinic

US Partners: National Perinatal Information Center, Care New England,

Lifespan Health Systems

Lori/Los Angeles, California

Caucasus Partners: Lori Regional Health Care Administration, Vanadzor

Polyclinic No. 5

US Partner: University of California – Los Angeles Medical Center

Lori/Milwaukee, Wisconsin

Caucasus Partners: Lori Regional Health Care Administration, Vanadzor

Polyclinic No. 5

US Partner: Center for International Health

Yerevan/Washington, DC

Caucasus Partner: Armenian American Wellness Center

US Partner: Armenian American Cultural Association

Azerbaijan

Baku/Houston, Texas

Caucasus Partner: Mir Kasimov Republican Clinical Hospital

US Partner: Baylor College of Medicine

Baku/Portland, Oregon

Caucasus Partner: Narimanov District Health Administration

US Partner: Oregon Health Sciences University in Portland

Annual Program Report 2004 25


Baku/Richmond, Virginia

Caucasus Partner: Binagadi District Health

Administration

US Partner: Virginia Commonwealth University

Ganja/Livermore, California

Caucasus Partner: Ganja City Health Administration

US Partners: ValleyCare Health System, Alameda

County Public Health Department

Georgia

Gori/Milwaukee, Wisconsin

Caucasus Partner: Shida Kartli Regional Healthcare

Administration Department

US Partners: Center for International Health

Medical College of Wisconsin, University of

Wisconsin Medical School – Milwaukee Clinical

Campus, Marquette University College of Nursing,

Marquette University School of Dentistry,

City of Milwaukee Health Department, Planning

Council for Health and Human Services,

Sixteenth Street Community Health Center,

Milwaukee County Division of Health Programs

Guria/La Crosse, Wisconsin

Caucasus Partner: Guria Regional Healthcare

Administration Department

US Partners: World Services of La Crosse, Inc.,

Gundersen Lutheran Medical Center, Franciscan

Skemp Mayo Health System, Viterbo University,

University of Wisconsin – La Crosse, Western

Wisconsin Technical College, Health Science

Consortium, City of La Crosse, La Crosse County

Health Department

Mtskheta/Milwaukee, Wisconsin

Caucasus Partner: Mtskheta-Mtianeti Regional

Health Administration

US Partners: Center for International Health

Medical College of Wisconsin, University of

Wisconsin Medical School – Milwaukee Clinical

Campus, Marquette University College of Nursing,

Marquette University School of Dentistry,

City of Milwaukee Health Department, Planning

Council for Health and Human Services,

Sixteenth Street Community Health Center,

Milwaukee County Division of Health Programs

Tbilisi/Atlanta, Georgia

Caucasus Partners: Central Children’s Hospital,

Gudushauri National Medical Center

US Partners: Partners for International Development,

Emory University, Georgia State University,

Georgia Institute of Technology, Grady

Health System, Morehouse College

Tbilisi/Scranton, Pennsylvania

Caucasus Partner: National Health Management

Center

US Partner: University of Scranton

Central Asia

Kazakhstan

Community-Oriented Primary Care:

Social Integration Model

CAR Sites: Family Group Practice No. 9, Family

Group Practice No. 11 (Semipalitinsk); Family

Group Practice No. 21 (Uralsk)

Prevention of Mother-to-Child

Transmission of HIV

CAR Sites: Maternity Hospital No. 1 (Almaty);

Oblast Maternity Hospital (Pavlodar); Maternity

Hospital (Temirtau); Maternity Hospital No. 2

(Karaganda)

Turkmenistan

Capacity Building for Primary Health

Care and Health Management

CAR Sites: Ministry of Health and Medical Industry,

Family Medicine Training Center and

Women’s Health at Health House No. 1, Family

Medicine Training Center at the Research Center

of Physiology, Health Management Training

Center at Turkmen State Medical Institute

Uzbekistan

Tashkent/Lexington, Kentucky

CAR Partners: Tashkent State Medical Institute

No. 1, Tashkent State Medical Institute No. 2

US Partner: University of Kentucky School of

Public Health

26 American International Health Alliance


Regional

Nursing Education and Leadership Development

CAR Partners: Astana Nursing College, Almaty

Nursing College (Kazakhstan); Bishkek Nursing

College, Kyrgyz State Medical Academy Higher

Nursing Education Department (Kyrgyzstan);

Borovsky Nursing College of Tashkent, Republican

Scientific Center for Emergency Medical Services,

Bukhara State Medical Institute Higher Nursing

Education Department (Uzbekistan)

US Partner: University of Minnesota School of

Nursing

Undergraduate Medical Education

CAR Partners: Kazakh State Medical Academy of

Astana, West Kazakhstan Medical Academy of

Aktobe (Kazakhstan); Kyrgyz State Medical

Academy of Bishkek, Medical Department of

Osh State University (Kyrgyzstan); Tajikistan

Medical Institute of Dushanbe (Tajikistan);

Tashkent State Medical Institute No. 1, Tashkent

State Medical Institute No. 2 (Uzbekistan)

US Partner: University of South Florida Health

Sciences Center

Nursing and Breast Health

CAR Sites: Uralsk Nursing Association, Women’s

Wellness Center of Almaty, Seminpalatinsk

Nursing Association, Republican Nursing College

of Almaty (Kazakhstan); Bishkek Nursing

College, Post-Graduate Training Institute (Kyrgyzstan);

Borovsky Nursing College of Tashkent,

Women’s Wellness Center of Tashkent, Tashkent

State Medical Institute No. 1, (Uzbekistan); Tajik

Nursing Association (Tajikistan)

Central & Eastern Europe

Albania

Lezha/Pittsburgh, Pennsylvania

CEE Partner: Lezha Directorate of Primary Health

Care

US Partner: Magee-Womens Hospital of the University

of Pittsburg Medical Center Health System

Tirana/Bucharest, Romania

CEE Partners: Institute of Public Health (Albania);

National Institute for Health Research and

Development (Romania)

Tirana/Providence, Rhode Island

CEE Partner: Maternity Hospital No. 1

US Partners: National Perinatal Information Center,

Women and Infants Hospital of Rhode Island

Croatia

HIV/AIDS Project

CEE Site: Andrija Stampar School of Public Health

Hungary

Gyo″r/Pittsburgh, Pennsylvania

CEE Partner: Gyo″r World Health Organization

Healthy Cities Project

US Partners: Magee-Womens Hospital of the University

of Pittsburg Medical Center Health System,

Family Health Council, University of Pittsburgh

Graduate School of Public Health

Pécs/Harrisburg, Pennsylvania

CEE Partner: Hungarian Association of Healthy Cities

US Partner: Institute for Healthy Communities

Kosovo

Gjakova/Hanover, New Hampshire

CEE Partners: Gjakova Municipality, Gjakova

Family Medicine Centers

US Partner: Dartmouth Medical School

Gjilan/Hanover, New Hampshire

CEE Partners: Gjilan Municipality, Gjilan Main

Family Medicine Center

US Partner: Dartmouth Medical School

Latvia

Riga/Little Rock, Arkansas

CEE Partner: WHO Collaborating Center for

Research and Training in Management of Multidrug-Resistant

Tuberculosis (State Center of

Tuberculosis and Lung Diseases of Latvia)

US Partner: University of Arkansas for Medical

Sciences

Romania

Susan G. Komen Breast Cancer

Foundation/USAID Radiology Project

CEE Sites: Oncological Institute of Cluj, District

University Hospital of Cluj, Oncological Institute

of Bucharest, Fundeni Hospital of

Bucharest, Renestera Foundation

Annual Program Report 2004 27


Russia

Kurgan and Shchuche/Appleton, Wisconsin

Russian Partners: Kurgan Oblast Administration,

Shchuche District Administration, Central District

Hospital of Shchuche, Kurgan City Maternity

Hospital

US Partners: ThedaCare (including Appleton

Medical Center and Theda Clark Hospitals), Fox

Cities-Kurgan Sister Cities, Physicians for Social

Responsibility, Lawrence University, University

of Wisconsin Family Practice Residency Program

and Family Living Program, Chamber of

Commerce, American Red Cross of Appleton

Sakhalin/Houston, Texas

Russian Partners: Sakhalin Oblast Health Department,

Korsakov Central District Hospital,

Sakhalin Department of Healthcare, City Health

Administration of Nogliki-Okha, City Health

Administration of Kholmsk, City Health

Administration of Yuzhno-Sakhalinsk, City

Health Administration of Korsakov

US Partner: Baylor College of Medicine

Sarov/Los Alamos, New Mexico

Russian Partners: Sarov City Duma, Office of the

Mayor, Medical-Sanitary Unit No. 50

US Partners: County of Los Alamos, Los Alamos

Medical Center, Los Alamos National Laboratory,

State of New Mexico Department of Health,

University of New Mexico School of Medicine,

Los Alamos School District

Stavropol and Samara/Des Moines, Iowa

Russian Partners: Samara Oblast Department of

Health, Stavropol Krai Department of Health

US Partners: Iowa Hospital Education and

Research Foundation, Central Iowa Health System,

Iowa Department of Public Health,

Planned Parenthood of Greater Iowa, University

of Osteopathic Medical and Health Sciences,

Iowa Sister States, Iowa Council for International

Understanding, Consortium of Iowa Community

Colleges

Tomsk/Bemidji, Minnesota

Russian Partner: Tomsk Oblast Health

Administration

US Partners: North Country Health Services,

Bemidji State University, Beltrami Area Service

Collaborative, Cass Lake Heath Service Indian

Hospital, Bemidji MeritCare, Beltrami County

Nursing Service, Headwaters Regional Development

Commission, Rural Physician Associate

Program

Volgograd/Little Rock, Arkansas

Russian Partners: Volgograd State Medical University,

Volgograd City Health Department, Volzhskiy

Health Center

US Partners: University of Arkansas for Medical

Sciences, Arkansas Department of Health,

Lowell Medical Center, Area Health Education

Centers – Northeast Family Medicine Center,

Mid-Delta Community Health Center, Arkansas

Academy of Family Physicians

Orenburg/New York, New York

Russian Partner: Orenburg Oblast AIDS Center

US Partners: Elmhurst Hospital Center, Mount

Sinai School of Medicine, New York City Department

of Health’s HIV Surveillance Unit, AIDS

Institute – AIDS Center of Queens County

Samara/Providence, Rhode Island

Russian Partners: Samara Oblast Ministry of

Health, Togliatti City Health Department, Samara

Oblast AIDS Center, Togliatti City AIDS Center

US Partners: National Perinatal Information Center,

Care New England Health System, Stanley

Street Treatment and Resources, Lifespan,

Rhode Island Department of Health

Saratov/Bemidji, Minnesota

Russian Partners: Saratov Oblast AIDS Center,

Engels City Health Department

US Partners: Northern Rivers HIV/AIDS Consortium

(North Country Health Services, Bemidji

State University, Minnesota Department of

Health’s Section for STDs and HIV, Beltrami

Area Service Collaborative, Indian Health Service,

Rural AIDS Action Network, New York

City’s Metropolitan Hospital)

28 American International Health Alliance


St. Petersburg/New Haven, Connecticut

Russian Partners: St. Petersburg City AIDS Control

Center, St. Petersburg Health Committee,

Botkin Clinical Hospital

US Partners: Yale University School of Medicine,

Yale University School of Nursing, Yale Center

for Interdisciplinary Research on AIDS, Yale

AIDS Care Program, Yale-New Haven Hospital,

Nathan Smith Clinic, Connecticut Department

of Public Health, Hispanos Unidos

Moscow Oblast – Dubna/La Crosse, Wisconsin

Russian Partners: Moscow Oblast Health Administration,

Dubna City Health Administration

US Partners: World Services of LaCrosse, Gundersen

Lutheran Medical Center, Franciscan

Healthcare System, Sister Cities

WEST NIS

Moldova

Comprehensive TB Control Project

WNIS Partners: Ministry of Health, Ministry of

Justice; State Medical and Pharmaceutical

University “Nicolae Testemitanu”

Lativian Partner: State Center of Tuberculosis and

Lung Diseases

US Partner: University of Arkansas for Medical Sciences

Ukraine

Donetsk/Pittsburgh, Pennsylvania

WNIS Partners: Donetsk Oblast Health Administration,

Polyclinic No. 1, City Hospital No. 25,

Kramatorsk Central City Hospital

US Partners: Magee Womancare International,

Allegheny County Health Department, United

Mine Workers of America, University of

Pittsburgh Graduate School of Public Health,

University of Pittsburgh Medical Center

Department of Family Medicine and Clinical

Epidemiology

Kharkiv/La Crosse, Wisconsin

WNIS Partners: Kharkiv Oblast Health Administration,

Kharkiv Student Polyclinic, Chuguev

Rayon Hospital

US Partners: World Services of LaCrosse, Gundersen

Lutheran Medical Center, Mayo Health System

– Franciscan Skemp Healthcare, University

of Wisconsin – La Crosse, Western Wisconsin

Technical College, Viterbo University

Kiev/Philadelphia, Pennsylvania

WNIS Partners: Kiev City Health Administration,

Darnitsky District Central Polyclinic, Darnitsky

District Family Medicine Center, Kiev Postgraduate

Medical Academy

US Partners: Temple University, Widener University,

Crozer-Keystone Health System, Health Federation

of Philadelphia

L’viv/Cleveland, Ohio

WNIS Partners: L’viv Oblast Health Administration,

L’viv City Polyclinic No. 5, Zhovkva

Rayon Hospital

US Partners: Cleveland International Program

Federation for Community Planning, Cuyahoga

County Board of Health, Case Western Reserve

University, Cleveland State University, Cleveland

Clinic Foundation, Ohio Department of Health,

Center for Health Affairs, Fairview Center for

Family Medicine, Cuyahoga County Board of

Mental Health, Heartland Behavioral Health,

Ohio Department of Mental Health, Case Western

Reserve University School of Nursing, Free

Clinic of Cleveland

Odessa/Boulder, Colorado

WNIS Partners: Odessa State Medical University,

Odessa Seaport Occupational Polyclinic,

Odessa City Council, Odessa Oblast Health

Administration

US Partners: Boulder Community Hospital, University

of Colorado School of Medicine, Boulder

County Health Department, Beacon Clinic,

Boulder County Healthy Communities Initiative

Uzhgorod/Corvallis, Oregon

WNIS Partners: Zakarpatska Oblast Hospital,

Central Velykoberesnyanska Rayon Hospital,

Zakarpatska Oblast Health Administration

US Partners: Corvallis Sister Cities Association,

Oregon Health Sciences University, Corvallis

Family Medicine, Western Oregon University,

Benton County Health Department, Good

Samaritan Hospital, Corvallis Clinic, Oregon

State University, Benton County Community

Outreach

Annual Program Report 2004 29


THE YEAR

IN NUMBERS

52 = Active partnerships and projects

27 = Partnerships that graduated

7 = New partnerships established

17 = Countries where AIHA had partnerships and projects

28 = US cities involved in AIHA partnerships

188 = US partner volunteers who traveled on overseas exchanges

345 = Person exchange trips

46 = Training manuals/materials developed and/or translated

27+ = Model primary healthcare centers opened and operational

through AIHA partnerships

32 = Active Women’s Wellness Centers

17 = Active Neonatal Resuscitation Training Centers

$16.2 million = Overall 2004 budget

$8.4+ million = Value of in-kind contributions by US partners in 2004

$184+ million = Overall budget since 1992

$234+ million = Value of in-kind contributions by US partners since 1992

Annual Program Report 2004 31


PARTNER PROFILES

Ramize Ibrahimi has been a nurse at Gjilan

Health House in Kosovo for many years and has

participated in health development activities sponsored

by a variety of international organizations,

including the World Health Organization. Despite

her participation in numerous training courses,

workshops, and conferences offered by these

organizations, she lacked the self-confidence to

openly express her opinions – especially in front of

the physicians and other medical professionals she

interacted with. “I just always felt like I was in a

lower position than those I was with,” Ramize says,

explaining that in Kosovo nurses have traditionally

been viewed as subordinate to the will and dictates

of physicians, not as equal partners in the provision

of medical care.

When AIHA’s Gjilan/Hanover (New Hampshire)

partnership was established in October 2001,

Ramize was asked to lead several working groups

tasked with health education programs, clinical

practice guidelines for nurses, and community

education and outreach. Drawing on the expertise

and support of her partners at Dartmouth Medical

School, Ramize conducted training courses for

nurses working in family medicine clinics

throughout Gjilan and its environs. She also spearheaded

efforts to develop community education

materials on hypertension, conducted outreach

and awareness activities throughout the community,

and even spoke out about the subject on local

radio programs urging listeners to pay heed to the

early warning signs of high blood pressure and ask

their healthcare provider about screening tests.

Ramize credits her participation in the partnership

not only with giving her important new skills as a

nurse and a health educator, but also with giving

her confidence in her own abilities and the

courage to voice her opinions. “By the time our

partnership entered its second year, I had developed

enough courage and self-confidence to freely

express my opinions and share my ideas during

training courses and other meetings,” she says. “I

am no longer scared to speak out, to voice my

opinions.”

Primary care nurse Ramize Ibrahimi gained knowledge, practical

skills and self-confidence from her involvement in AHIA’s

Gijilan/Hanover partnership.

Although the partnership with Dartmouth ended

in 2003, Ramize has continued her work as the

head nurse for patient education at Gjilan Health

House. Empowered by her newfound self-assurance,

she is now applying her considerable talents

and the knowledge she gained through her partnership

experience to the task of providing better

health education to the people of Gjilan. In addition

to developing an annual plan for communitybased

diabetes education, Ramize has been invited

by the Ministry of Health, the Association for

Health Education and Promotion, and the

Institute of Public Health to serve on a number of

national advisory groups addressing topics ranging

from reproductive health and family medicine

to health promotion activities throughout Kosovo.

Perhaps most importantly, she now serves as a

strong voice representing all Kosovar nurses striving

to enhance the role they play in providing quality

clinical and patient education services to the people

in their communities.

Photo: Violeta Shala

32 American International Health Alliance


PARTNER PROFILES

Dr. Steve Rith-Najarian has been practicing

family medicine in and around Bemidji,

Minnesota, since 1986 when he became a commissioned

officer in the US Public Health Service’s

Indian Health Service and was assigned to provide

care to Native Americans living on the Red Lake

Reservation. In addition to primary care and epidemiology,

some of his professional interests

include the prevention and management of diabetes,

hypertension and other chronic ailments.

“Just as patients with chronic illness have to examine

their lifestyle choices, we have to examine

choices we make in the organization of our clinical

practice,” he says, explaining that

this connection is one that all too

clearly underscores the close relationship

between continuous

quality improvement and effective

public health programs.

A keen interest in this link played

an important role in Steve’s decision

to participate in a primary

healthcare partnership that AIHA

established between a coalition of

health-related institutions in

Bemidji and the Russian city of

Tomsk in 2000 and a subsequent

alliance formed in 2004 between

the northern Minnesota town

and Saratov, Russia, to address

the latter community’s growing

HIV/AIDS epidemic.

From the beginning, both partnerships – like all

twinning alliances AIHA creates – focused on peerto-peer

exchanges of knowledge, information and

hands-on practical skills. One thing that became

apparent early on was that the American and Russian

healthcare providers shared the common goal of

providing the best possible care for their patients.

Family practitioner Steve Rith-Najarian

says he learned as much from his Russian

partners as they have learned from him.

“Our partners are eager to embrace the public

health model and adopt the principles of continuous

quality improvement to make positive changes

within their own community’s health systems,”

Steve says, noting that it is an inspiration to work

together with his Russian counterparts to develop

and implement exciting new programs and services.

“It’s important to point out that I’ve learned as

much or more through my affiliation with these

partnerships as I’ve shared, and this makes my

job at home a lot easier,” he continues. “At the

end of each exchange, I feel a sense of professional

growth and personal enrichment that

make the commitment of time and energy well

worth the effort.”

Photo: Courtesy of Steve Rith-Najarian

For Steve and the other US healthcare

providers and allied professionals

involved with the partnerships,

their work not only broadens their

horizons by introducing them to

other people, cultures and different

ways of doing things, it also

strengthens their sense of community

at home. “We’ve all learned

many valuable lessons from our

partnership experience, not the least

of which is to be more open and

flexible. Our shared experience has

opened the door to collaboration

among people and organizations

here that previously had no connection

just as it has enhanced existing

relationships,” he says.

On an international level, the partnerships

go a long way toward improving understanding

and goodwill on both sides, he explains,

concluding, “America has historically had a tendency

to be relatively ethnocentric, which can create

wide cultural barriers. Partnerships break

down these barriers allowing us to get past our

real or perceived differences and make lasting

connections based on our commonalities and

shared goals of making real improvements in

patient care.”

Annual Program Report 2004 33


FUNDERS AND

STRATEGIC PARTNERS

Funders

United States Agency for International Development (USAID)

US Department of Health and Human Services/Health Resources and

Services Administration (HHS/HRSA)

US Library of Congress/Open World Learning Center

Susan G. Komen Breast Cancer Foundation

World Health Organization (WHO)

The Global Fund to Fight AIDS, Tuberculosis and Malaria

Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ)

Strategic Partners

Abt Associates

AIDS Foundation East-West (AFEW)

AIDS Healthcare Foundation - Global Immunity (AHF-GI)

American College of Radiology

American Nurses Association (ANA)

Association for Professionals in Infection Control and Epidemiology

Association of Academic Health Centers (AHC)

Association of American Medical Colleges (AAMC)

Association of Nurses in AIDS Care (ANAC)

Annual Program Report 2004 35


Association of University Programs in Health

Administration (AUPHA)

Beth Israel Deaconess Medical Center/Division of

International Disaster and Emergency Medicine

Carelift International

Columbia University School of Social Work

Connect plus e.V. - Competence Transfer for

AIDS Prevention and Self-help

Deutsche Gesellschaft für Technische Zusammenarbeit

(GTZ)

Development Gateway

François-Xavier Bagnoud (FXB) Center at the University

of Medicine and Dentistry of New Jersey

Futures Group

International Association of Physicians in AIDS

Care (IAPAC)

International Training and Education Center on

HIV (I-TECH)

Liaison Committee on Medical Education (LCME)

March of Dimes

Médecins sans Frontières (Holland)/Ukraine

Medical Advocates for Social Justice (MASJ)

Medical Center of St. Petersburg

New York State Department of Health/AIDS

Institute

Open Society Institute (OSI) - International

Palliative Care Initiative

Sisters Together and Reaching (STAR),

Baltimore, MD

Southern Ukraine AIDS Education Center

(SUAEC)

UNAIDS

UNICEF

University of Nebraska Medical Center

School of Nursing

University Research Corp. (URC)

US Centers for Disease Control and Prevention

(CDC)

Volunteer Services Overseas (VSO)

36 American International Health Alliance


BOARD OF DIRECTORS

AND STAFF

Board of Directors

Donald W. Fisher, PhD (Chairman)

President and Chief Executive Officer

American Medical Group Association

Roger J. Bulger, MD (Secretary)

President

Association of Academic Health Centers

Sheila A. Ryan, PhD, RN, FAAN (Treasurer)

Professor; Charlotte Peck Lienemann and Alumni Distinguished Chair

Director, International Nursing Education Programs

University of Nebraska Medical Center

College of Nursing

Dennis P. Andrulis, PhD, MPH

Associate Dean for Research and Director

Center for Health Equality

Drexel University School of Public Health

Daniel P. Bourque, MBA (past Chairman of the Board)

Group Senior Vice President, System Operations

VHA Inc.

Henry A. Fernandez, Esq

Attorney at Law

Larry S. Gage, Esq (past Chairman of the Board)

President

National Association of Public Hospitals and Health Systems

Partner, Powell Goldstein, LLP

Louis W. Sullivan, MD

President Emeritus

Morehouse School of Medicine

Alan Weinstein, MBA

Healthcare Consultant

Annual Program Report 2004 37


AIHA Staff

Headquarters

Washington, DC

James P. Smith

Barbara Brocker

Donna Anderson

Sara Barnes

Timur Bazikov

Alesha Breedlove

Jason Brown

Matthew Burton

John Capati

Irina Carnevale

Eun-Joo Chang

Evangeline Crawford

Richard Custer

Keisha Dennis

Laura Faulconer

Emily Fedullo

Chase Gray

Frances Greene

Cheryl Halcrow

Teresita Herradura

Irina Ibraghimova

Zandra Isaac

Inna Jurkevich

Irina Kapitonova

Emily Korff

Maureen Lomo

Susan Luck

Muna Massaquoi

Sinem Mustafa

Hau Nguyen

Margo Nowakowski

Keith Pearson

Ntfombi Penner

Susan Pobywajlo

Melissa Rawlings

Anjuli Saharia

Amy Sanborn

Kate Schecter

Natasha Schweiger

Zoya Shabarova

Executive Director

Associate Executive

Director/CFO

Victor Stanilevskiy

Delia Stirling

Mark Storey

Ramesh Suri (Omega World Travel)

Kathryn Utan

Ngoc Vu

James Willis

Gosia Wolfe

Sara Wright

Jack Yau

Carole Zimmerman

Field Offices

Caucasus

Nata Avaliani Regional Director

Marika Abesadze

Gia Chigoyev

Anatoly Daniyarov

Julietta Eminova

Elena Godziashvili

Lela Kvachantiradze

Aleko Makharashvili

Jeyhoun Mamedov

Lali Mchedlishvili

Mehdi Mehdiyev

Nika Menteshashvili

Zaza Varsimashvili

Central Asia

Zhamilya Nugmanova

Gulnar Akhmetova

Bauyrzhan Amirov

Maya Annaberdiyeva

Kairat Davletov

Kair Doldin

Pavel Gulyaev

Assel Terlikbayeva

Viktoria Volgina

Saltanat Yageubaeva

Zhaniya Zhaikbaeva

Regional Director

38 American International Health Alliance


Central and Eastern Europe

Violeta Shala

Dusko Jagodic

Moldova

Viorel Soltan Project Director

Valeriu Crudu

Tatiana Dumbrava

Sergiu Gherman

Andrei Pruteanu

Slava Rodideal

Irina Zatusevski

Russia

Arsen Kubataev Regional Director

Marina Ayvazyan

Stela Bivol

Leonid Baichitsman

Ludmila Bogdanova

Ekaterina Dyakonova

Nancy Frazier

Yuri Gavryushin

Sergie Lavrushin

Ksenia Nykolaeva

Oksana Pinchuk

Elena Pokrovskaya

Sergie Popovski

Polina Safronova

Irina Shumilova

Ukraine

Maria Bodnar

Olena Dolotova

Vira Illiash

Olga Kostyuk

Grigoriy Naumovets

Natalia Nizova

Andriy Styopkin

Svetlana Sviridenko

Grigoriy Tyapkin

Photo: Frances Greene

Washington, DC Staff

Annual Program Report 2004 39

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