THE CHELYABINSK-MCGILL PARTNERSHIP IN

POPULATION CHILD HEALTH

EXECUTIVE SUMMARY

June 1999 to May 2003

The continued development and promotion of human rights, democracy, and good governance in Russia will be directly reflected by in Nation's state of health, in particular that of its children. Child health is not only an internationally acknowledged right, it is an important indicator of a Nation's progress and the success of its social policies and programs. This proposed partnership will focus on the health of children within one of Russia's more isolated regions, Chelyabinsk. This region is well known for its heavy metal industries, as well as being the site of the former Soviet Union's nuclear armament development. As a result of these combined exposures, much of the Chelyabinsk region and its population of 3 million are living in what has been termed and "environmental disaster zone.

As with other regions in Russia, Chelyabinsk in undergoing rapid change as a result of the transition to a market economy, privatization, and the devolution of authority in public sectors. This reforms, while holding tremendous potential for future generations, gas led to economic instability and a painful destabilization of social and health services. As a consequence of this destabilization, the health of the Russian population has experienced significant declines throughout the 1990s.

It is at the regional and district levels of the health system and related sectors that solution and a reversal in the current downward trend of the Nation's health will need to occur. While many well trained health practitioners are found within the regions, and important area of weakness within the health sector has been identified by local leaders which addresses the skills and related technologies required to systematically carry our population-based problem solving; and area in which Canadians have a worldwide reputation for expertise.

The Chelyabinsk-McGill partnership in population child health proposes to create a partnership among several health service and training the Chelyabinsk Region, in collaboration with McGill University, in a population health problem-solving exercise which specifically deal with childhood asthma. Childhood asthma is one of the leading causes of pediatric morbidity and hospitalization in the Region. Asthma has therefore been designated a high priority health problem in the region, for which local health authorities have specifically requested McGill's assistance. This represents and excellent match between training and service needs, since it is through direct application to a concrete public health problem that problem-solving and epidemiologic skills can most effectively be taught and subsequently generalized to other priority health problems.

The four collaborating Chelyabinsk institutions are: 1) the Chelyabinsk Regional Asthma Centre-Hospital #1 (where the Project will be directed and field office established), 2) the Ural State Academy for Advanced Medical Education (responsible for licensing and continuing education for all health disciplines), 3) the Chelyabinsk State Medical Academy (the regional medical School), and 4) the Chelyabinsk City and Health Administrations (responsible for all public services). In addition the project will be working in close collaboration with another NGO, the Chelyabinsk-Hanford Movement. For the past 5 years this NGO, through the funding and voluntary efforts of several pediatric groups in the United States, has carried out continuing medical education programs in Chelyabinsk and in Tacoma, Washington.

The proposed project will provide hand-on experience in and integrated approach to population-based problem-solving. This will include, 1) meaningful and effective community participation, 2) public health expertise in health promotion and prevention, and 3) evidenced-based clinical treatment programs which extent from the hospitals in children's homes. Three performance-based components have been developed to support this integrated approach; 1) training in population health sciences, community development,, public health, and evidence-based clinical decision making, 2) the conduct of a problem-solving exercise directed at childhood asthma, and 3) support for health policy and systems reform that will positively impact on child health.

We are requesting From CIDA $1,388,946 over 4 years. Over that same inter McGill University and the four Chelyabinsk partner institutions will contribute and additional $368,390 and $580,440, respectively. At the conclusion of the project it is expected the following will have been achieved;

1. Asthmatic children will suffer fewer and less intense asthmatic attacks. As well, hospitalization rates and lengths of stay will be reduced by 50%.

2. The parents and other household contacts of asthmatic children will have made positive changes in health related behaviors which lessen exposure to known indoor allergens.

3. The foundations for a Southern Ural Regional degree program in population health sciences will have been established.

4. Russian language training manuals in hard copy and electronic versions will have been produced for 8 certificate-level courses and 12 workshops addressing subjects relevant to problem-solving, community development, and health systems reform.

5. A local, community-based organization in support of child health and the rights of chidren will have been created and carry on a sustained presence within Chelyabinsk.

6. Strengthened civic coalitions in support of children's health will have been established and this strategy replicated to support other priorities.

7. "Health" health systems and policy reform will have been initiated at municipal and regional levels.

8. The Project partners will have participated in a cooperative, democratic, and transparent project which should lead to on-going partnerships in health and other human needs sectors. It is expected that this experience will be built upon in order to maintain longer term commitments.