[Previous Article] [Next Article] [Português] [Español]

A New Initiative in Health Professional Education in Londrina, Brazil: PROUNI-LD Project

Luiza Nakama Coordinator of PROUNI-LD Oral Health Work Group and Pediatric Dentistry Professor / UEL BR> Marta Tereza N. dos Santos Silva Coordinator of PROUNI-LD Oral Health Work Group and Dental Surgeon of Londrina Municipal Assistance Network

Introduction

Londrina is the third largest city in the south of Brazil, with a population of approximately 350,000 inhabitants. It is located in the northern part of the state of Parana (figure). Londrina is the home of Londrina State University (UEL), which is supported by the state government, and a private university.

UEL participates in the UNI Program through the Health Sciences Center, which embodies the Schools of Medicine, Dentistry, Nursing, Physical Therapy and Pharmacy.

The dental program was created in 1962. The dental curriculum consists of a ten-semester (5 year) course. Currently, student enrollment numbers about 250 with 40 additional students arriving each year.

The basic sciences are taught on the main campus of the university and the professional disciplines are offered in the clinics, which are located downtown, isolated from all other instructional areas.

At inception in August 1991, the dental component was integrated with PROUNILD through the departments of Pediatric Dentistry and Semiology. It was hoped that this project would trigger a process for much-needed improvement in the dental curriculum. Indeed, as the project evolved, other dental disciplines joined, fostering ideas for professional integration in a single course of study.

Project Operation Area

Londrina's south region consists of fourteen neighborhoods/tenements ("barrios") and seven rural districts. Of the total population of approximately 94,000 inhabitants, some 29,000 live in rural areas.

The region's socioeconomic profile is characterized by relatively low income and educational levels and is similar to other surrounding areas. In addition, the area contains a migrant settlement (Jardim Uniao da Vitoria), which has neither urban infrastructure nor social services.

There are two general hospitals in the area, one in the city and the other in the rural area, with 26 and 24 beds, respectively. There are 19 health posts, 5 urban and 14 rural. Though located away from the geographical area of the south SILOS, there are three tertiary care units taking part in the project: the North Parana Regional University Hospital (280 beds), the Dental Clinic (135 chairs) and the Specialties Regional Center.

In December, 1991, local residents' associations carried out the South Region Health Conference, defining their health priorities and organizing a health council (CONSUL).

South region structure: dentistry

Number of chairs

· Paiquere district: 3 chairs

· Gauaravera district: 1 chair

· Urban zone: 4 clinics with 2 chairs (health centers); 1 clinic with 2 chairs (community center)

· Rural zone: 2 clinics with 3 chairs;

1 clinic with 2 chairs

Working hours

· Rural zone: 1 six hour shift

· Urban Zone: 2 four hour shifts; 1 clinic with 3 four hour shifts

· Health center: 2 four hour shifts;

1 six-hour shift

Human resources

· Dentists:

rural zone: 3; urban zone: 14

· Dental hygienists:

rural zone: 5; urban zone: 4

· Dental assistants:

rural zone: 8; urban zone: 23

PROUNI-LD Objectives and Activities

Final Objectives

1. To contribute to the formulation of new academic and SILOS model typologies, establishing relationships with other UNI Projects;

2. To support the implementation of the SUSSOLE Health System in Londrina city, through the accumulation of experiences of a new health care model, thereby contributing to the Brazilian Sanitary Reform process;

3. To contribute to an increased coverage of services for the population and associated improvements in the quality of care.

General Objectives

1. To support the organization and implementation of a new academic model for graduate courses at UEL's Health Department;

2. To elaborate and implement a new care model in the south region of Londrina (South SILOS).

These objectives are translated into nine interdependent sub-projects. Four sub-projects comply with the new academic model recommended to CCS/UEL:

1. Support for curricular development: activities that enable curricular revisions (increased coordination between basic and clinical sciences; more time for extramural activities oriented toward problem solving; student meetings beyond completion of the courses; support for research);

2. Development of extramural activities: resources for interdisciplinary, multi-professional projects that work directly in the south region, complying with UNI guidelines;

3. CCS/UEL organizational development: support for the organization of the Curriculum Development Permanent Committee (CPDC); creation of the Pedagogical Support Nucleus (NAP); enlargement of library and lab patrimony; support for CCS transportation and general services structure; a study about CCS re-departmentalization; creation of the position of associate professor; organization of the PROUNI Executive Secretary;

4. Continuing Education Program: training, updating and improving human resources, introducing interdisciplinary, multi professional practice in health activities.

The three sub-projects that comply with SILOS operation are:

1. New institutional practices at South SILOS: planned activities for management and administrative development in health centers; implementation of diagnostic support and infrastructure activities that facilitate the adaptations in health services for teaching purposes;

2. New professional practices in South SILOS: development of a new care model, directing integrated and comprehensive health care to families, groups and communities. Aside from a coordinator, this sub-project employs twenty individuals, distributed among network professionals and teachers from various CCS/UEL courses. Herein lie the most significant activities of the oral health work group;

3. New social activities in South SILOS: support to health services directors, integration of technical and non-technical popular knowledge, and humanization of care.

The sub projects which aim to support community participation are:

1. Community action in health: leadership training; increased public awareness of sanitation; promotion of self-care health practices;

2. Social control in health: training of community organizations to take part in the management of services and local health systems (SILOS).

Dental Activities Planned in PROUNI-LD

The oral health issue has to be considered in the context of general health as a whole. Consequently, dentistry is concerned with putting into practice concepts such as interdisciplinary, multiprofessional teamwork. The same applies to the integration of teaching and health services, not only from a continuing education standpoint, but also in the development of cooperative arrangements between students and teachers on the one hand with public health professionals on the other. Obviously, multiple barriers exist in terms of differing objectives, contexts and timing. The challenge is find common ground so as to not lose sight of the outcome model which will ensure benefits for all.

The activities related to dentistry will concentrate on the following, in order of priority: care for infants (036 months old), guidelines for early care (beginning of the first year of life), self care (co-participation of parents and professionals), caries risk assessments (considering social, cultural factors), and multi-professionalism.

Accordingly, a training course in Dentistry for Infants was held July 59, 1993 for all dentists of the municipal public network, especially those in the South region.

This priority is based on the success of an early treatment program initiated at the UEL Baby Clinic, a pioneer in this type of care in Brazil. Children treated in the first year of life have remained 96% caries-free, yielding tremendous cost savings and a significant positive impact on the population's oral health.

Curative care will also be evaluated by age and risk group (with schoolchildren and pregnant women being favored), although emphasis on education and prevention will remain a top priority in any given group.

Conclusion

The UNI Project is a new step in the process of developing a model for the training of health professionals in the community. As the PROUNILD concept and the Project itself continue to evolve, so do the perspectives and experiences of its constituent parts.

At its core lies the need to embrace new visions and attitudes, all of which requires time and patience. Fundamentally, changes must occur in the hearts and minds of university faculty, health service staffs, and representatives of the communities acting on behalf of the citizenry.


[CEDROS Home Page] [Previous Article] [Next Article] [List of Articles]

CEDROS


Copyright 1995 CEDROS Network. All Rights Reserved.