Background, Principles and Aims

IHPBA, AHPBA, A-PHPBA and E-AHPBA International Outreach Programme

Introduction

The initial phases in the progression of health care in developing and developed countries involved the creation of effective public health programmes and basic health care. Once these programmes have been established, the natural progression of development will lead to a focus on delivery of more complex medical and surgical care. In many developed and developing nations care of HPB diseases often lags behind other areas of surgery and medicine.

The development of HPB programmes in developing countries requires a multi-faceted approach to the identification and training of capable surgeons interested in the treatment of HPB diseases. In addition, it requires the establishment of effective and capable multidisciplinary teams that incorporate the specialties of nursing, radiology, interventional radiology and critical care that are required for the care of patients’ hepatobiliary and pancreatic diseases. Finally, institutional resources must be improved to provide the necessary physical and technologic resources to support such programmes.

International Outreach Programmes

IHPBA and AHPBA have developed significant experience in the provision of outreach support to developing and developed countries. These programmes require the commitment of not only the associations, but also dedicated surgeons and multidisciplinary team members that are committed to multi-year projects that care for HPB patients and develop the capacity of local health care programmes to care for increasingly complex HPB diseases.

In this section you will find information about:-

  1. Team composition
  2. Overall Objectives
  3. Outreach Phases - Specific Objectives
  4. Anticipated impact of IHPBA/AHPBA Outreach Programmes

 

1.  Team composition

Outreach teams are comprised of committed individuals from a variety of complementary disciplines that are required to care for HPB patients. The composition of teams should reflect the capacities and needs of an individual country and may evolve as programmes progress. Experienced and internationally renowned HPB surgeons form the core of the outreach team.

These surgeons become mentors and teachers for the local HPB surgeons. A longitudinal commitment of team surgeons allows the establishment of rapport and an educational relationship that can occur over multiple outreach trips and continue between trips. As a result, these programmes lead to the formation of long-term relationships between emerging and established surgeons and programmes.

Skilled anaesthetic care is essential to the safety of HPB surgery. As a result, the inclusion of experienced HPB anaesthesiologists in outreach teams is crucial to the safety of procedures performed on outreach missions as well as the training of local anaesthesia personnel.

Other specialties such as critical care, radiology, hepatology and gastroenterology may be included in teams based on the needs of the project. Operating room nurses, allied health and advanced care practitioners (physician-assistants and nurse practitioners) can all be incorporated into teams to support outreach activities and train local health care personnel.

 

2.  Overall Objectives

The goals of individual outreach projects may differ and evolve according to the needs and resources of each region. The overall objectives of the programme can be summarised as follows:

  1. To promote the care of common liver, pancreatic, biliary and gastrointestinal disorders through improvements in surgical and medical care of these diseases
  2. To identify, train and support local surgeons and physicians who are dedicated to the care of HPB disease.
  3. To assist in building health care resources in the identified region to support the care of HPB diseases and complex surgical care
  4. To promote the development of health care resources to the management of HPB diseases with domestic and international public health, government and non-government agencies.
  5. Funding

 

3.  Outreach Phases - Specific Objectives

Each outreach project will address the project objectives through sequential phases of work which will progress and vary by the needs and resources of each project region.

Phase 1- Environmental and capacity assessment

The initial phase of outreach activity will be conducted by a small team to identify the following:

  • The high incidence and prevalence of liver, pancreatic and biliary health issues in the region.
  • To identify medical personnel and facilities currently providing care for HPB disease.
  • To assess the current resources and capacity of the regional health programme and local institutions providing care of HPB and complex surgical diseases
  • To identify key individuals providing surgical care of HPB disease and/or key surgeons with the interest and capacity to develop a HPB surgical programme.

 Phase 2- Early development of local HPB programmes and expertise

  • Outreach personnel will develop mentoring and partnership relationships with local surgeons and physicians identified in phase 1 as key personnel in the development of a local HPB surgical programme.
  • Outreach personnel will provide hands-on educational opportunities by participating in clinic and surgical procedures with local personnel. This will provide practical training and sharing of evidence-based best practices with local surgeons and health care providers.
  • Outreach personnel will engage key local government and non-government stakeholders to promote the development of multidisciplinary HPB teams and health care centres.
  • Local technology and resources will be augmented through industry and philanthropic support.
  • Outreach personnel will provide local and long-distance didactic and practical teaching opportunities to build the knowledge and skills of local personnel. Opportunities for international education, e-learning and telementoring will be key components of this objective.
  • Teams will provide pre- and post- visit support thought pre-operative assessments, post-operative care assistance, and multi-disciplinary case-based clinical decision-making will be provided using telemedicine technology.

 Phase 3- Late capacity development and ongoing support

  • With the establishment of HPB programmes in Phase 3, outreach teams will provide continued support to enhance the capacity and skills to programmes to provide increasingly complex surgical care of HPB diseases. The complexity of diseases and surgical care should increase in-step with the abilities of the local programme.
  • Surgical care will evolve from outreach team demonstrating procedures, to the support and assistance of local surgeons as they perform increasingly difficult HPB operations.
  • Outreach personnel will focus on maintenance and sustainability of local HPB programmes as well as identification of local trainees for international training support.
  • By leveraging the established mentorship relationships, the outreach teams will establish long-term continuing medical education objectives that will include teleconferencing, education partnerships for trainees, international conferences as well as leverage the resources of the sponsoring associations (IHPBA and AHPBA) to access travel and educational grants.

 

4.  Anticipated impact of IHPBA/AHPBA Outreach Programmes

The longitudinal investment of the Outreach programmes will be realised over several years and will result in the establishment and training of surgeons and medical teams dedicated to the surgical management of complex liver, pancreatic and biliary diseases. This progress will include the improvement in local health resources and capacity to provide complex surgical care; and establish long-term educational, training and mentoring relationships to ensure sustainable programmes for current and future surgeons.

Local improvement in HPB care may have extensive secondary effects in other medical and surgical disciplines as capacity, technology and resources improve in the local health environment. Ultimately, these efforts will enhance the health and welfare of individuals suffering from hepatobiliary diseases in developing nations.

 

5.  Funding

IHPBA cannot provide funding for Outreach Projects. However we can apply to the World Health Organisation for permission for you to use the WHO logo on your project literature.

 

If you would like to contact us about an Outreach Project please email outreach@ihpba.org

If you would like to submit a project for the Outreach Registry, please click here for a form to complete and return.