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Health Care – Alliances [2]
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Health Care – Alliances [2]
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Records of the First Lady's Office (Clinton Administration)
Melanne Verveer's Subject Files
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Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
SUBJECT/TITLE
DATE
RESTRICTION
AND TYPE
001. memo
Celinda Lake to Womens' Leaders (5 pages)
03/13/1995
Personal Misfile
COLLECTION:
Clinton Presidential Records
First Lady's Office
Melanne Verveer
OA/Box Number: 6202
FOLDER TITLE:
Health Care - Alliances [2]
2013-0534-S
rc1571
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
P1 National Security Classified Information [(a)(1) of the PRA]
b(1) National security classified information [(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute [(a)(3) of the PRA]
an agency [(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute [(b)(3) of the FOIA]
financial information [(a)(4) of the PRA]
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA]
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions [(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells [(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
AIHA
PARTNERS IN HEALTH
AMERICAN INTERNATIONAL HEALTH ALLIANCE
Not for Profit
Founded May 1992
Created by Coalition of Hospital Related
Organizations
Industry Focal Point For International
Development Assistance
AIHA FOUNDING ORGANIZATIONS
American Group Practice Association
American Hospital Association
Association of Academic Health Centers
Association of University Programs in Health
Administration
National Association of Public Hospitals
National Public Health and Hospitals Institute
Premier Health Alliance
Voluntary Hospitals of America
AIHA PRIORITIES IN THE NIS
Close Health Care Knowledge Gap
Improve Efficiency and Productivity of Providers
Train Administrators and Health Policy Makers
Recognize NIS Competence and Structure
Respond to Local and Regional Needs
Support Health Care Reform Objectives
AIHA PARTNERSHIP MODEL
Broad-Based Institution to Institution &
People to People Relationships
Breadth and Diversity of Institutional Participation
Involvement of "Hands-On" Practitioners
Emphasis on Professional Exchanges with Mutual
Gain
Recipient Investment and "Ownership"
A Non-Prescriptive but Rigorous Approach
Dissemination of Success
Voluntary Commitment and High Leverage of US
Government Funds
Community Involvement
A Platform for Other Assistance Efforts
Program Sustainability
Synthesis of Partnership Experience
Education
AIHA's ROLE
Partnership Development and Support
Supplemental Activities
Cooperative Efforts
AIHA's ROLE
(continued)
Partnership Development and Support
Identification
Logistical Support
Resource Coordination
Monitoring and Evaluation
Dissemination
Synthesis
AIHA's ROLE
(continued)
Supplemental Activities
Ministerial and Health System
Coordination
Partnership Conferences
Management Development Program
Health Policy Development Program
Communications/Clearinghouse
AIHA's ROLE
(continued)
Synthesis Programs
Emergency Medical Services
Neonatal Resuscitation
Infection Control
Nursing
AIHA's ROLE
(continued)
Cooperative Efforts
USAID and other US Governmental
U.S. Private Voluntary and Non-Governmental
U.S. Medical and Health Products Industries
International Multilateral Organizations
Bilateral Relations
American International Health Alliance
Key Program Indicators
From June 17, 1992 through October 1, 1994
21 NIS Medical Partnerships
U.S. Participants: 48 Hospitals/Health Systems
21 Medical Schools
19 Cities
16 States
NIS Participants:
43 Hospitals/Health Systems
12 Medical Institutes
17 Cities
10 Republics
Key Program Indicators
(continued)
3 CEE Medical Partnerships
US Participants:
5 Hospitals/Health Systems
3 Medical Schools
3 Cities
2 States
NIS Participants:
12 Hospitals/Health Systems
1 Medical Schools
3 Cities
3 Republics
AIHA Partnership
Exchange Days
16,000
14,000
12,000
10,000
NIS
8,000
TOTAL
6,000
4,000
2,000
0
'1993
'1994
Key Program Indicators
(continued)
Total Number of Trips:
405
Number of Person Days in the U.S.:
16,060
in the NIS:
12,371
Total Number of US Participants:
880
NIS Participants:
805
Total Number of Exchange Days:
28,431 Total
Key Program Indicators
(continued)
Total In-Kind Contribution:
Approx. $35,600,000
Equipment and Supply Contributions: Approx. $9,700,000
3 CT Scanners
CDRom Medical Library Equipment
5 Ultrasound Machines
5 Fetal Monitors
Extensive Pharmaceuticals
Key Program Indicators
(continued)
AIHA Workshops, Conferences and Seminars:
40
Partner and non-partnership participants:
2,800+
Conference topics:
Infection Control
Maternal and Child Health
Emergency Medical Services
Nursing Education
Neonatal Resuscitation
Health Services Management
Hospital Administration
National Health Policy
Cardiology
Key Program Indicators
(continued)
Partnership Newsletter, "CommonHealth"
Comprehensive English-Russian Orientation Publication,
"Directions"
E-Mail Communication Systems and E-Mail Based
Clearinghouse
AUPHA-AIHA Hospital and Health System Management
Seminars and Workshops
Monitoring/Evaluation System for Partnership
Assessment
Benefits for US Health Care Providers
& Their Communities
Perspective
Individual Growth
Team Building
Improved Problem Solving
Increased Cooperation in Local Marketplace
Alternative Methodologies, Techniques, Products
Investment and Trade
Key Accomplishments in the NIS
Decreased Length of Stay in All NIS Partner Institutions
Increased Patient Care Capacity in Several Institutions
Introduced Improved Infection Control Techniques
Trained over 200 NIS Physicians and Nurses in Health Care
Administration and Management
Reduced Rates of Abortions Due to Family
Planning Programs
Created 4 EMS Training Centers
Established 6 Neonatal Resuscitation Resource Centers
Increased Productivity and Performance of Complex
Operations
Emphasized the Role of Nurses in Patient Care and
Administration
Actively Disseminated Information from Target Hospitals to
Surrounding Areas
Improved Perceptions of Partner Countries
Louisville/Atlanta - St. Petersburg
Partnership
Partners:
Jewish Hospital, Louisville, Kentucky; Georgia Baptist
Medical Center, Atlanta, Georgia
Central Hospital No. 122; Pavlov Medical Institute,
St. Petersburg, Russia
Areas of Focus:
Maternal and Child Health
Nursing Education
Hospital Administration
Health Care Financing
Emergency Medical Services
Cardiovascular Surgery
Orthopedics
Louisville/Atlanta - St. Petersburg Partnership
(continued)
Partnership Accomplishments:
Restructured Nursing Curriculum to Heighten
Responsibility and Autonomy
Re-designed Management Structures
Developed Strategic Business Plan
Renovation at Hospital No. 122, financed by the U.S. and
Russian Partners, to Provide Care to Dignitaries at the
Goodwill Games and to the General St. Petersburg
Community.
Louisville/Atlanta - St. Petersburg Partnership
(continued)
Continued Training in Women's Health and Endoscopic
Surgery
Sponsored Symposium on Obstetrics and Gynecology in
June 1994 for NIS Clinicians on the Management of OB
and Reconstructive Techniques Following Surgery
Expanded U.S. Partner Base to Include the Louisville EMS
AMERICAN INTERNATIONAL HEALTH ALLIANCE, INC.
1212 NEW YORK AVENUE, NW, SUITE 750, WASHINGTON, DC 20005 TELEPHONE: (202) 789-1136 FACSIMILE: (202) 789-1277
ELECTRONIC MAIL: [email protected]
HEALTH CARE PARTNERSHIPS PROGRAM
Representing major hospital and hospital related organizations, the American International Health
Alliance, Inc. (AIHA), is the US health care provider community's most coordinated effort to work with
its counterparts abroad to address common health care issues and concerns.
Under a cooperative agreement with the US Agency for International Development (USAID),
AIHA has established twenty-one health care partnerships in ten of the New Independent States (NIS) of
the former Soviet Union. These partnerships are allowing American providers to assist their counterparts
in the NIS to address significant mortality and morbidity issues, improve health care organization and
introduce market-oriented solutions to hospital and health system delivery and finance problems. In
addition to working with their specific institutional counterparts, AIHA partnerships are working with
related ministries of health, local and regional health system administrations, and schools of health
sciences to ensure that critical areas of health education and administration are adequately addressed at
these higher institutional levels as well, and that the capacity to carry out other developmental assistance
efforts is enhanced. Preliminary evidence shows that the partnerships are having a significant impact on
the efficacy and productivity of health care delivery in their respective communities and are transferring
their experience to the larger health care delivery systems in the NIS.
USAID and AIHA have recently entered a second cooperative agreement to establish an additional
group of partnerships in the emerging democracies of Central and Eastern Europe (CEE). AIHA
anticipates all of the partnerships in the post-Communist countries of the NIS and CEE will be similarly
structured and strive to meet similar technical assistance needs.
The health care delivery system of the post-Communist countries of the NIS and CEE can benefit
greatly from US assistance. A history of insufficient investment, centralized, bureaucratic control systems
and a lack of up-to-date training for health care professionals have resulted in levels of productivity and
health outcomes far below those of the other industrialized nations. This already inefficient and rapidly
deteriorating health care system has been further devastated by the fragmentation of the central economies,
hyper-inflation, and political instability. Meeting their health care challenges successfully is a key test
of local, regional and national governments and of new democratic, market-oriented institutions in the NIS
and CEE.
To meet the most important technical assistance needs expressed by health providers in the NIS
and CEE, AIHA's programs focus on (1) closing the health care knowledge gap so that preventive and
curative techniques which have been successful elsewhere can be adapted and disseminated, (2) improving
the efficiency and productivity of existing health providers through better clinical and administrative
management and organization, and (3) training of health policymakers and administrators at all levels of
government so they can make informed choices and rational system changes with respect to delivery
system reform. In achieving these goals, AIHA programs recognize the high level of capability and
institutionalization already existing in the NIS and CEE, take into account the increased responsibility and
accountability of local and regional governments, and support the introduction of democratic and market-
oriented mechanisms.
March 1994
Page I
Technical assistance "partnerships" established between hospitals and health care institutions in
the United States and similar institutions in the NIS and CEE are especially cost-effective and practical
in support of these health care initiatives. Equality among all of the participating parties and emphasis
on collaborative solutions to health care problems in both the NIS/CEE and the US are hallmarks of the
program. Particular emphasis is placed on low-technology solutions which can improve productivity and
are economically viable for our partners in the NIS. Once these technologies have been adapted to the
specific cultural and economic circumstances in the NIS, they can be widely applied.
The AIHA partnerships are unique because they rely heavily on the voluntary efforts of many
individuals and donations from many institutions in the United States. These public-private partnerships
have already resulted in a tremendous commitment from non-government sources, with almost three
dollars of voluntary support and donations for every US government grant dollar expended. As then-
acting Secretary of State Eagleburger stated at an October 1992 Blair House reception and signing
ceremony, upon reflecting on the participation in the program of so many institutions and individuals from
around the United States,
"What you see out here is what my country is all about. This is the private sector, these
are average Americans who, with the help of the US Government, have tried to reach out
to provide assistance and support where they can, to people who are in need of help, or
who are intent on doing what they can to improve their own lives. This is not a case of
dependency, this is a case of partnership, and it's the kind of thing that makes me
proudest of my own country and proudest of all of you Americans out there."
In addition to establishing and supporting a health care partnership throughout the anticipated 36-
month project life, AIHA also develops and funds common training activities and programs, and sponsors
regional and international educational conferences to meet the mutual needs of partnerships in the most
cost-effective manner. The AIHA program includes the preparation of orientation materials for both US
and NIS/CEE travelers to minimize the actual exchange time needed to orient travelers. It also includes
a broad range of activities to communicate information beyond the NIS and CEE partners themselves.
CommonHealth, the AIHA bi-monthly newsletter published in both English and Russian, has a circulation
of nearly 12,000 copies, one-third of which is distributed directly to readers abroad. The AIHA
Clearinghouse of information on partnership activity and health issues in the NIS is being made available
through electronic mail to the partnerships and other interested parties in the US and NIS with electronic
mail capability. AIHA also disseminates information through meetings and conferences held in the NIS
and CEE to which many non-partnership health care providers are invited.
As an important complement to the practical training which occurs through the exchange program,
more formal coursework in health administration is being provided to senior managers of NIS and CEE
partner institutions though a contract with the Association of University Programs in Health
Administration.
Program support and administration is provided through AIHA's headquarters in Washington, DC
and regional offices in Moscow, Russia; Kiev, Ukraine; Almaty, Kazakhstan; and Zagreb, Croatia.
AIHA's Washington office provides program and financial oversight and administrative support in
accordance with USAID requirements. In the NIS and CEE, AIHA's regional offices provide logistical
support for travelers, carry out communications functions with the NIS partners, and serve as primary
liaison with the national ministry and local or regional health administrations in their respective regions.
March 1994
Page 2
With this infrastructure, AIHA is able to provide assistance to other US government agencies
assisting with programs in the NIS and CEE. AIHA partnerships and regional offices have also worked
closely with the US Department of Defense in Georgia, Kyrgyzstan, Russia, and Belarus to help
effectively distribute much needed medical supplies and equipment.
Demonstrable progress is being made on several fronts as shown through initial assessments of
programs in the NIS. For example, virtually all partnerships report improved productivity, citing statistics
of shorter lengths of stay, reductions of inpatient beds, increases in outpatient services and overall
increases in the numbers of patients being treated. Similarly, evidence of improvements in infection
control has been documented at every partner hospital assessed. Each of the partnerships is also achieving
significant change with respect to improving quality of care, and a number of important and far-reaching
innovations are being implemented. The partnership in Moscow with Magee Women's Hospital of
Pittsburgh, for example, has seen the first adaptation and introduction of modern prenatal and assisted
birthing techniques in the NIS. The first modern poison control centers in the NIS have been introduced
in Minsk and Bishkek as a result of the partnerships. Modern perinatal resuscitation techniques with the
capacity of sharply reducing infant mortality have been introduced through the partnerships in Kiev,
Tashkent, Almaty, Bishkek and Moscow and are being rapidly disseminated throughout the region.
Similar multiple examples of improved clinical and administrative practice with important effects on
medical outcome exist with respect to each of the partnerships.
There are twenty-one active partnerships. US participants include 47 hospitals and health systems
and 18 medical schools in 18 cities and 15 states; NIS participants include 42 hospitals and health systems
and 12 medical universities in 17 cities and 10 republics. During the start-up year, AIHA managed 214
exchanges involving over 875 health professionals, representing approximately 12,116 exchange days.
Of the health professionals involved in these exchanges, approximately 60 percent have been physicians,
10 percent have been nurses, and 30 percent have been administrators. The value of the voluntary
contribution represented in this start-up period through December 1993 by US health professionals is
approximately $15 million, or roughly three dollars for every US government dollar invested in the
program. Although the AIHA partnership program primarily involves technical assistance, over $2 million
worth of needed supplies and equipment were contributed by the US partners. Program activity in 1994
is expected to increase by approximately 70 percent over the start-up period, representing an estimated
$25 million.
March 1994
Page 3
American International Health Alliance, Inc.
AIHA MASTER SCHEDULE
National Health Policy Conference - Follow-Up
Tbilisi, Georgia
June 6-10, 1994
As a follow-up to the March National Health Policy Conference, participants from the
Ministry of Health and the government of the Republic of Georgia will re-convene with their
US partners to review progress in the establishment of a national health care system.
Symposium in Obstetrics, Gynecology and Neonatology
St. Petersburg, Russia
June 12-22, 1994
The Louisville/Atlanta - St. Petersburg partnership will host a series of demonstrations and
lectures in the management of complicated OB and reconstructive techniques following
oncology surgery. (Open to other interested AIHA - NIS partner representatives.)
EMS Regional Training Centers "Train the Trainers" Conference
Worcester, Massachusetts
July 16-29, 1994
Representatives of each of the NIS Training Center sites will attend a two week training
session at the UMass Medical Center, where their American partners will teach a course in
operating the Centers and how to use the recently developed curriculum.
Infection Control Workshop Planning Session
Washington, DC
August 1, 1994
The US faculty for Infection Control initiatives will meet at AIHA's offices in Washington,
DC to plan for the infection control workshops to be held during AIHA's Second Annual
Conference in St. Petersburg, Russia.
Nursing Task Force
Washington, DC
August 19, 1994
Nurses representing each of the twenty-one US partners will meet at AIHA's offices in
Washington, DC to identify critical issues and opportunities for expanding the role of nurses
in the NIS health care delivery system.
Regional Surgical Conference with Emphasis on Infection Control
Odessa, Ukraine
August 29-31, 1994
This conference, presented by the Odessa Oblast Hospital and Coney Island Hospital, will
explore various surgical topics including laparoscopy, laser surgery for ulcers, and liver
resections and endovascular techniques with a special emphasis on infection control. (Open to
other interested AIHA - NIS partner representatives.)
July 25, 1994
American International Health Alliance, Inc.
Neonatal Resuscitation Seminar
Bishkek, Kyrgyzstan
August 1-5 1994
The Institute of Pediatrics and Obstetrics, in conjunction with Kansas University Medical
Center, will present a seminar on neonatal resuscitation to health professionals in Kyrgyzstan.
(Selected professionals from AIHA partnership hospitals in Central Asia will be invited.)
Japan-Russia Medical Exchange Foundation Conference
Vladivostok, Russia
September 19-21, 1994
Richmond-Vladivostok partnership representatives will attend the second annual JRMEF
Conference to continue US-Japan collaboration in the NIS health care sector.
Third National Health Policy Conference
Tbilisi, Georgia
September 1994 (Tentative)
For the third National Health Policy Conference, participants from the Ministry of Health and
the government of the Republic of Georgia will reconvene with their US partners to review
progress in the establishment of a national health care system. This conference will
specifically focus on management of human resources in health care.
AIHA Pre-Conference Seminars
St. Petersburg, Russia
September 22-23, 1994
Graduates of AUPHA seminars in L'viv, Moscow and Almaty will convene with American
faculty to focus on strategies to extend the leadership, team-building and management lessons
learned during those seminars.
AIHA Annual Conference
St. Petersburg, Russia
September 24-28, 1994
Second annual meeting of US and NIS partnership representatives.
AIHA Post-Conference Seminar on Epidemiology
St. Petersburg, Russia
September 29, 1994
As a follow-up to the Infection Control Workshop conference in June, representatives from the
Ministry of Health, SHEA, AHA, and AIHA as well as partner representatives from the
Russian partnerships will reconvene to discuss progress in infection control and the spread of
the HIV virus and tuberculosis.
July 25, 1994
American International Health Alliance, Inc.
AIHA Post-Conference Seminars
St. Petersburg, Russia
September 29, 1994
Concurrent workshops and seminars in selected management and clinical issues.
CEE Partnerships in Health Third Annual Conference
Prague, Czech Republic
September 29-30, 1994
Representatives from health care partnerships in the CEE will meet to discuss partnership
activity.
Postgraduate Course in Pediatrics at the Minsk Medical Institute
Minsk, Belarus
Fall 1994 (Tentative)
The Pittsburgh-Minsk partnership will sponsor this course to disseminate partnership
information, improve pediatric care in Belarus and to initiate regional continuing medical
education. Topics will include pediatric poisonings, general diagnostic pediatrics, CPR,
thyroid cancer and hospital management.
Leadership in Nursing
Moscow, Russia
October 1994 (Tentative)
Pirogov Hospital will host this conference in cooperation with their US partner, Brigham and
Women's Hospital. Presentations will focus on the role of nurses in primary care in the US
and the potential advantages of expanded roles for NIS nurses in primary care and
administration. (Open to other interested AIHA - NIS partner representatives.)
Neonatal and Perinatal Health Conference
Tashkent, Uzbekistan
October 3-4, 1994
The University of Illinois at Chicago (UIC) is sponsoring a conference at TASHMI II on
topics in neonatal and perinatal health for the Republic of Uzbekistan. (Open to other
interested AIHA - NIS partner representatives.)
Magee/Savior's Obstetrics/Gynecology Conference
Moscow, Russia
October 11-12, 1994
The University of Pittsburgh will sponsor this conference designed for OB/GYNs from around
the world. They will explore new topics and assess trends in the field. (Open to other
interested AIHA - NIS partner representatives.)
July 25, 1994
American International Health Alliance, Inc.
EMS Workshop
Chisinau, Moldova
October 1994 (Tentative)
The Chisinau--Minneapolis partnership will host and EMS conference for health professionals
in Moldova. (Open to other interested AIHA - NIS partner representatives.)
July 25, 1994
American International Health Alliance, Inc.
AIHA CONFERENCE AND WORKSHOP SCHEDULE
Pharmaceutical Assessment
Kiev, Ukraine
November 29-December 15, 1992
Representatives from USAID, AIHA and major US pharmaceutical manufacturers travelled to
Ukraine to make a comprehensive needs assessment of Ukraine's pharmaceutical industry.
AIHA Annual Partnership Conference
Pittsburgh, PA
March 25-26, 1993
US Partners, representatives from USAID and AIHA staff met in Pittsburgh for the First
Annual AIHA Partnership Conference to discuss strategies for successful partnership
activities.
Clinical Engineers' Workshop
Boston, MA and Pittsburgh, PA
May 8-June 12, 1993
The American College of Clinical Engineering (ACCE) conducted an educational workshop
for ten Clinical Engineers from AIHA partner institutions in the NIS.
Advances in Modern Obstetrics Conference
Yerevan, Armenia
May 12-16
This conference, sponsored by the Erebuni--Beth Israel Partnership, presented lectures on
high-risk pregnancy; prenatal, neonatal and pediatric care; and obstetrical nursing to an
audience of Armenian health care professionals.
Contemporary Problems in Surgery
Moscow, Russia
June 1-3, 1993
This conference, sponsored by the Pirogov First Municipal hospital and its US partner,
Brigham and Women's Hospital, provided a overview of general surgical dilemmas and
medical complications to an audience of over 600 Moscow-area physicians.
Japan-Russia Medical Exchange Foundation Conference
Niigata, Japan
June 7-19, 1993
Eleven US physicians from AIHA partner institutions, AIHA Board Members and James P.
Smith travelled to Japan to participate in the JRMEF Conference and to coordinate Japanese
and American technical assistance efforts to the NIS in the health care sector.
June 5. 1994
Page 1
American International Health Alliance, Inc.
AIHA Health System Administration Workshop
New York, NY; Detroit, MI; Richmond, VA; Washington, DC
July 10-24, 1993
Nine senior health and hospital administrators from AIHA partner institutions in Russia and
Ukraine participated in this two-week workshop on health system management in the US.
Woman and Family Education Center Opens
Moscow, Russia
July 26, 1993
As an integral part of their partnership objectives, the Savior's Hospital for Peace and
Charity/Magee Women's Hospital Partnership opened the Woman and Family Education
Center at Savior's to conduct workshops in Prepared Childbirth, Women's Health, Family
Planning and Adolescent Health Issues opened to the general public in Moscow
Issues in Gynecology
Yerevan, Armenia
August 1-5, 1993
Physicians from Beth Israel Hospital, in conjunction with the Ministry of Health of Armenia,
conducted workshops in family planning, sexually transmitted diseases, cancer screening,
male infertility and cytology for health care professionals in Armenia.
Kiev Dissemination Conference: Neonatal Resuscitation and Surgical Techniques
Kiev, Ukraine
September 17-19, 1993
The AIHA Regional Office in Kiev, together with the four AIHA Ukrainian Partnerships,
hosted this three-day conference which aimed to disseminate neonatal resuscitation and
surgical techniques learned by Ukrainian physicians through partnership activities to a larger
audience of Ukrainian health care professionals.
AIHA Perinatal Micro Hospital Workshop
Samarkand, Uzbekistan
September 27-30, 1993
As part of the Second Universal Health Conference and Exhibition, an 8-member delegation
from the University of Illinois at Chicago provided a two-day micro hospital workshop
addressing topics such as neonatal resuscitaion and care for the premature newborn to an
audience which included 25 AIHA delegates from the NIS.
CEE Partnerships in Health Second Annual Conference
Warsaw, Poland
October 2-3, 1993
James Smith, AIHA Executive Director, Miron Fedoriw, AIHA Regional Director in Kiev, and
representatives from AIHA Partnerships in Ukraine and Moldova attended this conference
which explored the Partnership model and its implementation in Eastern Europe.
June 5, 1994
Page 2
American International Health Alliance, Inc.
AIHA Annual Partnership Conference
Washington, DC
October 21-22, 1993
Over 200 participants attended this conference, including representatives from 18 NIS and all
21 US partnerships. In addition, representatives from USAID and PVOs working in the NIS
attended the conference to explore ways the partnerships may be used as "platforms" for other
US government technical assistance and private sector development activities. Conference
attendees participated in the plenary sessions, breakout forums, as well as informal
discussions directed at the examination of partnership successes and dissemination strategies.
AIHA/AUPHA Workshop for Health Services Management Educators
New York, NY; Pittsburgh, PA; and Washington, DC
November 6-17, 1993
Nine educators from the NIS responsible for establishing programs in health services
management participated in this in-depth traveling seminar designed to introduce them to
health services education in the US.
AUPHA Workshop for Senior Health and Hospital Administrators
L'viv, Ukraine
January 9-23, 1994
Senior administrators from hospital partners in Ukraine and Moldova attended this interactive
two-week training program in health administration and management.
Partners in Birth Conference
Moscow, Russia
February 1-2, 1994
The Savior's Hospital for Peace and Charity/Magee Women's Hospital Partnership hosted this
conference, designed to inform and update physicians and midwives and other health care
professionals interested in family-centered maternity care through shared knowledge,
discussion, and active demonstration.
AUPHA Workshop for Senior Health and Hospital Administrators
Moscow, Russia
February 21-March 4, 1994
Senior administrators from hospital partners in Belarus and Russia attended this two-week
training program.
National Health Policy Conference
Tbilisi, Georgia
February 28-March 4, 1994
Organized by the Ministry of Health and the government of the Republic of Georgia with the
assistance of the US partners from Atlanta, this conference explored issues related to the
establishment of a national health care system and outline a health care strategy for the
Republic of Georgia.
June 5, 1994
Page 3
American International Health Alliance, Inc.
Murmansk Medical Project Conference
Murmansk, Russia
March 14-15, 1994
The Jacksonville-Murmansk Partnership hosted a conference which included forums and
practica in the areas of laparoscopy, ACLS, neurology, nursing, and hospital
administration/management.
Neonatal Resuscitation Task Force Meeting
Washington, DC
March 21, 1994
The Neonatal Resuscitation Task Force, comprised of US Representatives of nine AIHA
partnerships working in the area of neonatal resuscitation, met for the first time in
Washington, DC to develop a standard course in neonatal resuscitation to be replicated
throughout the NIS at regional training centers.
Invasive Cardiology Conference: Advances in Medical Practice and Nursing Interventions
Moscow, Russia
April 20-21, 1994
The Government Medical Center of the Russian Federation and Premier Health Alliance
hosted this conference, which included comprehensive seminars on surgical cardiac
procedures and the role of nurses in care of cardiac patients.
Emergency Medical Service Task Force
Washington, DC
May 8, 1994
The EMS Task Force, comprised of US Representatives of the nine AIHA partnerships working
in the area of EMS, will meet for the second time in Washington, DC to continue to develop
standard courses in EMS targeted to specific needs of the NIS.
AUPHA Workshop for Senior Health and Hospital Administrators
Almaty, Kazakhstan
May 10-20, 1994
Senior administrators from hospital partners in the Central Asian and Trans-Caucasian
Republics will attend this two-week training program.
EMS Basic and Intermediate Course Demonstration
Yerevan, Armenia
May 13-27, 1994
The Yerevan-BUMC partnership will present basic and intermediate courses in EMS, to NIS
partners and members of the EMS Task Force, who will be involved in setting up regional
EMS training centers.
June 5, 1994
Page 4
American International Health Alliance, Inc.
Neonatal Resuscitation Workshops
Tbilisi, Georgia and vicinity
May 23-31, 1994
In cooperation with the Ministry of Health of the Republic of Georgia, four neonatalogists and
pediatricians instructed Georgian clinicians in neonatal resuscitation. After the initial
training sessions in Tbilisi, the delegation traveled to Western Georgia to conduct additional
courses in this rural area. The Georgian clinicians plan to disseminate this information to
additional physicians and mid-wives in Georgia.
Women's and Children's Health Conference
Yerevan, Armenia
May 30-June 1, 1994
The Erebuni Medical Center-Beth Israel Partnership hosted this conference which involved
lectures and interactive sessions addressing topics in cytology/colposcopy, family planning,
neonatal resuscitation, cervical cancer, obstetrical anesthesia, and prenatal care. (Open to
AIHA partner representatives from the Trans-Caucus republics.)
Infection Control Workshop
Moscow, Russia
May 31-June 3, 1994
Representatives from all AIHA Russian partnerships and key city, oblast, regional and
Ministry of Health officials participated in this workshop, sponsored by AIHA's Moscow
Regional Office, focusing on the management of hospital infection control in compliance with
Regulatory Order #220 of the Russian Federation Ministry of Health. The Society for Hospital
Epidemiologists of America and the American Hospital Association worked with AIHA in
developing the workshop curriculum.
AIHA/AUPHA Workshop for Health Services Management Educators
Atlanta, GA; Chicago, IL; San Diego, CA
May 31-June 14, 1994
Ten educators from the NIS responsible for establishing programs in health services
management will participate in this in-depth traveling seminar designed to introduce them to
health services education in the US.
Issues in Maternal and Child Health
Kyyiv, Ukraine
June 2-4, 1994
The Center for Maternal and Child Health Care and the University of Pennsylvania hosted
several workshops addressing topics such as family planning, neonatal resuscitation, prenatal
assessment and pediatric nutrition workshop for health professionals in Ukraine. (Open to
other interested AIHA - NIS partner representatives.)
June 5, 1994
Page 5
American International Health Alliance, Inc.
National Health Policy Conference - Follow-Up
Tbilisi, Georgia
June6-10, 1994
As a follow-up to the March National Health Policy Conference, participants from the
Ministry of Health and the government of the Republic of Georgia will re-convene with their
US partners to review progress in the establishment of a national health care system.
Symposium in Obstetrics, Gynecology and Neonatology
St. Petersburg, Russia
June 12-22, 1994
The Louisville/Atlanta - St. Petersburg partnership will host a series of demonstrations and
lectures in the management of complicated OB and reconstructive techniques following
oncology surgery. (Open to other interested AIHA - NIS partner representatives.)
Regional Surgical Conference with Emphasis on Infection Control
Odessa, Ukraine
August 29-31, 1994
This conference, presented by the Odessa Oblast Hospital and Coney Island Hospital, will
explore various surgical topics including laparoscopy, laser surgery for ulcers, and liver
resections and endovascular techniques with a special emphasis on infection control. (Open to
other interested AIHA - NIS partner representatives.)
Neonatal Resuscitation Seminar
Bishkek, Kyrgyzstan
early September 1994
The Institute of Pediatrics and Obstetrics, in conjunction with Kansas University Medical
Center, will present a seminar on neonatal resuscitation to health professionals in Kyrgyzstan.
(Selected professionals from AIHA partnership hospitals in Central Asia will be invited.)
Japan-Russia Medical Exchange Foundation Conference
Vladivostok, Russia
September 19-21, 1994
Richmond-Vladivostok partnership representatives will attend the second annual JRMEF
Conference to continue US-Japan collaboration in the NIS health care sector.
AIHA Pre-Conference Seminars
St. Petersburg, Russia
September 22-23
Graduates of AUPHA seminars in L'viv, Moscow and Almary will convene with American
faculty to focus on strategies to extend the leadership, team-building and management lessons
learned during those seminars.
June 5, 1994
Page 6
American International Health Alliance, Inc.
AIHA Annual Conference
St. Petersburg, Russia
September 24-28, 1994
Second annual meeting of US and NIS partnership representatives.
AIHA Post-Conference Seminar on Epidemiology
St. Petersburg, Russia
September 29, 1994
As a follow-up to the workshop in June, representatives from the Ministry of Health, SHEA,
AHA, and AIHA as well as partner representatives from the Russian partnerships will
reconvene to discuss progress in infection control.
AIHA Post-Conference Seminars
St. Petersburg, Russia
September 29, 1994
Concurrent workshops and seminars on selected management and clinic issues.
CEE Partnerships in Health Third Annual Conference
Prague, Czech Republic
September 29-30, 1994
Representatives from health care partnerships in the CEE will meet to discuss partnership
activity.
Postgraduate Course in Pediatrics at the Minsk Medical Institute
Minsk, Belarus
Fall 1994 (Tentative)
The Pittsburgh-Minsk partnership will sponsor this course to disseminate partnership
information, improve pediatric care in Belarus and to initiate regional continuing medical
education. Topics will include pediatric poisonings, general diagnostic pediatrics, CPR,
thyroid cancer and hospital management.
Leadership in Nursing
Moscow, Russia
October 1994 (Tentative)
Pirogov Hospital will host this conference in cooperation with their US partner, Brigham and
Women's Hospital. Presentations will focus on the role of nurses in primary care in the US
and the potential advantages of expanded roles for NIS nurses in primary care and
administration. (Open to other interested AIHA - NIS partner representatives.)
June 5, 1994
Page 7
American International Health Alliance, Inc.
Magee/Savior's Obstetrics/Gynecology Conference
Moscow, Russia
October 3-4, 1994
The University of Pittsburgh will sponsor this conference designed for OB/GYNs from around
the world. They will explore new topics and assess trends in the field. (Open to other
interested AIHA - NIS partner representatives.)
EMS Workshop
Chisinau, Moldova
October 1994 (Tentative)
The Chisinau--Minneapolis partnership will host and EMS conference for health professionals
in Moldova. (Open to other interested AIHA - NIS partner representatives.)
June 5, 1994
Page 8
NIS MEDICAL PARTNERSHIPS BY COUNTRY
NIS COUNTRY
U.S. CITY, STATE,
NIS
FOCUS
SIGNED
City
HOSPITALS
HOSPITALS
MOU
ARMENIA
BOSTON,
Emergency
Trauma and
November
Yerevan
MASSACHUSETTS
Scientific Medical
Emergency Care
1992
Boston University
Institute
Medical Center,
Boston City Hospital
Yerevan
BOSTON,
The Center for
Women's Health
November
MASSACHUSETTS
Women's
Services
1992
Beth Israel Hospital
Reproductive Health
at Erebuni Hospital
AZERBAIJAN
None
BELARUS
PITTSBURGH,
Children's Hospital
General
March 1993
Minsk
PENNSYLVANIA
No. 4, Radiation
Pediatrics,
Children's Hospital of
Medicine Institute,
Radiology,
Pittsburgh
Minsk Medical
Oncology,
Institute
Nursing
Education,
Hospital
Administration
Poison control
GEORGIA
ATLANTA, GEORGIA
Tbilisi City Hospital
Hospital
October
Tbilisi
Grady Memorial
No. 2, Institute of
Management and
1992
Hospital, Emory
Medicine
Medical
University School of
Education, EMS,
Medicine, Morehouse
Medical Library
School of Medicine
KAZAKHSTAN
TUCSON, ARIZONA
First Aid Hospital
Infection Control,
May
Almaty
Tucson Medical
and Kazakh
Epidemiology,
1993
Center, seven other
Institute for
Medical
hospitals, plus the
Pediatrics
Education,
Pima County Health
Toxicology, EMS,
Department and a
Cardiac
private environmental
Rehabilitation
research firm
Maternal and
Child Health,
Hospital
Administration
KYRGYZSTAN
KANSAS CITY,
Institute of
Pediatric
October
Bishkek
KANSAS
Oncology and
Oncology,
1992
University of Kansas
Radiology, Institute
Maternal and
Medical Center
of Obstetrics and
Child Health,
Pediatrics
Nursing Education
NIS COUNTRY
U.S. CITY, STATE,
NIS
FOCUS
SIGNED
City
HOSPITALS
HOSPITALS
MOU
MOLDOVA
MINNEAPOLIS,
City Ambulance
Trauma care,
January
Chisinau
MINNESOTA
Center, Republican
Dialysis, Cardiac
1993
Hennepin County
Clinical Hospital
Surgery, Medical
Medical Center,
Education, Health
Healthspan
Care Financing
RUSSIA
BOSTON,
Pirogov First
Infection
February
Moscow
MASSACHUSETTS
Municipal Hospital
Control,
1993
Brigham & Women's
Cardiology,
Hospital
Orthopedics,
Internal Medicine,
Obstetrics,
Nursing Education
Moscow
PITTSBURGH,
Savior's Hospital for
Maternal and
December
PENNSYLVANIA
Peace & Charity
Child Health,
1992
Magee-Women's
(Moscow Municipal
Model Birthing
Hospital
Hospital No.70)
Center, Consumer
Education
Moscow
CHICAGO,
Russian Federation
Medical
August
ILLINOIS
Government
Education,
1993
Premier Hospitals
Medical Center
Cardiology,
Alliance
(Kuntsevo)
Hemodialysis,
Transplant
Surgery,
Insurance/
Hospital
Administration
Murmansk
JACKSONVILLE,
Murmansk Regional
Hospital
September
FLORIDA
Hospital, Murmansk
Management,
1992
Memorial Regional
City Ambulance
Health Financing
Medical Center, St.
Hospital
Systems,
Vincent's Hospital
Cardiology
Laparoscopic &
Endoscopic
Surgery, EMS
Dubna
LA CROSSE,
Hospital No.9,
Rehabilitation
September
WISCONSIN
Hospital No. 166,
Services,
1992
Lutheran Hospital, St.
Bolshaya Volga
Alcoholism, Home
Francis Hospital
Hospital
Care,
Infectious Disease
Control, Women's
Health
St. Petersburg
LOUISVILLE,
Central Hospital
General Surgery,
April
KENTUCKY
No.122, Pavlov
Reconstructive
1993
Jewish Hospital;
Medical Institute
Surgery,
ATLANTA, GEORGIA
Cardiovascular
Georgia Baptist
Surgery,
Hospital
Administration
NIS COUNTRY
U.S. CITY, STATE,
NIS
FOCUS
SIGNED
City
HOSPITALS
HOSPITALS
MOU
Vladivostok
RICHMOND,
Vladivostok Hospital
General Surgery,
May
VIRGINIA
No. 2,
Emergency/
1993
Medical College of
Vladivostock
Critical Care,
Virginia at Virginia
Medical Institute
Infection Control,
Commonwealth
Hospital
University
Administration
Stavropol
DES MOINES, IOWA
Stavropol Regional
Infection Control,
May
lowa Hospital
Hospital & six
Emergnecy/
1993
Association, Mercy
others in the region
Trauma Medicine,
Hospital of Cedar
Hospital
Rapids and six other
Administration
lowa hospitals
& Pediatric
Hemotology
TADJIKSTAN
None
TURKMENISTAN
CLEVELAND, OHIO
Ashgabat Medical
Nephrology,
April
Ashgabat
Cleveland Clinic
Consultative Center
Urology, General
1993
Foundation
Surgery
UKRAINE
NEW YORK, NEW
Odessa Regional
Opthamology,
September
Odessa
YORK
Hospital
Orthopaedic
1992
Coney Island-NYHHC
Surgery, Neonatal
Hospital, Maimonides
Care, Urological
Medical Center
Surgery, Infection
Control,
Outpatient Health
Services, Hospital
Administration
Kiev
PHILADELPHIA,
Children's Hospitals
Maternal and
September
PENNSYLVANIA
Nos. 1 and 2,
Child Health,
1992
University of
Obstetrical and
Neonatal
Pennsylvania Medical
Gynecological
Resuscitation,
School, The Hospital of
Hospital No. 2
Family Planning,
the University of
Pediatric Nutrition,
Pennsylvania,
Prenatal Care
Children's Hospital of
Pennsylvania
Lviv
BUFFALO, NEW
Western Ukraine
Infectious
April
YORK
Regional Railroad
Disease,
1993
Millard Fillmore
Hospital, Lviv
Oncology, US
Hospitals
Regional Perinatal
Health Systems
Center
Management,
Medical Library
Lviv
DETROIT, MICHIGAN
Lviv Oblast
Implementation of
April
Henry Ford Health
Hospital, Lviv
Model Patient
1993
System;
Medical Institute
Care Unit, Health
CLEVELAND, OHIO
Eduation
Kaiser Permanente
Outreach,
Hospital
Administration
NIS COUNTRY
U.S. CITY, STATE,
NIS
FOCUS
SIGNED
City
HOSPITALS
HOSPITALS
MOU
UZBEKISTAN
CHICAGO, ILLINOIS
Second Tashmen
Neonatal Care,
December
Tashkent
University of Illinois at
Medical Institute
Medical and
1992
Chicago Hospital
Nursing Education
April 1, 1994
AMERICAN INTERNATIONAL HEALTH ALLIANCE, INC.
1212 NEW YORK AVENUE, NW, SUITE 750, WASHINGTON, DC 20005 TELEPHONE: (202) 789-1136 FACSIMILE: (202) 789-1277
ELECTRONIC MAIL: [email protected]
FOR FURTHER INFORMATION CONTACT:
Donn A. Rubin, CEE Program Director
American International Health Alliance, Inc.
(202) 789-1136
AIHA ANNOUNCES FORMATION OF THREE NEW HOSPITAL
PARTNERSHIPS IN CENTRAL AND EASTERN EUROPE
FOR IMMEDIATE RELEASE August 23, 1994 -- Washington, DC -- The American
International Health Alliance, Inc. (AIHA), in collaboration with the United States Agency
for International Development (USAID), is pleased to announce the formation of three new
hospital partnerships between US hospitals and their counterparts in Central and Eastern
Europe (CEE). USAID has allocated nearly $9 million over a three-year period for
development and implementation of partnership activities, including an intense series of
professional exchanges. For every US government grant dollar expended, AIHA
anticipates matching amounts of voluntary support and in-kind contributions from the US
partner institutions and their communities. Three US hospitals have been paired with
health care institutions in Albania, Croatia, and Estonia, where they will provide much
needed assistance to their overseas counterparts by drawing on the expertise of
American physicians, nurses, hospital administrators, and technical staff whose time will
be contributed on a voluntary basis to the program.
The three new partnerships are:
The Bronx Municipal Hospital Center (BMHC) in New York City will work in
Tirana, Albania, with the University of Tirana Hospital Center (made up of
five separate specialty hospitals), the Maternity Hospital, and the Central
Trauma Hospital. The hospital partnership will focus on the most pressing
needs identified by Albanian officials, including improving trauma,
emergency, and women's health services -- all of which are centers of
clinical and educational excellence at BMHC. In October, BMHC, which
serves a large emigre community of Albanian Americans in the Bronx, will
host a delegation from Albania to help it celebrate the tenth anniversary of
its nationally acclaimed Women's Health Center.
The Dartmouth-Hitchcock Medical Center in New Hampshire will work in
Zagreb, Croatia, with its partners, "Sveti Duh" General Hospital, the
University Hospital of Infectious Disease, and the Children's Tuberculosis
Hospital. The war in the former Yugoslavia and the related flow of refugees
has placed enormous stress upon the Croatian health care delivery system.
In addressing the needs of the Croatians, Dartmouth-Hitchcock will draw on
the resources and clinical expertise of several institutions, including The
Mary Hitchcock Memorial Hospital, The Hitchcock Clinic, Dartmouth Medical
School, and The Veteran Affairs Hospital. These institutions have excellent
capabilities in the areas of pediatrics, trauma, and psychiatric treatment of
post-traumatic stress disorders, all of which likely will be among the areas
that the partnership will address.
The George Washington University Medical Center (GW) in Washington,
DC, will be paired with hospitals in Estonia, including Tallinn Central
Hospital and Mustamae Hospital, the central emergency hospital also in
Tallinn. At Tallinn Central Hospital, GW will concentrate its efforts on the
clinical areas of obstetrics, gynecology, perinatal medicine, and
ophthalmology. Activities at Mustamae Hospital will focus primarily on
cardiology, the organization and administration of emergency medicine, and
the creation of a regional Emergency Medical Services (EMS) training
center. Both Estonian hospitals will also participate in partnership efforts
to improve hospital management and quality assurance, and to expand the
role of nursing.
The AIHA Medical Partnership Program is a coordinated effort by the US health care
provider community to work with its counterparts abroad to address common health care
issues and concerns. In addition to the three new partnerships in the CEE, AIHA has
established 21 hospital partnerships in ten republics of the former Soviet Union as part
of the US assistance program to those countries. The program has enabled American
providers to work with their foreign partners to address significant issues of mortality and
morbidity, to improve health care organization, and to introduce market-oriented solutions
to hospital and health system delivery and finance problems.
In addition to working with their specific institutional counterparts, AIHA partnerships
collaborate with related ministries of health, local and regional health system
administrations, and schools of health sciences to ensure that critical areas of health
education and administration are adequately addressed at these higher institutional levels,
and that the capacity to carry out other developmental assistance efforts is enhanced.
Through supplemental programs such as conferences, publications, an e-mail network,
and train-the-trainer programs, AIHA encourages the dissemination of partnership
successes to the broadest possible audience.
#####
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ommonHealth
NEWSLETTER OF THE AMERICAN INTERNATIONAL HEALTH ALLIANCE
VOLUME 3, No. 1
gile
AMERICAN INTERNATIONAL HEALTH ALLIANCE, INC.
1212 NEW YORK AVENUE, NW, SUITE 750, WASHINGTON, DC 20005 TELEPHONE: (202) 789-1136 FACSIMILE: (202) 789-1277
ELECTRONIC MAIL: [email protected]
HEALTH CARE PARTNERSHIPS PROGRAM
Representing major hospital and hospital related organizations, the American International Health
Alliance, Inc. (AIHA), is the US health care provider community's most coordinated effort to work with
its counterparts abroad to address common health care issues and concerns.
Under a cooperative agreement with the US Agency for International Development (USAID),
AIHA has established twenty-one health care partnerships in ten of the New Independent States (NIS) of
the former Soviet Union. These partnerships are allowing American providers to assist their counterparts
in the NIS to address significant mortality and morbidity issues, improve health care organization and
introduce market-oriented solutions to hospital and health system delivery and finance problems. In
addition to working with their specific institutional counterparts, AIHA partnerships are working with
related ministries of health, local and regional health system administrations, and schools of health
sciences to ensure that critical areas of health education and administration are adequately addressed at
these higher institutional levels as well, and that the capacity to carry out other developmental assistance
efforts is enhanced. Preliminary evidence shows that the partnerships are having a significant impact on
the efficacy and productivity of health care delivery in their respective communities and are transferring
their experience to the larger health care delivery systems in the NIS.
USAID and AIHA have recently entered a second cooperative agreement to establish an additional
group of partnerships in the emerging democracies of Central and Eastern Europe (CEE). AIHA
anticipates all of the partnerships in the post-Communist countries of the NIS and CEE will be similarly
structured and strive to meet similar technical assistance needs.
The health care delivery system of the post-Communist countries of the NIS and CEE can benefit
greatly from US assistance. A history of insufficient investment, centralized, bureaucratic control systems
and a lack of up-to-date training for health care professionals have resulted in levels of productivity and
health outcomes far below those of the other industrialized nations. This already inefficient and rapidly
deteriorating health care system has been further devastated by the fragmentation of the central economies,
hyper-inflation, and political instability. Meeting their health care challenges successfully is a key test
of local, regional and national governments and of new democratic, market-oriented institutions in the NIS
and CEE.
To meet the most important technical assistance needs expressed by health providers in the NIS
and CEE, AIHA's programs focus on (1) closing the health care knowledge gap so that preventive and
curative techniques which have been successful elsewhere can be adapted and disseminated, (2) improving
the efficiency and productivity of existing health providers through better clinical and administrative
management and organization, and (3) training of health policymakers and administrators at all levels of
government so they can make informed choices and rational system changes with respect to delivery
system reform. In achieving these goals, AIHA programs recognize the high level of capability and
institutionalization already existing in the NIS and CEE, take into account the increased responsibility and
accountability of local and regional governments, and support the introduction of democratic and market-
oriented mechanisms.
March 1994
Page 1
Technical assistance "partnerships" established between hospitals and health care institutions in
the United States and similar institutions in the NIS and CEE are especially cost-effective and practical
in support of these health care initiatives. Equality among all of the participating parties and emphasis
on collaborative solutions to health care problems in both the NIS/CEE and the US are hallmarks of the
program. Particular emphasis is placed on low-technology solutions which can improve productivity and
are economically viable for our partners in the NIS. Once these technologies have been adapted to the
specific cultural and economic circumstances in the NIS, they can be widely applied.
The AIHA partnerships are unique because they rely heavily on the voluntary efforts of many
individuals and donations from many institutions in the United States. These public-private partnerships
have already resulted in a tremendous commitment from non-government sources, with almost three
dollars of voluntary support and donations for every US government grant dollar expended. As then-
acting Secretary of State Eagleburger stated at an October 1992 Blair House reception and signing
ceremony, upon reflecting on the participation in the program of so many institutions and individuals from
around the United States,
"What you see out here is what my country is all about. This is the private sector, these
are average Americans who, with the help of the US Government, have tried to reach out
to provide assistance and support where they can, to people who are in need of help, or
who are intent on doing what they can to improve their own lives. This is not a case of
dependency, this is a case of partnership, and it's the kind of thing that makes me
proudest of my own country and proudest of all of you Americans out there."
In addition to establishing and supporting a health care partnership throughout the anticipated 36-
month project life, AIHA also develops and funds common training activities and programs, and sponsors
regional and international educational conferences to meet the mutual needs of partnerships in the most
cost-effective manner. The AIHA program includes the preparation of orientation materials for both US
and NIS/CEE travelers to minimize the actual exchange time needed to orient travelers. It also includes
a broad range of activities to communicate information beyond the NIS and CEE partners themselves.
CommonHealth, the AIHA bi-monthly newsletter published in both English and Russian, has a circulation
of nearly 12,000 copies, one-third of which is distributed directly to readers abroad. The AIHA
Clearinghouse of information on partnership activity and health issues in the NIS is being made available
through electronic mail to the partnerships and other interested parties in the US and NIS with electronic
mail capability. AIHA also disseminates information through meetings and conferences held in the NIS
and CEE to which many non-partnership health care providers are invited.
As an important complement to the practical training which occurs through the exchange program,
more formal coursework in health administration is being provided to senior managers of NIS and CEE
partner institutions though a contract with the Association of University Programs in Health
Administration.
Program support and administration is provided through AIHA's headquarters in Washington, DC
and regional offices in Moscow, Russia; Kiev, Ukraine; Almaty, Kazakhstan; and Zagreb, Croatia.
AIHA's Washington office provides program and financial oversight and administrative support in
accordance with USAID requirements. In the NIS and CEE, AIHA's regional offices provide logistical
support for travelers, carry out communications functions with the NIS partners, and serve as primary
liaison with the national ministry and local or regional health administrations in their respective regions.
March 1994
Page 2
With this infrastructure, AIHA is able to provide assistance to other US government agencies
assisting with programs in the NIS and CEE. AIHA partnerships and regional offices have also worked
closely with the US Department of Defense in Georgia, Kyrgyzstan, Russia, and Belarus to help
effectively distribute much needed medical supplies and equipment.
Demonstrable progress is being made on several fronts as shown through initial assessments of
programs in the NIS. For example, virtually all partnerships report improved productivity, citing statistics
of shorter lengths of stay, reductions of inpatient beds, increases in outpatient services and overall
increases in the numbers of patients being treated. Similarly, evidence of improvements in infection
control has been documented at every partner hospital assessed. Each of the partnerships is also achieving
significant change with respect to improving quality of care, and a number of important and far-reaching
innovations are being implemented. The partnership in Moscow with Magee Women's Hospital of
Pittsburgh, for example, has seen the first adaptation and introduction of modern prenatal and assisted
birthing techniques in the NIS. The first modern poison control centers in the NIS have been introduced
in Minsk and Bishkek as a result of the partnerships. Modern perinatal resuscitation techniques with the
capacity of sharply reducing infant mortality have been introduced through the partnerships in Kiev,
Tashkent, Almaty, Bishkek and Moscow and are being rapidly disseminated throughout the region.
Similar multiple examples of improved clinical and administrative practice with important effects on
medical outcome exist with respect to each of the partnerships.
There are twenty-one active partnerships. US participants include 47 hospitals and health systems
and 18 medical schools in 18 cities and 15 states; NIS participants include 42 hospitals and health systems
and 12 medical universities in 17 cities and 10 republics. During the start-up year, AIHA managed 214
exchanges involving over 875 health professionals, representing approximately 12,116 exchange days.
Of the health professionals involved in these exchanges, approximately 60 percent have been physicians,
10 percent have been nurses, and 30 percent have been administrators. The value of the voluntary
contribution represented in this start-up period through December 1993 by US health professionals is
approximately $15 million, or roughly three dollars for every US government dollar invested in the
program. Although the AIHA partnership program primarily involves technical assistance, over $2 million
worth of needed supplies and equipment were contributed by the US partners. Program activity in 1994
is expected to increase by approximately 70 percent over the start-up period, representing an estimated
$25 million.
March 1994
Page 3
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Clinton Library
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COLLECTION:
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FOLDER TITLE:
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file
When Sparky's Waste Control went looking for a group
health policy, insurers weren't anxious for their business.
The problem was that one of the 11 employees had a child
with cerebral palsy and potentially large health care costs.
PLANS
COMPARE
Health Care
ALLIANCES IN SOME FORM
Under the Alliances
Clinton: States must establish alliances.
Cooper: States must establish alliances.
Chafee-Dole-Thomas: Private groups, such as
business firms, have option to create alliances.
olls show that the public is confused about
Stark: States have option to create alliances, but
P
how people would get their health insurance
most people would be covered through their
from regional alliances. Here are some of
employer or expanded Medicare program.
the most common questions and the
McDermott: No. Federal government is sole
administration's responses:
health insurer.
Can I cross state lines to get care?
As the Clinton bill is currently written, alliances
WHO IS ELIGIBLE TO USE ALLIANCES
would not cross state lines. But health plans
Clinton: All workers in firms under 5,000
approved by alliances could cross state lines, just as
employees; unemployed.
they do now. That means if you lived in one state
Cooper: All workers in firms under 100
but wanted to use a doctor or hospital in another
employees; unemployed.
state, you would be able to do so under a variety of
Chafee-Dole-Thomas: Firms with under 100
conditions. If you chose a fee-for-service plan,
workers and their employees; uninsured individuals.
allowing you unrestricted choice of your own
Stark: Employers with up to 1,000 workers and
medical service providers, you could go anywhere.
some individuals.
If you chose an HMO, you could go anywhere that
McDermott: Everyone in the country is insured
plan has doctors and facilities as part of its service
directly by the federal government.
network. In an area like the national capital region,
an HMO would probably have doctors and facilities
GENERAL EMPLOYER MANDATE TO PAY
in several jurisdictions. Even if you chose an HMO
FOR WORKERS' HEALTH-CARE COVERAGE
that was limited to only one geographic area, you
Clinton: Yes. Employers are required to pay roughly
could use a hospital or doctor elsewhere if, when
80 percent of average policy cost for all employees.
you bought the HMO plan, you opted to enroll in
Cooper: No.
the "point of service" option. That option allows you
Chafee-Dole-Thomas: No
to use doctors and hospitals outside the HMO's
Stark: Yes. Employers are required to pay roughly
normal network, but you would have to pay a larger
80 percent of average policy cost for all employees.
portion of the bill.
McDermott: No. All Americans are insured by
Could I choose to go 1,000 miles away to a
federal health policy paid for by taxes.
special center?
The same general rules apply. If you had a rare
DATE FOR UNIVERSAL COVERAGE
cancer and wanted to go to Memorial
Clinton: 1998.
Sloan-Kettering in New York or some other special
Cooper: Not set in bill.
cancer center, you could do so if you had a
Chafee-Dole-Thomas: 2005.
fee-for-service policy; if your HMO had an
Stark: 1997.
agreement with that institution and believed you
McDermott: One year after enactment.
needed to go there, or if you had chosen the HMO
Compiled by Spencer Rich
point-of-service option.
What if I live in a poor region of the country?
Will coverage through my alliance be more
expensive?
States cannot carve up regions or metropolitan
areas so that people at high risk of needing health
care are concentrated in any one alliance. At the
same time, if you live in an alliance area, such as the
District of Columbia, that has a high proportion of
poor and sick residents, would your own premiums
go up enormously to help cover their costs when
they are enrolled in the alliances? Some observers
believe that as the Clinton plan is now written, this
could be a serious problem in certain parts of the
country. Administration officials have said that
premiums might go up somewhat in some areas, but
the federal government would pay subsidies to help
alliances cover costs for low-income people and
TUESDAY, MARCH 22. 1994 THE WASHINGTON POST
businesses, especially small firms. The amount a
business must pay as a percentage of its payroll for
health premiums is capped in the Clinton plan, as is
the amount an individual must pay as a percentage
of pay.
In the final legislation, it is also possible that
Congress would specifically address the situation in
the District of Columbia, which is unique in that it
has a disproportionate number of poor families who
many believe require more health care services
than a state with a more balanced population.
If I work part-time for a firm in D.C. and my
spouse has a full-time job in Virginia, would we
get our coverage through the same alliance?
Yes. You buy where you live in the Clinton plan.
You can both join the same health plan through your
local alliance and your employers would split the
costs.
file
THE TRUTH ABOUT ALLIANCES
Alliance
# of
Admin. # Spent on
# of Enrollees
Premium $/Year
% of Premium for
Staff
Outisde Contacting
Total Admin. Cost
Calpers
78
$15 M
900,000
$1.4 B
.5%
Minn. State
25
$75 K
144,000
$300 M
.9%
Employee
Program
Wisconsin PERS
15-20
N/A
190,000
$310 M
.3%
Federal Employee
175
0
9,000,000
$14 B
.125%
Health Benefits
Program (FEHB)
AT PRESENT, BUREAUCRACIES INFLATE
THE HEALTH CARE SYSTEM
For smaller businesses, administrative costs consume 40 cents of every health dollar.
According to the Congressional Budget Office, administrative costs consume 40
percent of the total health costs for businesses with fewer than five employees.
Our Nation spends almost $4.5 million an hour on the health insurance administrative
bureaucracy.
Americans spend $48 billion a year on insurance administrative costs. That comes
to almost $4.5 million an hour.
In 1990, the number of those employed by private insurance carriers and insurance agents
was over 2.4 million people. This is two hundred thousand more than the number of people
employed by the United States Government in all the legislative, judicial and nondefense
executive agencies, including postal workers and temporaries hired by the Census Bureau
to take the 1990 census.
what
HEALTH: State Alliance Gives Clout to Smaller Companies
State Alliance
3/21/9
Continued from BS
California and Florida officials
avoided. Insurers didn't like to
people trying to sell him insurance.
tion.
are betting that their voluntary
How the Health Alliance Works
write policies for restaurants be-
"I would tell them I'm a diabetic
In Los Angeles County. for ex-
approach will be a giant step
cause many cooks, busboys, wait-
who had a kidney transplant, and
toward Clinton's goals of providing
ers and waitresses were transients
Gives
Workers
ample, a worker whose small com-
the phone would go "click," he
pany has joined the HIPC can
insurance protection for everyone
Who may participate? Firms with five to 50 workers.
They avoided lawyers because
said.
choose among 15 plans-12 health
while controlling the soaring costs
What does It offer? Statewide, a choice of 15 health maintenance
they might sue and doctors be.
He paid $1,000 a month for
maintenance organizations and
of medical care.
organizations and three preferred provider networks. Twelve of the
cause they would demand a lot of
insurance for the four workers at
three preferred provider organiza-
By offering wide choice and low
HMOs and all three PPOs operate in Los Angeles: fewer are
high-cost care.
his agency, plus $1,500 out of his
Health Clout
tions-including such well-known
prices, they hope to W00 enough
available in other parts of the state.
Addressing this problem, the
own pocket for special drugs to
names as Kaiser, Aetna, FHP,
businesses to make significant in-
What do the HMOs cost? For workers in the standard plan,
California law guarantees that no
ensure that his body did not reject
Healthnet and Prucare. That dif-
roads in the ranks of the uninsured;
co-payments of $15 per doctor's office visit, $100 per hospital
individual or company could be
the kidney.
fers dramatically from the conven-
among the nearly 40 million Amer-
admission and $10 per generic drug prescription.
refused coverage for any reason.
Now a monthly bill of $851 from
By ROBERT A. ROSENBLATT
tional situation in which the com-
icans without coverage. about 80%
For workers in the preferred plan, co-payments of $5 per doctor's
Any insurance product must be
the HIPC covers both Levine and
pany makes available one or
are full-time, low wage workers,
office visit. no co-payment for hospital admissions and $5 for generic
available to all customers
his employees-and drugs are part
TIMES STAFF WRITER
perhaps two health plans.
their spouses and children.
drugs and $10 for brand names.
Premiums may vary with the
of the package.
WASHINGTON-Forty thousand work-
Clinton wants to require all em-
The:HMO pays if it refers enrollees to outside specialists.
age, family composition and geo-
The state has kept down costs
A
II plans must offer the same
ployers to offer insurance and pay
Maximum out-of-pocket cost per year $2,000 for individuals and
benefits. but the doctors and
graphic location of the insured. An
and avoided building a new bu-
ers at small California businesses will get
80% of the cost of an average-
$4,000 for families under both plans.
hospitals are more desirable in
insurer may ask a 60-year-old to
reaucracy by hiring a private firm
an extraordinary piece of good news on
priced plan. He also wants to
What do the PPOs cost? A 20% co-payment for office visits to
pay more than someone who is 30,
to act as the HIPC's sales agent,
some than others. Monthly fees
require everyone except workers
network doctors and hospitals and 40% to outsiders.
a married woman with three chil-
record-keeper and administrator.
Tuesday: At a time when health insurance
range from $84 to $173.14 for a
costs are climbing by 6% to 8% a year,
in firms with more than 5,000
For workers in the standard plan, a $500 yearly deductible per
25-year-old worker and from
dren to pay more than a single
Employers Health Insurance won
$342.80 a month to $674.44 for a
employees to enroll in health alli-
person.
woman, and a resident of Los
the contract and collects a fee for
their premiums will actually be reduced for
ances that would negotiate on their
For workers in the preferred plan, a $250 yearly deductible per
35-year-old employee with a
Angeles, where medical costs are
each person enrolled. The compa-
person.
the year starting July 1.
spouse and children. The company
behalf with insurance companies,
high, to pay more than someone
ny started with 15 sales represen-
Prescription drug co-payments of 20% for generics and 30% for
These fortunate few are members of the
must pay an amount equal to at
health maintenance organizations
who lives in Ukiah.
tatives and now, anticipating a
brand names.
state's unheralded health alliance, a pur-
least half of the cost of the lowest-
and other networks of health care
boom year, has 30.
Maximum yearly out-of-pocket payments of $2,000 per person
make only
"We have forced the market to
priced plan; the worker pays the
providers.
and $4,000 per family in the network, and $5,000 per person and
in rates to
chasing agency that gives companies with
respond," said Kirk Rothrock, ex-
rest.
F
ear of a compulsory national
$10,000 per family outside the network.
compensate for different health
ecutive vice president of the HIPC,
five to 50 workers an opportunity to band
"You get one monthly bill
whether you have 13 employees in
program of alliances made it
How can sign up? Call your insurance agent or the HIPC
conditions. If the cost of insurance
talking about the alliance's influ-
together and achieve the same buying
easier for all factions in Florida-
directly at 1-800-447-2937.
for a typical group of five people is
one health network or in 13 differ-
ence far beyond the comparatively
clout in the health care market as giant
businesses, insurers and politi-
$100 a month, the insurer cannot
ent networks." said Diane Bouras-
small number of people enrolled.
cians-to work together for a vol-
charge more than $120 for a group
Alliance backers in Florida
corporations.
sa, office manager for Telenet-
untary program. Gov. Lawton
will announce that the average
of California, which covers 5 mil-
of five people in which two have
agree. "You don't measure success
Even as President Clinton's proposal for
works, a software firm in Petalu-
Chiles said he was grateful that the
insurance premium will decline in
lion California and dominates the
cancer, two have heart disease and
by the number of small businesses
alliances covering every citizen is being
ma. "It's a great variety of choices
and avoids a tremendous adminis-
President's plan prodded everyone
price, a testament to the negotiat-
small-group market.
the fifth suffers from diabetes. A
they insure but by the impact they
ing skills of the organization and
If anything, we are having to be
denounced in Washington as a blueprint for
trative load on small companies
to get down to work.
group of four marathon runners in
have on the market." said Bill
Florida officials say they hope to
the desires of the insurance com-
more competitive than ever to
perfect health cannot get a rate
like us, where typically you have
Hirrle, a Florida business lobbyist.
a menacing new bureaucracy, a staff of just
one person running the office."
get prices down simply by publish-
panies to crack the important
compete with the HIPC," he said. It
lower than $80.
"You invent them to bring health
13 state workers in Sacramento has put
ing the bids offered by insurers to
small-group market.
was "no coincidence," he added,
These ground rules enable the
Rates are 10% to 15% below
care prices down."
together a working alliance, the first in the
small firms through the alliance.
The average company now en-
that a slowdown in California in-
HIPC to avoid becoming the dump-
many comparable plans in the
The alliances ultimately could
Side-by-side comparisons will
rolled in the HIPC has 10 workers.
surance inflation began last July
nation. And its customers seem delighted.
ing ground for companies with sick
conventional insurance market,
fall short of bringing insurance to
make businesses aggressive in
Companies with as few as four
when the HIPC opened for busi-
workers who couldn't get coverage
"It was heartbreaking to want to get
according to a recent study by a
everyone. After all, they are vol-
HIPC board member. The reason
seeking better deals and force the
employees will be able to join as of
ness.
elsewhere. The HIPC's aggressive-
untary and employers remain free
insurance for your workers and not be able
high-priced insurers to bring their
July 1, and the threshold will drop
At the beginning of the decade,
ly low rates and broad selection of
Providers are willing to offer dis-
to refuse to spend money on health
to afford it," said Cynthia Chauvie of Van
prices down, they say.
to three a year later. About three-
California was grappling with the
plans make it attractive for healthy
insurance.
counts to gain access to as many as
Nuys, whose precision-instrument repair
"A lot of what we do in Florida
quarters of the employers in the
same thing the President and First
40,000 customers.
as well as high-risk groups of
Three-quarters of the HIPC's
"There's no mystery here." said
will send a message to the nation,"
HIPC bought their coverage
Lady Hillary Rodham Clinton, who
workers.
enrollees already had coverage
firm was once quoted an impossible $2,500-
said Lynn Kislak, chairwoman of
through insurance agents, a fact
headed the Administration's health
AL LG2WB Engineers in Costa
John Ramey. the HIPC's executive
elsewhere; only one-quarter come
a-month premium for its seven workers.
director. "We're trying to get a
the alliance for Dade County. "The
that has made agents friendly
care reform task force, denounce
Mesa, for example, the $8,000-a-
from the ranks of the uninsured.
Last July she joined the new state health
large-volume deal for our small
wonderful thing Florida has is
rather than antagonistic toward
again and again in speeches at-
month premium under the HIPC
California still has a staggering 6.3
employers."
choice."
the alliance.
tacking insurance companies: the
represents a saving of as much as
million uninsured people under age
alliance, and now she pays $780 a month for
In May. Florida will become the
But California took a bigger step:
HIPC membership should double
specter of sick people crying in
20% from the firm's old insurance
65, and 83% of them are workers
the whole office.
second state to try voluntary alli-
Republican Gov. Pete Wilson and
in the coming year and could grow
vain for help and uninsured fami-
plan.
and their dependents, according to
"It's a great relief to have coverage now
ances when it begins enrolling
the Democrat-controlled Legisla-
even faster as word spreads, Ra-
lies ruined by costly medical bills.
The range of choices is welcome,
Richard Brown, director of the
for all of us," she said.
small businesses in a voluntary
ture decided to give the health
mey and his staff estimate.
Many insurers engaged in "cher-
if a bit intimidating. Marilyn Hall,
UCLA Center for Health Policy
purchasing group called the Com-
alliance real muscle by granting it
Beyond that, the competitive
ry-picking"-insuring the healthy
the firm's vice president, says the
Research.
The alliance, formally called the Health
munity Health Purchasing Allian-
the authority to negotiate rates
impact of the HIPC is being felt in
but not those who were likely to
45 workers have enrolled in 11
"We will need a national health
Insurance Plan of California, offers some-
ces.
with insurers.
the rest of the state's sprawling
face big medical bills. This meant
networks.
care plan to complete the job,"
thing never before available for employees
The California and Florida expe-
When the first set of bids came
insurance market, where compa-
seeking out firms with young. edu-
"Some employees come to me
Chiles said.
of small companies: a wide choice of
riences may offer some direction
in last year, the HIPC gave the
nies are offering more choices and
cated workers in white-collar jobs
and say: 'Which one should I
Although he said he is confident
for the increasingly bitter national
companies 48 hours to lower
trying to slow the rate of increase
and giving them bargain rates. If
choose, Marilyn. Tray, 'If you have
the voluntary approach will make
different insurance programs, with work-
debate over health care reform.
rates-and many of them did.
in premiums.
their medical bills were higher
a doctor, find out which network
progress in his state, "I don't want
ers-not management-making the selec-
Clinton's plan is being torn apart in
On Tuesday, the HIPC board will
The HIPC is the "standard by
than expected, insurers' rates
he belongs to.' Once they under-
to second-guess the President" on
Please see HEALTH, B7
Washington by partisan Republi-
approve its second rate schedule:
which every other health plan's
would RO up or the firm's coverage
stand it, people love the choices."
the call for mandatory coverage
cans and skeptical Democrats, with
the figures covering 40,000 people
offerings and prices are com-
might be canceled without expla-
Before the HIPC, Steve Levine,
and compulsory alliances.
enthusiastic lobbying by business-
from 2,300 employers for the 12
pared," said Mark Weinberg, exec-
nation.
who owns an ad agency in Venice,
"I've got my hand to play and he
es large and small.
months starting July 1. The HIPC
utive vice president at Blue Cross
Some industries were to be
got several calls a week from
has his," he said.
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JOURNAL OF THE AMERICAN INTERNATIONAL HEALTH ALLIANCE . SPRING 1995