The inaugural China-Tennessee Rural Health Exchange Program was the result of an initiative undertaken by Governor Phil Bredesen to establish a Tennessee Trade and Development office in Beijing China. In the fall of 2007, Governor Bredesen selected a Tennessee academic healthcare team to strengthen ties between Tennessee and China. The identified faculty from Tennessee academic institutions had established relationships with members of the Chinese health system. A training curriculum was developed with counterparts in the Ministry of Health in Beijing in October 2007. An agreement signed jointly by Tennessee Commissioner Matt Kisber and the director of the Chinese Ministry of Health Foreign Loan Office (MOH FLO), Dr. Baoduo Zhu, resulted in the inaugural China-Tennessee Rural Health Exchange Program Summer Institute held May 12-31, 2008, in Tennessee.
Over the three week period in-residence, 44 Chinese health officials and scholars represented their central government and eight provinces participating in a new World Bank-supported rural health initiative attended the Exchange Program. The Program provided training in public health and rural health management, leadership development, and health care financing at the University of Memphis, East Tennessee State University, and Vanderbilt University. The Vanderbilt Institute for Global Health (IGH) provided logistical support along with Mr. Ian Prunty and colleagues from the Governors office.
Among the 44 Chinese trainees, 19 spent the first two weeks at The University of Memphis. Their curriculum explored a wide range of health economics issues related to rural health care reform in China, such as the new cooperative medical system and its development into a stable insurance program. Course work was supplemented with site visits to medical facilities and other healthcare providers such as telemedicine, medical devices, and pharmaceuticals throughout the Memphis area to provide first-hand exposure to topics covered in course material.
The other 25 trainees spent their first two weeks at East Tennessee State University (ETSU) in Johnson City. They attended an interactive course on Evidence-based Public Health as part of ETSU at the Appalachian Summer Institute of Epidemiology. Classroom topics focused on evidence-based rural public health practice with daily seminars covering culture, poverty, traditional medicine and local public health. Exchange members also visited multiple county health departments, local nurse-run clinics, schools, and a chemical company to complement coursework on healthcare in rural communities.
All 44 trainees including four translators reconvened in Nashville for training at the Vanderbilt Center for Better Health focused on leadership development. The course was highly interactive, with extensive use of breakout teams, tools for accelerated learning, case studies, simulations and other innovative methods for learning. The course closely linked learning to application of knowledge and skills, and global health themes were emphasized in lieu of US-specific examples.
At the close of the three weeks, four members of the Chinese delegation provided an overview of the health care challenges facing rural China in a special symposium at Vanderbilt. The speakers were Professor Genming Zhao, Professor Jiaying Chen, Mr. Lusheng Wang, and Mr. Bing Fan who also served as chief of party for the delegation. The Chinese speakers then led the entire group in a discussion of potential future directions for the China-Tennessee Rural Health Exchange Program. Dr. Ben Zhang of the MOH FLO also played a special coordination role on behalf of Dr. Zhu. The symposium was chaired by Dr. Tim Jones, Tennessee state epidemiologist.
Participant evaluations suggested that Chinese exchange members left with a deeper understanding of the strengths and weaknesses of the US healthcare system, especially as it provides services for rural areas, as well as the benefits and limitations of various payment systems used in the US and elsewhere. Participants found the exposure to an integrated teaching form combining coursework with site visits to be most beneficial and appreciated the opportunity for extensive interactions with US experts. Overall, exchange members expressed a strong desire to enhance the US/China relationship through close collaboration in planning of future events to enhance mutual exchange and to keep coursework in line with trainee needs.
To enhance information sharing, the University of Memphis, East Tennessee State University, and Vanderbilt University posted course content and summaries on their respective websites for participants to access material covered during the 2008 exchange. All materials were provided in both Chinese and English.
Vanderbilt IGH faculty member Han-Zhu Qian, MD, PhD, travelled to China in June 2008 and met with Dr. Baoduo Zhu and his colleagues at MOH FLO to solicit feedback from Chinese officials and Exchange program trainees. Along with written evaluations, their suggestions for future training include:
- involving Chinese faculty in the training;
- combining trainee groups into one and not splitting them between institutions (the entire group had health financing and public health interests);
- conducting coursework primarily in China and using the Tennessee for field visits and case studies;
- inviting an American team to China to better understand the challenges being confronted in rural health reform.
Chinas Rural Health Development initiative sponsored by the World Bank is also supported by the U. K. Department for International Development (DFID), particularly for training. Part of the anticipated training component involves a Resource Center to be funded by DFID. Since Dr. Zhu and his colleagues expressed interest in continuing collaboration with Tennessee partners in the provision of this training, Tennessee faculty have decided to respond to any request for applications for the Resource Center, anticipated in the late summer 2008.
While the University of Memphis (Dr. Cyril Chang), East Tennessee State University (Dr. Randy Wykoff), and Vanderbilt University (Drs. Tom Lloyd, Hanzhu Qian, and Sten Vermund) took a lead role in the training, faculty from the University of Tennessee made vital contributions, as did leaders and staff from the Tennessee Department of Health. The Tennessee State Department of Economic and Community Development is strongly committed to working with the Chinese to further address their rural health training needs and to develop even closer collaborations moving forward.