国際医療協力研究委託費 17 公６アフガニスタンの看護学部カリキュラム協働開発 Collaborative Development of Baccalaureate Program

国際医療協力研究委託費　17（公）６アフガニスタンの看護学部カリキュラム協働開発 Collaborative Development of Baccalaureate Program in Afghanistan 田代　順子（Junko Tashiro, RN, Ph. D）協働研究者： Shamsurahim Rahim, Sherin Aqua Zarif (Kabul Medical University) 松谷美和子、長松康子、山崎好美、梅田麻希、林亜希子（WHO 看護開発協力センター聖路加看護大学）武田優子、大西弘高（東京大学国際医学教育研究センター）水嶋春朔（国立保健医療科学院）第 6回医学教育国際協力研究フォーラム 12月14日 2007年 12月 14日 2007年

話題（Topics) アフガニスタンの看護学部カリキュラム　　協働的開発の背景と経緯（Background of this project) n カブール医科大学看護学部のカリキュラム　　　開発過程 (Progress of this project) n カブール医科大学看護学部プロジェクトの　　　　今後の課題 (Future direction of this project) n

アフガニスタンの看護学部カリキュラム　　協働的開発の背景と経緯（Background of Collaborative Nursing Education Project for Afghanistan） n n n n July, 2002: “Comprehensive Needs Assessment in Education (CAN)” ODA (Japan International Cooperation Agency) started to plan. January, 2005: The first trainees from Kabul Medical University (KMU) hosted by Japanese International Cooperation Agency (JICA), designated by International Research for Medical Education (IRME), Tokyo University. March, 2005: JICA started “Medical Education Project” August, 2005: Collaborative Inter-disciplinary Study Team consists of IRME and WHO C. C. at SLCN for Nursing Education started October, 2006 Started to work with faculty members of Faculty of Nursing of Kabul Medial University

実践研究の枠組み Conceptual Framework 　Structure （構造） People's Health Status Life Expectancy Major Causes of Death Infant Mortality Maternal Mortality Health Care Providers Human Resources Health Care System Health policy Regulations　　　　　　Financial condition 　Human resource development Process（過程） People’s Self-care Health Care Providers Quality of health care services Workload Health Care system Accessible health care facilities Financial support and Health professional and workers education Development of Educational Program for Human Resource for Health Outcome(成果） People’s Health Status People’s accessibility of care People’s satisfaction Financial burden Health Care Providers Satisfaction Health Care System 　Cost-effectiveness

目的と 2005－2006年の目標（Main goal and Studies in 2005＆2006） The main goal of educational development in Afghanistan is strengthen nursing and consequently promote the health of the people by focusing on women and children Goals of 2005 To determine Afghanistan’s critical health needs that would guide the development of their baccalaureate nursing program Goals of 2006 To develop educational program of Faculty of Nursing, Kabul Medical University 　

2005年度の研究成果（既存データ分析） Findings of Study in 2005 Health Indicators of the Afghanistan n Life Expectancy at Birth: 42 years old (WHO, 2004) Under age 5 yrs. mortality rate: 258/1000 Infant Mortality: 144/1000 lb (Ministry of Health Afghanistan, n Sex ratio at birth: 1. 05 male/female n n 2002) n Maternal Mortality: 160/100, 000 birth n Population Growth: 2. 67% (2006 est. ) Human Resource in Health (WHO, 2001) n Number of Physician: 4, 104 Nurses: 4, 752 Dentist: 630 Pharmacist 525 ( Density per 1000 people) ( 0. 19/1000 ) ( 0. 22/1000) ( 0. 03/1000) ( 0. 02/1000)

政府保健行政官・指導者ニーズ調査結果： A：　ヘルスケアニーズ Findings (A) : Health care needs n n n (A-a) Destroyed health care system and institutions (A-b) High maternal mortality (A-c) High infant mortality (A-d) High blood pressure and other chronic diseases (A-e) Infectious disease: Measles, HIV/AIDS (A-f) Psychiatric illness such as post traumatic stress disorder (PTSD) and depression.

政府保健行政官・指導者ニーズ調査結果： B：　保健人材育成ニーズ Findings (B) : Human resource development needs n n n (B-a) unbalanced distribution of health worker or personnel between urban and rural areas; (B-b) reduced numbers of female human resource in health because of the cultural and regional value; (B-c) less management of human resource development due to heavily relied on nongovernmental agencies.

2005年度の研究方針： Future Directions of Collaborative Study Team for Development of Nursing Education　in 2005 n n n To form international inter-disciplinal study team between Afghanistan and Japan To develop a nursing program that prepares nurse leaders who can manage and develop nursing and health activities within the health system consisted of tertiary, secondary, and primary This collaborative work developing a nursing educational program, it should be based on the cultural values such as gender-role in Afghanistan, and community health.

Shamsurahim Rahim Dean of Nursing faculty October 1４, 2006

学部案内内容（Contents） n n n n I. History of Kabul Medical University II. Organization and Administration III. Health system in Afghanistan IV. Philosophy of education V. Goals of Nursing education VI. Concept of Nursing VII. Components of Baccalaureate Curriculum of Year of Study XIII. Subjects and Credit

カブール医科大学の歴史 I. History of Kabul Medical University n In 1933, The nucleus of higher education established as a Medical Faculty by the supervision of Turkish professor Refqi big with 8 lecturers.

　In 1985, the mentioned Medical faculty progressed to Medical institute and to Medical University in 200３.

アフガニスタン看護教育の歴史 History of Nursing　Education • the Ministry of Public Health. 　 In 1940, the Medical Faculty established 　　　the Primary Nursing School 　In 1962, the Secondary Nursing School 　 established, with the cooperation of　　 German government

• In 1976, the Primary Nursing School of Medical Faculty joined to this Secondary Nursing School, and after that has promoted to Health and Science Institution. • In May, 2006, Kabul Medical University established the Faculty of Nursing which is the first faculty of nursing in Afghanistan.

• II. 組織と管理体制：Organization and Administration Chancellor Executive Board of the University Vice CH. in scientific affairs EDC Research Center Vice CH. in education affairs Publication Academic Council Vice CH in Administrative affairs University Hospitals G. Director Finance Library Audiovisual Curriculum committee Evaluation committee Account Human resource Postgraduate committee PBL committee Curative faculty 11 Dept. Pediatric faculty 11 Dept Dentistry Faculty (Stomatology) Nursing Faculty Fundamental　 Public Health ４　 Dept Clinical Nursing 10 Dept. Research & Education

プライマリーヘルスケア Basic package of health services (primary care system) Components: 1 -Maternal and newborn health. 2 -Child health and immunization. 3 -public nutrition. 4 -Disability. 5 -Communicable diseases. 6 -Mental health(community management).

保健サービス（Basic Package of Health Services） -Community health workers -limited curative care -out patient. -Same services as a HP -But more complex out patient care -Will be staffed by a nurse , mid wife and vaccinators. - Covers area of 30000 to 60000 people -Offering BHCs, normal delivery, handling Some complications, grave care of child illness, complicated malaria, physiotherapy. - Covered 100, 000 -300, 000 population -30 -75 beds, for surgery, medicine, pediatrics, obst & gyn, and out patient for mental health & dental services.

医療サービス（Essential Package of Hospital Services） 1 -District hospital (DH): mentioned before. 2 - provincial hospital(PH): 100 -２００ beds, services offered by DH , infectious diseases, rehabilitation, nutrition, physiotherapy services as well. 3 -Regional hospital(RH): 200 -400 beds beside offered PH, ENT, Urology, Neurosurgery, Orthopedics, plastic, Cardiovascular and the other specialties. has training program. 4 -University　hospital: serve as RH, in addition practical field of medicine, Pediatrics, Nursing and Dentistry students and research. is under the authority of the medical university.

VI. 看護教育の理念：（Philosophy of Nursing Education） n n n Education is characterized by training the mind to think, gaining knowledge through engagement in intellectual activities, pursuing research and disseminating knowledge that is useful for all citizens and that also encourages their continuous intellectual growth. The education should help individuals to live usefully and happily, able to solve problems. Faculty of Nursing, Kabul Medical University will establish a strong system of education in order to enable our students to seek the goals including the highest quality of life of the people and progress of health care in Afghanistan.

V. 看護の理念（Concept of Nursing） n n n A graduate nurse serve all individuals equally A graduate nurse has sufficient knowledge on how to practice in health system for both treatments and prevention of diseases A graduate nurse gains professional attitude and skills to help both patients and clients in the community A graduate nurse associates with health care professionals, health workers, birth attendants, community volunteers and leaders A graduate nurse has sufficient capacity for taking leadership in nursing practice and administration in health care services.

看護理念図（Concept of Nursing） Community Hospital Basic Package of Health Service Essential Hospital Service Nursing

VI. 看護教育の目標 (Objectives of Nursing Education) n n use a framework of assessment, planning, implementation, and evaluation in providing nursing care in the (BPHS) and in the (EPHS) analyze situations using multiple sources of data in order to identify problems, possible courses of sector of their consequences. make and defend decision on basis of evidence and ethical considerations. communicate about health matters with members of the community.

n n n deliver basic preventive and curative care services for communicable diseases. use advanced knowledge to provide services within specialized areas. teach and work together with families and community health other workers. use basic nursing strategies and to promote health comfort. conceptualize, and analyze data for purposes of quality assurance and research. work collaboratively in the health care system.

VII. 学部カリキュラムの概要（Components of Baccalaureate Curriculum of Year of Study ） Fourth Year Anesthesia Nursing （１８）; Operating Theater Nursing （１８）; Critical Care Nursing （１８）; Psychiatric Nursing　（１８）Community Midwifery　（１８）; Public Health Nursing (１８)　 Nursing　（１８） Midwifery　（１８） (１８ Nursing Education（３）; Nursing Administration（３）; Nursing Research（１０）; Biostatistics　（２） Education（３） Administration（３） Research（１０） Biostatistics　（２）　　　　　　 Third Year Adult Nursing III　（４） ; Pediatric NursingⅠ（４）; Maternal NursingⅠ（３）; Psychiatric Nursing & III　（４） NursingⅠ Mental HealthⅠ(3); Community Nursing Ⅰ( ４); Adult Nursing　Ⅳ　（４）; Pediatric NursingⅡ（４）; HealthⅠ NursingⅡ Maternal Nursing　Ⅱ（４）; Psychiatric Nursing and Mental Health Ⅱ（３）; Community Nursing Ⅱ（ Nursing　 3) Second Year Adult Nursing I　(３）; Adult Nursing II　（５）; Anatomy and Physiology I　（３）; Pathology　（２）; I　 II　（５） I　（３） Pathology　（２） Pharmacology I　（３）; Health system （２）; Nutrition （２）; Anatomy and Physiology II （４）; I　（３） Physiopathology　（３）; Pharmacology II　（３）; Medical ethics　（１）; Foreign Language III （２） Physiopathology　（３） II　（３） ethics　（１） Law　(optional)　（１）; Foreign Language IV　（２） Law　 (optional)　（１） IV　（２） First Year Fundamental Nursing I　（３）; Fundamental Nursing II　（５）; Chemistry I （３）; Biology I, （３） II　 Chemistry II (Biochemistry) （３）; Biology II, （３）; Information Technology (Computer) （２） (optional); Physical Education　（１）; Art　（３）; Islamic Study I　（１）; Foreign Language I　（２）; Information Education　（１） Art　（３） I　（１） I　（２） Technology (Computer skill)　（２）; Psychology　（２）; Sociology　（２）; Islamic Study II ( １）; skill)　（２） Psychology　（２） Sociology　（２） Foreign Language II　（２）

Reference n n n n WHO The World Health Report 2006 WHO The World Health Report 2005 http: //www. cia. gov/cia/pubications/factbook/af. html WHO (2006) The World Health Report. WHO. JICA (2005). Report on Preliminary Evaluation of Medical Education in Afghanistan. JICA. International Research Center for Medical Education (2005). Proceedings: The 4 th Forum of International Cooperative Research for Medical Education. IRCME, Tokyo U. Afghan Ministry of Health (2003). Guidelines for Development of a Health Worker Certification System. Ministry of Health, Afghanistan. Afghan Ministry of Public Health, CDC & UNICEF (2002) Maternal Mortality in Afghanistan: Magnitude, causes, Risk Factors and Preventability. Ministry of Health, Afghanistan.

今後の課題カリキュラムの概要試案の評価と洗練 n 科目シラバスの作成のためのファカルティ力量開発 n 更なる教育支援のための協働計画 n

国際医療協力研究委託費 17 公 ６ アフガニスタンの看護学部カリキュラム 協働開発 Collaborative Development of Baccalaureate Program

国際医療協力研究委託費 17 公６アフガニスタンの看護学部カリキュラム協働開発 Collaborative Development of Baccalaureate Program