Ensam nou capav: together we can decrease CNCD for our children as a model for the world by the 5-2035 community health vision

By considering health care an inalienable right and a collective responsibility, the 5-2035 plan conceives of a new class of health professionals called CHNPs (community health nurse practitioners). These CHNPs will work closely with the citizens they serve and will revolutionize health in Mauritius as a model for the rest of the world by being frugally innovative, driven by the SEED-SCALE (Self-Evaluation for Effective Decision-making + System for Communities to Adapt Learning and Expand) model for sustainable community empowerment [1].  The 5-2035 plan envisions an integrated and sustainable community-centered health care and human development with the 5-2035 CHNP at its heart.  Let us here explore in overview what we mean by these concepts. For a full detailed analysis, please request the 5-2035 White Paper  Introduction: the 5-2035 CHNP Innovation Economists are fond of noting that there are no bad people, only bad incentives.  In 5-2035, we will tap into communities to incentivize individuals towards better health and quality of life for them and their children while standardizing and improving health care delivery. At the center of this innovation is the 5-2035 concept of the community health nurse practitioner (CHNP) supervised by a community health doctor (CHDr).  Each 5-2035 CHNP will closely care for 1,000 citizens to transform their health, lifestyle and quality of life. The CHNP will work with the community health cell (CHC) elected from the 1,000 citizens, and will be motivated by 3 pillars of practice: 1) clinical excellence; 2) community engagement, and 3) research and training. Traditionally, nurses have shared an immense burden of health care delivery in the inpatient setting.  In the mid-sixties, Loretta Ford, a nurse, and Henry Silver, a medical doctor, at the University of Colorado created the first training program for nurse practitioners (NPs), and the designation was thus born [2].  At its very inception, health care prevention and primary care were at the center of NP training.  Today, in the United States alone, there are over 230,000 licensed NPs.  Practically, most NPs evolve in the outpatient setting and work under supervision of a medical doctor. To conceive of the 5-2035 CHNP, from a curriculum and practice point of view, we have taken the essence of the traditional NP function and maintained the clinical excellence pillar while vastly expanding the community engagement, and research and training functions in our concept.  From a philosophical point of view, we view the CHNP as equal part clinician, community organizer and researcher. In our 5-2035 CHNP curriculum, we are therefore able to draw from traditional fields of clinical practice, community engagement and clinical research, and amalgamate them into one health care professional. This curricular starting point of the three pillars of clinical excellence, community engagement and research and training (see Figure below) in the 5-2035 CHNP make-up generates an exciting and profound potential that has the promise to revolutionize care of 21st century CNCD in Mauritius as a model for the rest of the world.  In our opinion, the failure of health care systems around the world battling high prevalence of CNCD has been to consider these three vital domains of primary care activity in silos.  In outlook and practice, we fundamentally coalesce these components into a new type of health care professional, the 5-2035 CHNP.  When we apply the power of our 5-2035 CHNP to the SEED-SCALE model of community empowerment and modern research techniques, we are convinced that the outcomes will be spectacular. This innovative system of community health with the 5-2035 CHNP at its heart will ensure the following:
  1. 1.  For citizens with CNCD, close follow-up with a health professional team (the CHNP, supervised by a CHDr), akin to a ‘personal coach’ through the journey of optimizing medical management of their condition.  Every individual is unique, facing individual pressures and influences that prevent them from adherence to their medical regimen or in some cases, a sub-optimal regimen.  The CHNP will get to know each patient as an individual who is part of a family living in a community to generate the understanding of what tools they need to succeed in their medical management and how best to implement them;
  2. 2. Community engagement to explore how individuals in each local community can help each other collectively for behavior change to adopt better lifestyles, and
  3. 3.  A culture of continual learning through research and training that will enable iterative improvement towards generational behavioral change needed to stall, and then curb the rise of CNCD in Mauritius as a model for the world.
At capacity, 1,500 CHNPs and 150 CHDrs, supported by public / private partners, will define frugally innovative health care delivery as a model for the world.  Our internal very rough estimate shows that if we make the 5-2035 vision a reality in Mauritius, we could stand to save Rs 158 billion (~$5B) by the year 2035. Introducing the SEED-SCALE* model for sustainable community empowerment for 5-2035 *Self-Evaluation for Effective Decision-making + System for Communities to Adapt Learning and Expand The key to the SEED-SCALE model [1] is that to build better lives, we do not necessarily need technical breakthroughs, but we need to change behavior at the community level. In what we view as an exquisite syncretism of the Koranic concept of Umma | Shura | Maslaha (community | mutual consultation | public interest), American philosophy of pragmatism and Indian practice of jugaad (frugal innovation) in practice, SEED-SCALE re-imagines the relationship between stakeholders, content experts, officials and the community itself (Fig. above). In the traditional model (Fig. above, A), there is a one-way top-down flow from content experts who advise government officials, who then implement programs in communities.  By this mechanism, grassroots effort often fail because larger, more complex systems are required for people in communities to learn how to take advantage of opportunities, and this traditional model is usually in a tight timeline with changing content experts and officials with no follow-through and sustainability. Effective change, write the Taylors [1], grows from the community level, but the bottom-up growth does not happen on its own.  Grass provides an analogy.  To grow the roots, grass needs top-down nourishment from sun and rain (government help) and outside-in nourishment from fertilizers and micro-nutrients (content experts).  Likewise, the SEED-SCALE approach (Fig. above, B) builds from what should be self-evident: on their own, communities are unlikely to make significant (behavioral) changes. Mobilizing community growth is a complex process, requiring a three-way partnership of top-down support from government, outside-in innovation from experts and bottom-up hard work from local people, seamlessly interacting with each other.  The 5-2035 vision with the CHNP / CHDr team at the center, motivates new and existing institutions to unleash the power of SEED-SCALE to strengthen communities to work towards the goal of 5-2035. The SEED-SCALE system views community development akin to successful parenting: the child must believe in their capacity and build on strengths.  Communities that are skeptical about their potential may endure, accommodate, or pretend, but they will not develop.  Privileged starting points and resources do not matter as much as resourcefulness and positive conviction about the future.  A vision, that is shared in the community, a conviction that the common future will be better, is the foundation for development. Please see the 5-2035 Executive Summary to have an overview of our plan or request the full 76-page 5-2035 White Paper  for further details.  The GFCH Mission Statement and Charter can be found here. If you have any specific questions, please do not hesitate contact us.  Our response time may be slow as all of us at the GFCH are volunteers for the 5-2035 mission and have full time commitments. Thank you for your understanding and patience. References
  1. 1.  Taylor-Ide, D. and C.E. Taylor, Just and Lasting Change. 2002, Baltimore, MD: The Johns Hopkins University Press.
  2. 2.  O’Brien JB.  How Nurse Practitioners Obtained Provider Status: Lessons for Pharmacists 2003 Am J Health Syst Pharm 60(22): 2301-2307
  3. 3.  Donaldson, M.S., et al., eds. Primary care: America’s health in a new era. 1996, National Academy Press.