Building Healthcare Capacity in Pediatric Neurosurgery and Psychiatry in a Post-Soviet System: Ukraine.

Abstract

Many academic centers in North America are initiating global partnerships to build physician capacity in resource-poor countries. An opportunity arose to develop a pediatric program (Ukraine Paediatric Fellowship Program, UPFP) in Ukraine, a large European country in transition from a Soviet/communist political and social system. This entailed dealing with a centralized and rigid healthcare system based on the Semashko model of the former Soviet Union. Our capacity-building model has several key features: endowed philanthropic funding for sustainability, bilateral exchange of knowledge, a focus primarily on pediatric brain disorders, and team building. Centers for partnering are selected on the basis of need, receptivity to change, and participants' fluency in English. Ukrainian physicians attend month-long observerships in Toronto, and biannual teaching visits are conducted by Canadian clinicians. Over 5 years, 7 teaching visits have taken place, and 20 physicians have trained at SickKids Hospital in Toronto. Six Ukrainian children's hospitals are now collaborating with UPFP. New surgical procedures have been introduced, such as endoscopic ventriculostomy and corpus callosotomy. Patient referrals to regional institutions have increased, and new projects that affect fetal and infant neurodevelopment have been initiated (e.g., treatment of perinatal maternal depression and folic acid fortification of flour). Ukrainian participants rate the program highly in their evaluations. In a short time, UPFP has had considerable success in increasing physician capacity for improved pediatric care in regions of Ukraine. The keys to success have included focusing locally, selecting trustable partners, building incrementally, and creating interspecialty synergies.