Table of Contents
Justification of the budget by activity
Training.:
1) Winter School - Psychology and sociology in Public Health (was asked by participants of the Summer Seminar 2002)
2) Summer School in Vyborg
3) Seminar on EBM for Decision-makers
4) Distance learning course "Statistical analysis with SAS system, part II"
The situation with health in Russia is still far from the ideal, but at least in the training in Public Health the situation starts slowly change. The more and more institutes, including both undergraduate and postgraduate start to look for improvement public health curriculum. Earlier this year during competition announced by OSI (Soros foundation) for creation undergraduate public health curriculum two proposals has been judged to fulfill all requirements - one submitted by Association of the Schools of Public Health and the second, submitted by the several undergraduate training institutes of South Russia. The Public Health Schools faculties are now invited as experts to participate in discussion about shaping new undergraduate curriculum along with the heads of undergraduate training departments of medical schools. Now both parties are in process in creating joint curriculum. Also widens geographic of institutes participating in Public Health training both in courses organized by members of Association of the Schools of Public Health and abroad. All this show renewed interest in new Public Health in Russia.
As a representation of this was decision of the Collegium of Ministry of Health which explicitly stated support from the side of Ministry to creation of the Schools of Public Health.
The St.Petersburg School of Public Health exists as a part of Medical Academy for Postgraduate Studies from summer 1999. The idea of creation of the system for training of health care administrators of the different levels (from heads of the hospital Departments to the Heads of the Health Care Committees) has been proposed in 1998 jointly by the Health Care Committee of St.Petersburg, Ministry of Health of Leningrad Oblast and Swedish Eastern Europe Committee. Later the efforts of creating such establishment joined Finnish Ministry of Health And Welfare through STAKES.
At the beginning School operated one time a year, organizing only Summer Schools. Starting with the year 2001, School is organizing up to 6 courses per year, with total training time more than 550 contact hours.
Now St.Petersburg School has gained recognition as one of the leading centers for training in Public Health in Russia, especially in fields of prevention and evidence-based medicine/health technology assessment. Only one fact could illustrate this: in the spring this year OSI has announced competition for creating evidence-based clinical recommendations. More than 50 proposals has been submitted, only 5 (out of maximal 10) got an approval of expert committee, of them 2 were submitted by MAPS groups (other winners included Russian Cochrane Collaboration and Moscow Medical Academy). Moreover, OSI has asked St.Petersburg School of Public Health to organize workshop on evidence-based medicine to inform more wide groups of specialists about this movement.
In general now Schools of Public Health start to play increasing role in Public Health training in Russia. And St.Petersburg School of Public Health occupies one of the leading roles among them.
From the very beginning it important to allow specialists from different cities of North-West region of Russia to come to the School and be able to be trained. Keeping this in mind it was decided, that MAPS is providing for the School facilities and cover expenses of the MAPS lecturers and technical staff, participating in the courses, whereas to cover feeding, lodging for participants outside of the St.Petersburg and suburbs and expendables, School will apply to external grants (mostly from SEEC and partially from STAKES). Regulation of the Ministry of Health are not providing money for the covering of such kind of expenses which creates a barrier to the participation of the students, especially outside of St.Petersburg.
Also in 2001 a MPH-level curriculum for the School has been finalized and distributed among other Schools-members of the Association of the Schools of Public Health in Russia for comments and standardization.
Also administration of the School could accredit other courses delivered at MAPS or elsewhere to credit to the full MPH program (i.e. instead of one of three Summer Schools or elective distance learning course).
So, for example, Prevention track with accent on STD prevention could look as follows:
|
Course |
Length |
Type |
|
Foundation of Public Health |
30 |
Distance |
|
Basic Epidemiology |
50 |
Distance |
|
Survey Design |
36 |
Contact |
|
Prevention and Health Promotion |
108 |
Contact |
|
Health Care Management |
108 |
Contact |
|
Design and analysis of biomedical studies |
144 |
Contact |
|
Dermatovenerology |
288 (144 count to MPH track) |
Contact |
|
Methods of barrier contraception in prevention of STD |
40 |
Distance |
|
Women's health |
50 |
Distance |
|
Total |
710 |
Also student will be expected to write Master Paper on questions of STD prevention and control, i.e. "Modeling of HIV spread among heterosexual population of Russian Federation"
In case of basic courses organized once per year, it will take at least three years for student to cover MPH program. Some special courses (like familistics) could be even more rare, which will take more time to completion course. If financing will permit, more courses will be organized with corresponding shortening of the training time
In the year 2002 the first round of obligatory courses has been completed so, that all themes in the curriculum will be presented to the students at least one time. In the end of 2001 the School has been registered as non-profit organization under name of "St.Petersburg Institute for Public Health" (Russian name School is used on the formal education level only).
One approach to ensure sustainability of the project, that will be tested by St.Petersburg School of Public Health in 2003 is regionalization - conducting courses off St.Petersburg, in large cities of North-West region of Russia. In 2003 it is planned to conduct Summer School in Vyborg, also it is proposed to organize Workshops in Murmansk and Vologda. The regionalization of the School work is based on fact that MAPS has started creation of regional Departments (Pskov, Murmansk), and increased collaboration with regional Health committees.
Regionalization could work as cost-containment mechanism by decreasing travel cost for participants from this region, by willingness of regional health committees to cover lodging expenses and sometimes even trainers costs.
To ensure sustainability and provide foundation for the School operation in the future next year (2003) it would be necessary to concentrate less on training and more on capacity-building. In terms of capacity-building during previous three years of School operation the curriculum has been created and tested on students, School is recognized by partners in Russia, faculty has been trained, new approaches to training has been tested. Now more attention should be paid to development materials for distance learning (books in Russian and Web-based materials), library to ensure supply of books for preparation of the new courses and research activity. Also courses on regional bases should be organized.
In the year 2003 it is planned to organize 3 courses, 2 in Russian, 1 in English and 1 distance learning course. Also 3 seminars are planned.
The seminars are:
According to the system, used in the St.Petersburg School of Public Health, Winter and Summer Schools are considered a part of obligatory course, whereas other courses organized during a year constitute electives, so-called deep courses.
Other activities of the School will include selecting and purchasing books for the library, selecting, translating and publishing textbooks in Russian for the students and research activity.
|
MAPS contribution |
|
|
Training |
15963 |
|
Library |
7600 |
|
Translation/Russian |
1272 |
|
Sub-grants |
360 |
|
HTA lab |
3830 |
|
Meetings |
|
|
Total |
29,025 |
Total cost by budget lines (excluding MAPS contribution)
|
% total |
|
|
PERSONNELL COSTS |
|
|
Total personnel costs |
21.1% |
|
Total Travel |
49.1% |
|
Total non-expendable |
7.4% |
|
Total expendable |
5.7% |
|
Total other direct |
12.7% |
|
Total indirect |
4.0% |
50 participants, 20 outside St.Petersburg, two weeks
Feeding will be provided at the MAPS filial N 2 cafeteria and is fixed on a low number of 13 USD per day per participant, no feeding coverage will be provided on weekend or on days before or after the training days. Lodging at the MAPS hostel at a price 17 USD per night will be covered for 20 participants from North-West region of Russia (Petrozavodsk, Novgorod, Pskov, Murmansk, Leningradskaya Oblast) and, probably, some other regions of Russia (Tver, Cheljabinsk, Rostov).
Total training time during the course will be 92 hours (or 9.2 academic hours per day).
During this course we are planning to invite 4 teachers from Moscow (Moscow Medical Academy for Postgraduate Studies and Al--Russia Center for Prevention) with covering their travel expenses (airfare - roundtrip Moscow-St.Petersburg-Moscow - for a price of 140 USD, their per diem/in city travel expenses of 10 USD and fee of 19 USD per hour for 4 hour-lecture + employer tax (36.5%) and income tax (12%). Total cost for one lecturer is 266.7 USD (150 travel expenses and 116.7 USD lecture expenses (employer tax is paid by organization, in this case School; income tax is also deducted )). Total training time covered by three lecturers will be 12 hours.
We are also plan to invite 2 Swedish lecturers for total training time of 18 hours. The coverage for them should include airfare (about 500 USD), per diem (20 USD) and lecture fee (70 USD per hour). Total cost will be 2300 USD for two lecturers.
Rest of the lecture fees will be covered by MAPS faculty, at the cost of 1808 USD (62 training hours * 19 USD per hour * 36.5% employer tax * 12% income tax).
All participants will be presented with lecture handouts, Xerox copies of some materials and articles, the lecturers will be provided with LCD, overhead, possibility to print out transparencies, with flipchart, etc. All those expenses will be covered from "Expendables" budget line, which is for two-week course estimated to be about 10 USD per participant (500 USD total).
The School also needs to cover expenses that arise in preparing the course from the side of financial matters; those include: bank commissions and fees, tax office reports (regular and on the money received), bank transfer preparation, office work on tickets, invitation and booking, small office supplies, etc. Employing professional accountant covers most ( but not all) of this work. Preparatory translation services are also covered under administrative budget line, as well as any materials Web-publishing. All those expenses are included under umbrella of Administrative costs and are estimated to be 6% of the total sum spent on the course on Russian side.
50 participants, two weeks
Feeding will be provided at the training site and correspondingly will be cheaper with about 12 USD per day of which 8 will be covered with SEEC grant support and Vyborg health administration covering rest of the cost (4 USD per participant per day, 2000 USD total)
Lodging will be provided for the St.Petersburg teachers on the seminar. At least five people from the School should be present during each day in Vyborg (2 lecturers, 2 workgroup leaders and course leader). For three of them (workgroup leaders and course leader) provision of lodging would be necessary at a non-sponsored price (20 USD per night)
Total training time during the course will be 92 hours (or 9.2 academic hours per day).
We are planning to invite 3 Swedish lecturers for total training time of 18 hours. The coverage for them should include airfare (about 500 USD), per diem (20 USD) and lecture fee (70 USD per hour). Total cost will be 2820 USD for three lecturers.
Rest of the lecture fees will be covered by MAPS faculty, at the cost of 2575 USD (74 training hours * 19 USD per hour * 36.5% employer tax * 12% income tax).
As all teachers will come from St.Petersburg, it is necessary to cover their trip to and from Vyborg. Some days (opening/closing, Monday/Friday) there will be more teachers traveling, some days less. Included also travel of translators. In the average there will be 4 trips per day at a cost of 7 USD per trip, totally 280 USD.
Each teacher should get per diem, as training commence outside of St.Petersburg city. Per diem is 15 USD per day and is not covered for workgroup leaders.
Expendables like transparences, flipchart, paper for copy-machines, etc. included in expendable line and decreased from usual 10 USD per person to 8 USD per person with rest 2 USD per person covered by Vyborg Health Authority (100 USD).
Administrative cost will include banking costs, as during winter school, but also phone and fax services (Vyborg is in a long-distance charging area), as well as additional expenses on mobile phone connections for faculty, staying in Vyborg during the course (on top of usual in-city prices and due to increased volume). Preparatory translation services are also covered under administrative budget line, as well as any materials Web-publishing. Correspondingly administrative expenses are increased to 10% of the total sum.
3) Seminar on EBM for Decision-makers
30 participants, 3 days
Feeding will be provided at the MAPS cafeteria and is fixed on a low number of 12 USD per day per participant. Lodging at the MAPS hostel at a price 20 USD per night (lux) will be covered for 2 teachers from abroad.
Total training time during seminar will be 27 hours (or 9 academic hours per day).
We are planning to invite 2 Swedish lecturers for total training time of 6 hours. The coverage for them should include airfare (about 500 USD), per diem (20 USD) and lecture fee (70 USD per hour). Total cost will be 1460 USD for two lecturers.
Rest of the lecture fees will be covered by MAPS faculty, at the cost of 610 USD (21 training hours * 19 USD per hour * 36.5% employer tax * 12% income tax).
All participants will be presented with lecture handouts, Xerox copies of some materials and articles, the lecturers will be provided with LCD, overhead, possibility to print out transparencies, with flipchart, etc. All those expenses will be covered from "Expendables" budget line, which is for three-day course estimated to be about 3.3 USD per participant (100 USD total) or 1/3 of costs for two-week (10 working days) course.
Administrative cost will include banking costs, as during winter school, also phone and fax services, invitation preparation and distribution. Preparatory translation services are also covered under administrative budget line, as well as any materials Web-publishing and Internet access for demonstration during seminar. Seminar hall leasing, as training conditions for decision makers should be different from regular courses, is also included into administrative costs. Correspondingly administrative expenses are calculated to be about 300 USD (banking/accountant cost + taxes 185 USD per month, leasing, phone, Internet, mail, fax, preparatory translation is 115 USD).
4) Distance learning course "Statistical analysis with SAS system, part II"
10 participants
Most of cost for distance learning course will be for covering course preparation.
The course is planned to have length equivalent to the of 36 hours of full-time training (FTEH) (one week face-to-face training course), equal to the three-week distance-learning course. Such length of course demand the preparation of the at least 360 pages of text and about 100 MCQ.
Total time demands will be as follows
Materials preparation: 36 FTEH * 30 hours/FTEH = 1080 person-hours
Materials Web-publishing: 360 pages * 1/6 hour/page = 60 person-hours
MCQ preparation: 100 MCQ *1/6 hour/MCQ =17 person-hours
MCQ Web-publishing: 100 MCQ *0.1 hour/MCQ =10 person-hours
(estimations of time are made from preparing distance learning courses at MAPS and from expert estimations of experts from CDC Training Division, Atlanta, USA; Open University, London, UK; St.Georges Medical School, London, UK))
Total time:
Faculty time, materials preparation: 1097 person-hours
Web-publishing: 70 person-hours
In the preparation of the course, there will be at least 250 pages of English-language materials from different books on the SAS system translated, including excerpts from SAS User guide vol. 1 and 2. Categorical Analysis using the SAS system, Applied multivariate statistics with SAS software, Survival Analysis with SAS software and others. Translators will be paid 3 USD per page (1800 signs) plus all necessary taxes.
The materials will be reviewed and used in preparing the course itself.
The time cost for the course development will be donated to the project at the following estimated cost:
1097 person-hour at a rate 10 USD per hour = 10970 USD
Cost of preparation of materials for Web-publishing at a rate of 7 USD per hour with taxes will be covered from the grant means (490 USD).
Expendables will include coverage of CD-ROM disks, floppy disks, necessary additional equipment for the computers (LAN card, CD-RW etc.) at the total cost 520 USD.
For training of students it would be necessary to have valid license on using SAS software on each of the trainees computer. As the full license is too expensive to buy for all students from grant allowance, organizers has decided to purchase 11 copies of the book "SAS learning edition" which contains v.8 SAS software with license for BASE/SAS and SAS/STAT software at a cost of 1320 USD
Administrative cost will include banking costs, as described for winter school, hiring translators, handling bank transactions for them and people in Web publishing, etc., also phone and fax services, invitation preparation and distribution. Administrative expenses are calculated to be about 300 USD (banking/accountant cost + taxes 185 USD per month, for 1.5 month during course preparation for a total of 270 USD, phone, fax and invitations - 30 USD).
At present library at the School of public health is only in the process of preparation. It consists of two parts: paper library and electronic one.
Paper-based library
Paper library is mostly supplying with foreign-published books faculty during preparation of the lectures and seminars. Due to limited amount of volumes (all of them exist in a single copy) no free access for students is granted, but is planned to be in future. At present paper library holds about 250 foreign books (state of 15.10.2002) in the library at a total cost of about 20,000 USD.
40% of them has been purchased with OSI funds, 16% from grants given by USAID (administered by IREX) and about 13% from grants administered by STAKES. Until now Swedish contribution has been relatively modest in paper library (4% of books), but provided almost complete coverage for subscription in electronic library (together with OSI). In the paper library books are classified as follows by the major topic:
40% of them about epidemiology,
17% on statistics
8% on infectious diseases
17% on prevention
18% on management
19% on HTA (some belongs to more than one theme)
We are applying to SEEC for purchasing additional at least 50 volumes during 2003 at the total cost of 4000 USD. Money will be better spent in Sweden with books then sent to Russia as purchasing of foreign special literature in Russia is not very easy.
Electronic library
Electronic library is housed at the Information center. At present information center provides access to:
1) EBSCO full-text database, including (Business Source Premier, MasterFILE Premier, Newspaper Source, Clinical Reference Systems, Health Source: Consumer Edition, USP DI Volume II, Advice for the Patient, Business Wire News, Academic Search Premier, Health Source: Nursing/Academic Edition)
E-library (Full-text database of journals from 31 publishing house (1384 journals total))
2) Cochrane Library 2001
3) International Journal of Medical Practice 1996-2000
4) Russian Medline 1988-2000
5) MEDLINE (PubMed, with training)
6) Free Journals on Internet (and limited access journals: BMJ, Lancet, NEJM, JAMA, AJPH, ACP Journal Club)
Total cost of electronic library operation per year is
3 person working full-time salary and taxes 7100 USD
Subscription to EBSCO-Med and E-library (part not covered by OSI) - 1500 USD
Cochrane library - 200 USD
Russian MEDLINE - 200 USD
Internet access - 1000 USD per year (leased line)
Total operation cost - 10,000 USD
This year we are applying to the SEEC to provide coverage of subscription to electronic databases and journals a total cost 1900 and half of the cost of Internet access (second half will be covered by MAPS)
As was indicated above now St.Petersburg School has gained recognition as one of the leading centers for training in Public Health in Russia, especially in field of evidence-based medicine/health technology assessment. But not to lose momentum it is necessary to have people, who will devote significant portion of their time to the development of HTA approaches and will help faculty and students at the School to use evidence-based methodology in their work, lectures and seminars. To this end, the School, together with MAPS and SEEC has created HTA Laboratory, which is a part of College of Public Health at MAPS. Unfortunately, government-provided salary for scientists and people working at such lab is much lower than for faculty, correspondingly additional support is needed if we are not to lose gifted people working there. Correspondingly it is the only subproject with directly planned salary. The tasks for the HTA lab during 2003 will be: development of the training materials for courses on EBM (continuation of the series of books Basics of EBM part III Search for the literature; part IV Randomized controlled trials: design and analysis, part V - "Evidence Basis of Diagnosis") and participation in training. Development of POEM database (patient-oriented evidences that matters). Translation of the selected HTA reviews (including Cochrane reviewes. Web-publishing of translated and created materials
Breakdown of the costs on the School side
Two persons, working at the lab will receive salary addition of 75 USD per month. For 12 months with taxes it will be 2752 USD. Basic salary & taxes provided by MAPS is 2300 USD for two persons. Provision of E-mail/Internet access for the laboratory personnel will cost 155 USD per year, calculated from 40 hours per month dial-up access at the lowest rate for 12 months for two persons.
120 USD are planned for two persons as membership fees for International Society for Health Technology Assessment which include subscription to the International Journal of Health Technology Assessment (yearly subscription rate 108 USD).
For the work on preparing systematic reviews it is necessary to have possibility to purchase copies of articles which are unavailable in the local libraries. This, together with necessary computer expendables (printer cartridges, paper, Xerox toner, etc) forms expendable budget line.
Administrative costs include coverage of bank expenses, logistic, and coverage of overhead expenses incurred during providing activity of informational center. They are 75 USD per month.
Office lease is MAPS contribution. At present MAPS is providing lab with a room at the filial number 1, with area 17 square meters and all communications. Cost of leasing is 7.5 USD/sq.m.*12 mnth* 17 sq.m.=1530 USD
Creation of Russian language books/ translation.
One of the problems, faced by people providing training in Public Health in Russia is a lack of good textbooks and other teaching materials. To alleviate this it is possible to write Russian books, but it will be time until material for such books will accumulate and they eventually will be written. The task of this part of the project is to support of creating books in Russian that will eventually start to fill gap in knowledge among non-English speaking Russian health care workers. To address this issue two approaches are possible - translation of existing books and creation of originally Russian books. In both cases it should rest on some additional financing as major publishing houses are not very interested in publications devoted to Public Health as they foresee not wide market for those books and if they will pay for the whole cycle the final price will be such high, that there will be no demand for the books. Correspondingly, by accepting part of the costs associated with preparation and translation of the books, final price could be lowered substantially. The project includes financing of two kinds: translation of books (two or more) and getting in touch with foreign publishing house to get permission for publishing this book in Russia; preparation of the book on basic epidemiology and covering publishing expenses.
First stage of the project will be selection and translation of the two or more books. First selection round will be made by several experts in the field. Examples could be:
Book on prevention and health promotion (by A.Rimpela) - translation and publishing will be covered by STAKES
User's Guide to Medical Literature (by G.Guayatt et al.)
Health Economics (by C.Phelps)
The translation will be made with fixed budget of 5,885 USD; the sum, which is sufficient for translation of 1100 pages (1800 signs) if translator is paid 3.5 USD per page + taxes. For comparison it should be noted, that "Health Economics" is 963 translation pages long, User's Guide to Medical Literature is 1200 translation pages long.
The publishing will be covered for about 4000 USD per book, if cost will be higher, the cost splitting should be negotiated with publishing house.
Second translated book will be published with money, received from STAKES.
Second stage of the project will be preparation of the book on epidemiology and publishing it. Expenses include author(s) compensation and publishing cost. Publishing cost is fixed on 2000 USD and author(s) compensation on 3 USD per page + taxes. In this case total cost of the 250 printed pages book (360 typed pages) will be 3664 USD.
This information is presented below in condensed form
Administrative cost for this part of the project will be covered from administrative costs of HTA lab and training activity.
MAPS and School will donate time of experts and assistants work at the cost of 1272 USD (3 meeting of three experts for 3 hours per book = 540 USD and 0.5 USD per page for reviewing by assistant = 731USD)
The support for research activity of Russian Public health specialists is a top priority in the School of Public Health. Many young scientists are participating in the large projects, but there should also be a possibility for them to prepare their own research paper or research work on a question, important for the Russian Health Care. We are applying for the of 2000 USD which will be awarded to two young scientists (under 37 years of age) who will submit a proposal for study a question of economical results of health care intervention and/or analysis connected with health systems development. Scientists should not hold senior position inside MAPS or Schools of Public Health.
Proposal should be written in English and will be submitted first to Russian committee for approval and estimation of relevance of the proposal to Russian situation, and then will be directed to SEEC for final approval. The grant itself should not be transferred to Russia until subgrantees will write a proposal and then submit them to SEEC.
The proposal should contain budget, including two major sources of expenses: individual financial support and expendables. No laboratory equipment could be purchased with the funds, purchasing of computers should be explained in terms of necessity for achieving goal of the project. All financial support should include all necessary taxes. The total grant sum could be used for financial support (after taxes size of support is 654 USD) or for expendables/books/supplies or any combinations of them.
Final responsibility for supervision of the projects and their completeness and reporting rests with the School of public Health Administration. School will have the right of prematurely terminating sub-grant with return of remaining funds to SEEC.
Recommended budget breakdown for Subgrants:
Individual Financial Support - 400 USD
Taxes - 210 USD
Expendables (paper, cartridges) - 100 USD
Books & journals - 150 USD
Internet & E-mail - 140 USD
Administrative costs for grant administration, accounting etc, are 25 USD per grant (50 USD total)
MAPS and School will donate time of experts at the cost of 360 USD (2 meetings of three experts for 3 hours per project = 360 USD)
To ensure reliable interaction between international teams participating in the School development it would be necessary to organize annual meeting of the School Administration with SEEC and SBU in Stockholm, Sweden. Also, for seamless interaction with other Schools of Public Health in Baltic Region it would be necessary to participate in BRIMHealth meeting in Goteborg, at the NHV