In April 1997, the Turkmenistan government declared Order 55, "Improving the Organization of Primary Health Care by Implementing Family Practices for Serving the Population." Turkmenistan's intent was to cover the nation's nearly 5 million people (55% residing in rural areas) by a family practice system. The Ashgabat/North Dakota partnership was crafted by North Dakota nurses and funded through American International Health Alliance/USAID to assist in meeting this ambitious goal. Using the "train-the-trainer" model, a series of collaborative activities between the North Dakota partners (the College of Nursing, State Health Department, School of Medicine and Health Sciences, and two rural health centers, St. Aloisius and West River) and the Turkmenistan Ministry of Health were implemented to strengthen primary care services. Goals for the partnership are to: provide short-term training in primary care, increase primary care continuing education for physicians and nurses, demonstrate quality primary health care delivery in a model unit, improve access of primary health care professionals to current medical information, and contribute positively to Turkmenistan's primary health care reform efforts. A primary care curriculum was developed collaboratively with the Turkmen partners, and a training center officially opened May, 2001. A 4-week course in primary care skills and concepts is taught to Turkmen nurse-physician teams by Turkmen colleagues trained in primary care by the North Dakota partners. Internet skills are important tools for ongoing communication and updating nursing and medical practices. Turkmen trainers visit North Dakota for intensive skill and content training and to understand US primary health care. North Dakota nurse-physician teams visit Ashgabat to further the skills of the Turkmen trainers and to continue to enhance Ministry of Health support for the Center. To date, over 125 teams have been trained, the Center is being replicated in Lebab, Turkmenistan, and the partnership is expanding into Dushanbe, Tajikistan.
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