Project Title

Capacity Building in Clinical Infectious Diseases for APEC Economies 

Project Year

2013   

Project Number

HWG 06 2013A 

Project Session

Session 3   

Project Type

Standard 

Project Status

Completed Project   
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Project No.

HWG 06 2013A 

Project Title

Capacity Building in Clinical Infectious Diseases for APEC Economies 

Project Status

Completed Project 

Publication (if any)

 

Fund Account

APEC Support Fund 

Sub-fund

ASF: Health and Emergency Preparedness 

Project Year

2013 

Project Session

Session 3 

APEC Funding

146,720 

Co-funding Amount

90,400 

Total Project Value

237,120 

Sponsoring Forum

Health Working Group (HWG) 

Topics

Health 

Committee

SOM Steering Committee on Economic and Technical Cooperation (SCE) 

Other Fora Involved

 

Other Non-APEC Stakeholders Involved

 

Proposing Economy(ies)

Singapore 

Co-Sponsoring Economies

Brunei Darussalam; Indonesia; Philippines 

Expected Start Date

01/03/2014 

Expected Completion Date

31/12/2014 

Project Proponent Name 1

Leo Yee-Sin 

Job Title 1

Associate Professor 

Organization 1

Institute of Infectious Disease and Epidemiology, Communicable Disease Centre 

Postal Address 1

Moulmein Road, Singapore 308433 

Telephone 1

65-63577901 

Fax 1

65-62524062 

Email 1

yee_sin_leo@ttsh.com.sg 

Project Proponent Name 2

Not Applicable 

Job Title 2

Not Applicable 

Organization 2

Not Applicable 

Postal Address 2

Not Applicable 

Telephone 2

Not Applicable 

Fax 2

Not Applicable 

Email 2

Not Applicable 

Declaration

Associate Professor Leo Yee-Sin 

Project Summary

This is a training proposal on infectious diseases that covers 4 key areas: HIV Medicine, Infection Control, Antimicrobial Stewardship and Outpatient Parenteral Antibiotic Therapy. The training will be organised by Institute of Infectious Disease and Epidemiology, training sites include three major tertiary teaching hospitals:  Tan Tock Seng Hospital, National University Hospital and Singapore General Hospital. Training activities include lectures, tutorials, non-hands on close observation of clinical practices in all 3 training locations. Leveraging on multi-centre collaboration, this program provides comprehensive experience on infectious disease management.  Through trans-national sharing of experience and expertise, it enables our participants from the developing APEC Economies to gain greater insights, wider knowledge; foster greater interactions and to encourage future collaborations with the APEC members.

The program aims to start in first quarter of 2014 providing one to three months of attachment to each of this training topic.  A total of 4 training places; pending on demand, certain topic may host more than one attachment. This program is suitable for physicians from APEC and selected non-physician practitioners’ active in the field at their country of origin.   

Relevance

Infectious diseases remain a major public health problem in the APEC region. In this proposal we focus on four key areas; HIV, antimicrobial stewardship, outpatient parenteral antibiotic therapy and infection control. 

The South and South-East Asia ranks second in shouldering HIV burden in the world (http://www.who.int/hiv/data/en/). This area of focus is selected because of our extensive experience in treating the majority of HIV patients in Singapore. This project has tied in well with the commitment from the recently concluded APEC Ministerial Meeting (4-5 October 2013, in Bali, Indonesia.) as it aims to work towards zero new HIV infections, zero discrimination and zero HIV-related deaths, especially through HIV prevention programs in the APEC region. The project designs to elevate knowledge and skill of participants in HIV management. The Institute of Infectious Disease and Epidemiology (IIDE) comprises of the Communicable Disease Centre (CDC) and many other components of ID services in Tan Tock Seng Hospital are well-placed to coordinate and conduct this training.  CDC, the National HIV Referral Centre sees more than 2500 HIV patients on regular follow-up. Our hospital data show that >90% of our patients who are on highly active antiretroviral therapy are virologically suppressed. This training will help participants will enhance their HIV management that will enable them to strive towards the aims set forth at the APEC Ministerial meeting.

Antimicrobial resistance is a global concern that impacts the APEC economies (http://www.who.int/drugresistance/en/index.html). Antimicrobial resistance has been highlighted by the World Health Organisation (WHO) on World Health Day 2011 as an urgent public health issue as many APEC Economies have high prevalence of antimicrobial resistance. In reducing the emerging and spreading of multi-drug resistant organisms, we put together 3 related training modules - Antimicrobial Stewardship Program (ASP), Infection Control and Outpatient Parenteral Antibiotic Therapy (OPAT). This area of focus was selected as ASP is well established in many developed areas including Singapore and our hospital that faces the challenge of multi-drug resistant bugs that are difficult to treat and carry poor outcomes. Participants armed with this knowledge and skill will be able to integrate key principles into their areas of practice with an aim to reduce the emergence of resistant organisms.    

While reducing the emergence of multi-drug resistant organisms, infection control is key to stop the spread of these highly resistant organisms in the health-care settings (http://www.cdc.gov/hicpac/mdro/mdro_0.html).. The project would also address the importance of reducing Healthcare-Associated Infections (HAIs) via knowledge transfer and implementation of infection preventive and control policies. This area of focus is selected as we have a comprehensive infection control programme in each of the 3 training hospitals.  According to WHO, HAIs affect hundreds of millions of patients worldwide each year and estimates the prevalence in hospitals to be 5-12% in developed economies and 5-19% in developing economies. WHO has also recommended to APEC economics to consider recognising the tremendous health and economic burden HAIs places on economies, health systems, patients and their families, and healthcare workers and to recognize that HAIs threaten to undermine the gains achieved and investments made in our health care systems. This training will come in handy in preparing the participants to enhance their infection control program at their respective hospital. 

This project would also introduce Outpatient Parenteral Antibiotic Therapy (OPAT) in the APEC region. OPAT aims at providing patients with cost-effective outpatient parenteral antibiotic treatment to reduce their risk of nosocomial complications and inpatient hospital length of stay. OPAT is an established infectious disease programme in many developed countries including the United States, Canada, the United Kingdom, Australia, New Zealand and parts of Europe. In a recently published global review of OPAT (http://www.ncbi.nlm.nih.gov/pubmed/24200469), there is a lack of OPAT as a key service in many APEC economies in contrast to its presence in North America, Europe, Australia and New Zealand.  We have chosen to offer this because OPAT has been established since 2001 with comprehensive services at Tan Tock Seng, National University and Singapore General Hospitals.

We reckon that developed APEC Economies have sufficient manpower in public health epidemiology, microbiology and infectious disease physicians, but in developing APEC Economies, there may be a shortage of infectious disease physicians and inadequate infectious disease skills level among general staff. This lower than normal human resource trained staff might  limit the clinical leadership needed in the development of Infection Control, Antimicrobial Stewardship, OPAT and HIV Medicine. This training program provides the knowledge and skills to enable participants playing this leadership role in transforming the infectious disease and infection control landscape at their respective countries.

The network of professional relationship built up with this project will strengthen outbreak communications and responses. This aligns with APEC 2013 leaders’ recognition that resource scarcity presents an immense challenge that limits our ability to pursue economic growth and grave economic consequences of natural and human-caused disaster. This recognition prompted one of the proposed steps of engaging in capacity building efforts and effective regional and global partnerships across the public and private sectors with the aim of addressing emerging infectious diseases and strengthening public health systems.

Objectives

a) Offer clinical fellowship in the training of participants from APEC Economies in 4 specific domains including Infection Control, Antimicrobial Stewardship, Outpatient Parenteral Antibiotic Therapy and HIV Medicine

b)  Upgrade the knowledge and skills of participants from APEC Economies in the above four domains

c)  Prepare participants from APEC Economies in their readiness to build capability and capacity in their own Economies in the above four domains

d)  Build on-going bilateral relationships between training providers and trainees to facilitate better      collaborations and to strengthen outbreak communications and responses 

Alignment

This proposal falls in the domain of healthcare and in particular infectious diseases. Infection Control, Antimicrobial Stewardship and OPAT can all contribute to the containment of antimicrobial resistance, with OPAT facilitating the early discharge of patients from over-crowded hospitals with high risk of cross-transmission of multidrug-resistant organisms. HIV Medicine is an area of need in many APEC Economies albeit outside of the over-arching domain of antimicrobial resistance.

The proposal fulfils many priorities under the APEC Leaders’ Growth Strategy, namely:

(1)  Inclusive growth [human resources development]

(2)  Secure growth [strengthening health system and prevention and control of infectious and non-communicable diseases, and emergency preparedness and disaster management]

(3)  Innovative growth [education, and promoting innovation policy and research collaboration]

Additionally, this project supports two recommendations set out by APEC Ministers and Leaders that was drafted after the 3rd APEC High Level Meeting on Health and the Economy (24-25 September 2013,  Bali, Indonesia):

a) Work to ensure that economies’ health workforces are sufficient in size and adequately trained.

b) Sharing of best practices on health promotion and preventative care, nutrition and education.

This project supports the training needs of the economies’ health workforces by sharing best practise on health promotion and preventative care in the keys area of Infection Control and Antimicrobial Stewardship. Knowledge transfer in HIV Medicine and OPAT will complement the training needs of the participant’s economy health workforce by increasing expertise in these areas.

This project will support Singapore’s interest in contributing to the regional development of healthcare manpower resources.  Singapore as a developed APEC economy has invested in the development of the specialty of infectious diseases for well-over two decades. Infection Control and Antimicrobial Stewardship programmes are funded in all public hospitals. OPAT is available in 5 out of 7 public hospitals. In Nov 2012, the Institute of Infectious Disease and Epidemiology was established at CDC to enhance the national and regional infectious disease training and collaboration. The timely formation of the Institute of Infectious Diseases and Epidemiology provides an ideal platform for this pilot project to prove that it can be delivered successfully. This will eventually pave the way for the up and coming National Centre for Infectious Diseases which is scheduled to be completed in 2018.

TILF/ASF Justification

(a) Capacity building needs
We hope to offer clinical fellowship to doctors endorsed by their hospital and Ministry/Department of Health to gain exposure to and develop advanced skills in the above four domains. The training will empower them to develop or enhance similar programmes in their respective hospitals. If similar programmes are absent in the developing APEC economies, the hospitals involved may serve as pioneers for these programmes to further spread via a hub and spoke model.

(b) Engagement
The clinical fellowship will be offered via the Ministry/Department of Health of participating APEC economies, and advertisements will be made via professional societies such as the Academy of Medicine. This ensures that doctors selected for the clinical fellowship have the endorsement of their hospitals and the Ministry/Department of Health to develop the targeted programmes in the above four domains. After the training, we can continue to be actively engaged by visiting the developing APEC economies to assist them in the local training and development of these programmes. Separate funding sources will be obtained for this if the need arises.

Beneficiaries and Outputs

The project is based on “Train the Trainer” concept and the main output of this project is to nurture human capitals. Participants equipped with knowledge and experience in the above four domains upon returning to their local health authorities can contribute to develop, implement or enhance these programmes.

The beneficiaries of this project will be the local health authorities and hospitals that the participants come from. The knowledge and skills gained can be transferred from the participants to other doctors and healthcare workers on returning to their hospitals. We hope this “train the trainer” methodology can spread via a hub and spoke model to augment the benefits from this proposal beyond the direct course participants.

This programme also includes a post-training visit to the trainees’ site of practice, the intention is to allow sharing between trainee and trainer, and for the trainer to assess and advise with an aim to improve the work implementation by the trainee. The benefits are in many folds that include elevation of knowledge and improved practice at individual and institution level at the receiving institutions, ripple effect to achieve better infection control practices, appropriate use of antibiotics in reducing antimicrobial resistance.

This programme aims to share extensive experiences and ID expertise in Singapore including how they have overcome the numerous hurdles and solution they have learnt with participants from other APEC economies in the domains of Infection Control, Antimicrobial Stewardship, OPAT and HIV Medicine. We anticipate that participants from developing APEC Economies may find the fellowship in Infection Control, Antimicrobial Stewardship and HIV Medicine useful, and doctors from developed APEC Economies may find value in fellowship in Antimicrobial Stewardship and OPAT.

The participants would be introduced various important tools/techniques such as correct hand washing techniques, increased hygiene or mask fitting that can improve their own healthcare workplace setting (e.g. correct mask fitting improves workplace safety) in their organisation. The knowledge of proper use of antibiotics under Antimicrobial Stewardship can lead to better community care for their patients by reducing the long term medications bills without depending on stronger and more expensive antibiotics.

OPAT programmes can effectively reduce the length of stay and bed occupancy, and optimise manpower utilisation in over-crowded hospitals. Successful implementation of OPAT in participant economy can effectively help save hospital beds and reduce inpatient bills for patients.

Enhanced clinical capability in HIV Medicine can directly benefit patients by optimising the delivery of HIV care. The enhancement of knowledge in different treatment regimens like 1st or 2nd line antiretroviral (ARV) drugs for HIV clinical management would improve the well being and health of HIV patients in participant’s economy. This may shift the dependence of treatment of HIV patients from inpatient to an outpatient setting thus reducing patient treatment bills and optimizing hospital/healthcare resources.

Dissemination

Once approved and funded, we will start developing the training curriculum which will be published after endorsement by the Academy of Medicine, Singapore, on our website, that of APEC and other relevant professional bodies, and disseminated to the Ministry/Department of Health of APEC economies.

Our experience of regional training and engagement can be written up for an International Medicine or Global Health journal to showcase the benefit of APEC funding in capacity building. The project’s outputs can be promoted via the APEC Bulletin on Health and Website. We are also very keen to share with participants our Institute of Infectious Diseases & Epidemiology website where they are free to visit to view the relevant course materials and even raise questions pertaining to the course. 

The target audience will be healthcare policy makers, healthcare and global health professionals in the relevant domains. The intention is to publicise the benefit of regional collaboration under the auspices of APEC.

Gender

There is no gender discrimination in this project. The selection of participants for this training course will be gender neutral. The selection criteria will be based on eligibility factors such as professional training and the roles/responsibilities they hold in their hospitals or organisations. The main objectives and outputs of this proposal is aimed to benefit both men and women equally. In the event if all eligible applicants are males, additional advertising efforts will be made to increase the odds so that more eligible women candidates can be considered or selected for the interviews. We aim to recruit a balance of 2 males and 2 females in this project to ensure that both genders can benefit from this training.

We also aimed to build capacity on gender in health (or gender learning) in our course materials or knowledge transfer process to highlight to participants that addressing health inequities and differences between different groups of women and men is important. One example is the inclusion of a topic on impact of infectious disease on women and economic participation and to discuss and share recommendations on gender assessments of health sector plans, strategies in the participant’s economy.

Work Plan

The programme is for 2  trainee to be trained together and immersed in the Singapore system for 3 months each (total of 4 trainees in the programme) so as to give greater emphasis on guidance and mentoring. The programme is supported by all 3 tertiary teaching hospitals in Singapore. A training programme will be put in place including rotations to all 3 training hospitals for a broad range of exposure to different hospital set-ups.  Supervisors will be assigned to each clinical fellow for mentoring.

Training curriculum of all the 4 areas will stipulate the educational objectives, training activities, duration and sites of training, training supervision, possible projects and training assessment. The Academy of Medicine, Singapore will be enlisted for endorsement and accreditation and to provide certification on completion of the clinical fellowship under the Chapter of Infectious Disease Physicians, College of Physicians, Singapore. This is a multicentre training fellowship involving major university teaching hospitals with large, well-established infectious disease departments or units to ensure broad exposure across a number of training sites in Singapore.

A detailed training curriculum with course period and benefits will be sent to the respective Ministries of Health of APEC Economies to advertise for this clinical fellowship via Ministry of Health, Singapore. We will state that this project will benefit their economies and health workforce and that by nominating an eligible candidate the chances of success of this project will be enhanced. We aim to send this advertisement to all APEC economies Ministries of Health requesting for nomination of at least one suitable candidate to ensure fairness to all economies. 

A committee panel will be established to review and select appropriate applicants. Detailed curriculum vitae of candidates will be requested and submitted to the committee panel for evaluation. Telephone interviews with suitable candidates will be conducted. The Institute of Infectious Diseases and Epidemiology (IIDE) will arrange and assist with the logistics for successful applicants including the registration with the Singapore Medical Council, if necessary, air travel and accommodation. Eligible candidates would be doctors who are training or qualified in infectious diseases in the APEC Economies. However, interested candidates in APEC Economies without formal infectious disease specialty training, doctors who work in the domains of public health epidemiology, microbiology or other relevant professional groups can also apply.

Proposed Eligibility Criteria:

a) Nominated by Ministries of Health of APEC economies

b) Supported by institutions to work in or establish programmes in the four training domains

c) Certified specialist physicians in ID / Microbiology / Public Health / Internal Medicine / Others

The timing of the project depends on the application and approval process for APEC funding. However, development and endorsement of training curriculum will proceed based on the timeline below. For this pilot project we plan for four participants to arrive at 2 different quarters depending on their needs and logistical arrangement such as air travel and medical registration.

Timeline:

Jan-Mar 2014

Apr-Jun 2014

Jul-Sep 2014

Oct-Dec 2014

Development of training curriculum

Submission of training curriculum for endorsement by the Academy of Medicine, Singapore

Advertisement of training fellowship via Ministry of Health, APEC Economies

Interview and selection of applicants; logistics for successful applicants

-Start of training

(1st pax and 2nd pax)

- Start of training

(3rd pax and 4th pax)

Completion of pilot project, preparation and submission of report to APEC Secretariat

Risks

Risks in this project include both professional and logistical. Logistical risks include delays in the development and approval of training curriculum, dissemination via the various Ministry/Department of Health of APEC economies, and obtaining approval for clinical fellowship in Singapore. This proposal has already received its strong support from Tan Tock Seng, National University and Singapore General Hospitals, Institute of Infectious Diseases and Epidemiology, and the Ministry of Health, Singapore. We are confident that we can manage the logistic risks presented in Singapore.

Another possible logistical risk is arranging interview with prospective trainees reside at different time-zone. This can be pre-arranged to identify a mutually available time for video-conferencing. The hosting institution is familiar with the arrangement of video-conferencing at different time-zone.

Project duration of one year including recruitment time may be too short to select suitable candidates to participate in this programme. We will mitigate this risk by intensifying our recruitment efforts so that a wider audience can be reached. A request for nomination sent out by Ministry of Health, Singapore, to Ministries of Health may encourage participation from APEC economies.

Professional risks include the lack of appropriate candidates with the relevant professional training and institutional and administrative support to attend the training and return to pioneer or enhance similar programmes. Additionally inadequate skill sets gained during the clinical fellowship may hamper local development and implementation. Our proposal to have endorsement and support by their local institution and Ministry/Department of Health will mitigate many of these risks. We offer professional mentoring relationship post-training as part of the mission of Institute of Infectious Diseases and Epidemiology in regional training and professional engagement to reduce the risks associated with post-training development and implementation.

Monitoring and Evaluation

Evaluation of the effectiveness of training will comprise a pre- and post-training survey. This survey will cover the status of the domain of training (e.g. infection control, antimicrobial stewardship, HIV medicine, OPAT) in home institution and APEC economy, level of support for pilot programme or programme expansion, possible obstacles and requirements for overcoming these obstacles. The survey content will include quantity and quality of teaching materials, effectiveness of training delivery, quality of trainers, etc.    A qualitative assessment of perceived effectiveness of training will be conducted as well. As part of the attachment and training, a project implementation plan will be developed with the trainee setting out realistic timeline, requirements for a staged implementation, anticipated obstacles and possible solutions.

We will conduct a post-course implementation trip to participants’ economy of origin for a one-on-one hands-on guidance and problem solving opportunities. Besides ensuring the timely completion of the proposed project recommendations; stronger ties are forged between Singapore and the participants from the APEC countries which only bodes well for more potential collaborations. The visits will evaluate how course participants are using the knowledge and materials in training their local staff.

The operational team from the Institute of Infectious Diseases and Epidemiology and funded by Tan Tock Seng Hospital will assist with the logistics and together with their operational/admin support will ensure the timely implementation of the project timeline.

Linkages

Engagement: We aim to engage all the Ministry/Department of Health within APEC economies in nominating eligible participants. Beyond this avenue, we have contacts via ANSORP (http://www.ansorp.org/) and ReAct (http://www.reactgroup.org/) to attract interested applicants. The Society for Infectious Diseases (Singapore) (http://www.id-singapore.org/) is part of the International Society of Chemotherapy, Infection and Cancer (http://www.ischemo.org/), which has some 85 national and regional member societies we can tap on as well. Experts from within APEC can be invited after this pilot project to adequately address all the teething issues and share diverse experience. However, this is contingent to having more funds being provided to bring them in.

Previous work: We have prior experience having organized many training programs in the region. The past workshops we have organised include the Antimicrobial Stewardship Programme in Singapore (2012) and in Malaysia (2013). Doctors from Kameda Medical Centre, Chiba (2011), and Wakayama Red Cross Hospital, Wakayama (2013), Japan, and the Princess Margaret Hospital, Hong Kong (2013) visited to learn about OPAT. In addition, we have partnered WPDR/WHO and local partners in conducting the biyearly Asia-Pacific Dengue workshop. 

As a training institution that aspires to be one of the leading training centres nationally and regionally; we constantly improve our training methodology by incorporating recommendations received from all previous courses/training. A good example would be the “Capacity Building in the Prevention of Contagious Diseases” organized by us (4 runs in total) and jointly sponsored by the Ministry of Foreign Affairs (Singapore) and the Japan International Cooperation Agency have seen us shifting from a theoretical lecture type of delivery to one that has more hands-on application such as the mask-fitting procedure where participants get the opportunity of trying out the test methods themselves.

Without designated funding, we can only provide training on an ad-hoc basis. We therefore hope to establish a formal platform to provide a more comprehensive regional training in the four domains mentioned above.

APEC’s comparative advantage: APEC economies comprises developed and developing countries which share more similar healthcare problems. Our proposal is aligned with several of the APEC Leaders’ Growth Strategy. Importantly, we can disseminate this effectively within the APEC economies to encourage active participation.

Sustainability

Follow-up reports from the participants on their status of project implementation will be requested at 6 and 12 months post-training. We will continue to provide professional mentoring to the doctors who return to their respective areas of work, assisting them to establish or enhance their area of works. From our experience, the doctors will more often than not encounter unique local hurdles/constraints upon returning to their countries and hospitals. It is therefore critical to discuss and to provide on-going advice on how to overcome these hurdles as a way of helping them ease the implementation of these new programmes. Our proposal of a planned trip to the participant’s economy of origin will certainly help to address and untangle these obstacles they are experiencing. The post-course trip will include discussion and coaching on the methods and materials the participant are using in training their local staff. In some circumstance we have availed ourselves during regional and international professional meetings to visit and continue further the discussion and mentoring process.

We believe in long term engagement by constant communication by electronic mails or video/telephone conferencing with the participants. This has enhanced on-going professional engagement work that we are partaking in. Easy accessibility and availability will provide the additional support required to maintain the sustainability of this project.

We hope that successful implementation of this proposal will gain us the experience and track record in undertaking more ambitious regional training and collaboration. This may in rerun bring in funding from within or outside of Singapore. 

Project Overseers

Professor Leo Yee Sin is the Project Overseer and she will be assisted by Dr David Lye as co-Project Overseer.

Professor Leo is the director of Institute of Infectious Disease and Epidemiology and the clinical director of Communicable Disease Centre (CDC), Prof Leo is also a senior consultant in the Department of Infectious Diseases, Tan Tock Seng Hospital. She was the founding head of the HIV programme at CDC.

Dr Lye is a senior consultant infectious disease physician at Department of Infectious Diseases, Tan Tock Seng Hospital, and Communicable Diseases Centre. He heads the Training and Education Unit at the Institute of Infectious Diseases and Epidemiology, He runs the Blood Culture Notification and Advisory Service and Antimicrobial Stewardship Programme at Tan Tock Seng Hospital. He has organised/participated in two ASP training workshops in Singapore and Malaysia, and has been invited as speakers for two ASP workshops in Hong Kong. He has ongoing collaborations in developing OPAT in the Asia-Pacific region (Japan and Hong Kong) with Professor Dale Fisher at the National University Hospital.

Cost Efficiency

The proposed concept of “Train the Trainer” is that the investment in individuals can generate more impact than the actual investment in time and money. This is contingent on the selection of the right candidate who is motivated sufficiently to learn and to share knowledge, to develop and implement programmes, troubleshoot and solve problems. Hence, as part of our selection criteria, we prefer young specialists in the fields of infectious diseases, microbiology and public health, although other relevant specialties can also be considered. But there is no age discrimination because the ability to embrace new ideas and push new programmes is not restricted to younger age groups.

Apart from willing individuals, institutional and administrative endorsement and support is vital. An individual doctor cannot change institutional culture unless there is institutional and administrative support. This proposal has a higher chance of success in APEC economies which recognise the urgent clinical problems in infectious diseases covered under the four domains, and have the intention to act on these problems. With high level support, motivated individual doctors can change and improve patient care on the ground.

We certainly hope to follow up with the hub and spoke model by subsequently bringing the training to the participating APEC economies with professional support to the doctors who undertake the clinical fellowship. This will generate good value for return on investment in this proposal.

Drawdown Timetable

Not Applicable

Direct Labour

Not Applicable

Waivers

Not Applicable

Are there any supporting document attached?

No 
Attachments
Version: 9.0 
Created at 23/12/2013 16:03  by Lucy Phua 
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Version HistoryVersion History

Project No.

Project Title

Project Status

Publication (if any)

Fund Account

Sub-fund

Project Year

Project Session

APEC Funding

Co-funding Amount

Total Project Value

Sponsoring Forum

Topics

Committee

Other Fora Involved

Other Non-APEC Stakeholders Involved

Proposing Economy(ies)

Co-Sponsoring Economies

Expected Start Date

Expected Completion Date

Project Proponent Name 1

Job Title 1

Organization 1

Postal Address 1

Telephone 1

Fax 1

Email 1

Project Proponent Name 2

Job Title 2

Organization 2

Postal Address 2

Telephone 2

Fax 2

Email 2

Declaration

Project Summary

Relevance

Objectives

Alignment

TILF/ASF Justification

Beneficiaries and Outputs

Dissemination

Gender

Work Plan

Risks

Monitoring and Evaluation

Linkages

Sustainability

Project Overseers

Cost Efficiency

Drawdown Timetable

Direct Labour

Waivers

Are there any supporting document attached?

hdFldAdmin

Project Number

Previous Fora

Secretariat Comments

Reprogramming Notes

Consolidated QAF

Endorsement By Fora

PD Sign Off

Batch

Forum Priority

Committee Ranking Category

Committee Priority

PDM Priority

Priority Within Funding Category

Monitoring Report Received

Completion Report Received

PMU Field 1

PMU Field 2

PMU Field 3

On Behalf Of

Proposal Status

Originating Sub-Forum

Approval Status
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