Having the privilege to heard from firsthand Dr. C. Boelen's "Towards Unity For Health" (TUFH) Project of the WHO HQ during the VII International Seminar "Primary Health Care (PHC) to Guarantee Health For All (HFA) in the 21-Century", last October at Havana, and studying TUFH draft, the author has written some reflections about the great importance for the future progress of the Cuban public health & medicine to use its approach.

The TUFH approach, recognising the scientific problem of the fragmentation of the medical & health delivery and education systems, and suggesting strategies & tactics to achieve a momentum towards "unity", has already solved it in 50%. To solve the other half, its strategies are: use of innovative patterns of services, consideration of implications for health professionals, building a partnership among policy makers, health managers, health professionals, academic institutions and communities, and search for an evidence of impact.

The Cuban Health Delivery and Education Programmes are giving examples to the Southern Countries of high quality, equity and relevance, specially concerning to the Mother & Child, and Infectious Diseases Programmes, among others. However, the Family Medicine Programme (FMP) needs to harmonise better with the Technological Medicine Programme, to promote the highest cost-effectiveness and quality in all the programmes.

The Cuban FMP has been institutionalised for 15 years, through a strong state health and education policy. It is recognised as a foundation for health care organisation, and has a centralised partnership among many more than five partners. Family medicine is a medical speciality with similar incentives as the others, but is requiring more than that. It should be recognised rightfully as a scientific discipline, with a specific scientific agenda for a more creative participation in the Adult & Elderly, and Non Infectious Diseases Programmes.

In 1990, the author, encouraged by the policy of PAHO/WHO for the development of a scientific research infrastructure to achieve the goal HFA intensifying the PHC strategy, passed from the National Oncology & Radiobiology Institute to the Plaza Community Polyclinic, to work as medical statistics consultant and clinical epidemiology investigator.

Promoting there high quality scientific research standards for the Health System, Clinical & Epidemiological Research Plan, previously outlined in that FMP national reference centre, he felt the necessity to design research projects of an "Integration Programme in Medical & Health Sciences", whose results can be considered as a crucial conceptual cement for an intelligent unification of all the forces of the Health Delivery and Education Systems.

The projects are innovative, speculative & venturous. They shape together an emergentist programme, and can make up a nuclei of a world wide R&D plan of a higher educational & research family medicine centre, part of the international R&D Agenda in a Cuban TUFH Project with other countries. All the projects are based on a strong use of rational scientific methods, computing, high communication technology & Internet. They are as follows:

a) Emergentist Research Strategy to Assist the Formulation of Unifying Principles, Medical & Health Integral Hypotheses, Complementing the Reductionist Research Programme

b) Development of New Self & Shared Disciplinary Research Spaces of General & Family Medicine & Practice

c) Unified Logic & Methodological Approach to Scientific Research, Across the Laboratory, Clinic & Community. Research Educational Programmes:

i. On Public Health, Clinical & Experimental Medicine Scientific R&D Policy Research

ii. For Health, Clinical & Laboratory Researchers on Medical & Health Sciences Logic

d) Foundations & Programmes of an International Research & Training Centre for Medical & Health Scientific R&D Policy Research.

e) Improvement of an Internet's Discovery Support System of Recombinant Hypotheses with Medical & Health Unifying Principles.

The integrationist scientific programmes appear after the explosion of the reductionist ones, not only as feasible options for the poor countries, but also as cardinal needs for the rich countries to complete the cycle of progress of the present medical & health sciences.

There should be strengthened the foreign activities & exchanges of the general & family medicine scientific society, developing a top academic centre for R&D over these scientific problems of family medicine progress in Cuba, common to Canada, USA, UK, Australia, Germany, etc. Their specific scientific solutions must serve as a light, illuminating the darkness of all partners and scientific societies, but first beginning by the family medicine physicians, nurses, dentists, psychologists, social workers, pharmacists, themselves.

Only within the broad scientific conceptual frame offered by the TUFH approach to PHC, it will be possible to find out real integration solutions of its problems. There are some Cuban generalists interested in work on it, but it needs foreign partners & support. I hope within the frame of the TUFH Project, major integrative initiative of the WHO, will be the way.

Rodolfo J. Stusser, MD

Clinical Research Centre/Plaza Community Polyclinic, Havana, Cuba

Acknowledgements: Projects c, d, and e, have been encouraged by awards of the RPS World Health Organisation, the Global Forum for Health Research, and the International Society for Internet in Medicine, respectively.

Integration Science Program for Medicine, Nursing, Technology & Health
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