Special Project Grants

New and continuing special project grants were awarded to 103 schools eligible under the Health Professions Educational Assistance Act of 1969 to schools which were eligible and had received institutional grants. An estimated 140 grants will be awarded in 1970. The continuation in 1971 of these and previous grants requires an estimated $45,596,691, leaving $23,953,309 for other awards including $14,128,000 in support of the projects awarded for the Physician Augmentation Program.

The United States will continue to have a projected physician deficit of some 50,000 in 1975 unless different approaches to providing physician manpower are developed. During 1970, the Physician Augmentation Program was initiated as one means of reducing the physician deficit. The original goal was to add permanently 1,000 additional first-year places in the fall of 1970. However, due to the extremely short time the schools have had to plan such a significant increase, this goal cannot be reached. By working closely with the schools to increase substantially the enrollment of medical students in the fall of 1970 and 1971 which has required many arrangements to be made for the faculty, space, curriculum development and the like, we anticipate that 29 schools will participate this first year (fall of 1970) and will be able to add 507 additional new first-year places. About 400 of these places are in currently approved projects, with the balance in projects now under review. $10,000,000 will be used for this expansion. As a result of the Physician Augmentation grants, these same schools will further expand first-year enrollment by 43 in 1971 for a total of 550 new first-year places. The 1971 budget includes $14,128,000 for the 1,057 students (550 freshmen and 507 sophomores).

The current physical, financial, and human resources of these schools are already taxed to capacity according to their grant applications and as verified through selected site visits. As a result, implementation of the Physician Augmentation Program will require substantial Federal support. Assistance is needed to affect alterations and renovations of the physical facilities, to purchase additional teaching equipment and other instructional aids and to employ new faculty in order to increase enrollment as planned. The Bureau is well aware that it would be unwise to try to increase enrollment in new and existing schools and yet permit any school to close due to financial difficulties. On-going grants will continue to aid schools in difficulty and the situation will be carefully watched and plans adjusted as necessary.

These schools must continue to respond to increasing demands such as acceptance of more disadvantaged students, implementation of major curricula changes, development of other types of health workers, production of family physicians, and greater participation in community health services.

It is essential that the special project grant funds requested be made available to stimulate greater participation and to capitalize on the widespread interest on the increased physician output.

A distribution of special project grants by discipline follows:

49-433 0-70-pt. 5 -38

The apportiorment of the awards to the schools per specific categories was as follows:

1/ Although no new projects are included for schools of pharmacy and veterinary

medicine, they are eligible and may be granted upon council recommendation.

Authority for this program is contained in section 805 of the Public Health Service Act. The amount of $40,000,000 authorized in 1971 includes funds to provide support for formula grants for nurse training as well as project grants. The legislation states however, that of the sums appropriated, $15,000,000 will be available for project grants. Therefore, as $11,000,000 is requested, no request may be made for formula grants.

Experience over the past five years has demonstrated the effectiveness of these project grants in accomplishing the intent of the Nurse Training Act of 1964. Projects have resulted in (1) curriculum improvements in the individual schools, (2) decreased attrition and increased enrollments in some instances, (3) co-operative efforts among schools which extend faculty, facilities and new techniques to many more students than those in the grantee schools, and (4) production of teaching materials that are being used by nursing education and nursing service institutions nationwide. One hundred and thirty-two schools received grants during these five years; 200 additional schools participated in these projects with the grantee schools benefitting an estimated 49,000 students in the 332 schools.

Program Plans for 1970 and 1971

Projects now underway are assisting certain schools to increase enrollments by accommodating students on other campuses through television and by expanding and developing new clinical resources for teaching. The broadened authority under the Health Manpower Act of 1968 has extended eligibility participation and has permitted projects to plan and establish new and modified programs; to assist schools, particularly hospital schools in staying open, in helping hospitals to continue their teaching efforts, and to maintain quality during this period when nursing is moving from apprentice-type training to a program combining the resources of educational institutions, hospitals and other service agencies. Special project grants reflect planning on the part of communities and existing schools in the establishment of new nursing educational programs to meet their specific needs.

Most of these projects require from three to five years of support for completion. Those for developing new or modified programs, and those involving a number of schools and/or community agencies and communications equipment are especially costly, as compared with those for a single school, thus, an increase of four million is requested in 1971 for these purposes.

Special project grants for the improvement of nurse training, as authorized under the Health Manpower Act of 1968, allows all schools of nursing (over 1,300) to request funds, on an competitive basis, for support of projects designed to improve, strengthen or expand programs to teach murses. Other health agencies and institutions are also eligible to apply for these funds to carry out projects to strengthen nursing. Table Number One contains statistical information on nursing programs in the United States. Table Number Two reflects 1969 expenditures by categories. The 1971 budget excludes funds for fomula grants, an entitlement program. Therefore, no distribution is shown for this program.

The $11,000,000 requested for 1971 will provide support for an estimated 191 projects (including 42 more projects than awarded in 1970) to hospitals and other agencies as well as schools of nursing to assist in maintaining enrollment and in improving the quality of their educational programs in accordance with the purposes of the Health Manpower Act of 1968.

Section 309(c) of the Public Health Service Act authorized Federal grants to schools of public health to assist them in providing comprehensive professional education and training, specialized consultative services, and technical assistance in the fields of public health and in the administration of State or local health programs. These grants which were first authorized by Congress in 1958, are awarded on an entitlement basis which gives primary consideration to the number of federally sponsored students attending each school.

Since 1958, the number of accredited schools of public health has increased from 11 to 16. Five additional institutions are currently in various stages of planning new schools of public health.

Program Plans for 1970 and 1971

It is anticipated that at least one new school will receive its accreditation by 1971. Several schools are undertaking major expansions and increases in responsibilities, and three schools which have recently opened, Loma Linda, Oklahoma, and Texas, will expand significantly in scope of program and in numbers of students within the next two years. In the five year period 1964-65 to 1968-69, total enrollments in schools of public health, including full-time and part-time students, increased by almost 60 percent, from less than 2,000 to over 3,000. During this same time, the number of graduates increased from approximately 1,000 to almost 1,500.

Equally important to expanding the schools' educational and training capacity is the need to assure that their curriculums provide the preparation necessary for, and pertinent to, changing health requirements. The grants to schools of public health have provided a continuing means which can be quickly adapted by the schools for use in new areas of concern. Most of the schools have utilized these grants to develop and strengthen curriculum to prepare students in such emerging areas as medical care administration, environmental health, health planning, and population dynamics. Examples of how individual schools have used formula grant funds include adding new full-time faculty to offer courses such as family planning and maternal health guidance, conducting extension programs for outlying health departments, strengthening field training needs, and developing specific training programs to meet immediate needs of ghetto areas and other problems of urban population. Funds have been allocated primarily for faculty (61 percent) and supportive personnel (24 percent) with a smaller proportion budgeted for equipment and travel.

In addition to their specific responsibilities for graduate public health training, the schools serve as a university resource in providing the public health content in the professional education and training of medical, dental, nursing, social work, environmental health engineering, and other related teaching programs. The teaching staff also fosters continuing education programs and participates in community activities on local, State, and national levels.

In exercising the authority to use funds for purposes of program planning and evaluation, in addition to exercising this authority through grants and contracts, these funds will also be used to finance consultative and other services required to prepare, monitor, and review various forms of evaluation. Such consultative services would be performed under contract or through the use of part-time or intermittent consultants.