IMPORTANT
Please answer each question clearly and completely. Detailed answers are required to ensure the most appropriate study arrangements. Before attempting to fill in this form please read the instructions attached. Please submit four typewritten copies. If necessary, additional pages of the same size may be attached. Please complete in a language appropriate to the country of study. Be sure to sign and date the form. / Attach recent photograph here1. PERSONAL DATA
1) Family name (Surname)
Qian / First/other names
Bohua / Dr√Mr Mrs Miss Ms
2) City and country of birth
Beijing, China / Date of Birth
07/04/1974
(day/month/year) / Nationality
Chinese / Marital status
Married / Sex
√M F
3) Mailing Address
Department of International Cooperation, MOH,
1 Nanlu Xizhimenwai
Beijing 100044, P.R.China / Office telephone 8610-68792996
Office fax 8610-68792279
Office telex
4) Home Address
207, Building 3, JINDIAN Garden
Beijing
P.R.China / Home telephone 8610-68792996
Home fax 8610-68792279
5) Name and address of person to be notified in case of emergency
XING Jun, Department of International Cooperation, MOH, Beijing
Office telephone 8610-68792277
Fax 8610-68792279 Telex / Relationship
Colleague
Home telephone
Fax
2. LANGUAGE ABILITY / MOTHER TONGUE:Chinese
1) For language(s) other than mother tongue enter below the appropriate
letter from the code system at right to indicate your level of skill. Note that you may be required to take a language proficiency test. /
Understanding of spoken language
A I understand at the level of university discussionB I understand at the level of normal conversation
Language
/ Understand / Speak / Read / Write / C I understand simple daily usageSpeaking ability
A I speak at the level of university discussion
English / B / B / A / B / B I speak well enough to engage in normal
conversation
C I speak adequately to meet limited social needs
Japanese / C / C / B / C /
Reading ability
A I can read without difficulty all technicalmaterial in my field
B I can read with some difficulty all technical
material in my field
C I can read newspaper articles and similar material
Writing ability
A I can write technical papers and reports easilyB I can write technical reports with some difficulty
C I can write ordinary correspondence
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2) Test(s) of language proficiency. Indicate any test(s) of language proficiency ever takenName of test / Date / Place / Results / Attach official copy(ies) of the certificate(s) or test
results.
3) Language experience
Indicate your previous experience in the language(s) of your proposed study resulting from residing in a country where that
language is spoken, or studies in an institution at home or abroad for which that language is the medium of communication.
Dates
From/To / Country and Institution (if any) / Activity undertaken / Languages
Feb. –Mar. 2003
Feb. –Mar. 2006 / Australian International Health Institute
University of New South Wales, Australia / Training progam in project management
Health Management / English
English
3. FELLOWSHIP(S) PREVIOUSLY AWARDED
Indicate any fellowship(s) which you were previously awarded
Dates (From/To) / Awarding Body / Place of Study / Field of study / Language used
Feb. – Mar. 2006 / World Health Organization / University of New South Wales, Australia / Health Management / English
4. EDUCATION
Provide full details in chronological order. Give the exact name of the institution and title of degrees/certificates/diplomas. Exclude primary/secondary school(s) if you have a university qualification or equivalent. Include courses and postgraduate studies in your professional or related fields.
Dates (From/To) / Institution
(name, city and country) / Qualification
Obtained / Major Fields of study / Language used
Oct. 2002 to Jun. 2004
Sep. 1992 to Jul. 1996
Jan. 2003 to Jan. 2004 / Shanxi University
Shanxi University
Shanghai Holland International Correspondence Center and European School for Correspondence Course / Graduated
Bachelor
Certificate / Law
Literature
Human resource management / Chinese
English
Chinese/English
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5. EMPLOYMENT RECORD
Beginning with your present post, provide precise details of your responsibilities and activities and describe what you are doing (supervising, planning, training, etc.). Give particular attention to any duties which relate to your qualifications for this fellowship or to your need for the further study proposed.a. Present Post / List your specific duties
From: 2004 To: present
Title of your post
Programme Officer
Name and address of employer
YIN Li
Dept. of International Cooperation
1 Xizhimenwai Nanlu, Beijing, 100044
Name and address of supervisor
REN Minghui
Dept. of International Cooperation
1 Xizhimenwai Nanlu, Beijing, 100044
Type of employment
√Public service Private
Teaching Research Other / Chinese participation in WHO governmental body，managing the coordination and cooperation with WHO prequalification project, participation in China’s voluntary contribution for Tsunami Relief, Chinese regular budget contribution and donation to WHO, Chinese secondment to WHO and WHO Collaborating Centers in China¸ other administrative issues related to WHO programmes or projects, particularly in public health capacity and pilot assessment methods, etc.
b. Previous post / List your specific duties
From: 2000 To: 2001
Title of your post
Project Officer
Name and address of employer
Zhu Baoduo
Foreign Loan Office, MOH
154, Gulouxi Str., Beijing 100050
Name and address of supervisor
Liu Yunguo
Foreign Loan Office, MOH
154, Gulouxi Str., Beijing 100050
Type √Public service Private
Teaching Research Other / Managing the coordination and planning and facilitation of Projects of World Bank Loan in Chinese central level such as Strengthening Basic Health Services in Rural Areas and integrated DFID-donated projects on the focus of health services delivery planning and execution and supervision, participation in priority interventions, civil works, cooperative medical system and medical financial assistance in pilot provinces and counties, responsible for communication with DFID defined resource center in workshops planning and organization, facilitating international experts during workshops and site visits, etc.
c. Preceding post / List your specific duties
From: To:
Title of your post
Name and address of employer
Name and address of supervisor
Type Public service Private
Teaching Research Other
6. PROPOSED FIELD OR SUBJECT OF STUDY
1) Field or subject of studyHealth Management, advanced theories and practices in health policy and management
2) Indicate name(s) of the programme/project of technical cooperation with WHO, if any, in which you are currently involved
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7. FELLOWSHIP STUDY OBJECTIVES
- The following information provided by you and your Government will enable the WHO Placement Officer to plan your programme. It is of the utmost importance that the Officer fully understands your wishes to ensure maximum relevance, efficiency and effectiveness of your study in terms of: expertise (knowledge to be assimilated); practical skills (applications to be mastered); attitudes (behaviours to be adopted). State precisely and in detail the knowledge and/or skills you wish to acquire:
(2) To get in-depth understanding of advanced theories and skills to execute generated policies and measures,
(3) To enable primary drafting a mode of advanced theories’ development and efficient team work in drafting and creating
(4) To dig up and extend self capacity of public health management and policy development
Please utilize page 6 for additional remarks:
- Based on your objectives as stated above, please complete three following statement:
(1) enhance my own performance and capacity of health management, specially in public health, by thinking of Chinese contexts by the advanced methods and international vision learned in the country of study. Practiced previous skills and working experience will be strengthened in their functions and importance in the future public health administration. Working language in English and Chinese will be furnaced for more fluent and effective use.
(2) able to deliver advanced principles and methods of policy making to local use, for more understanding and knowing, find some suggestive solutions from analysis on public health assessment to China,
(3) devote myself to the dissemination and generalization of the advanced health management methods and skills, decision making techniques and evidence-based thinking.
(4)
(5)
Please utilize page 6 for additional remarks:
8. PROPOSED STUDY
1)To achieve my fellowship objectives, I wish to (please circle a and/or b as applicable):
a)Undertake an academic course. State which academic qualification you are seeking:
Name of qualification
Degree ____Public Health or Health Policy Management or Health Care Management orequivalent_Diploma ______
Other qualification ______
b)Undertake observation visits or practical attachments:
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2)List one or more institutions where you believe the fellowship objectives outlined in item 7(a) can be best achieved. Please indicate if you have already contacted these institutions and attach related correspondence and/or other documents. Also, indicate which objectives listed in item 7(a) can bee fulfilled at this institution. The information requested in this section is most important since it will aid WHO in arranging a programme relevant to your stated objectives. PLEASE UTILIZE PAGE 6 IF YOU WISH TO PROVIDE ADDITIONAL INFORMATIONInstitution
Include address and name of Proposed Host, if known /Country
/Duration of Proposed Study and Objectives
Harvard School of Public HealthYale School of Public Health
University of California College of Los Angeles / United States of America / 12 months
Health Management, advanced theories and practices in health policy and management
9. PROPOSED DURATION OF STUDY Total: months: 12 weeks:
10. WHAT DO YOU PROPOSE TO DO AFTER COMPLEETION OF STUDY?
1) On the completion of this study and back China, I would like to put my study results into Chinese health reforms and Chinese collaborating with WHO in health development, particularly in quality management, public health intervention plan and policy making. Achieved skills and knowledge during the fellowship study will be voluntarily used for health reform practice and actively handling the real problems encountered in my daily work. Above all, I would like to devote myself to health reforms key to current health development in China.
How will it contribute to health development in your country?
To help select modes and theories in the global and the country of study for Chinese use, considerably to put into use methods of thinking of new theories for public health reform in the context of Chinese public health within one calendar year, to carry out sustainable development of new local modes and methods suiting Chinese setting within 10 calendar years, to assist screening poor and bad parts of on-going public health reform in China for its effective advancement
2)Indicate which service, programme or project in your country will benefit from the knowledge and skills you propose to acquire, with special reference to Primary Health Care or the WHO Health for All strategy in your country:
My fellow study will take all available methods and modes in the country of study and even international range for reference to Chinese public health reform, especially in combination with situation assessment analysis and specialized information use. The enhancement of health management and policy making will spur firstly senior health authority then the realization of WHO Health for All strategy in Chinese senior health administration.
11. START OF FELLOWSHIP
1)Give the earliest date you could start if awarded a Fellowship
2)Is there any definite period you cannot be absent from your country?
12. COMMITMENT
I am aware that a WHO fellowship can be awarded only after acceptance of my candidature by the World Health Organization and that the World Health Organization will make the necessary arrangements with the countries and/or institutions concerned.
I agree to return to my home country on the of my WHO fellowship and to resume or enter service in my national health administration, or a technical institution approved by the administration, for a period of at least three years. I also agree to reimburse WHO for the total cost of my fellowship in the event that I do not return home and fulfil my obligation.
I certify that the above statements are correct and complete to the best of my knowledge. I will comply with the rules summarized in the information booklet, “WHO Fellowship”
______
(Signature) (Date) .
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13. MEDICAL CERTIFICATETo be completed by a registered medical practitioner designated by the appropriate administrative authority after a rigorous clinical and laboratory examination, including a chest X-ray. The Organization requires that a medical examination shall have taken place within four months of the starting date of thee fellowship and may therefore request the candidate to undergo a further medical examination before taking up his/her fellowship. The medical practitioner should attach a separate letter informing WHO if the candidate has a health condition that might require special assistance and/or treatment while in the country of study. Such information will assist WHO in preparing the most appropriate programme of study on behalf of the candidate.
On the basis of a thorough clinical examination and laboratory test, including a chest X-ray. I hereby certify that in my professional judgement
Qian Bohua 32
______
(Full name of applicant) (Age)
is in good physical and mental health and is capable of carrying out an intensive programme of study away from home;
is free of any chronic condition or disease which might interrupt his/her studies;
is free of any serious infectious disease which could present risks for his/her contacts during the fellowship.
______
(Signature) (Date) / ______
(Full name and title)
______
(Address)
______
- FELLOWSHIP CANDIDATES MAY UTILIZE THIS SPACE FOR ANY ADDITIONAL REMARKS OR
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