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At least 1,801 records · Page 100Linked to original sources
PubMed2005

Regionalization of health services in Newfoundland and Labrador: perceptions of the planning, implementation and consequences of regional governance.

OBJECTIVES: To describe the context and key drivers for regionalization of one provincial health care system in Canada; to document the original expectations of regionalization on governance and the extent to which these expectations were met; to identify the perceived successes and weaknesses of the process; and to examine the key issues and concerns that warrant further consideration and action in the future. METHODS: Forty-five CEO/senior administrator or senior health department officials in the period 1993-2001 were invited to participate, of whom 35 were interviewed (67% of senior health officials and 85% of CEOs/senior administrators). RESULTS: For the most part, key informants felt that expectations of reform with respect to reduction in the number of boards and integration of services under each board's mandate did occur. However, ongoing financial restraint, failure to include the full range of health services under the regional board mandate (including physician and pharmaceutical services), uncertainty regarding the level of authority the regional boards had for decision-making, and unclear accountability mechanisms between the regional boards and the provincial Ministry of Health limited the extent to which broader expectations related to development of a population health focus, and improved continuity of care for individuals and families was achieved. CONCLUSIONS: Implications for policy-makers were identified in four main areas: alignment between health policy goals and the governance structure; clarification of authority and accountability relationships; clarification of roles and responsibilities among all key actors; and strengthening of mechanisms that support accountability.

Adult↗
PubMed2004

A participatory process for developing quality assurance tools for health education programs.

There is a constant need to find methods and tools for achieving high quality in health education and health promotion programs. The aim of this initiative was to develop standards and criteria for quality assessment of health education programs. Health educators participated in a process to develop these standards and criteria. A consensus was reached regarding the list of standards by participation of the health educators in two workshops. This list consisted of the three main stages of health education programs: planning, implementation and evaluation. Operational criteria for each standard were developed in order to be able to measure the standards. Four different subjects were chosen for the development of the criteria: menopause, smoking cessation, cardiac rehabilitation and prenatal care. A consensus regarding these criteria was reached by discussions in workshops. The tools developed were tested by interviewing health educators who were planning and running these programs. The tools built were found acceptable by the health educators as they provided information on the quality of the programs.

Attitude of Health Personnel↗
PubMed1992

Health promotion and disease prevention.

Health promotion and disease prevention programmes improve the health status of populations, preserve freedom, and empower individuals. Yet, despite important advances in many countries, including a more health-conscious public, it would be beneficial in the United States and in other countries to have a comprehensive plan to make health promotion and disease prevention personal and societal priorities. I have called this climate a 'culture of character', a climate of individual responsibility to encourage healthy behaviour. I want to encourage the readers of Medical Education to participate in the formulation of plans to implement greater health promotion and disease prevention efforts. Such a climate of personal responsibility could be created if doctors, educators and policy-makers agreed on some workable, positive goals and steps that would help meet realistic national goals over a defined period of time. If there were such agreement, then doctors could more clearly focus their own efforts with their patients, in concert with other health professionals, and with policy-makers who have the same goal--healthier people.

Health Planning↗
PubMed1993

Health of the nation: way forward in sexual health.

Sexual health is a wide concept encompassing education, health promotion and disease prevention, diagnosis and management of sexually transmitted diseases, screening and counselling for HIV antibodies, management of HIV infected patients, family planning, termination of pregnancy, psychosexual counselling, prevention of cervical and lower genital tract cancers, and sexual abuse. Implementation of The Health of the Nation (1992) will include assessing the current situation, views, alliances and interventions, need for research and development and within alliances setting challenging but achievable targets. The Health of the Nation includes a target for gonorrhoea which is a surrogate for partner change, sexually transmitted diseases in general and HIV infection, and a target for conceptions among those under 16 years of age. These targets need to be adjusted locally and may be staged. All interventions to achieve these targets must be available. Implementation of The Health of the Nation to achieve the main objectives which are to reduce the incidence of HIV infection and other sexually transmitted diseases as well as reducing the number of unwanted pregnancies and provision of effective family planning services will be challenging but sexual health gain will be well worthwhile.

Family Planning Services↗
PubMed2004

Review of the 2003 National Syndromic Surveillance Conference--lessons learned and questions to be answered.

Syndromic surveillance is a rapidly evolving field within public health practice. Substantial experience has been gained in learning how to conduct syndromic surveillance, informed by a growing body of research and practice, including refinement of surveillance methods, development of new tools for analysis and evaluation, findings from statistical models and applied evaluations, and expansion of syndromic surveillance to uses beyond preparedness for biologic terrorism. Despite these advances, additional evaluation is needed to help health departments determine whether to conduct syndromic surveillance. This paper summarizes the lessons learned from the 2003 National Conference on Syndromic Surveillance, which provided a foundation for defining a research and evaluation agenda and for developing preliminary guidance for public health agencies planning to implement syndromic surveillance.

Bioterrorism↗
PubMedDate not supplied

[Psychosocial workload, sick leave, and health-related well being: an empirical study from the perspective of gender research].

PURPOSE: The aim of this study was to test hypotheses on the consequences of gender role expectations with regard to the extent of work stress, selected health-related measures and their associations. METHOD: Data on psychosocial workload (questionnaire of effort-reward imbalance), sick leave (self-reports of the duration of medically certified sick leave during the past two years) and health-related well being were collected in a representative sample of German full-time employees (n = 666). Hypotheses were tested using analyses of variance (ANOVA) and covariance (ANCOVA) and moderated linear regression analyses. RESULTS: Women reported lower health-related well-being as compared to men while effort-reward imbalance and sick leave did not differ between the sexes. Parents reported slightly longer durations of sick leave during the past two years than childless participants (not significant). The results of stratified linear regression analyses show stronger associations between effort-reward imbalance and both health-related measures for women with children than for men with children, while single men and women do not differ in this regard. CONCLUSIONS: Evidence of this kind can be useful for the purposeful planning and implementation of health promotion measures at work. Women with children would be a group deserving special attention. The findings also point to continuing differences in gender role expectations in the family context.

Adolescent↗
PubMed2002

Evaluation of the Quality Assurance Project and BASICS Joint Project in Niger.

OBJECTIVE: The 1998 evaluation sought to assess the Quality Assurance Project (QAP) in Niger since 1993 and the degree of quality assurance institutionalization in the Tahoua Department, and to summarize lessons from introducing the Integrated Management of Childhood Illness (IMCI) guidelines in a quality management (QM) environment. DESIGN: This evaluation collected data from interviews with staff and managers, from focus groups conducted in the communities, and from medical records. The data were then compared with three sources of evaluation criteria. A pre-project assessment provided a baseline across certain impact indicators for tracking progress. Other measures were derived from the objectives and indicators from the QAP/Tahoua project plan, the joint QAP/BASICS (Basic Support for Institutionalizing Child Survival Project) project plan, and from an additional US Agency for International Development (USAID) objective that the joint project be a model for West Africa. SETTING: The evaluation took place in the two departments of Niger in which the joint project was carried out: Tahoua and Dosso. The QA Project launched a pilot program in Niger in 1993 to strengthen newly decentralized regional and district management, and to improve the quality of primary health care in Tahoua. The principal QA Project approach was QM. The BASICS Project became active in Niger in 1995, helping to improve child health services. In 1997, the projects merged in Niger to form the joint QAP/BASICS Project. The Ministry of Public Health (MPH) planned to implement IMCI in 1998, and wished to determine whether QM facilitated the introduction of IMCI. RESULTS: The evaluation team found that QM had been effectively implemented in Tahoua and that there were related improvements in health program indicators. The team also found that the joint project had met most of its objectives and that QM facilitated the introduction of IMCI. A follow-up evaluation 2 years later found continued practice of QM by Nigerien health care providers. CONCLUSION: Several factors contributed to the success of the Tahoua QA program and the joint project: teamwork, focus on patients, clarity of roles through standards, and synergy between the QA Project and the BASICS Project.

Child Health Services↗
PubMed1975

National health planning in the United States: prospects and portents.

The National Health Planning and Resources Development Act of 1974 in the United States demonstrates a growing determination in Congress to motivate the system of health services toward greater efficiency in utilization of resources. The Act was designed to overcome some of the weaknesses in earlier planning legislation. More complete coverage and more functional local jurisdictions for planning should result. The Act provides better financial support, and more effective incentives and inducements to assure adherence to plans. Concern is expressed about aspects of the legislation which the authors feel may deserve consideration. The principle of delegating responsibility to voluntary agencies for disbursement of public funds is questioned, and the authors suggest that local public health authorities apply for designation as planning agencies. Reservation is expressed about the adequacy of regional organization as provided by the Act to accomplish its purposes, and the authors recommend demonstrations of regional administrative agencies to implement plans developed by Health Systems Agencies. Failure to incorporate the provision of the House planning bill to set up a national health policy council in the Act is considered unfortunate. Persistence in pursuing the course outlined in the Act is urged.

Financing, Government↗
PubMed2002

Public and private collaboration in establishing a young person's sexual health clinic in a commercial setting.

OBJECTIVE: To define the key factors and constraints in public-private sector collaboration in establishing and delivering a young person's sexual health clinic within an existing commercial establishment. CONSULTATION, PLANNING AND IMPLEMENTATION PHASES: Consultations were held between the Health Promotion Department, family planning and commercial outlets, resulting in the establishment of the UK's first sexual health service within commercial premises. Once the clinic had been operational for 6 months, a single researcher carried out semi-structured interviews with 13 staff representing all levels within the partner organisations. POST-IMPLEMENTATION INTERVIEWS: There was agreement by all interviewees on the objectives of the clinic. The problems encountered during the establishment of the service were with the legislation pertaining to pharmacies and the adverse press coverage of a minority public view of the provision of sexual health services to young people. No respondent identified conflict between the aims of the clinic and the strategic objectives of their organisation. RECOMMENDATIONS: Common aims are imperative for successful interagency working. Wider initial consultations may have helped to identify potential problems and confirm common aims at an earlier stage of the development of the project. The involvement of senior management may also have improved the smooth running of the project.

Adolescent↗
PubMed2003

The application of geographic information systems and global positioning systems in humanitarian emergencies: lessons learned, programme implications and future research.

Geographic information systems (GIS), global positioning systems and remote sensing have been increasingly used in public health settings since the 1990s, but application of these methods in humanitarian emergencies has been less documented. Recent areas of application of GIS methods in humanitarian emergencies include hazard, vulnerability, and risk assessments; rapid assessment and survey methods; disease distribution and outbreak investigations; planning and implementation of health information systems; data and programme integration; and programme monitoring and evaluation. The main use of GIS in these areas is to provide maps for decision-making and advocacy, which allow overlaying types of information that may not normally be linked. GIS is also used to improve data collection in the field (for example, for rapid health assessments or mortality surveys). Development of GIS methods requires further research. Although GIS methods may save resources and reduce error, initial investment in equipment and capacity building may be substantial. Especially in humanitarian emergencies, equipment and methodologies must be practical and appropriate for field use. Add-on software to process GIS data needs to be developed and modified. As equipment becomes more user-friendly and costs decrease, GIS will become more of a routine tool for humanitarian aid organisations in humanitarian emergencies, and new and innovative uses will evolve.

Altruism↗
PubMed1991

The evolution and impact of the national AHEC program over two decades.

The national Area Health Education Center (AHEC) program began in 1972 with the purpose of addressing problems of the shortage of physicians and the maldistribution of health professionals. The 40 projects of the program have involved 37 states, 55 medical schools, numerous other health professions schools, and 117 local community AHECs. This 19-month study (1988-1990) was undertaken to systematically assess and clarify the organization, functions, activities, and effects of the national AHEC program over two decades. Data sources were mainly 263 interviews of persons representing the full spectrum of those associated with and participating in AHECs. The findings describe a national network of school and community partnerships that were engaged in planning and implementing educational activities and were responsive to changing needs of health care. The individual AHECs differ in structure and activities as a function of the era in which each began, legislative requirements, and the specific community's needs for health professionals. As organizations, AHECs have unique functions that appear to have benefited the target communities or regions, participating schools, students, and medical school residents. Viability of AHECs in the future will depend on their ability to maintain a focus on health professions education in spite of state or community pressure to provide direct services--both clinical services and public education. At the same time, success will depend on the AHECs' capacity to respond effectively to changing needs of the community and the health care delivery system.

Area Health Education Centers↗
PubMed2000

Oral health status and treatment needs of 35-44-year old adults in Lebanon.

OBJECTIVES: The purpose of this study was to assess the oral health status and treatment needs of a Lebanese adult population. DESIGN: An epidemiological survey of 401 Lebanese adults aged 35-44 years was carried out in 1996. It followed the WHO methodology in assessing the oral health status and treatment needs of adult populations. A structured questionnaire and a standardised oral health exam were used for the investigation. RESULTS: Showed that the Decayed, Missing and Filled Teeth (DMFT) index was 16.3 and that 1.5 per cent of the sample had a DMFT score of zero, whereas, 55 per cent had a score of less than 4. Of the 401 subjects, 24 per cent had at least one bridge and 16 per cent had a removable prosthesis. Compared to other neighbouring countries, Lebanon ranked the highest in the DMFT index and its separate components. Close to 60 per cent of the sample was in need of operative treatment, 31 per cent needed tooth extraction and 60 per cent were in need of a crown or a bridge. Significant variations were observed in the oral health status as well as treatment needs of the sample when examining gender, socio-economic status, and place of residence differences. CONCLUSION: This study can be used as a stepping stone in the direction of building the base of knowledge on oral health in Lebanon. The planning and implementation of any strategy for oral health status improvement is crucial, alongside the country's infrastructure development.

Adult↗
PubMed1998

[Public health work in connection with a new international airport].

During the six years between the parliament decision in 1992 to build a new international airport and the opening of this airport at Gardermoen, public health authorities experienced strong challenges when exercising their authority, when planning and implementing the airport health services, and when trying to describe possible health hazards to the population living in the area. Environmental and population health considerations led in some instances to opposite conclusions. The opinions of local health authorities were overruled by national authorities as regards noise limits. The food control authorities were not included in the first stage of planning. Efforts to cooperate emergency health services, ambulance services, and services for the prevention of contagious diseases did not succeed initially. Population studies before and during the airport construction period showed that persons being forced to move because of the new airport reported increased illness, developed a lower self-assessed health quality, more often generalized pain, and more often moderate mental problems.

Aircraft↗
PubMed2005

A procedural model for planning and evaluating behavioral interventions.

OBJECTIVE: A model for planning, implementing and evaluating health behavior change strategies is proposed. Variables are presented which can be used in the model or serve as examples for how the model is utilized once a theory of health behavior is adopted. RESULTS: Examples of three innovative strategies designed to influence behavior change are presented so that the proposed model can be modified for use following comprehensive screening and baseline measurements. Three measurement priorities: clients, methods and agency are subjected to three phases of assessment: goals, implementation and effects. CONCLUSION: Lifestyles account for the majority of variability in quality-of-life and premature morbidity and mortality. Interventions designed to influence healthy behavior changes must be driven by theory and carefully planned and evaluated. The proposed model is offered as a useful tool for the behavior change strategist.

Behavior Therapy↗
PubMed2003

Integrating reproductive health services in a reforming health sector: the case of Tanzania.

Universal access to comprehensive reproductive health services, integrated into a well-functioning health system, remains an unfulfilled objective in many countries. In 2000-2001, in Tanzania, in-depth interviews were conducted with central level stakeholders and focus group discussions held with health management staff in three regional and nine district health offices, to assess progress in the integration of reproductive health services. Respondents at all levels reported stalled integration and lack of synchronisation in the planning and management of key services. This was attributed to fear of loss of power and resources among national level managers, uncertainty as to continuation of donor support and lack of linkages with the Health Sector Reform Secretariat. Among reproductive health programmes, sexually transmitted infection (STI) control alone retained its vertical planning, management and implementation structures. District-level respondents expressed frustration in their efforts to coordinate STI service delivery with other, more integrated programmes. They reported contradictory directives and poor communication channels with higher levels of the Ministry of Health; lack of technical skills at district level to undertake supervision of integrated services; low morale due to low salaries; and lack of district autonomy in decision-making. Integration requires a coherent policy environment. The uncoordinated and conflicting agendas of donors, on whom Tanzania is too heavily reliant, is a major obstacle.

Attitude of Health Personnel↗
PubMedDate not supplied

Launching a self-assessment process for systems integration: framework and findings.

The National Chronic Care Consortium developed the SASI tool to help health-care networks plan, implement, and measure chronic care integration across their full continuums of care. An integrated network for chronic care can be applied to any care population, and the SASI tool can assist in integration efforts in a variety of circumstances.

Chronic Disease↗
PubMed2005

Lessons learned: the implementation of an Alternative Funding Plan at SCO Health Service in Ottawa.

Physicians of SCO Health Service in Ottawa recently entered into an Alternative Funding Plan agreement with the Ministry for Health and Long-Term Care in Ontario. The plan provides agreed monthly funding to the SCOHS Academic Medical Organization in return for medical services. Funds are then paid to physician Practice Plans for services provided. The plan almost entirely eliminates fee-for-service billing, and also provides funding for teaching and research activities. The process of establishing the plan has provided some insights that might be useful to organizations undertaking the same process. Some of these insights are shared in this paper.

Aged↗

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