Feasibility of community participation for vector control in villages.
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An account is presented of how a diarrhoeal disease outbreak was combatted by a community in a remote area of southern Bangladesh. Temporary treatment centres were set up in epidemic areas, and large numbers of patients used those facilities. Government health personnel cooperated with the community, which mobilized all available resources in an effort to forestall a catastroph. The case fatality rate at the treatment centres was reported to be 1.4%. Ninety-three percent of patients came from a radius of three km or less. From this experience, it may be concluded that increased community efforts and involvement are effective long-term means of controlling diarrhoeal diseases.
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A team of researchers, including one behavioral scientist (S.M.N.) and three epidemiologists (L.Q., O.S. and S.N.) conducted community analyses to assess the social and cultural factors that affect the detection and reporting of disease cases in a surveillance system, using acute flaccid paralysis (AFP) surveillance in Niger as a case study. Over a 60-day period in the country, the research team reviewed written field reports and interviewed epidemiologists, nurses, community members and persons in governmental and non-governmental organizations. Overall, we found that the logistical difficulties of travel and communication, which are common in developing countries, constrain the conventional surveillance system that relies on epidemiologists visiting sites to discover and investigate cases, particularly in rural areas. Other challenges include: community members' lack of knowledge about the possible link between a case of paralysis and a dangerous, communicable disease; lack of access to health care, including the low number of clinics and health care workers; cultural beliefs that favor seeking a local healer before consulting a nurse or physician; and health workers' lack of training in AFP surveillance. The quality of surveillance in developing countries can improve if a community-based approach is adopted. Such a system has been used successfully in Niger during smallpox-eradication and guinea worm-control campaigns. In a community-based system, community members receive basic education or more extensive training to motivate and enable them to notify health care staff about possible cases of disease in a timely fashion. Local organizations, local projects and local leaders must be included to ensure the success of such a program. In Niger we found sufficient quantities of this type of social capital, along with enough local experience of past health campaigns, to suggest that a community-based approach can improve the level of comprehensiveness and sensitivity of surveillance.
Five community partnerships (CP) were initiated in South Africa as demonstration projects aimed at the re-orientation of health professionals' education (HPE) to be more community responsive and interprofessional. A cluster evaluation of these partnerships has demonstrated that, in addition to motivating all stakeholders to forge closer working relationships, it is necessary for partnerships to pay close attention to a variety of structural and operational dimensions, the lack of which could prove to be major constraints to effective partnership functioning. This study critically reviews the challenges to collaborative working as experienced by the South African cluster. Within the context of the post-apartheid restructuring and development, the discussion highlights the insights that partnerships offer to clarify the extent to which potential barriers could affect the stakeholder groups. The paper identifies potential impediments, and makes explicit how they impact on partnership fostering. Evidence is also presented for their early detection and possible solutions are identified. The lessons learnt from these South African cases are that wide representation, commitment and a sense of ownership, sound leadership skills, regular and effective communication, reliable member expertise and capabilities and attention to power issues are crucial elements in the partnership equation. The paper concludes with an invitation to health administrators and partnership executives to devote attention to the array of interacting components that, collectively, could impinge on the effectiveness of the multifaceted nature of interprofessional joint working arrangements.
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