Program packaging. A process of health program planning and implementation.
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Community Health Services↗
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[The realization of the Madrid International Plan of Action on Ageing: role of scientific research].
The article focuses on the role gerontological science is supposed to play in the implementation of the Madrid International Plan of Action on Ageing. Its purpose, structure, the process of development and concordance, as well as problems arising in the course of its realization are discussed by the authors. The contribution of the Russian gerontological science in the realization of the Madrid Plan of Action is debated.
Aging↗
On the way to Psychiatric Reform in Israel: notes for an ideological and scientific debate.
Israel has launched its program for Psychiatric Reform. However, the implementation of its three areas of action, as the Reform has been conceived thus far, is uneven. While the development of the rehabilitation component has progressed as planned, the one that refers to the insurance component remains stalled. The third one, dealing with dehospitalization and community care, has advanced only in part. Although many of the issues related to the three components of the Reform, of a curative and rehabilitative nature, have been adequately addressed, some crucial aspects are still awaiting a more extensive discussion by all mental health stakeholders. This paper reviews some value-laden and scientific issues as well as strategic measures that are suggested to be taken into account in a forward-looking and democratic Reform. Examples of these issues are: the quest for equity, at the time when the poor population is increasing in the country; scientific issues (e.g., the application of epidemiological data in planning for community needs, training for community-based personnel), that if left aside bear the risk of undermining the depth of the Reform; and strategic measures, purported to recruit the support of professionals and the general public that is essential in a movement that thrives on inclusion and promotes community-based care.
Health Care Reform↗
Compliance with the recommendations of the Institute of medicine report, The Future of Public Health: a survey of local health departments.
In 1989 a survey of state health officials was conducted to ascertain the extent that the recommendations of the 1988 Institute of Medicine's report, The Future of Public Health, were in place. We applied a similar survey in 1996 to assess the level of implementation of the IOM recommendations at the local health department level. Agreement with the specific IOM recommendations at the local level was, in almost all cases, greater than 90%. However, when one views the extent of these recommendations in place, nearly half fall below 50%. While there have been improvements in areas such as education of the public and outreach towards legislators and voluntary health organizations, our results show that there are still major short-comings when it comes to implementing the recommendations. Lack of resources at the local level appears to be the predominant cause of the low level of implementation, with restricted authority and lack of support also contributing to the problem. We feel the IOM recommendations can provide a strong foundation for our public health system, and hope these results help serve as a benchmark for further study.
Forecasting↗
Changing healthcare organisations to change clinical performance.
We propose the formation of evidence-based clinical practice support units in hospitals and clinical research implementation networks. The purpose of these initiatives will be to increase the uptake of beneficial forms of care and remove harmful or ineffective practices. They will bring together clinicians and other professionals to improve clinical care across the healthcare system.
Australia↗
Heart Partners: a strategy for promoting effective diffusion of school health promotion programs.
Heart Partners uses a straightforward, interpersonal approach to increase acceptance and use of innovations in school health promotion. In accord with the linkage model of innovation diffusion, developers of a new program or technology (i.e., resource system) simply designate and train selected members to be recruiters and allies of individual advocates at the campus-level (i.e., user system). Linkage is supported by supplying advocates and allies with guidelines and materials that encourage ongoing, interactive, interpersonal partnerships to promote effective implementation of the new technology at the school. Empirical assessment of this simple strategy implemented by the Texas Affiliate of the American Heart Association showed a twofold to fourfold increase in actual use and reach of school health promotion packages, with an average reported volunteer time of less than three hours per month.
American Heart Association↗
Slip! Slop! Slap! and SunSmart, 1980-2000: Skin cancer control and 20 years of population-based campaigning.
The Anti-Cancer Council of Victoria has been running sun protection programs for more than 20 years: Slip! Slop! Slap! from 1980 to 1988 and SunSmart from 1988 to the present. The Victorian Health Promotion Foundation has provided funding for the SunSmart program for the past 13 years. These programs have played an important role in changing the whole society's approach to the sun and have resulted in marked reductions in sun exposure. This article describes the social, political, economic, and organizational context within which these programs developed. Then 10 areas are discussed that illustrate a critical aspect of the development and implementation of this successful systemwide health promotion program. These areas focus on key aspects of the context within which the program operates and on issues that derive from the experience of implementing program strategies. In summary, the success of the two programs is described as having been built on two key foundations: the vital integration of research and evaluation, on one hand, and a strong basis of consistency and continuity, on the other.
Adolescent↗
The challenges of employing performance monitoring in public health community-based efforts: a case study.
The development of community-based coalitions has acquired great popularity as a health promotion strategy. The Institute of Medicine recommends that community-based health coalitions employ a performance monitoring process in their efforts. The results of the current study indicate that in the community setting, implementing a performance monitoring process and sustaining the specialized functions entailed in this strategy are challenging. Many of the challenges result from fundamental differences between the organizational environment of bureaucracies--in which these techniques are developed, supported, and greatly successful--and the realities of the loosely-structured and resource-limited community environment. The performance monitoring process is measurement-driven. One challenge of implementing this process at the community level is that public health problems of local concern are not always documented in current surveillance systems and thus a performance monitoring strategy is not always, or immediately, applicable. When data which document a health problem of local concern are available, a second challenge facing community-based coalitions is acquiring the resources, especially the wide-range of specialized expertise, required to fully implement and sustain the performance monitoring process. These issues are examined in the context of the Massachusetts Department of Public Health's Community Health Network Area (CHNA) Initiative which entails the formation of coalitions of local health service providers. The CHNA initiative is a statewide project in which health service providers in specified geographic regions work collaboratively on health improvement projects.
Adolescent↗
Genetics in the reformed health service. Changes for the better?
The practical value of medical genetics, in particular the development of molecular genetics complemented by clinical diagnosis and counselling, is widely recognised. There is strong independent support from government and patient organisations for augmenting genetics services in all health regions; this support gives much reason for optimism. But there appears to be a hiatus following the reform of the Health Service: no genetics centre has, as yet, adequate resources and there has been no increase in clinical genetic manpower in the last two years. Even worse, Wales and at least one English region have devolved genetic services to districts, which appears to be contrary to government policy for genetic services. These factors have inevitably limited the implementation of many opportunities for improved patient care and the prevention of genetic disease. However, medical geneticists, assisted by the Royal College of Physicians and others, want to respond positively to the changes in the Health Service. Recommendations are made for strategies which promise to maintain integrated regional clinical and laboratory services and to achieve well evaluated developments.
Career Mobility↗
Evaluation of child health services at Gelukspan Community Hospital, Radithuso, Bophuthatswana, 1976-1984.
Since the independence of Bophuthatswana in 1977 many new services have been established. The policy of the Department of Health and Social Welfare to practise primary health care has been implemented step by step and special attention has been given to the well-being of infants and preschool children. During this period several parameters of child health have been monitored, such as mortality rates, nutritional status and immunization status. In a few years significant changes have taken place.
Child Health Services↗
Community mobile treatment. What it is and how it works.
In 1984, Paul Hanki of Prince George, British Columbia, Canada, developed community mobile treatment, an innovative approach to substance abuse treatment in Native communities. The feature that distinguishes community mobile treatment from most other forms of treatment is the strong emphasis on community involvement. Before an actual treatment program is implemented, the community must acknowledge that a substance abuse problem exists and be committed and involved in addressing the problem. Once a community is mobilized, a 21 to 28 day intensive alcohol and drug treatment program for substance abusers and their families is brought into the community. Since its inception in 1984, community mobile treatment has been implemented in approximately 17 Canadian communities. The few evaluations that have been conducted suggest that this approach holds much promise in reducing alcohol and drug-related problems. This article reviews the existing documentation and provides a comprehensive description of this unique approach.
Aftercare↗
General practitioners with a special interest in respiratory medicine: national survey of UK primary care organisations.
BACKGROUND: To meet the universally recognised challenge of caring for people with long-term diseases many healthcare cultures are encouraging family physicians to develop specialist skills. We aimed to determine the major factors influencing the appointment of respiratory General Practitioners with a Special Interest (GPwSI) in the UK, and to determine the priority attached to the potential roles, perceived barriers to implementation, and monitoring planned. METHODS: We sent a piloted semi-structured questionnaire to a random sample of 50% of English and Welsh primary care organisations (PCOs) (n = 161) during winter 2003. In addition to descriptive statistics, we used hierarchical cluster analysis to classify service priorities. Free-text responses to open-ended questions were analysed qualitatively by a multidisciplinary group to identify emerging themes. RESULTS: Of the 111 (69%) PCOs who responded, 7 (6%) already have, and a further 35 (32%) are planning, a respiratory GPwSI service. This proportion is considerably lower than in specialities linked to National Health Service clinical priorities. Local needs and pressure on hospital beds were the main described motives for developing a service. Stated service priorities were to relieve pressure on secondary care and to improve quality of care, including the strategic planning of respiratory services within PCOs. CONCLUSION: The relatively few respiratory GPwSIs currently in post reflects the lack of government prioritisation of respiratory care. However, respiratory GPwSI services are increasingly being considered as a local strategy for reducing pressure on secondary care respiratory services and raising standards of chronic disease management in primary care.
Attitude of Health Personnel↗
[Health promotion by the public health service--problem areas and perspectives].
For more than ten years policy makers and researchers in the field of health policy have been requesting the local health departments in Germany to focus primarily on population-oriented and structural strategies in health promotion. Based on empirical findings of a study carried out in Berlin, this article argues that several structural and organizational factors in practice influence the implementation of these strategies by the local health departments. These factors can constrain or enable the implementation of the strategies. The paper draws the conclusion that several requirements must be fulfilled for the local health departments to define themselves in health politics and policy. More than ever, the definition of their tasks and targets needs to be linked to questions of organizational change and personnel. Moreover, the local health departments should define their role more clearly in relation to the other institutions in the sector of public health and in relation to the citizens.
Forecasting↗
The implementation of workplace violence policy in state government.
Workplace violence has received an increasing amount of attention in the last five years. While it is difficult to conclude that it is actually escalating, the numerous studies do provide numbers that lead one to believe that it is a serious problem. Although agencies and corporations are beginning to develop workplace violence policies, there is no published research that documents the results of the implementation of such policies. The current research examines North Carolina state employees' familiarity with their new workplace violence policy and reporting procedures, how uniformally the policy is being utilized, victims' perceptions of their agencies' responses to their own violent incidents, and their generalized perceptions of the agencies' intent to keep the workplace safe.
Adult↗
Malaria and pregnancy: the implementation of interventions.
The choice of interventions for improving malaria control during pregnancy depends on several factors. These include the efficacy of the intervention, consumer acceptability and compliance, provider acceptability, cost, safety, integration with other interventions and the local system of health-care delivery, and the degree of combination of these factors. For successful implementation the following should be recognized: appropriate policy formulation based on a process of advocacy, research and demonstration programmes; regulation and legislation; resource mobilization; consumer awareness; and appropriate delivery, targeting, monitoring and evaluation. Malaria in pregnancy is a priority area for control and a major public-health problem. Improved control of such disease requires better integration into health-care practices.
Africa↗
Strategies implemented but goals not attained. Some comments on an evaluation of the Swedish mental health services.
Is the development of Swedish psychiatry a success or not? Available information allows different answers to this question. Valid knowledge would demand psychiatric health service research on a much larger scale and with considerably higher ambitions than hitherto. Strong arguments can be raised about the need for such research to avoid that psychiatry will remain a medical wasteland in which confused policy makers will allocate less interest and money than ever.
Health Plan Implementation↗
What is important for the introduction of cancer screening in the workplace?
Although cancer screening has been introduced into physical checkup programs in the workplace, it has not been regulated by the Occupational Health and Safety Law in Japan. In addition, the target age groups and strategy for cancer screening have not been defined. To aid in development of better screening programs, we investigated primary factors considered for introducing cancer screening in workplaces. A mail survey targeted 441 facilities of the Kanto Occupational Health Management Association in June 2002. We received ninety-one responses (20.6%), including 59 facilities of manufacturing companies. The implementations of gastric and colorectal cancer screening were higher than other cancer screenings, exceeding 90% in the responding facilities. Thirty years old or over was the target age in most facilities. The facilities were divided into two groups, A and B, except for two examples whose strategies for cancer screening were not well-documented in their response. There were 35 facilities in group A and 54 in group B. In group A, cancer screening was conducted using strategies for all of which effectiveness has been established. On the other hand, in group B, cancer screening was conducted using strategies whose effectiveness were at least partially unestablished. We chose five items to evaluate important factors for introducing a cancer screening program into the workplace: prevalence, screening strategy, effectiveness, efficacy and needs of workers. The most important was the same in both groups, effectiveness. However, there was a tendency for neglect of this aspect in actual conducted plans. Appropriate cancer screening should be carefully coordinated in accordance with the guidelines of the Task Force for Cancer Screening in Japan in the workplace.
Health Plan Implementation↗
Communitarian claims and community capabilities: furthering priority setting?
Priority setting in health care is generally not done well. This paper draws on ideas from Amartya Sen and Martha Nussbaum and adds some communitarian underpinnings to provide a way of improving on current uses of program budgeting and marginal analysis (PBMA) in priority setting. The paper suggests that shifting to a communitarian base for priority setting alters the distribution of property rights over health service decision making and increases the probability that recommendations from PBMA exercises will be implemented. The approach is built on a paradigm which departs from three tenets of welfarism as it is normally conceived: (i) individuals qua individuals seek to maximise their individual utility/well-being; (ii) individuals want to do this; and (iii) it is the values of individuals qua individuals that count. Some of the problems of PBMA, as it has been applied to date, are highlighted. It is argued that these are due largely to a lack of 'credible commitment'. Bringing in the community and communitarian values to PBMA priority setting exercises can help to overcome some of the barriers to getting PBMA recommendations implemented. The approach has the merit of reflecting Sen's concept of capabilities (but extending that to a community level). It avoids the often consequentialist base of a conventional welfarist framework, and it allows community values as opposed to individual values to come to the fore. How to elicit communitarian values is explored.
Attitude to Health↗