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Capacity building to improve women's health in rural China.

The Women's Reproductive Health and Development Program (WRDHP) is an ambitious attempt to operationalize two important tenets of health development thinking within a rural reproductive health context. First, it is important for communities to participate in decisions about the services and programs that affect them. Secondly, the complex nature of healthcare is best addressed by intervention processes which call for a multi-functional approach to planning and coordination. In both planning and intervention approach, the WRHDP recognizes the social, cultural and economic realities that affect women's efforts to secure the health and well-being of themselves and their families. The focus of the WRHDP is on capacity-building within a rural reproductive health environment, in this case Yunnan Province in rural China. Rather than using international donor funding to provide a specific intervention, the WRDHP used Ford Foundation funding as a lever to encourage community investment in environmental resources that affect health, to improve the technical skills of individuals within the existing health bureaucracies, and to promote structural changes within existing health and development bureaucracies to support interagency collaboration and community empowerment within the region's health and development agencies. This article describes how the WRHDP created new methods for provincial and local agencies to overcome obstacles and work with one another to improve women's health. It also describes the processes used in the rural areas of Chengjiang and Luliang counties to assess local conditions and needs, and the supported and expanded local efforts in improving woman's reproductive and family health that resulted from the processes.

China↗

Evaluation of the role of the health care assistant within a community mental health intensive care team.

BACKGROUND: Recent changes in UK legislation concerning community care of mentally ill people have initiated comprehensive changes in the delivery of healthcare. The NHS and Community Care Act (Department of Health 1990) added impetus to the run down of residential facilities and the speed of development of community mental health services. A community mental health intensive care team was established in Essex and employed a high ratio of unqualified to qualified staff. At a time of tension within the Health Service around issues such as skill mix and unemployment among qualified nurses, it was perhaps not unreasonable that the introduction of healthcare assistants might be viewed with suspicion, as a way of diluting the workforce with a less expensive alternative. The importance of evaluating new services is self-evident. OBJECTIVE: The growth of consumerism has led to acknowledgement that mental health service users' views have a role in shaping service provision. An attempt was made to determine the service users' evaluation of the role of the healthcare assistant within a community mental health intensive care team. RESULTS: The use of Kelly's (1955) repertory grid technique and theoretical sampling provided rich descriptions of the role of the healthcare assistant as experienced by service users. Analysis of the healthcare assistant-client relationship demonstrated a client-centred approach was apparent with considerable emphasis placed on the personal qualities of the care provider, supporting Roger's (1961) view that 'healing' comes not so much from the therapists 'techniques', as from their personality. CONCLUSION: It is self-evident that the clients' expressed satisfaction with the care provided by healthcare assistants argues against the professional ideology of nursing, which proposed that nursing may only be given by those with a statutory qualification. A complementary role for healthcare assistants in the provision of mental health care is proposed.

Community Health Workers↗

In rural Ugandan communities the traditional kinship/clan system is vital to the success and sustainment of the African Programme for Onchocerciasis Control.

In rural Ugandan communities where onchocerciasis is meso- or hyper-endemic, control of the disease is now being carried out using a strategy of community-directed programmes for the annual distribution of ivermectin to all persons eligible to take the drug. For these programmes to achieve their annual target coverage of at least 90% of the population eligible to take ivermectin, and to continue to sustain themselves for 10-15 years or more, even after external donor funding ceases, it has been found essential to replace the initial community-based strategy, imposed from outside, by a community-directed strategy developed by the community members themselves. Furthermore, it is essential for success that full use be made of the traditional social system, which is very strong in all rural communities in Uganda. This system is based on patrilineal kinships and clans, governed by traditional law, and in it women pay an important role. If this system is ignored or by-passed by government health personnel or by the sponsors and promoters of the programme, the communities are likely to fail to reach their targets. When rural communities increase in size and complexity, following development and the arrival of migrant families, they become semi-urbanized. The kinship/clan system is then weakened, community-directed drug distribution is much more difficult to organize, and coverage targets are not often achieved. This effect is of minor importance in a rural disease, such as onchocerciasis, but is likely to be of greater significance in the control of diseases, such as tuberculosis and lymphatic filariasis, which thrive in urban environments.

Community Health Workers↗

An urban intergenerational program for cancer control education.

BACKGROUND: Recognizing the disparities in cancer morbidity and mortality that exist between African Americans and whites, an urban university and its neighborhood community undertook the development of an education program to transfer state-of-the-art cancer prevention, detection, and treatment information from an academic medical center to community residents, including school-age children. METHODS: An intergenerational, multilevel intervention was developed to: 1) assess the health beliefs of the community, 2) identify, develop, and train an intergenerational group of community residents who would serve as health educators, and 3) promote behavioral change among the target population. RESULTS: Ten community residents were trained as educators. Over the course of two years they conducted cancer education programs that reached 775 adults. During the same period, the school-based educational intervention reached 264 seventh-grade students. CONCLUSIONS: Implications for the design and implementation of community-based cancer education programs in this African American community are identified.

Academic Medical Centers↗

Leadership in a public housing community.

Community Health Advocate (CHA) programs train community members to assist and advocate for other members of the community regarding health and other community issues. These programs have been successful in improving the health and quality of life of communities. We developed a CHA program in a single public housing development. This program faced unique challenges since the advocates both worked and lived in the same setting. However, confronting and resolving these issues ultimately enhanced the quality of the program.

Community Health Planning↗

Fighting arsenic at the grassroots: experience of BRAC's community awareness initiative in Bangladesh.

The study evaluates the arsenic mitigation project of BRAC in raising awareness of arsenic poisoning in rural communities in Bangladesh. Data came from selected project villages in south-western Bangladesh. Comparison villages were also selected from the same region. A total of 1240 randomly selected adults were interviewed in May 2000. Findings reveal that the mitigation project played a significant, positive role in raising awareness of the safe water options, signs of arsenicosis, mode of transmission and the type of treatment. Testing tube-well water for arsenic created curiosity, innovation and interest in the community, and the water treatment plant became a symbol of the arsenic campaign. The study concludes that the behavioural change aspects of the arsenic mitigation project have the potential to significantly improve the level of understanding about arsenic contamination in the traditional communities.

Adult↗

Detection of cervical and breast cancer: a community-based pilot study.

Pilot screening clinics were conducted in two Los Angeles County health districts where cervical cancer incidence and mortality rates were high. Results are of interest because they provide information on planning and operating community-based clinics in low-income areas where there are women who are unlikely to seek or are ineligible for available health services.

Adult↗

Training and management for primary health care.

Training depends for its success upon initial selection of both students and teacher, and secondly on the curriculum content relevance to realistic job designations, consequent upon community appraisal, epidemiological surveys, manpower studies and facilities analysis. Examination systems should not be an encumbrance to real learning and the acquisition of appropriate skills. Management in primary health care depends for its improvement upon accepting that the delivery system is supportive to the primary health care unit rather than the reverse; that the structure of the delivery system and educationa; programmes correlate and form a simple referral chain and that data gathering be designed for a community information system rather than for cantralized statistics. The two aspects, manpower development and delivery system, can be made more relevant one to the other by reconsidering the overall roles of the teacher and the practitioner. Supervision is a key issue and is primarily an educational activity, not administrative. Teamwork, to be effective, must be learned and instilled from inception of training.

Community Health Workers↗

The nurse-community health advocate team for urban immigrant primary health care.

PURPOSE: To describe: (a) development and implementation of an urban outreach health program for Latino immigrants; (b) nurse-community-health advocate (CHA) partnership roles in primary health care delivery, and (c) lessons learned from these activities over 7 years in urban community settings. METHODS: Descriptive study of a community-based health project in a large Midwestern American city. Information was gathered from participants and staff, from observing staff, and from a variety of sources to describe the program and its individual, family, and community effects. FINDINGS: Major findings pertain to the project team's ability to address the health promotion needs of Latino immigrant families and to successfully incorporate CHAs in planning and implementing the program. CHAs were a "bridge" between health programs and the community, promoting cultural sensitivity. CHAs and nurses provided a range of services including health education and promotion, outreach through home visits, assessment of family needs for referrals to appropriate resources, and follow-up support. CONCLUSIONS: The nurse-CHA team was an effective strategy for promoting Latino immigrant families' access to needed health care. This framework allowed for flexibility in assisting clients of different cultural backgrounds to obtain appropriate health care.

Attitude of Health Personnel↗

Supervision and the emerging professional.

A model for the training of supervisors of new professionals is presented. Highlighted are concepts, principles, and methods of supervision, with emphasis on such issues as entry, race, class, sex, and upward mobility of the emerging professional in the established mental health system.

Administrative Personnel↗

The informal community caregiver: a link between the health care system and local residents.

A group of "informal" caregivers, local people to whom residents turn for information and advice, was identified in the east Harlem community and enlisted in a two-month study. Results suggest that formal human services agencies and their intended clientele would benefit by increased efforts on the part of these institutions to locate and work with community caregivers.

Adolescent↗