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PubMed2004

Report from the CDC. The National Public Health Initiative on Diabetes and Women's Health: leading the way for women with and at risk for diabetes.

Diabetes is a serious public health problem in the United States. The burden of the disease has had a significant impact on individuals, communities, and society at large, and the number of people with diabetes is expected to double by the year 2025. In response to the growing burden of the disease and the profound health consequences for women and their offspring, the National Public Health Initiative on Diabetes and Women's Health convened a call-to-action conference to form a collective effort to address diabetes and women's health issues. This paper documents the process of developing a call-to-action conference and identifying potential stakeholders and presents results from the conference and the accomplishments of the National Public Health Initiative on Diabetes and Women's Health.

Adolescent↗
PubMed2002

Do essential service packages benefit the poor? Preliminary evidence from Bangladesh.

In 1998 Bangladesh began a sector wide approach (SWAp) to the extension of health care to vulnerable groups in the country. The central feature of this approach is the funding of an essential service package (ESP) emphasizing maternal care, certain communicable diseases and child health. This study examines the way in which public sector expenditures are distributed by comparing the actual beneficiaries of spending with the target groups identified by the sector strategy. It finds that while the ESP is helping to target resources at priority services, considerable barriers to access by vulnerable groups persist. The study suggests a number of issues that need to be addressed to improve the performance of the programme. First, improved targeting requires greater emphasis on the process of access to key services. Secondly, improving the efficiency of service provision at primary level is a key element to increasing access, since individual primary providers are often not ready to provide the standard of care required by the ESP approach to services. Finally, the system of financial control and management needs to be modified in order to make allocations more responsive to the priorities determined by the SWAp. Given the widespread adoption of the ESP approach to health care, the paper also suggests a wider research agenda that examines its impact in other countries and evaluates this worldwide experiment in health service prioritization.

Bangladesh↗
PubMed1994

Micro-level planning using rapid assessment for primary health care services.

This paper describes the use of a rapid assessment technique in micro-level planning for primary health care services which has been developed in India. This methodology involves collecting household-level data through a quick sample survey to estimate client needs, coverage of services and unmet need, and using this data to formulate micro-level plans aimed at improving service coverage and quality for a primary health centre area. Analysis of the data helps to identify village level variations in unmet need and develop village profiles from which general interventions for overall improvement of service coverage and targeted interventions for selected villages are identified. A PHC area plan is developed based on such interventions. This system was tried out in 113 villages of three PHC centres of a district in Gujarat state of India. It demonstrated the feasibility and utility of this approach. However, it also revealed the barriers in the institutionalization of the system on a wider scale. The proposed micro-level planning methodology using rapid assessment would improve client-responsiveness of the health care system and provide a basis for increased decentralization. By focusing attention on under-served areas, it would promote equity in the use of health services. It would also help improve efficiency by making it possible to focus efforts on a small group of villages which account for most of the unmet need for services in an area. Thus the proposed methodology seems to be a feasible and an attractive alternative to the current top-down, target-based health planning in India.

Community Health Centers↗
PubMed2004

Program sustainability: focus on organizational routines.

Program sustainability is an ongoing concern for most people in health promotion. However, the current notion of sustainability in organizations, namely routinization, needs refinement. This article examines organizational routines. In so doing, it refines the notion of sustainability and the assessment of routines. Drawing on the organizational literature, a routinized program is defined by the presence of routinized activities, meaning that these activities exhibit four characteristics of organizational routines: memory, adaptation, values and rules. To answer the question of how these characteristics are useful, we conducted an empirical study of the routinization of the Quebec Heart Health Demonstration Project in five community health centers. Our method consisted of a multiple-case study. We observed project activities in each center in 2000. The data came from documents and interviews with project actors. Our results show that, in one of the centers, no resources had been officially committed to project activities. Even so, the actors continued some activities on an informal basis. In another center, the activities satisfied three of the four routine characteristics. In the three others, activities satisfied all of the characteristics. These results suggest focusing the study of program sustainability on the routinization of activities resulting from it. They indicate four distinct degrees of sustainability: (1) the absence of sustainability; no program activity is continued; (2) precarious sustainability; some residual activities are pursued, at least unofficially; (3) weak sustainability; the program produces some official activities that are not routinized; and (4) sustainability through routinization; routinized activities result from the program.

Community Health Centers↗
PubMed2006

What makes for sustainable Healthy Cities initiatives?--A review of the evidence from Noarlunga, Australia after 18 years.

This paper examines the factors that have enabled the Healthy Cities Noarlunga (HCN) initiative to be sustainable over 18 years (1987-2005). Sustainability related to the ability of the initiative to continue to operate continuously in a manner that indicated its existence was accorded value by the community and local service providers. The analysis is based on a narrative review of 29 documents related to HCN, including a number of evaluations. Nine factors emerged as important to ensuring sustainability: strong social health vision; inspirational leadership; a model that can adapt to local conditions; ability to juggle competing demands; strongly supported community involvement that represents genuine engagement; recognition by a broad range of players that Healthy Cities is a relatively neutral space in which to achieve goals; effective and sustainable links with a local university; an outward focus open to international links and outside perspectives; and, most crucial, the initiative makes the transition from a project to an approach and a way of working. These sustainability factors are likely to be relevant to a range of complex, community-based initiatives.

Community Health Planning↗
PubMed2006

Determinants of health promotion action: comparative analysis of local voluntary associations in four municipalities in Finland.

The World Health Organization makes a case for the importance of voluntary organizations in promoting health at local levels. The purpose of this paper is to contribute to understanding which factors explain local voluntary associations (LVAs) participation in health promotion in local contexts. It does so through (i) identifying indicators that represent determinants of health promotion action which were reported by LVAs and by (ii) comparing their actions with these determinants. The data reported are from a questionnaire survey of all registered LVAs in four municipalities in Finland. Principal component analysis revealed four determinants of health promotion action. Four factors in the final multivariate model explained over half of the variance of LVAs engagement in health promotion action: competence, values 'healthy' and also opportunities and municipality. There is some evidence to support a model of health promotion action which has not been tested empirically in relation to these types of organization. More detailed studies of determinants of health promotion action are needed to shape strategies in local communities.

Community Health Planning↗
PubMed1998

Health promotion: perceptions of Project 2000 educated nurses.

The new approach to pre-registration nursing education in the UK (Project 2000) has an overt health focus as well as a specific remit to prepare nurses for a role as promoters of health. Data reported in this paper illuminate Project 2000 students' understanding of the concepts of health promotion and health education, and indicate the extent to which qualified nurses who have completed this new Project 2000 programme perceive themselves to be prepared for a health promotion role. Findings indicate that students are confused about the terms health education and health promotion, although most feel there is a distinction between the two. Students' descriptions emphasize individualistic approaches, and lifestyle and behaviour changes. Many recognize that health promotion should have a broader application and demonstrate a sophisticated grasp of the philosophy underpinning the promotion of health through their general perceptions of nursing. This understanding is not labelled health education or health promotion, but is embedded in their articulation of concepts such as holism, patient-centred care and enhancing independence. Paradoxically, both students and Project 2000 qualified nurses (diplomates) illustrate a clear grasp of the more complex issues surrounding the concept of health promotion while remaining confused by the terminology and its relationship to practice.

Education, Nursing↗
PubMed2002

The Chilean legacies in health care quality.

OBJECTIVE: The Chilean quality assurance (QA) program evaluation took place in July 1999, at the request of the Chilean Ministry of Health. The main objectives of the evaluation were to identify key aspects of the 8-year-old Chilean QA program that could be considered by other countries and to make strategic recommendations. SETTING: In 1991, the Ministry of Health of Chile launched a national QA program. A national-level team initiated countrywide training of health care providers in QA skills, the development of quality committees at facility levels to direct local quality improvement activities, and training of quality monitors to provide technical support for training and quality improvement activities. DESIGN: The evaluation team, consisting of two international consultants and a regional consultant from the Costa Rican Ministry of Health, visited six regions and seven health 'servicios' (geographically defined administrative units within a region). The regions and servicios were purposefully chosen to represent different geographic areas, types of facilities, and levels of performance of QA activities. The evaluation was based on a framework developed and applied by the Quality Assurance Project (Center for Human Services, USA). Group and individual interviews with staff complemented document and record reviews. RESULTS: The evaluation team found that Chile's QA program had been successful in achieving sustainability and institutionalization. Factors contributing to this success included the enabling environment, management and leadership, technical functions, and support functions. CONCLUSION: The Chilean QA program constitutes an interesting experience for consideration by other countries. Key features include its sustainability, nationwide coverage, decentralization, and alliance of quality improvement and regulation. Training results are impressive: almost 20% of Ministry of Health personnel received training, and 19 training modules are in use. Coaches are active and technically sustaining quality assurance activities nationwide.

Chile↗
PubMed2006

Challenging the world: patient safety and health care-associated infection.

Improving the safety of patient care is an issue which affects health systems in both developed and developing countries. To co-ordinate and accelerate improvements in patient safety, the World Health Organization (WHO) has supported the creation of the World Alliance for Patient Safety which was launched in October 2004. The six action areas of the Alliance are Patients for Patient Safety, Taxonomy, Research, Solutions for Patient Safety, Reporting and Learning, and a biennial Global Patient Safety Challenge. The first Challenge covering 2005-2006 was launched in October 2005 under the banner 'Clean Care is Safer Care'. The Challenge addresses health care-associated infection, a major, patient safety problem affecting hundreds of millions of people worldwide.

Cross Infection↗
PubMed2004

Study of infant feeding practices: factors associated with faulty feeding.

KEM Hospital, Mumbai was recognized as a 'baby-friendly' hospital on the basis of adherence to the 'Ten steps to successful breastfeeding', a decade ago. This study was undertaken to determine the sustainability of the programme in terms of feeding practices undertaken by the mothers on the basis of advice given to them. A total of 92.11 per cent of the infants up to 6 months of age received exclusive breastfeeding. Timely complementary feeding rate was 95 per cent. Thus interventions used in the programme seem sustainable.

Breast Feeding↗
PubMedDate not supplied

Preconceptional health promotion: progress in changing a prevention paradigm.

Preconceptional health promotion is a proven strategy to impact reproductive outcomes. Despite energy to incorporate this prevention strategy into the care of women in this country, little evidence exists that the paradigm shift necessary to reframe the clinical care of women has occurred or that public awareness about critical opportunities for preventing reproductive casualties is high. This article reviews the rationale for preconceptional counseling, discusses progress in moving the agenda of prepregnancy wellness forward, and reveals some of the lessons learned from efforts to redesign prevention emphases for reproductive healthcare.

Counseling↗