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PubMed1998

Health promotion in different medical settings: women's health, community health and private practice.

This paper describes the health promotion role of doctors in two medical practice settings: women's and community health centres, and fee-for-service practice. It proposes the establishment of divisions of primary health care in Australia which would be multi-disciplinary and focus on community-wide health issues. The paper is based on data from an interview survey of medical practitioners who had worked in metropolitan Adelaide women's and community health centres and from a questionnaire survey of GPs in private practice. The types of health promotion activity by the doctors in the different settings are discussed. It is concluded that private practice GPs are involved primarily in providing health education advice to individual patients. Doctors within women's and community health centres are more likely to report involvement in group health promotion activity and broader community development initiatives. The study concludes that health promotion which focuses on the health of the local community is best conducted within multidisciplinary health centres. GPs in private practice are limited by the structure of their setting (particularly the fee-for-service basis and reliance on a single discipline) to health promotion which focuses on the needs of individual patients.

Attitude of Health Personnel↗
PubMed1988

Comprehensive planning for AIDS-related services.

Because of the potentially devastating effects AIDS has on both individuals and the health care system, nursing administrators can take a leadership role in developing comprehensive and humane strategies to combat this disease. To develop such strategies, the authors present an AIDS-related services planning model for provision of patient care, human resource management, and community development.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Lacrimal surgery at St John, Jerusalem.

Lacrimal surgery forms a prominent component of a general ophthalmic surgeon's workload at the St. John Ophthalmic Hospital, Jerusalem. The hospital caters for the Palestinian community of East Jerusalem, the West Bank and Gaza, the combined population totaling approximately 2.2 million. The area is under-developed economically and, in addition, the ongoing political conflict, the Intifada, makes the provision of health care difficult. Nonetheless the St. John Ophthalmic Hospital provides a level of surgical care which is notable for the fact that it is consistent and high. Advanced, obstructive lacrimal disease is endemic in the region; in 1993/94 256 operations were performed for lacrimal obstruction at the St John Ophthalmic Hospital. Lacrimal disease on the West Bank and Gaza Strip is the result of well defined causes which have not been previously documented. This paper proves that conventional lacrimal surgery is successful in relieving advanced lacrimal obstruction in the developing community.

Adolescent↗
PubMed1980

Household distribution of contraceptives in rural Egypt.

Oral contraceptives were offered to all married, fecund women 15-44 years of age living in 38 Egyptian villages with a population of 200,000. Before the household distribution, contraceptive prevalence was 19.1 percent. Nine months after the distribution, the contraceptive prevalence increased to 27.7 percent, a relative increase of 45 percent. Based on this study, a modified delivery system is currently being tested on a governoratewide basis. The modified system will include a wider range of fertility regulation methods and will also have health and community development components.

Adolescent↗
PubMed1986

Health care expenditures in a rural Indian community.

Financing health services is an increasing concern that looms as one of the major obstacles to achieving an equitable distribution of primary health care in developing communities. An important step in solving this problem is the assessment of current levels of health care expenditures in these communities in order to determine the extent to which local resources are being used for these purposes. Ways to maximize the effectiveness of these resources can then be sought. Village level studies carried out between 1968 and 1974 in Punjab, India, revealed that at least 80% of all health care expenditures in this rural area were for services of traditional practitioners or private 'modern' doctors. This paper explores various aspects of these expenditures including the source of services and the effect of individual characteristics such as caste on the amount spent on health care. Out-of-pocket expenditures are contrasted to expenditures in the government system. Assessment of the impact of 'free' village level primary care services in this setting revealed that the poor reduced their expenditures on health care more than the wealthy, but both groups took almost equal advantage of the 'free' services. The results raise the possibility of mobilizing some of the savings accruing to the community to help support the 'free' services as well as the potential of encouraging private traditional and modern practitioners to cooperate in achieving primary health care goals.

Developing Countries↗
PubMed1987

Gay women, men, and families in rural settings: toward the development of helping communities.

The urban biases of empirical research on gay men, women, and families have resulted in minimal knowledge about gay people in rural settings. The diversity of lives of rural gay women and men and the variety of patterns of meeting the challenges of rural living are described. Processes of help-seeking and help-giving are discussed and the need for a helping community of family, friends, and caring others is affirmed. Collaboration between rural gay people and rural community psychologists is suggested to promote the development of helping communities for gay people and thereby initiate a process of change in rural settings.

Adaptation, Psychological↗
PubMed1991

The WAMI Rural Hospital Project. Part 6: Overview and conclusions.

The Rural Hospital Project (RHP) appeared to make a meaningful difference in the six Northwest rural communities that participated in this integrated community development and strategic planning effort. Although the methodological approach used in the evaluation precludes us from attributing observed changes in outcomes solely to the project interventions themselves, several elements of the process appear to be useful in stabilizing or expanding local health care systems. These include: (1) the involvement of outside organizations in fostering community change, (2) a high degree of community commitment and investment in all stages of the process, (3) comprehensive identification of problems in the health care system by outside consultants, (4) the use of periodic meetings of communities confronting similar issues, (5) identification and development of local leadership, (6) enhancing teamwork among local health care providers, and (7) the development of conflict-resolution mechanisms within health care organizations. Future attempts to use this strategy to strengthen rural health care systems can be enhanced by broadening the range of participation in health services planning, enlisting involvement of medical staff throughout the strategic planning cycle, addressing the issue of physician recruitment, and clarifying responsibility for implementation of community plans. Rural communities will predictably need to identify and resolve a set of core issues. To the extent that external organizations such as medical schools can strengthen the ability of rural health professionals and community leaders to identify and address these issues, the quality and viability of rural health care systems will be enhanced.

Alaska↗
PubMedDate not supplied

Opportunities and challenges in educating community-responsive physicians.

Medical educators, funders, and policy makers are placing greater emphasis on educating physicians-in-training to provide community-responsive care and to participate in community-focused health-promotion and disease-prevention efforts. The MCP [symbol: see text] Hahnemann School of Medicine requires all first-year students to work in the community on projects involving health education, needs and resource assessment, advocacy, outreach, and other community health skills. The Department of Community and Preventive Medicine at MCP [symbol: see text] Hahnemann directs these required courses, as well as other elective programs that provide students the opportunity to develop community health competencies. This article summarizes key elements of these educational activities and discusses challenges we have encountered developing and implementing these activities and our responses. Finally, we suggest some issues and questions deserving further exploration.

Community Medicine↗
PubMed1986

Social inequality and healthy public policy.

For decades, health education programmes have been based on the assumption that individual behaviours (for example smoking, drug use, eating patterns) are the major risk-factors in contemporary illness. This assumption often led to interventions that subtly "blamed the victim" for his or her ill-health. In recent years the broader social conceptualization of health and illness has directed many health educators' attention towards socio-economic and environmental factors which condition and constrain lifestyle choices, and which may be directly associated with increased disease risks. While it is becoming common for government health departments and agencies to acknowledge poverty, unemployment and other forms of social inequality as potent health hazards, programmes to ameliorate such conditions are rare. Since 1983, the Toronto health department has developed programmes based upon a socio-environmental model of disease which specifically targets social systems rather than individual behaviour for change. Elements of this approach include extensive media reports on the health implications of such issues as welfare benefits, poverty, unemployment and housing; health education programmes to stimulate a critical understanding of the causes and structure of social inequality; health advocacy initiatives to influence political and legislative reforms; and a community development orientation which involves the department in broad-based coalitions working towards healthy social change. Most recently, the department has become a resource to groups attempting to create employment and service community needs through cooperative forms of economic development. Several examples of the department's programmes in each of these areas are provided. To meet the challenge of the World Health Organization's Alma Ata Declaration, health educators must examine their own potential to act as social-change agents, and must become more sophisticated in the political analysis of their practice.

Health Education↗
PubMedDate not supplied

Women's health. Community input into health.

In this paper, the author examines the continuing role of nurses across the world to ensure women are empowered to look after their own health and that of their children. On a recent Commonwealth Nursing fellowship visit to Pakistan and Sri Lanka, the author found that women were denied access to services because of lack of resources and limited mobility. The role of non-governmental organisations in reaching primary health-care goals is discussed, as well as the appropriateness of multi-skilling in developing communities.

Community Health Nursing↗
PubMed2002

Effectiveness of community health financing in meeting the cost of illness.

How to finance and provide health care for the more than 1.3 billion rural poor and informal sector workers in low- and middle-income countries is one of the greatest challenges facing the international development community. This article presents the main findings from an extensive survey of the literature of community financing arrangements, and selected experiences from the Asia and Africa regions. Most community financing schemes have evolved in the context of severe economic constraints, political instability, and lack of good governance. Micro-level household data analysis indicates that community financing improves access by rural and informal sector workers to needed heath care and provides them with some financial protection against the cost of illness. Macro-level cross-country analysis gives empirical support to the hypothesis that risk-sharing in health financing matters in terms of its impact on both the level and distribution of health, financial fairness and responsiveness indicators. The background research done for this article points to five key policies available to governments to improve the effectiveness and sustainability of existing community financing schemes. This includes: (a) increased and well-targeted subsidies to pay for the premiums of low-income populations; (b) insurance to protect against expenditure fluctuations and re-insurance to enlarge the effective size of small risk pools; (c) effective prevention and case management techniques to limit expenditure fluctuations; (d) technical support to strengthen the management capacity of local schemes; and (e) establishment and strengthening of links with the formal financing and provider networks.

Community Health Services↗
PubMed1995

Roles and approaches of nongovernmental organizations in health development.

The use of a systems model of rural society for analysing the roles and approaches of nongovernmental organizations (NGOs) in health development is outlined with special reference to conditions in northern Thailand. Comparisons are drawn between approaches in the fields of relief and welfare, community development, sustainable systems development, and people's movements.

Community Health Planning↗
PubMed2005

The impact of a macroalgal mat on benthic biodiversity in Poole Harbour.

Blooms of macroalgal matting are increasingly common within temperate zones and are often comprised of opportunistic species such as Ulva lactuca. Where this algae forms a dense mat, a stressful environment is created in the sediment below, influencing the invertebrate infaunal assemblage. This study was conducted over a six month period during which a dense mat of U. lactuca developed and subsequently dispersed. The algal mat was found to have a significant negative impact on species richness, abundance and biomass of the macroinfauna. However, a faunal community developed within the algal mat which contained several species not previously observed. This community increased the abundance and diversity of the overall invertebrate assemblage. The results are discussed in relation to impacts on the ecosystem as a whole.

Analysis of Variance↗
PubMed2002

Dental aid organisations: baseline data about their reality today.

AIM: To collect basic data about non-governmental dental aid organisations on a global scale and thus contribute to a better understanding of their diversity, activities and limitations. METHODS: Data was collected through a mailed questionnaire to all organisations listed by the FDI World Dental Federation. A second questionnaire was e-mailed to those organisations identified as non-governmental organisations (NGO) by the first questionnaire. FINDINGS: The response rate to the first questionnaire to detect NGOs was 36.2%, to the second e-mailed form 84.4%. About two thirds of NGOs originated in developed countries, one third responded from developing countries. The majority had been established after 1980. Developed countries dental NGOs tended to have larger membership and disposed of greater budgets. In general, income was generated predominantly from donations and own resources. The workforce was primarily based on volunteers. High priority activities: service provision, education and training, technical assistance, community development. Measures for quality assurance showed low complexity. Frequent areas of problems were associated with funding and staff. Collaborative links with other stakeholders in development were weak and focussed on information exchange. CONCLUSIONS: Recommendations for NGOs, donors, FDI and future research are developed.

Budgets↗
PubMed2003

Risks and benefits of genetically modified maize donations to southern Africa: views from Malawi.

In 2001 and 2002, many countries in the Southern African Development Community (SADC) have suffered from severe food shortages resulting in an estimated 14 million people facing starvation due to inadequate quantities of the staple maize. The international community's response has been the donation of foodstuffs, including genetically modified maize. Reactions of the recipient countries of Zambia, Zimbabwe, and Malawi have been different. Zambia appealed to the donors not to send genetically modified maize, whereas Malawi accepted the maize donations. Malawi is currently facing many public health challenges because 10% of its 10-million population is HIV-positive, maternal mortality rate has almost doubled between 1992 and 2000, and there are also an estimated 1 million orphans due to HIV/AIDS. In the European Union, genetically modified maize falls under "Novel Foods" and its marketing and distribution are strictly regulated by law. This has never been the case in the southern African countries. In this article, we discuss the ethical challenges associated with genetically modified maize donations to southern Africa. Although genetically modified food offers a way to avoid many adverse effects of food shortages, we believe that some of the ethical questions of genetically modified food donations should be solved first, under the leadership of the donor countries and partnership of the developing countries. There are fears that consummation of genetically modified maize could have adverse health effects. These fears must be addressed if the confidence of developing countries in the donor community is to be maintained.

Bioethical Issues↗
PubMedDate not supplied

Impact of annual immunisation programme with oral polio vaccine on the prevalence of paralytic poliomyelitis.

Lameness survey was conducted in a rural community development block of Haryana in 1985. Enumerators contacted school teachers, anganwadi workers and several key informants in the community to identify lame children in 1-11 years age-group. Physician verified 219 lame cases to be due to poliomyelitis. Prevalence of poliomyelitis lameness was 7.3/1000 children born in 1974-76, 7.7/1000 children born in 1977-1980 and 2.3/1000 children born in 1981-1984 (expected to increase to 3.1/1000 when all children born in 1981-84 cross 5th year of life). Immunisation coverage with 3 doses of oral polio vaccine (OPV) was less than 10% during 1974-80 when immunisation was a clinic based activity. Coverage increased from 50 to 80% during 1981-85 when OPV was given in annual immunisation campaign. The results indicate that prevalence of paralytic poliomyelitis dropped at least by 60% after giving OPV in annual immunisation campaigns.

Child↗
PubMed2002

Haemophilia care in the developing world: benchmarking for excellence.

Seventy-five percent of patients with haemophilia receive no or inadequate treatment, and often do not survive to adulthood. With efficient organization, the disorder is treatable and becomes part of normal life. In developing countries there is a large discrepancy in haemophilia care. Some have zero treatment levels, while others already have comprehensive care centres. This paper attempts to assess and standardize the levels of haemophilia care for developing countries, setting up benchmarks or guidelines for future development. Four major areas are emphasized: clinical care, laboratory, blood products and patient organization. For each country or community, development work begins after the assessment of competency level in each area. The next step is then to plan, organize, improve and move up to the next level. To become successful, a sound and realistic strategy should be employed, starting from the identification of key leaders and the recruitment of an expert team. To obtain recognition and support from health authorities, the haemophilia care programme should not limit itself to haemophilia care but should also include medical care for all bleeding disorders, including the improvement of blood banks, blood products, coagulation laboratories and other medical facilities. This would directly improve the overall medical care standard of the whole hospital. It is also important to emphasize the need for selfreliance, employing simple yet effective methodology, equipment and mechanical facilities. The effective coordination of World Federation of Hemophilia assistance and the host country's committed action will ensure success in the emerging trend of better haemophilia care in developing countries.

Blood Banks↗
PubMed1990

Alternative models for the delivery of rural health care: a case study of a western frontier state.

This is a case study illustrating the wide variety of models for rural health care delivery found in a western "frontier" state. In response to a legislative mandate, the University of Nevada School of Medicine created the Office of Rural Health in 1977. Utilizing a cooperative, community development approach, this office served as a resource, as well as a catalyst, in the development and expansion of a variety of alternative practice models for health care delivery to small, underserved rural communities. These models included small, single, and multispecialty group practices; self-supporting and subsidized solo practices; contract physicians; midlevel practitioners; and National Health Service Corps personnel. The rural health care system that was created featured regional and consortial arrangements, urban and medical school outreach programs, and a "flying doctor" service.

Delivery of Health Care↗