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PubMed1994

The planning and implementation of government-sponsored community-based primary prevention: a case study.

Governments at all levels have become increasingly involved in initiating and funding projects within which community residents work collaboratively with local service providers in the development of programs for the betterment of themselves, their families, and their community. Inherent in these initiatives, however, are a number of possible sources of tension which, left unresolved, may hamper the intentions of governments to seed grass-roots solutions to community problems. A qualitative research methodology was used to examine the nature of the relationship between government and community representatives (both residents and local service providers) in establishing community-based primary prevention programs under the auspices of the Better Beginnings, Better Futures initiative of the Government of Ontario. We examine a number of issues and tensions that have arisen from this project, both during the development of the program model by the government, and through to its implementation in several communities in the province.

Affective Symptoms↗
PubMedDate not supplied

[Economics of health care in Mali].

From the results obtained regarding the financing of health care in Mali, we emphasize two important points. First, there is a lack of criteria for the distribution of finding in the health care sector, resulting in a waste of resources. Secondly, there is an absence of adequate pharmaceutical policies. The field studies led in 1987 provided the following observations. The rate of occupation of the beds is very low. Also, the numerous new investments are not yet put into service because of the lack of necessary equipment of qualified personnel. In addition, this does not consider the excessive investments occurring in certain localities where neither the rate of frequentation nor the economic conditions will ever allow the use of the capacity created. Among the possible solutions for the crisis of health care funding in Mali, the following should be priority: first, to fight against the complete lack of organization of the activities at the health care centers; secondly, to fight against the waste and misappropriation of money resulting from the behavior of the medical and paramedical personnel: and thirdly, to clarify the management of the resources coming from the charges for each service. The pharmaceutical policies adopted and implemented in recent years Largely contributed to, first, the creation of competition between essential generic medications and nongeneric medications that can be replaced, and then, the destruction of the public network of drug distribution. These conditions considerably limited the distribution of essential medications; yet, this is the only manner of reducing the pharmaceutical expenses and accordingly, allowing more funding for other medical services. As the distribution network is disorganized, the only alternative for the population to obtain the medications at the lowest price was to create centers of purchasing and distribution and to multiply the number of retailers of essential medications. Extensive work has been conducted in the health care sector in Mali, accompanied by concrete proposals allowing for improved functioning of the system. However, despite these improvements, these conclusions are rarely considered by the health policy makers. This is because behind the financial aspects of health services, there is an important political stake. Also, the governments of many countries, including Mali, had to resort to adjustment programs that reduce their maneuverability of economic policies in general, and of health care policies in particular. The sponsors "give" large sums of financial aid to the health care sector, but are not interested in the results. The promotion of the health care sector requires a courageous political will. In contrast, microeconomic studies allowed the creation of the first community health centers in Mali. These examples, now followed in many village throughout Mali, constitute the hope of the health care sector.

Bed Occupancy↗
PubMed2000

Privatizing indigent health services in Los Angeles County: understanding the effects on community-based providers.

Faced with imminent financial collapse of its public healthcare system, the Los Angeles County Department of Health Services solicited community-based providers to supply primary care health services to the medically indigent. This study highlights the effects that participation in the programme has had on these community providers. While strongly committed to the programme's objectives, community providers tended to overextend themselves financially, putting their organizations at substantial risk of failure should contractual expectations or patient demand forecasts not be met. Because of this risk, policymakers involved in public-private partnerships with community-based providers must exercise extreme caution owing to the unique status many of these providers hold as centrally positioned actors in their communities. On the positive side, we found evidence of increased levels of co-operation and innovation between community providers outside their formal roles in the county-sponsored public-private partnership programme.

Community Health Centers↗
PubMed1980

Sustaining board trains future trustees.

The sustaining board of fellows of Mount Sinai Medical Center, Miami Beach, FL, serves as a training ground for future members of the hospital's board of trustees. The sustaining board also sponsors numerous hospital projects, including a student scholarship program and various community outreach programs.

Allied Health Personnel↗
PubMed1995

The importance of human exposure information: a need for exposure-related data bases to protect and promote public health.

As a subfield of public health, environmental health is concerned with evaluating and ameliorating the effects of people on the environment and the effects of the environment on people. Separating hazards from risks, and characterizing the magnitude, likelihood, and uncertainty of risks is at the heart of environmental health in the 1990s. To this end, a full range of data is needed, including data that characterize the distribution of hazards, the population potentially at risk, and the contact between people and pollution that creates the risk. Several government-sponsored data systems contain information on a range of exposure estimators. The challenge is to develop meaningful, properly validated models to identify public health needs and evaluate public health programs.

Data Collection↗
PubMed2001

A help or a hindrance? The impact of job training on the employment status of disadvantaged women.

The objective of this study is to evaluate whether welfare-sponsored, government-funded job training helps participants improve their employment status. The negligible effects found in prior studies may be due to design limitations or inherent flaws in job training programs and therefore do not necessarily contradict human capital theory. The present study uses longitudinal and representative data, dynamic modeling techniques, an appropriate counterfactual, and important contextual variables to assess the likelihood of obtaining employment for job training participants and nonparticipants. It also describes the types of jobs women obtain by examining wages, industry, occupation, and labor union membership. Whereas some of the results support prior research, the focus is on the unique contributions of this study, which include a differential training effect for full- and part-time workers and a detailed analysis of macro-structural variables, which are rarely included in studies of labor supply.

Adult↗
PubMed2000

The federal response to child abuse and neglect.

Addressing the problem of child maltreatment is a high priority for the Clinton administration. Guided by the principles of safety, permanency, and the child's well-being, the Administration on Children and Families (ACF) has made great strides in improving the lives of maltreated children. Critical programs administered by ACF include the Adoption and Safe Families Act, Community-Based Family Resource and Support Program grants, Children's Justice Act programs, and Child Abuse Prevention and Treatment Act research and demonstration projects. Projects serve both to expand existing programs and to develop innovative approaches. ACF has also sponsored several multidisciplinary national conferences designed to generate a sense of shared responsibility and a renewed commitment to solving problems of child abuse and neglect.

Adoption↗
PubMed1995

Charles H. Best, the Canadian Red Cross Society, and Canada's first national blood donation program.

This article examines how Canada's first national blood donation program originated during World War II. It focuses on the genesis of Charles H. Best's serum project at the University of Toronto, and the federal government's decision in 1940 to sponsor it as the nation's most viable blood banking option. While Best's personal initiatives were crucial, his project's success was also a result of the larger scientific, political, and institutional circumstances of Canadian medicine. The article also analyzes why the federal government gave responsibility for blood collection to the Canadian Red Cross Society. It shows how the organization's traditional association with military medicine, its more recent involvement with community health services (including blood transfusion), and its flexible national structure suited it for this task. Moreover, Ottawa's willingness to assign this role to a volunteer agency was an indication of the structural deficiencies in Canada's primitive health-care system. The decisions of 1940 flowed from the immediate wartime pressures and individual initiatives. They reflected as well the deeper scientific, institutional, and cultural realities of the time.

Blood Banks↗
PubMed2006

Characteristics of substance abuse treatment programs providing services for HIV/AIDS, hepatitis C virus infection, and sexually transmitted infections: the National Drug Abuse Treatment Clinical Trials Network.

Illicit drug users sustain the epidemics of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), hepatitis C (HCV), and sexually transmitted infections (STIs). Substance abuse treatment programs present a major intervention point in stemming these epidemics. As a part of the "Infections and Substance Abuse" study, established by the National Drug Abuse Treatment Clinical Trials Network, sponsored by National Institute on Drug Abuse, three surveys were developed; for treatment program administrators, for clinicians, and for state and District of Columbia health and substance abuse department administrators, capturing service availability, government mandates, funding, and other key elements related to the three infection groups. Treatment programs varied in corporate structure, source of revenue, patient census, and medical and non-medical staffing; medical services, counseling services, and staff education targeted HIV/AIDS more often than HCV or STIs. The results from this study have the potential to generate hypotheses for further health services research to inform public policy.

Acquired Immunodeficiency Syndrome↗
PubMed1997

[Collaboration between non-governmental organizations and governments for health sector reform].

One of the most prominent current trends is the vital and increasingly visible role played by nongovernmental organizations (NGOs) in the world in general and in the activities and conferences sponsored by the United Nations (UN). Given these circumstances, part of the mission of PAHO is to strengthen the ties between governments and NGOs through provision of technical cooperation and support in priority program areas, such as health care, and facilitation of the exchange of information and experiences. This report examines different lines of action designed to improve collaboration between NGOs and governments in the area of health sector reform.

Government Agencies↗
PubMed1997

Opioid availability in Latin America: the Santo Domingo report progress since the Declaration of Florianopolis.

The World Health Organization (WHO) has indicated that opioid analgesics are insufficiently available, particularly in developing countries, due to a variety of reasons, including legislative, educational, and policy issues. In its effort to promote the rational use of medical opioids and the adequate treatment of patients with cancer, WHO has sponsored a meeting of Latin American representatives every 2 years, which includes health professionals and government regulators. During March 24-27, 1996, a group of 86 representatives of cancer pain relief and palliative care programs from nine Latin American countries met in Santo Domingo under the auspices of the WHO Palliative Care Program for Latin America. For the first time since the First Latin American Meeting, government regulators were present to help address the issue of opioid availability from their perspective. During the meeting, issues pertaining to cancer pain, opioid availability, and palliative care were discussed. This report summarizes some of the events and presents a summary of the conclusions of an earlier meeting in 1994, as described in the Declaration of Florianopolis, and presents its follow-up, The Santo Domingo Report, generated following the 1996 meeting.

Analgesics, Opioid↗
PubMed1990

Health aspects of resettlement in Ethiopia.

The literature on health implications and effects of government-sponsored resettlement in Ethiopia is reviewed with the objective of providing an initial evaluation of the health status of settlers and the health hazards of resettlement in western Ethiopia. Emphasis is on the 1984/85 resettlement program, which resulted in the movement of about 600,000 drought victims from northern and central Ethiopia to the western part of the country. Malaria, trypanosomiasis, onchocerciasis, yellow fever, nonfilarial elephantiasis, sand-flea infestation, and psychological stress are identified as immediate and greater health hazards than in the areas of settler origin, based on the geographic distribution and ecology of the major communicable, nutritional, and geochemical diseases in Ethiopia, and on the impact of program deficiencies on settler health. More studies are needed on the epidemiology and ecology of bancroftian filariasis, visceral leishmaniasis, dracunculiasis, eye and skin diseases, tuberculosis, meningitis, intestinal parasitism, diarrhea, and calorie/protein malnutrition before their public health and economic significance in settlements can be evaluated. Schistosomiasis appears to be less common, for the time being, in resettlement areas than in the areas of outmigration. Research needs and constraints in resettlement planning, implementation, and operation are identified, and some recommendations made for disease control programs.

Adult↗
PubMed1994

Terror, silencing and children: international, multidisciplinary collaboration with Guatemalan Maya communities.

In recent years psychologists and other mental health workers have begun to document the effects of state-sponsored violence and civil war on civilians and to develop specific clinical and community interventions to address these issues. During the past decade between 50,000 to 100,000 Guatemalans have been murdered and at least 38,000 people disappeared. Over 400 rural villages were destroyed and the Guatemalan army's scorched earth policy forced hundreds of thousands who survived to flee, either to another part of the country or to leave Guatemala altogether. State-sponsored terror and silencing persists in Guatemala despite a return to civilian government. This article describes some of the problems encountered by Maya children in situations of ongoing war and state-sponsored terror and the development of one specific response, Creative Workshops for Children, an international, interdisciplinary program organized by mental health workers from Argentina, Guatemala and United States. The inadequacies of psychological theory based on a medical model that sees trauma as an intrapsychic phenomenon and conceptualizes its effects in situations of war as post-traumatic stress are described and a reconceptualization of trauma as psychosocial is proposed. The accompanying need to address the "normal abnormality" of war and state-sponsored terror through a community-based group process is presented. The model incorporates drawing, story telling, collage and dramatization in a group process that seeks to create a space and time in which the child can express him or herself, communicate experiences to others, and discharge energy and emotion connected to previous traumatic experiences. The work draws on existing cultural traditions (e.g. oral story telling and dramatization) and resources (e.g. nature, plants) of indigenous communities, offering additional resources to those seeking to collaborate in the development of mental health in their communities and suggesting alternative bases from which to understand the cultural and social psychological effects of war. Through participation in the creative workshop the child survivor enhances natural means for communication that will facilitate the expression of physical and mental tensions and the development of a capacity to construct an identity that is not exclusively subject to the dehumanizing and traumatizing reality of war. The strengths of this work and the limits of psychoassistance work within a context of war are enumerated and discussed.

Child↗
PubMedDate not supplied

The effect of governing board composition on rural hospitals' involvement in provider-sponsored managed care organizations.

Rural hospitals are actively pursuing various strategic alternatives to confront the dramatic changes taking place in the delivery, organization, and financing of healthcare. One of these strategic alternatives is involvement in provider-sponsored managed care organizations. Studies have argued that this form of managed care would enhance public trust and might improve the performance of hospitals. The changing healthcare environment has also increased the importance of the competence and composition of hospital boards. This article examines the effect of the governing board's composition on rural hospitals' involvement in provider-sponsored managed care organizations. The study sample consisted of 140 rural hospitals in Iowa and Nebraska whose CEOs responded to a survey conducted by the Center for Health Services Research at the University of Iowa between June and December 1997. The principal finding was that the likelihood of a hospital owning any form of managed care organization increases with the number of community leaders and health professionals on the board. The number of business leaders had no effect on the likelihood of involvement in such an arrangement. Other factors that affected the likelihood of owning a managed care organization were the health status of the population and ownership type. Key recommendations to managers are to (1) revisit the hospital board's composition before actively pursuing a strategic action, (2) examine the compatibility of the type of strategic activity pursued with the background of board members and the interests of the populations they represent, and (3) use the governing board as a resource in determining which new strategic activities to undertake.

Attitude of Health Personnel↗
PubMedDate not supplied

Health planning in Ontario.

Stephen C. Hanson's article, "Health Planning: The Fourth Generation," (Hospital and Health Services Administration 27/4, 1982, pp. 55-65) comments on the possible "downsizing" of Health System Agencies (HSAs) because of severe budget cuts. Hanson suggests that they shift from regulatory to planning agencies. A relatively recent development in Ontario, Canada, involves the establishment of area-wide planning agencies known as district health councils (DHCs) which may provide a model for HSAs of the future. Although DHCs operate in a government-sponsored healthcare system and are advisory rather than regulatory in nature, the DHC concept can be adapted to HSAs in order to become true planning agencies. This article outlines the salient features of the Ontario DHC Program and compares its similarities and differences with Hanson's "Fourth Generation" model of HSAs. While Hanson proposes a model, Ontario's experience for which comparisons and insights are offered has gone beyond the conceptualization stage and has been operating for over ten years. The DHC Program is still evolving, tentative in some areas, and searching for the most appropriate role and means in other areas. As HSAs will be transformed out of necessity, a close look at the Ontario DHC program may prove to be both instructive and timely.

Health Plan Implementation↗
PubMed1966

The recurring bibliographies program of MEDLARS.

Recurring bibliographies are by-products of the MEDLARS system which are prepared by the National Library of Medicine in collaboration with nonprofit scientific and professional societies and institutions and government agencies that represent a specialty area of biomedical research or practice. The sponsor generally assumes responsibility for the costs of publication and distribution. At present MEDLARS has a planned capacity of fifty such recurring bibliographies. The subject parameters and format are defined by the representatives of the sponsoring organization and the NLM Search, MeSH, and Index staffs. As citations are regularly put into the MEDLARS store, each one that qualifies for a recurring bibliography is identified and tagged by the computer with the number assigned to the pertinent RB. The MEDLARS store is searched for citations for a particular recurring bibliography according to the schedule specified by the sponsoring organization, and the output is printed from a GRACE tape.

Abstracting and Indexing↗
PubMed1983

Primary care and local health departments: the initiation of a state-sponsored grant program.

This study examines factors that differentiate health service organizations that were successful applicants for a grant program to initiate primary-care services from a matched sample of organizations that did not apply for the program. Factors that were different between the two sets of organizations include the attitudes and behaviors of physicians in the local community, previous success of the organization in obtaining grant support, and employee perceptions of selected organizational and grant program characteristics. These findings suggest that factors both internal and external to the organization are influential in decisions to initiate activities sponsored through grant programs. Implications of these findings for the design of state block grant programs are discussed.

Attitude of Health Personnel↗