[Share and place of medical education in community and health planning].
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Community Health Services↗
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A guide for planning community-oriented health care: the health sector resource allocation model.
The objective of this study was to demonstrate the value of a planning model for the design and evaluation of community health services. The health status of Washtenaw County, Michigan was modeled. Data were obtained from the Michigan Department of Public Health, Medstat Systems, and the medical literature for 32 diseases or conditions, representing approximately 85% of causes of death and 56% of medical payments (excluding medication costs). An expanded life-table approach was used for 16 age-and sex-matched cohorts exposed to a disease attack rate, access-to-care rate, case fatality rate, morbidity, and costs. Rates can be modified to reflect changes due to treatment, secular trends, or prevention programs. Two alternative delivery methods were considered to show the potential impact of reducing cardiovascular deaths (worksite initiative), or increasing utilization of services (lay health promotion) on county health status and costs over time. Deaths, bed days, and annual medical payments were the main outcome measurements. Cardiovascular and cancer conditions are and will be the primary causes of death in this population. The most important causes of bed days are musculoskeletal conditions, chronic obstructive pulmonary disease, accidents, strokes, and depression. The major health-care payments are for angina pectoris and/or other cardiac conditions, musculoskeletal conditions, accidents, prenatal care, and/or childbirth, and depression. The two alternative scenarios illustrate how reductions in mortality are not necessarily equated with similar improvements in morbidity or costs. This model presents an overview of the current and projected health status of a community. With such a planning tool, a community can better understand the impact of potential prevention or intervention programs, and help design its health-care system within the constraints of available resources.
Cause of Death↗
Leadership will overcome obstacles in community mental health planning.
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Community Mental Health Services↗
[The opinions of the different participants on community participation in family health and planning].
Community participation constitutes a central strategy in the provision of health services, particularly in poor communities in this country. Little is known, however, about the different actors's point of view regarding this strategy. This is true particularly for female community members and community workers. In this paper, historical antecedents of community participation are discussed and some results of a research work are presented, which explored attitudes and opinions of different groups of interviewees, regarding the idea of community participation in health and family planning. The involved groups are: female community members, community workers, community leaders, medical supervisors which control community workers, and medical executives which control those supervisors. It is emphasized that medical executives are the strongest supporters of community participation, while community members are the weakest. The importance of taking into account the community members' position on matters such as community participation in family planning is stressed.
Adult↗
Te Whanau Cadillac--a waka for change.
Community action research is an effective mechanism to improve the relationship between research and public health practice. The Alcohol and Public Health Research Unit (APHRU) and its Maöri research partner Whariki have developed practice in building partnerships with communities characterized by mutual respect of the different resources the partners bring to public health. A current APHRU/Whariki project focused on youth and drugs is a partnership with six communities in rural and urban areas throughout New Zealand, many predominantly Maöri. This project illustrates a model that aims to bridge the gap between research and practice, and to improve health and well-being through working with communities to increase their capacity to deal with alcohol and drug issues, and to introduce sustainable initiatives.
Adolescent↗
The community action model: a community-driven model designed to address disparities in health.
The community action model is a 5-step, community-driven model designed to build communities' capacity to address health disparities through mobilization. Fundamental to the model is a critical analysis identifying the underlying social, economic, and environmental forces that create health and social inequities in a community. The goal is to provide communities with the framework necessary to acquire the skills and resources to plan, implement, and evaluate health-related actions and policies. The model was developed in the context of tobacco-related health disparities. Concrete policy outcomes demonstrate the model's potential application to a wide variety of grassroots policy development efforts.
California↗
The role of non-government organizations in supporting and integrating interventions to improve child health.
In Papua New Guinea there are many organizations providing sparsely spread and fragmented health services. Government health facilities are often relatively well functioning in urban and periurban areas, but sporadic or nonexistent in rural areas. In some remote areas churches are the major health service providers. Increasingly other community groups are providing village-based health services. Much financial support is now pledged by major international donors for community-based health services, but few people working at a district or community level have the management skills to access the funds or plan programs effectively, and few of the major donors have any significant presence in rural areas. Such a management skill gap also exists at the level of many provincial health offices and this seriously limits the effectiveness of all major donor projects. There is need for integration of health services to avoid replication and to extend services to areas where no effective services are currently provided. There is also a great need to train people at a community and district level in program planning and management. Non-government organizations (NGOs) working at a district or community level have the potential to bridge this skill gap and to help integrate community-based services with government institutions. This paper reports, as an example, the activities of Save the Children, an international NGO in Papua New Guinea. Essential for the success of community-based health projects is the development of local management skills, reliable funding, integration with established health institutions, objective evaluation and community support. Skilled NGOs working at a community, district or provincial level can have important roles in assisting local people to run effective and sustainable health programs.
Child↗
Sustainability: the elusive dimension of international health projects.
OBJECTIVE: The Canada-China Yunnan Maternal and Child Health Project (1997-2003) sought to improve the quality of village life and promote development of productivity and social prosperity in Yunnan province, China. PARTICIPANTS: The project targeted grassroots maternal and child health workers: new and in-service village doctors; traditional village midwives; doctors at township health centres; doctors at county maternal and child health hospitals; and provincial health staff. SETTING: Ten impoverished counties (population 2.2 million) in Yunnan province with high proportions of ethnic minority populations. INTERVENTION: There were three major innovations: training grassroots maternal and child health workers in participatory and community-based approaches and clinical skills; designing a model comprehensive referral system including provision of basic equipment; and introducing participatory monitoring and evaluation methods. Strategies to support sustainability were built into the project from the outset. OUTCOMES: Over 4,000 village, township, and county health workers received training. Maternal, infant, and under-five mortality rates declined over 30% in project counties. Project innovations were disseminated throughout the province, into other donor-funded initiatives, and integrated into national health projects by local partners. CONCLUSION: Maintaining the long-term benefits of international health interventions depends on sustaining innovations beyond short project timelines. Achieving sustainability poses a conundrum to implementing agencies. Three mechanisms influenced uptake in the Yunnan project: maintaining a good fit between core project elements and the existing health system; developing adequate organizational supports; and creating a handover plan from the outset. This project highlights some of the ways in which sustainability can be operationalized.
Adult↗
Community mental health. Planning, not platitudes.
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Community Mental Health Centers↗
Some uses of client and census records in community mental health planning.
A conceptual framework is presented which outlines uses of client and community data for mental health planning. Client records from a mental health center and 1970 census data were analyzed three ways to illustrate some of these uses: (a) a geographic analysis which compared service utilization rates with the social characteristics of census tracts; (b) a demographic analysis which compared the social characteristics of clients with those of the catchment area population; and (c) an analysis of clients who dropped out of treatment and who left therapy unimproved. The results revealed that (a) census areas characterized by high proportions of disenfranchised groups (e.g., divorced, low status, Spanish heritage) showed high service utilization rates; (b) higher proportions of divorced, high school educated, and unemployed residents utilized services than expected by population estimates; and (c) dropouts from therapy could be discriminated based on demographic differences in marital status, income level, employment status, educational level, ethnicity, and previous mental health treatment.
Community Mental Health Services↗
Quality management in public and community health: examples from women's health.
Quality assessment and improvement activities are as relevant to the public health sector and community-based health care organizations as they are to the rest of the health care industry. This article provides a framework for the types of quality assessment and improvement approaches available to public health and community-based health care organizations and provides two examples drawn from the field of women's health. The first focuses on a population-based assessment of the performance of the health care system using indicators for the nation as a whole and for the states specifically in a women's health report card. The second focuses on measuring quality of care provided to clients of one type of safety-net organization, Title X family planning clinics. Either type of approach can serve as the basis for developing strategies for improving the performance of health care organizations.
Community Health Planning↗
School psychology and comprehensive community mental health planning.
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Adolescent↗
The city government's role in community health improvement.
Amid increasing pressures to address complex issues not traditionally assigned to localities, Healthy Cities is seen as a powerful model for community improvement and quality-of-life enhancements for individuals and organizations willing to think beyond the traditional local government management models and responsibilities. As a model for community-oriented government, it offers opportunities for fostering a return to "barnraising" concepts, civic responsibility, participation, tailoring solutions to local circumstances, and the transition of local government to governance models.
City Planning↗
Citizens and professionals in community mental health planning.
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Community Mental Health Services↗
Community approaches to providing care for the uninsured.
Faced with rising uninsurance rates and little response at the state or federal levels in recent years, communities have developed various strategies to provide care for uninsured people. This paper profiles local strategies in the Community Tracking Study sites, focusing on efforts that go beyond traditional safety-net access. Our findings suggest that more-recent community efforts--which tend to be privately sponsored--are relatively modest in scope compared with more-mature programs that enjoy public financing. Although local strategies can fill some holes, communities often do not have the resources necessary to fully address the problems of the uninsured on their own.
Community Health Planning↗
Sowing the seeds for sustainable change: a community-based participatory research partnership for health promotion in Indiana, USA and its aftermath.
Community-based participatory research (CBPR) increasingly is being used in both developed and developing countries to study and address community-identified issues through a collaborative and empowering action-oriented process. In 2003-2005, a study was undertaken to document the impacts of CBPR on healthy public policy in the US. From an initial review of 80 partnership efforts, 10 were selected as best capturing the range and diversity of projects meeting the study criteria, and were the subject of in-depth case study analysis. This article presents and analyzes one of these cases, a collaboration between researchers at the Indiana University School of Nursing and the Healthy Cities Committee of New Castle, IN, USA. With its action component still underway a decade after the formal study's completion, the partnership was selected to enable an examination of sustainable change through CBPR. Beginning with a participatory door-to-door health survey of 1000 households using a non-probability quota sampling strategy, the project involved community members in many stages of the research process. A smoking rate of twice the national average was among the study findings that helped to galvanize the community into action. A variety of health promoting environmental and 'small p policy' changes were undertaken ranging from a bill restricting indoor smoking in public places to an initiative to develop a system of trails throughout the county to promote physical fitness and decreased reliance on automobiles. This article examines the evolution of the original CBPR partnership, its research methods and findings, and the environmental changes it sought to promote healthier lifestyles. Success factors, barriers and sustainability benchmarks are discussed. The case study offers an example of the potential of CBPR for helping to lay the groundwork for long-term sustainable change in support of healthier communities.
Air Pollution, Indoor↗
Community-based participatory research increases cervical cancer screening among Vietnamese-Americans.
Using community-based participatory research methods, a community-research coalition in Santa Clara County, California (SCC) conducted a quasi-experimental, controlled trial to increase Pap test receipt and to build community capacity among Vietnamese-American women. From 1999 to 2004, the Coalition planned and implemented an Action Plan with six components: multimedia campaign, lay health worker outreach, Vietnamese Pap clinic with patient navigation, registry and reminder system, continuing medical education for Vietnamese physicians, and restoring a Breast and Cervical Cancer Control Program site. Components were evaluated individually. Community-wide, cross-sectional telephone surveys of Vietnamese women in SCC (intervention community) and Harris County, Texas (comparison community) measured overall project impact. Receipt and currency of Pap tests increased significantly in the intervention compared with the comparison community. Community involvement, system changes, community and research capacity building, dissemination of results, and program sustainability were also demonstrated. Community-based participatory research is feasible and effective in Vietnamese-American communities.
Adolescent↗
Triad's new market strategy: a threat to community hospitals.
Faced with unprecedented financial pressures, many nonprofit hospitals today contemplate hooking up with large corporations and converting to for-profit status. In the deals that result, the talk is largely about stock value and the interests of investors. The larger public-interest question of how the conversion will affect the health of community members often receives short shift. Most recently, Triad, an HCA spin-off, has emerged as a major player in the market for faltering nonprofits, zeroing in on institutions all the way from Alaska to North Carolina, and this has advocates worried, because the company can be singularly insensitive to community health care needs. But Triad is also remarkably adept at winning public favor. In this States of Health, we'll look at the broader public policy questions raised by such corporate health ventures, questions that point to the need for stronger oversight and regulatory mechanisms to assure that the public interest is protected in our increasingly market-driven health system.
Community Health Planning↗