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PubMed2005

The United States health centers initiative: a state by state status report.

In 2001, the United States federal government began a 5-year initiative to expand services offered by health centers to people who live in area designated "underserved" because there are insufficient primary care medical practitioners. There were national targets for expansion. How the Health Resources and Services Administration (HRSA) reviewed and monitored State plans to expand health centers is presented. These early results suggest that collectively the States would meet the target. Several States would require major efforts to move toward the national average and they were examined more closely.

Community Health Centers↗
PubMed2004

Applying service-learning through a community-academic partnership: depression screening at a federally funded community health center.

CONTEXT: Increasingly, health care facilities worldwide, particularly those that comprise the safety-net, are finding themselves understaffed and challenged to meet patients' needs. Identifying additional sources of support and resources is critical for facilities to be able to sustain current and develop new initiatives to improve patients' health. APPROACH: We present one community health center's reliance on a partnership with an academic medical/nursing institution to develop and initiate a depression screening and treatment project. Incorporating students to help implement or pilot a needed clinical service for a high prevalence condition presents significant rewards as well as challenges. Nevertheless, an academic-community partnership has the potential to initiate systems change at the clinical level. RESULTS: Using a service-learning modality, medical and nursing students worked with health center providers to initiate a pilot depression screening and treatment program based on the chronic disease model. Implementation of this initiative succeeded in poising the health center for participation in a large, federally supported collaborative on depression in primary care. While students gained insight into some of the challenges faced by safety net providers and their patients, discontinuity in student availability led to uneven pacing in project implementation. CONCLUSION: Curricula that employ a service-learning framework can enable health care facilities world-wide to gain additional resources for needed initiatives. Students' learning experiences can provide an excellent mutually beneficial opportunity as a "jumpstart" for new evidence-based clinical initiatives and demonstration projects. Such programs can help meet the needs of patients while enhancing students' education. However, students can neither make up for staffing shortages nor be expected to maintain programs. In order to be successful for the long term, service-learning projects must skirt the pitfalls of the inherent logistical incompatibilities e.g. schedules and length of commitment, between academic institutions and health care facilities.

Academic Medical Centers↗
PubMed1995

Quality of primary outpatient services in Dar-es-Salaam: a comparison of government and voluntary providers.

This study aimed to test whether voluntary agencies provide care of better quality than that provided by government with respect to primary curative outpatient services in Dar-es-Salaam. All non-government primary services were included, and government primary facilities were randomly sampled within the three districts of the city. Details of consultations were recorded and assessed by a panel who classed consultations as adequate, inadequate but serious consequences unlikely, and consultations where deficiencies in the care could have serious consequences. Interpersonal conduct was assessed and exit interviews were conducted. The study found that government registers of non-government 'voluntary' providers actually contained a high proportion of for-profit private providers. Comparisons between facilities showed that care was better overall at voluntary providers, but that there was a high level of inadequate care at both government and non-government providers.

Community Health Centers↗
PubMed2002

Assessing the cost and willingness to pay for voluntary HIV counselling and testing in Kenya.

OBJECTIVE: Voluntary counselling and testing (VCT) should be an important component in a country's HIV/AIDS prevention and care strategy. However, the high cost of VCT raises concerns about the affordability of VCT in low-income countries. This study was designed to assess the costs of VCT and to identify potential ways of introducing VCT more affordably. METHODOLOGY: An economic evaluation was performed of VCT services in two rural health centres in Thika District and an urban health centre in Nairobi, Kenya. A contingent valuation study was also performed among VCT clients. Estimates were developed regarding the national cost of offering VCT services in Kenya. RESULTS: VCT added US dollars 6800 per year to the average cost of providing services at each of these three health centres. The evaluation revealed that the incremental cost, from the government's perspective, of adding VCT is approximately 16 dollars per client. The estimated incremental cost per client is significantly less than a previous cost estimate in Kenya which estimated a cost per client of 26 dollars. The difference in cost estimates is in part attributable to the emphasis of this project on integrating VCT services into existing health centres, rather than creating stand-alone sites. The cost of VCT services might be further reduced to as little as 8 dollars per client if a government health worker could perform the counselling. A contingent valuation study indicated that most VCT clients would be willing to pay at least 2 dollars for the service. However, if the full cost of the service were charged to the client, less than 5% of clients indicated they were willing and able to pay for the service. CONCLUSIONS: Integrating services into existing health centres can significantly reduce the cost of VCT. Additional cost reductions may be feasible if health centre staff are hired to perform the counselling. Furthermore, it appears that some level of cost recovery from VCT clients is feasible and can contribute to sustainability, although it is very unlikely that the full cost of the service could be recovered from the clients. The national provision of VCT in all Kenyan health centres is likely to be an affordable option, although additional operational research is required to determine the most appropriate way of scaling up VCT services throughout the country.

AIDS Serodiagnosis↗
PubMed1994

Community ownership and program continuation following a health demonstration project.

Community ownership and maintenance of heart health programs was a major study goal of the Minnesota Heart Health Program (MHHP), a community-based National Heart, Blood and Lung Institute (NIH)-funded demonstration project. A partnership between the University of Minnesota and three Upper Midwest intervention communities was initiated in 1981. Local citizen boards were instrumental in planning, implementing and incorporating programs. Through an 8 year process of community organization, training and volunteer involvement, MHHP educational program responsibility was transferred to existing community-based groups and organizations. In 1989, when federal funding was withdrawn, 70% of all heart health intervention programs initiated by MHHP were being continued by local sponsors and supported by local funds. By 1992, maintenance of programs had decreased to an average 60%. Differential results of program incorporation among the three intervention communities are presented including findings on community sectors that most frequently sponsored programs. Factors that facilitate or impede local ownership are discussed. Research on longer-term maintenance of heart health programs in the three communities continues.

Community Health Services↗
PubMed1995

Management techniques at primary care health centers: the impact of management innovation.

Long-term financial viability was a goal of The Program to Strengthen Primary Care Health Centers. To accomplish this, it was expected that participant centers would increase their management capabilities. We evaluated 32 management techniques in five principal areas: budgeting, strategic planning, general financial management, collections, and general health services management. Eight of the techniques showed change over the course of the demonstration (six increases and two decreases). It appears that there was somewhat more improvement among study centers than in a comparison group. Management sophistication has been expanding among health centers in general; Program participation appears to have accelerated this growth.

Community Health Centers↗
PubMed1995

Case studies of management innovation at primary care health centers.

This article discusses the experiences of four individual health centers that participated in The Program to Strengthen Primary Care Health Centers. These centers were attempting "typical" initiatives, were considered highly likely to succeed, and were located in geographically diverse areas. Given these characteristics, it is likely that other centers could replicate their endeavors and could gain valuable knowledge from their implementation experiences. This article presents each center's characteristics, history, and mission; describes the environment in which the center operates; and discusses the barriers to implementation of selected innovations.

Community Health Centers↗
PubMed1995

One center's perspective on participation in The Program to Strengthen Primary Care Health Centers: a slow harvest.

This article presents an account of one center's experience participating in The Program to Strengthen Primary Care Health Centers. The center developed a multifaceted strategy that aimed to increase and diversify revenue, both earned and nonearned. The first year got off to an uneven start, although the project eventually progressed according to plan but on a slower time line than anticipated. By the end of the three-year project period, most of the initiatives had become fully integrated into center operations. The center was able to increase financial reserves. However, their financial stability remained tenuous.

Arizona↗
PubMed1997

Injury prevention capacity building in New York State: federal support played a significant role.

Federal funds contributed substantively to an expanded infrastructure for injury prevention (IP) in New York State at all levels. Indicators of capacity building included increased recognition of injury as a priority public health (PH) issue, enhanced interagency collaboration around IP, stimulation of planning around preventive strategies, training of more PH practitioners in IP, improved use of injury surveillance data, increased local IP projects, development of a PH approach to violence prevention, and broadened statutory authority for IP. Practical "lessons learned" offer generalizable insights. Specific funding strategies to support IP infrastructure and to link research with application can maximize the effectiveness of future injury capacity building efforts.

Allied Health Personnel↗
PubMed2002

Turning point: the Robert Wood Johnson Foundation's effort to revitalize public health at the state level.

The Robert Wood Johnson (RWJ) Foundation initiated Turning Point in collaboration with the W.K. Kellogg Foundation (Kellogg) in 1997. The purpose of this major national initiative was to strengthen the public health infrastructure in the United States so that states, local communities, and their public health agencies might respond to the challenge to protect and improve the public's health in the 21st century. RWJ funded 21 states and Kellogg funded 43 communities to work together to create a new way of thinking about how health could be improved and who should be involved. Although the ultimate outcome was to improve health, both foundations expected diverse partnerships to work together to create strategic health improvement plans at both the community and state levels. The foundations funded a variety of strategies within those health improvement plans during an implementation phase. The premise in funding partnerships, as opposed to a single entity, was that effective public health systems would be developed best through a shared responsibility (including the private sector) for the health of a community.

Community Health Planning↗
PubMed2002

Innovations in collaboration for the public's health through the Turning Point Initiative: the W.K. Kellogg Foundation perspective.

The need for a more integrated public health system led the W. K. Kellogg Foundation (WKKF) to establish Turning Point (TP): Collaborating for a New Century in Public Health, with a goal of transforming and strengthening the current public health infrastructure. WKKF partners with the Robert Wood Johnson Foundation (RWJF), the National Association of County and City Health Officials, the University of Washington, the Lewin Group, and the New York Academy of Medicine to support activities of 41 community and tribal jurisdiction grantee partnerships in 14 states. Preliminary evaluation of partnerships participation indicate: (1) most have accomplished breadth; (2) many did not achieve depth prior to the end of initial recruitment and (3) when the mission was internalized, penetration occurred. Strengthening public health systems requires redevelopment of human, organizational, financial, educational and information resources, and as in the past, WKKF will work to this end.

Community Health Planning↗
PubMedDate not supplied

Public education strategies for delivering breast and cervical cancer screening in American Indian and Alaska Native populations.

A 1993 amendment to the authorizing legislation for the Center of Disease Control and Prevention's National Breast and Cervical Cancer Early Detection Program allows direct funding to tribal organizations and urban Native health centers. This study examined tribal programs' implementation of the public education and outreach component utilizing a multisite case study design implemented in partnership with tribal programs. Data were collected from 141 semistructured interviews with key informants and 16 focus groups with program-eligible women. Innovative strategies built on native iconography and personal encounters have encouraged participation and made the programs culturally relevant, providing insights for other communities with little experience in providing early detection services.

Breast Neoplasms↗