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PubMed2006

[Participatory planning in health organizations: the case of the Bonsucesso General Hospital, Rio de Janeiro, Brazil].

This article presents the experience with participatory planning in the Bonsucesso General Hospital in Rio de Janeiro, Brazil, from 2003 to 2004. The participatory and communicative characteristics and the resulting institutional format are identified for guaranteeing the implementation of collective decisions from the planning workshops. The limits of implementation in participatory planning and management proposals are argued from the perspective of change and power relations in these institutions. The results support the notion that projects involving changes in hospitals and failing to take into account the different internal rationalities and power relations end up having reduced potential for implementation.

Brazil↗
PubMed1993

Integrating health-related quality of life into cross-national clinical trials.

When planning to implement health-related quality of life (HRQL) assessment in a multinational clinical trial, there are at least four general considerations: the natural history of the disease or condition, the characteristics of the population, the treatment under consideration, and the structure and function of the clinical trial organization. Each of these considerations must be addressed simultaneously when planning, implementing and analysing a cross-national clinical trial. There are five relevant polar components of the natural history of a given disease or condition: (1) time frame (acute versus chronic); (2) life threat (yes versus no); (3) symptomatology (present versus absent); (4) symptom expression (episodic versus constant); and (5) functional impact (present versus absent). Differences in population characteristics, (e.g., age, conditions, co-morbidity), embedded within any cross-national trial, must be addressed conceptually prior to initiating the trial, methodologically when planning implementation, and statistically after the collection of the data. In terms of treatment, issues such as adverse and positive effects and timing of effects must be considered. The methods entailed in planning, implementing and analysing HRQL data will depend upon the degree of centralization of personnel and resources within any given clinical trial. The range of possibilities runs from complete centralization, in which all planning and coordination of data collection and transmittal is done by one office, to complete decentralization, in which the work is distributed to participating sites and interested investigators. Finally, successful implementation of HRQL data collection is enhanced by heightening awareness of the importance of, and value in, assessing HRQL in clinical trials.(ABSTRACT TRUNCATED AT 250 WORDS)

Cross-Cultural Comparison↗
PubMed2001

Health sector reform agenda in the Philippines--its effect on private hospitals.

Despite the gains that Philippines posted towards improving the health of the Filipinos, more challenges need to be hurdled to further improve the country's health status i.e. high threat from infectious diseases, increasing degenerative conditions, emerging health problems due to environmental and work-related factors, etc. The development and implementation of the Health Sector Reform Agenda (HSRA) is expected to address these problems through organization/policy changes and financing structure needed to improve health care delivery, regulation and financing: 1. Provide fiscal autonomy to government hospitals; 2. Secure funding for priority public health programs; 3. Promote development of local health systems; 4. Strengthen health regulatory agencies' capacities; 5. Expand the coverage of the National Health Insurance Program. There is a need however to evaluate the implications of the HSRA implementation in the private hospital system as this sector accounts for 67.91% of the total number of hospitals, servicing 48.35% of the country's total bed requirements. Major effects are: 1. Increased competition for patient market; and consequently; 2. for funding/payments; 3. Lesser capital and financing access for service/facility improvement; versus; 4. pressure from consumers/patients to render better quality, high-technology service at a lower cost. Certainly, any adverse effect on their operation will affect the access of a large percentage of the population currently using their services. This paper will provide an in-depth analysis of the implications of the HSRA implementation on private hospitals, major initiatives being undertaken to minimize adverse effect and innovations that can be capitalized to survive/grow in the new health environment. The authors' active participation in the National Health Planning Committee convened to oversee the HSRA implementation, the dialogues and conferences held with hospital sector for the Philippine Hospital Association, and actual involvement in hospital operation will provide a unique perspective and authority for this analysis.

Delivery of Health Care↗
PubMed1992

Rural health screening: a case study in coordination.

Collaboration helped a group of health care professionals identify clients' health needs, exchange professional knowledge, offer insight, and plan and implement a health screening program for rural older adults at risk for diabetes mellitus. The authors found collaboration with health professionals to be synergistic and energizing. When nurses with various educational and experiential backgrounds work together, rural clients' needs can be addressed. This project was funded by the American Diabetes Association, Ohio Affiliate.

Aged↗
PubMed1995

Assessing health opportunities: a course on multisectoral planning.

Multisectoral planning can yield major benefits for health, especially in the case of water resource development projects. A two-week course, designed to involve mid-level officers from at least six government ministries in the planning and implementation of such projects, has been tested in Ghana, the United Republic of Tanzania, and Zimbabwe.

Curriculum↗
PubMed1988

A method for evaluating systems of epidemiological surveillance.

Epidemiological surveillance is the systematic collection, analysis and dissemination of health data for the planning, implementation and evaluation of public health programmes. Established surveillance systems should be regularly reviewed on the basis of explicit criteria of usefulness, cost and quality; systems should be modified as a result of such review. Attributes of quality include: (i) sensitivity, (ii) specificity, (iii) representativeness, (iv) timeliness, (v) simplicity, (vi) flexibility and (vii) acceptability. To date, evaluation of surveillance systems has been limited in scope and content. The evaluation method proposed in this article offers an organized approach to the evaluation of epidemiological surveillance systems. The usefulness of a surveillance system is measured by whether it leads to prevention or control or a better understanding of adverse health events. The measure can be qualitative, in terms of the subjective views of those using the system, or quantitative in terms of the impact of surveillance data on policies, interventions or the occurrence of a health event. The cost of a system includes indirect as well as direct costs, and should be measured in relation to the benefits obtained, such as reduction of medical-care expenses and of time lost from work. All elements of the system should be included in the cost: data collection, analysis and dissemination. The sensitivity of a surveillance system is its ability to detect health events (completeness of reporting). Its specificity is inversely proportional to the number of false positives it reports. Reports of a disease that do not meet the case definition are false positives, and may result in resources being wasted in investigating them.(ABSTRACT TRUNCATED AT 250 WORDS)

Costs and Cost Analysis↗
PubMed1994

Ethnographic approach to community organization and health empowerment.

The purpose of this article is to address pertinent issues relative to the association between community organization and health empowerment methods in ethnic communities of colour. It seeks to address these issues by utilizing ethnographic procedures for documenting community health concerns and by advocating for empowerment for people of colour and their participation in coalition partnerships. Increasingly the importance of citizen participation in the planning, assessment, and implementation of community-based health initiatives has been identified as essential for effective health promotion and disease prevention programs. This article argues for the utility of a community organization approach for achieving health empowerment, and subsequently decreasing the excess deaths in communities of colour. The interface of ethnographic procedures, community organization, and development of community-owned action plans for programming health interventions is discussed.

Black or African American↗
PubMed2006

Mutual obligation, shared responsibility agreements & indigenous health strategy.

Since 2004 the Howard Coalition government has implemented a new policy framework and administrative arrangements as part of its program of reform in Indigenous affairs. In this paper I will describe both the parameters of this reform program and review the processes established to support the implementation of national Indigenous health strategy. In particular, I will consider both the shift from a policy framework based on 'self-determination' to one based on 'mutual obligation', and the implementation of Shared Responsibility Agreements (SRAs) that are based on the latter principle. I will use the example of the Mulan SRA to illustrate the difficulties in articulating the 'new arrangements' with current approaches to Indigenous health planning and strategy implementation. I conclude that 'new arrangements' pose a number of problems for Indigenous health planning and strategy that need to be addressed.

Journal Article↗
PubMedDate not supplied

Integrating environmental health into an undergraduate community health nursing course.

Nurses are often the first members of the healthcare system to whom the public turns when environmental health hazards cause concern. Yet most nursing programs include scant formal environmental health content. This article describes a project that integrated significant environmental health content into an undergraduate community health nursing course. The revised course included additional environmental health classroom content and field experiences. Details are provided regarding changes to classroom content, revision of written assignments to include environmental health issues, planning and implementation of nursing student field experiences with environmental health professionals, and evaluations of the revised course. The article concludes with three recommendations to guide other schools of nursing, wishing to integrate environmental health into their curricula.

Community Health Nursing↗
PubMed1999

Health information systems in developing countries: benefits, problems, and prospects.

Health information systems are important support tools in the management of health care services delivery in both developed and less developed countries. An adequate health information system is vital not only for assessing the health needs of populations and groups, but also for planning and implementation of health interventions. It is equally important in the evaluation of programmes from both the perspectives of effectiveness and coverage. This paper examines the practical difficulties of health care provision amidst inadequate statistics to inform decisions. Major obstacles to the introduction of effective health information systems in developing countries are examined, and practical suggestions on measures to overcome them discussed. It is concluded that the establishment of well co-ordinated information collection systems at the various levels of the health care system in developing countries, using appropriate staff, could contribute greatly to improvements in health care delivery.

Data Collection↗
PubMed1994

Survey of neighborhood-based, comprehensive community empowerment initiatives.

There is a developing consensus among health educators and other public health specialists that successful programs--especially among low-income people--emerge from empowered communities that participate proactively in all phases of program planning, implementation, and evaluation. Yet, there is no consensus on the definition of empowerment or on the guidelines that successful community empowerment initiatives have followed. The author surveys 17 community empowerment initiatives based in neighborhoods representing the diversity of low-income communities--both rural and urban--throughout the country. The objective of the paper is to explore the ways different initiatives have defined and operationalized their commitment to community empowerment and to examine the implications of these data for health educators. In order to understand the varying effectiveness of the initiatives surveyed, the author compares them considering several variables:their history and neighborhood context, their planning process and structure, their goals and objectives, their strategies, their relationships to their funders, and their accomplishments.

Community Health Services↗
PubMed2006

Planning and implementing a community-based public health advocacy campaign: a transport case study from Australia.

Facilitating community action is a key goal of health promotion. This paper describes a public health advocacy framework. It then presents a case study of its application for planning community action by a community alliance concerned about increased heavy traffic on roads through a small regional city in the South West region of Western Australia. The case study illustrates defining the public health problem, the solution and the target for action; and the implementation of a comprehensive range of strategies including a media advocacy strategy to attract public attention, to reframe media messages, and to provide a policy alternative to government and industry. The campaign was evaluated in terms of process and outcomes, and was successful in putting pressure on key stakeholders and achieving the alliance's two main goals. The case study demonstrates the value of a well-planned campaign and including public health advocacy in public health practice, as an important strategy to facilitate the creation of healthy environments through healthy public policy.

Accidents, Traffic↗
PubMed2003

Implementing health care reform in Israel: organizational response to perceived incentives.

Devising new incentives was a main element of health care reform in Israel, which created a regulated market that embodies many principles of managed competition. This study examined sick fund directors' perceptions of the new incentives and their strategic responses to these incentives, enabling the testing of how managed competition works in practice. The methodology used was a multiple case study of Israel's four sick funds. Data were gathered through in-depth interviews with 160 senior officials, analysis of national health insurance legislation, and analysis of published and unpublished archival documents, newspaper articles, public statements of senior managers, and other published data on the sick funds' behavior. The study revealed discrepancies between planned and perceived incentives and highlighted the effect of the latter on strategy formulation. Analysis of sick fund strategies showed that their responses to managed competition incentives deviated from theoretical expectations, compromising some of the objectives of the reform. The study also shows that contextual features account for the specific model of managed competition that was implemented and for the specific strategies employed by the sick funds. The study concludes by highlighting the need to build a process that will enable policy makers to consider local contextual factors when planning and implementing reform, involving health care providers in designing incentives, continuously monitoring processes and outcomes in the reformed system, and allowing for flexibility in policy making.

Attitude of Health Personnel↗
PubMed2006

Evidence-based health practice: knowing and using what works for older adults.

Community-based health care agencies are facing demands for improved outcomes, cost-effective programming, and higher customer satisfaction. Implementing evidence-based health interventions and programs can help to address these challenges. This article provides an overview of evidence-based health practice, including the definition and advantages of this approach, other key terms and concepts inherent to evidence-based practice, and the tasks and steps necessary to its implementation. The article concludes with a list of resources to help health care providers learn about, plan, and implement evidence-based health interventions and programs.

Aged↗
PubMed1987

Nicaragua: a health system developing under conditions of war.

Since its inception in 1979, the Nicaraguan National Health System has dramatically improved health care in Nicaragua through the provision of universal coverage, emphasis on preventive community-based primary care, and community participation in health activities. Of major importance in the development of the health system has been the decentralization of the administration, planning, and implementation of health programs. The war in Nicaragua has had a major impact on the development of the health system. Nicaraguan health personnel and facilities have been the objects of attack by the contras and scarce resources have been diverted from the development of social programs to military activities. A large refugee population has been created which further strains existing resources. Community-based preventive health programs have been adversely affected, particularly in rural areas where military activity is the most intense. Because of the war, efforts to optimize regionalization of the health system have been retarded. Economic pressures both within Nicaragua resulting from the war and within the entire Latin American area have further hampered efforts for development. Continued major improvements in health care in Nicaragua will depend on a settlement of the present military conflict which is draining resources in all sectors of development, including health.

Economics↗
PubMed1994

An American macromanaged health care system?

The implementation of President Clinton's proposed health reform plan that ensures universal access and relatively comprehensive health insurance benefits to over 250 million Americans would have a significant impact on their hospitals, physicians, and other health care providers. With this projected coverage, the 36.7 million Americans now uninsured would demand an additional volume of services. It is doubtful, because of this nation's trade and budget deficits, that any significant increases in expenditures for health will be made available from the public sector. Therefore, providers in the US will need to deliver significantly more care with a minimal increase in total reimbursement. These conclusions are further supported by the experiences of the Canadian and the German macromanaged health care systems that provide considerably more hospital and physician services per person per year than the US at a lesser cost per discharge and percentage of their respective nation's gross domestic product. America may be heading toward macromanaged global budget targets, but for political and other reasons President Clinton's health reform plan will be implemented with a multi-payer, managed competition approach.

Canada↗