PubMed · 15638332
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H J Simmons, John M Harris. 2004. Community based physician need planning methodologies evolve.. https://pubmed.ncbi.nlm.nih.gov/15638332/
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BACKGROUND: Intersectoral Action for Health (IAH) and its Health Impact Assessment (HIA) tool are built on collaboration between actors and sectors, requiring multidimensional and horizontal way of working. The study aims to analyse the enablers and barriers when such a new way of working and tool have been initiated to replace a traditional, vertical operation at the local level in Slovakia-a country in transition-in 2004. METHODS: Up to date, there are few studies that have analysed intersectoral initiatives in relation to politics. In this study the conceptual framework of Kingdon has been used by which the actual problems, the governmental actions (or non-actions) (politics) and the understanding, implementation and evaluation of the initiative (policy) could be analysed. All actors involved, civil servants, politicians, representatives of the local public health institute and researchers, were interviewed and made to answer a questionnaire. RESULTS: The results showed that there were a number of factors behind the initiation of HIA, which either delayed or accelerated the process. The problems identified were e.g. the prevailing traditional health care focus and the deteriorating health status of the population. There was a lack of multi-intersectoral knowledge, co-operation and function between sectors and actors. Enablers on the other hand were the membership of international organizations which called for new solutions, and the strong political commitment and belief that intersectorality would have a positive effect on health. CONCLUSION: The actors on the local level would have the capacity to work intersectorally to bring about policy change if HIA was to be more supported/institutionalized.
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INTRODUCTION: Aboriginal and Torres Strait Islander health workers (hereafter called health workers) can play a major role in facilitating culturally appropriate health care delivery and program development through the acquisition of improved skills in the planning, monitoring and evaluation of these programs (RCB). However, many Aboriginal and Torres Strait Islander people and communities remain concerned about research and related activities. Health workers are well placed to assist communities to not only embrace research, but to be active players and promoters of relevant, appropriate and acceptable research. One means of achieving the twin goals of RCB and community acceptance and involvement in research, is through health workers undertaking research of health priority issues and evaluation of activities, such as program delivery, that are of direct relevance to their community's aim of improving or enhancing service delivery. This article outlines the development and content of a community-based RCB framework for health workers. The focus is on the major issues that enhance a proactive service delivery model using culturally appropriate research methods. Development process: The RCB framework described here was developed, over a period of time, through community workshops and consultations aimed at deriving general consensus on the key issues and components of a culturally-appropriate, community-based training process. The framework has subsequently been reviewed by Aboriginal and Torres Strait Islander community representatives from across Australia. The overall aim of the framework is to supplement current (institutionally-based) education and training resources for health workers with community-based research training modules. These modules can be tailored to provide research and evaluation skills relevant to health workers taking a more proactive role in facilitating health and wellbeing programs in their own communities. The use of collaborative consultation and participatory methods are intended to be a two-way education process. Course content: A visual pathway is used that encompasses the impact of health and practice in the community for health workers at a grass-roots level. This enables elements of the RCB process to be divided into a series of connected modules. These are: (i 'assessing' Existing Services; (ii) methods and measures for Identifying Need at various levels; (iii) important issues in Program Development; (iv) how the former contributes to Service Improvement; (v) resultant Outcomes that will impact on community and service provision; and (vi) Evaluation Methods and applying findings to service delivery. CONCLUSIONS: Active participation by the Aboriginal and Torres Strait Islander community is fundamental for effective research practices and outcomes. The aim is to provide health workers and community members with a working knowledge of research ethics and methods so that they can assist, monitor and steer the development of culturally appropriate research activities that will lead to provision of the highest quality services 'back' to the community. This RCB framework will enable health workers to be more proactive, self-reliant and self-sufficient within their community and healthcare settings.