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PubMed2001

Monitoring antimalarial drug resistance within National Malaria Control Programmes: the EANMAT experience.

The National Malaria Control Programme (NMCP), organized within the Ministry of Health (MoH), is an essential component for the planning, execution and coordination of malaria control activities. As effective case management remains the mainstay of malaria control in almost every African country, antimalarial drug resistance is a major barrier to the implementation of effective malaria control policies. In order to function effectively, these units must have an efficient surveillance system which can provide reliable and current estimates of the severity of drug resistance. Without this information, it is impossible for the MoH to design and promote a rational antimalarial policy, but because of limited resources, especially of people and expertise, most NMCPs have been unable to initiate and manage such a system. The need for collaborative partnerships between the MoH and the research community prompted the establishment of the East Africa Network for Monitoring Antimalarial Treatment (EANMAT). EANMAT has attempted to bring together the complimentary skills of malaria researchers and MoH staff in four east African countries. After 3 years of operation, data generated by EANMAT have been used to review and modify national malaria treatment policies in Kenya, Uganda, Rwanda and Tanzania. This new approach, which forges a closer working relationship between the research and policy communities, has effectively built capacity around the complex of surveillance, interpretation and use of evidence within a policy environment. The added-value of this approach is that the research community has learned to appreciate the constraints of policy development, and that the control community has established the need to build capacity and ownership of research evidence. Networks similar to EANMAT should be encouraged elsewhere in Africa to engender similar partnerships: to assist the development of rational treatment policies, and thus more effective malaria chemotherapy leading to significant lowering of malaria morbidity and mortality.

Africa, Eastern↗

PubMed2004

The Victorian Active Script Programme: promising signs for general practitioners, population health, and the promotion of physical activity.

BACKGROUND: The Active Script Programme (ASP) aimed to increase the number of general practitioners (GPs) in Victoria, Australia who deliver appropriate, consistent, and effective advice on physical activity to patients. To maximise GP participation, a capacity building strategy within Divisions of General Practice (DGPs) was used. The objectives of the programme were to (a) train and support GPs in advising sedentary patients, and (b) develop tools and resources to assist GPs. OBJECTIVE: To evaluate the effectiveness of the ASP. METHODS: A systems approach was used to promote capacity in Victorian general practice. Economic analyses were incorporated into the programme's evaluation. Participants were selected DGPs and their GP members. The programme worked with DGPs to train GPs and provide relevant resources. The main outcome measures were (a) changes in GP knowledge and behaviour and (b) cost effectiveness, based on modelled estimates of numbers of patients advised and adopting physical activity and gaining the associated health benefits. RESULTS: GP awareness and provision of physical activity advice increased. Although the programme's reach was modest, based on actual GP involvement, the cost effectiveness figures (138 Australian dollars per patient to become sufficiently active to gain health benefits, and 3647 Australian dollars per disability adjusted life year saved) are persuasive. CONCLUSIONS: The ASP increased DGPs' capacity to support GPs to promote physical activity. There is a strong economic argument for governments to invest in such programmes. However, caution is warranted about the maintenance of patients' activity levels. Programme refinement to encourage GPs to use community supports more effectively will guide future development. Further research on long term patient adherence through a multisectorial approach is warranted.

Adult↗

PubMed2003

Micro enterprise initiative in water sector and poverty reduction .

The author reports on the Kerala model for water sector development, broadly adopted as a role model for poverty reduction and build up of social capital. It is a community based organisation with its focus on facilitating a stable income to the poor, and composed of a People's Plan Campaign, the Kudumbashree (women-based poverty eradication programme), with grassroot level neighbourhood groups, federated into an area development society. It promotes savings and credit channelling, capacity building and entrepreneurship development. Activities include awareness raising on water conservation and hygiene, utilization of student power, promotion of small, cheap and low technology projects that people can understand and undertake (small reservoirs, tanks, rainwater harvesting structures, water meters), as well as microenterprises, and training of women-based repair groups.

Adult↗

PubMedDate not supplied

MAPP in Chicago: a model for public health systems development and community building.

The Chicago Department of Public Health's (CDPH's) community planning efforts came from a city-wide strategic plan that called for the establishment of a city-wide network of community partnerships that focus on community needs and resource assessment and program development. Using Mobilizing for Action through Planning and Partnerships as a framework for planning at the community level, the CDPH supports five community coalitions through the Chicago Center for Community Partnerships. The overall goal of the Center is to increase community capacity, build new partnerships, provide coalitions with access to decision makers, and inform the role of local public health agencies in supporting this type of work. Bringing together a wide spectrum of stakeholders, coalition members work to conduct assessments and develop and implement strategies. While coalitions demonstrate outcomes related to specific strategies, they also exhibit infrastructure-level results, with increased levels of community organizing, leveraging of existing resources, and new systems for information dissemination. Simultaneously, the CDPH has gained new partners in public health, increased collaboration, and more information about communities. These outcomes are contingent on certain elements of success: (1) committed leadership; (2) commitment to a new way of doing business; (3) prepared public health workforces; and (4) community readiness.

Chicago↗

PubMed2006

Estimating the resource needs of scaling-up HIV/AIDS and tuberculosis interventions in sub-Saharan Africa: a systematic review for national policy makers and planners.

Considerable effort has been made to estimate the global resource requirements of scaling-up HIV/AIDS and tuberculosis (TB) interventions. There are currently several medium- and long-term global estimates available. Comprehensive country specific estimates are now urgently needed to ensure the successful scaling-up of these services. This paper reviews evidence on the global resource requirements of scaling-up HIV/AIDS and TB interventions. The purpose of this review is to summarise and critically appraise the methods used in the global estimates and to identify remaining knowledge gaps, particularly those relevant to country level estimation. This review found that the estimates of global resource requirements provide sound methodological guidance for countries on the basic steps to follow. However, there are still many areas that require further development or evidence. These include the following. Firstly, the methods used to assess the capacity to scale up HIV/AIDS and TB services need to be further refined. In particular countries need simple methods to assess human resource capacity. Secondly, investments need to be made to improve country level data on the costs and effectiveness of HIV/AIDS and TB services. In particular efforts should be focused on producing standardised unit costs for each intervention by country, which reflect the reality of domestic resource use. Thirdly, simple costing models, which appropriately integrate systems costs need to be developed for use at the country level. Finally, resources needs estimation needs to be embedded by countries in multi-sectoral expenditure planning processes. Countries and global agencies will continue to need estimates for different purposes at different times. Therefore attention should move away from specific estimates, to the longer term aim of building capacity at the country level, supported by global agencies. This will be of mutual benefit. Those making national resource estimates can learn from the experience of global estimation. Concurrently, global resource estimates can build on the evidence emerging from improved national resource estimates.

Africa South of the Sahara↗

PubMed1999

Geochemical consequences of increased atmospheric carbon dioxide on coral reefs

A coral reef represents the net accumulation of calcium carbonate (CaCO3) produced by corals and other calcifying organisms. If calcification declines, then reef-building capacity also declines. Coral reef calcification depends on the saturation state of the carbonate mineral aragonite of surface waters. By the middle of the next century, an increased concentration of carbon dioxide will decrease the aragonite saturation state in the tropics by 30 percent and biogenic aragonite precipitation by 14 to 30 percent. Coral reefs are particularly threatened, because reef-building organisms secrete metastable forms of CaCO3, but the biogeochemical consequences on other calcifying marine ecosystems may be equally severe.

Journal Article↗

PubMed2006

Comprehensive long-term follow-up programs for pediatric cancer survivors.

BACKGROUND: The objective of this study was to provide a detailed description of comprehensive long-term follow-up (LTFU) programs for pediatric cancer survivors. METHODS: Program directors from 24 comprehensive LTFU programs in the U.S. and Canada completed a 6-page survey that provided details in 5 categories: description of the program, perceived benefits and strengths of the program, barriers to the development and use of the program, methods to improve the program, and an ideal model of care for pediatric cancer survivors. RESULTS: Participants identified the following primary benefits to health care delivered to survivors through LTFU programs: health care delivered by clinicians familiar with long-term risks of survivors, provision of risk-based screening and surveillance for late effects, and targeted education for risk reduction and healthy lifestyles. Key barriers to the functioning of LTFU programs included system-driven and patient/survivor-driven factors. System-driven factors included inadequate resources and finances to sustain programs, low institutional commitment toward the provision of survivorship care, lack of capacity to care for the growing population of survivors, and difficulties with ongoing communication with community physicians. Survivor-driven barriers included lack of interest and lack of awareness of cancer-related risks. CONCLUSIONS: This report describes the frequency, content, and setting of follow-up care delivered by pediatric comprehensive LTFU programs. Critical challenges as survivorship care evolves will include integrating a structured process of program evaluation and building capacity for care.

Adolescent↗

PubMed2002

A framework for institutionalizing quality assurance.

OBJECTIVE: To develop a framework to support the institutionalization of quality assurance (QA). DESIGN: The framework for institutionalizing QA consists of a model of eight essential elements and a 'roadmap' for the process of institutionalization. The essential elements are the building blocks required for implementing and sustaining QA activities. Core QA activities include defining, measuring and improving quality. The essential elements are grouped under three categories: the internal enabling environment (internal to the organization or system), organizing for quality, and support functions. The enabling environment contains the essential elements of leadership, policy, core values, and resources. Organizing for quality includes the structure for implementing QA. Three essential elements are primarily support functions: capacity building, communication and information, and rewarding quality. The model can be applied at the level of an organization or a system. The paper also describes the process of institutionalizing QA, starting from a state of preawareness, passing through four phases (awareness, experiential, expansion, and consolidation), and culminating in a state of maturity. The process is not linear; an organization may regress, vacillate between phases, or even remain stagnant. Some phases (e.g. awareness and experiential) may occur simultaneously. CONCLUSION: The framework has been introduced in nearly a dozen countries in Latin America and Africa. The conceptual model has been used to support strategic planning and directing Ministry of Health work plans, and also as a resource for determining the elements necessary to strengthen and sustain QA. The next step will be the development and evaluation of an assessment tool to monitor developmental progress in the institutionalization of QA.

Decision Making, Organizational↗

PubMed2026

A scalable HPC framework for bioinformatics in resource-limited settings: design principles, implementation, and sustainability from the UVRI experience.

MOTIVATION: Building and sustaining High-Performance Computing (HPC) infrastructure for bioinformatics research in resource-limited settings presents significant technical, financial and operational challenges. Institutions in low-and middle-income regions often face constraints such as limited technical expertise, unstable infrastructure and restricted funding which can hinder the deployment of large-scale computational platforms necessary for modern genomics and bioinformatics analyses. RESULTS: We present a scalable and modular HPC framework developed at the Uganda Virus Research Institute (UVRI) to support large-scale genomics and other omics data analyses in resource-limited settings. The framework integrates open-source HPC management tools, infrastructure automation, and reproducible configuration management to enable reliable deployment and maintenance. Optimized storage and networking configurations combined with a phased capacity-building strategy support high-throughput genomic workflows while strengthening local technical expertise. From our implementation experience, we derive ten practical design and operational rules that provide a transferable methodology for establishing and sustaining in-house HPC infrastructure. These rules emphasize strategic investment in human capacity, structured planning, leveraging collaborations, adoption of open-source technologies and service management practices to improve operational resilience and long-term sustainability. AVAILABILITY: The design principles, automation strategies and implementation guidelines described in this work are applicable to institutions seeking to establish sustainable HPC resources for bioinformatics research in resource-constrained environments.

Computational Biology↗

PubMed2004

Secondhand tobacco smoke in public places in Latin America, 2002-2003.

CONTEXT: The success of measures to restrict smoking in indoor environments and the intensity of enforcement vary among countries around the world. In 2001, the Pan American Health Organization (PAHO) launched the Smoke-Free Americas Initiative to build capacity to achieve smoke-free environments in Latin America and the Caribbean. OBJECTIVE: To assess secondhand smoke concentrations in public places in the capital cities of Argentina, Brazil, Chile, Costa Rica, Paraguay, Peru, and Uruguay in conjunction with the Smoke-Free Americas Initiative. DESIGN AND SETTING: Multicountry assessment of vapor-phase nicotine concentrations using a common protocol in all 7 Latin American countries. A total of 633 sampling devices were placed for 7 to 14 days in 1 hospital, 2 secondary schools, 1 city government building, 1 airport (2 in Argentina), and restaurants and bars in each country. MAIN OUTCOME MEASURE: Concentrations of airborne nicotine. RESULTS: Airborne nicotine was detected in most (94%) of the locations surveyed. By country, Argentina and Uruguay had the highest median concentrations in most environments (eg, in hospitals: 1.33 [interquartile range [IQR], 0.51-3.12] microg/m3 and 0.8 [IQR, 0.30-1.69] microg/m3, respectively). Overall, bars and restaurants had the highest median concentrations (3.65 [IQR, 1.55-5.12] microg/m3 and 1.24 [IQR, 0.41-2.48] microg/m3, respectively). Nicotine concentrations were also found in a number of key, sentinel buildings, including 95% (155/163) of hospital samples (in the physicians' and nurses' stations the median was 0.27 [IQR, 0.02-1.94] microg/m3), schools, government buildings, and/or airports in most countries. CONCLUSIONS: The finding of airborne nicotine in critical locations in Latin America provides a basis for enforcing smoke-free initiatives and for strengthening the protection of the public from unwanted exposure to secondhand smoke.

Argentina↗

PubMed2002

Building an HIV continuum for inmates: New York State's criminal justice initiative.

The benefits of public health, corrections, and community-based organization (CBO) collaboration to meet HIV prevention needs of inmates are recognized. Each year over 100,000 inmates, most of whom have a history that put them at HIV risk, pass through the New York State (NYS) prison system. The NYS Department of Health AIDS Institute, the NYS Department of Correctional Services, the NYS Division of Parole, and a statewide network of CBOs collaborate to meet HIV prevention and support services needs of inmates and parolees through a continuum of interventions and services. This article describes the evolution of the prevention, supportive services, and transitional planning continuum within the NYS prison system. It identifies other agencies involved, obstacles to service delivery, describes approaches to overcome them, discusses ways to meet capacity building and technical assistance needs of CBOs, identifies challenges remaining, and provides practical advice from actual experience in NYS.

Community Health Services↗

PubMed1996

The National Breast and Cervical Cancer Early Detection Program: a comprehensive public health response to two major health issues for women.

The passage of the Breast and Cervical Cancer Mortality Prevention Act established a nationwide, comprehensive public health program to increase access to breast and cervical cancer screening services for women who are medically underserved. This act created the first opportunity for state health agencies to build a public health infrastructure for cancer control at the state and community levels. The Congress appropriated $30 million in fiscal year 1991 for the first year of this program. In the summer of 1991, the Centers for Disease Control and Prevention (CDC) used a competitive application process to fund the first eight states to establish early detection programs. Since then, the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) has become a nationwide program with a budget of $100 million. Thirty-five states and nine American Indian Tribes are supported to implement comprehensive screening programs. Fifteen states, three territories, and the District of Columbia receive planning and infrastructure grants as part of the Capacity Building Program. The NBCCEDP surveillance data through January 31, 1995 shows that 556,003 screening tests have been provided to women who are medically underserved. The success of NBCCEDP has contributed to the growing pressure on state health agencies to focus more attention and resources on chronic disease prevention and control.

Adult↗

PubMedDate not supplied

Relevant in times of turmoil: WHO and public health in unstable situations.

For millions of people world-wide, surviving the pressure of extreme events is the predominant objective in daily existence. The distinction between natural and human-induced disasters is becoming more and more blurred. Some countries have known only armed conflict for the last 25 years, and their number is increasing. Recently, humanitarian sources reported 24 ongoing emergencies, each of them involving at least 300,000 people "requiring international assistance to avoid malnutrition or death". All together, including the countries still only at risk and those emerging from armed conflicts, 73 countries, i.e., almost 1.8 trillion people, were undergoing differing degrees of instability. Instability must be envisioned as a spectrum extending between "Utopia" and "Chaos". As emergencies bring forward extreme challenges to human life, medical and public health ethics make it imperative for the World Health Organisation (WHO) to be involved. As such, WHO must enhance its presence and effectiveness in its capacity as a universally accepted advocate for public health. Furthermore, as crises become more enmeshed with the legitimacy of the State, and armed conflicts become more directed against countries' social capital, they impinge more on WHO's work, and WHO must reconcile its unique responsibility in the health sector, the humanitarian imperative and the mandate to assist its primary constituents. Health can be viewed as a bridge to peace. The Organization specifically has recognised that disasters can and do affect the achievement of health and health system objectives. Within WHO, the Department of Emergency and Humanitarian Action (EHA) is the instrument for intervention in such situations. The scope of EHA is defined in terms of humanitarian action, emergency preparedness, national capacity building, and advocacy for humanitarian principles. The WHO's role is changing from ensuring a two-way flow of information on new scientific developments in public health in the ideal all-stable, all-equitable, well-resourced state, to dealing with sheer survival when the state is shattered or is part of the problem. The WHO poses itself the explicit goals to reduce avoidable loss of life, burden of disease and disability in emergencies and post-crisis transitions, and to ensure that the Humanitarian Health Assistance is in-line with international standards and local priorities and does not compromise future health development. A planning tree is presented. The World Health Organization must improve its own performance. This requires three key pre-conditions: 1) presence; 2) surge capacity; and 3) institutional support, knowledge, and competencies. Thus, in order to be effective, WHO's presence and surge capacity in emergencies must integrate the institutional knowledge, the competencies, and the managerial set-up of the Organization.

Altruism↗

PubMed2003

Caribbean Public Health Laboratory Surveillance Project: a Department of Defense-sponsored humanitarian mission.

This report describes a Department of Defense humanitarian assistance project to develop and build a regional computer-assisted laboratory-based electronic disease surveillance system in the Caribbean basin. From 1997 through 2000, the project donated 146 computer systems and trained more than 250 personnel from 14 ministries of health to operate this system. This humanitarian mission provided the region with a sustainable and locally maintained and operated surveillance system having a broad and long-term impact on public health. It has improved data gathering, analysis, and reporting at the local, national, and regional level. Benefits to the region include the dissemination through the Internet of increasingly timely and accurate information on the incidence and prevalence of endemic, epidemic, and newly emerging diseases. This serves the Caribbean residents, travelers, and U.S. national interests. The project is a model for cooperative Department of Defense capacity building and training programs in support of partner countries and international public health agencies.

Altruism↗

PubMedDate not supplied

Developing community-academic partnerships to enhance breast health among rural and Hispanic migrant and seasonal farmworker women.

PURPOSE/OBJECTIVES: To examine effective strategies for building community-academic partnerships for the promotion of breast cancer education and outreach among rural and Hispanic migrant and seasonal farmworker women, mostly from Mexican descent. DATA SOURCES: Published research and education articles and books, community-education models, personal experiences, and community key informant feedback. DATA SYNTHESIS: Effective community partnerships for enhanced education and outreach include a framework based on a network of partners with common goals, communication processes based on trust, and bilingual/bicultural and culturally competent staff. CONCLUSIONS: A sustainable community partnership can be achieved through systematic but flexible approaches to community planning. Involvement of community members in the development and implementation of education and screening activities helps ensure that community needs are met. Relationships based on mutual respect are key. IMPLICATIONS FOR NURSING PRACTICE: Nurses can act as catalysts through community capacity building to create community-academic partnerships to reach medically underserved populations with cancer screening, outreach, and education through the delivery of strategies that are based on common goals.

Academies and Institutes↗

PubMed2002

A CLAS act? Community-based organizations, health service decentralization and primary care development in Peru. Local Committees for Health Administration.

In 1994 Peru embarked on a programme of health service reform, which combined primary care development and community participation through Local Committees for Health Administration (CLAS). They are responsible for carrying out local health needs assessments and identifying unmet health needs through regular household surveys. These enable them to determine local health provision and tailor services to local requirements. CLAS build on grassroots self-help circles that developed during the economic and political crises of the 1980s, and in which women have been prominent. However, they function under a 3 year contract with the Ministry of Health and within a framework of centrally determined guidelines and regulations. These reforms were implemented in the context of neo-liberal economic policies, which stressed financial deregulation and fiscal and monetary restraint, and were aimed at reducing foreign indebtedness and inflation. We evaluate the achievements of the CLAS and analyse the relationship between health and economic policy in Peru, with the aid of two contrasting models of the role of the state - 'agency' and 'stewardship'. We argue that Peru's experience holds valuable lessons for other countries seeking to foster community involvement. These include the need for community capacity building and partnership between community organizations and state (and other civil) agencies.

Community Health Planning↗

PubMed1999

Institutional, Legal, and Economic Instruments in Ghana's Environmental Policy.

/ This paper reviews the state of the environment in Ghana and explores the potential for the use of institutional, legal, and economic instruments in environmental management in the specific context of this developing country.The environmental situation in Ghana is characterized by desertification, land degradation, deforestation, soil erosion, and inadequate water supply in the northern regions of the country. The population as a whole is growing at a rate of 3% per annum, with even greater urban growth rates, due to rural out-migration. Large parts of the coastal zone in the south are rapidly developing to become one large suburbanized area. Water quality is particularly threatened in the urban and industrialized areas, which are mainly located in the southern part of the country. The coastal lagoons and coastal waters are moderately to heavily polluted. Erosion extends along the whole Ghanaian coast with excesses, for example, in the Keta area, where during the last century over 90% of the original buildings have been washed awayby the sea. The obvious environmental consequences of the mining sector are illustrative of the environmental threats caused by a fast growing industry and industrializing agriculture, in a country where environmental policy is only in its formative years. Desertification, food insecurity and coastal erosion all contribute to an increasing number of environmental refugees.Environmental policy in Ghana is a post-Rio phenomenon. Environmental laws, a Ministry of Environment, Science and Technology, an advisory National Committee for the Implementation of Agenda 21, and a fully mandated environmental administration have been established. This administration advocates a progressive attitude towards environmental legislation and points out the specific utility of economic and legal instruments in environmental management in this relatively fast developing country.The choice of instruments for environmental management is increasingly influenced by the specific state of African environmental and technological capacity and by a call for the recognition of the role of traditional customs in nature conservation. This African perspective on environmental management is further intensified by an unmet need for regional, transboundary cooperation in the West African subcontinent. This specific West African context calls for an elaboration of an effective capacity-building program for environmental management in the area.KEY WORDS: Environmental profile; Environmental policy; Legal instruments; Economic instruments; African perspective; State of the environmenthttp://link.springer-ny.com/link/service/journals/00267/bibs/24n3p337.html

Journal Article↗

PubMed1999

Managing external resources in the health sector: are there lessons for SWAps (sector-wide approaches)?

Drawing on the case studies presented in this issue, from Bangladesh, Cambodia, Mozambique, Zambia and South Africa, and examples from other countries, this paper asks what general conclusions can be drawn about the management of external resources, and specifically what lessons could inform the future implementation of sector-wide approaches (SWAps) in the health sector. Factors constraining the management of aid by ministries of health are grouped under three themes: context and timing, institutional capacities and the interplay of power and influence in negotiations over aid. Two factors, often underplayed, were found to be important in facilitating management of resources: the inter-relationship of formal and informal relationships, and the extent to which incremental changes are tolerated. The main conclusion is that coordination and management of external resources is inherently unstable, involving a changing group of actors, many of whom enjoy considerable autonomy, but who need each other to materialize their often somewhat different goals. Managing aid is not a linear process, but is subject to set-backs and crises, although it can also produce positive spin-offs unexpectedly. It is highly dependent on institutional and systemic issues within both donor and recipient environments. In promoting sector-wide approaches the key will be to recognize context-specific conditions in each country, to find ways of building capacity in ministries of health to develop and own the future vision of the health sector, and to negotiate a realistic package that is explicit in its agreed objectives. The paper ends with identifying crucial actions that will enable ministries of health to take the lead role in developing and implementing SWAps.

Developing Countries↗