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PubMed2000

Making a difference: the social ecology of social transformation.

A multidisciplinary and multilevel framework for social transformation is proposed, encompassing four foundational goals: capacity-building, group empowerment, relational community-building, and culture-challenge. Intervention approaches related to each goal are presented at the setting, geographic community, and societal levels. Four exemplars of social transformation work are then discussed: the Accelerated Schools Project, Meyerhoff Program, ManKind Project, and women's movement. These examples illustrate the synergistic relationship among the four transformational goals, within and across levels of analysis, which is at the heart of the social transformation process. The paper concludes with three challenges to guide our efforts as we enter the new century: (1) to move social transformation to the center of our consciousness as a field; (2) to articulate jointly with allied disciplines, organizations, and citizen groups an encompassing, multidisciplinary, and multilevel framework for social transformation; and (3) to do the above with heart, soul, and humility.

Culture↗

PubMed2003

Identifying best practices of community participation in providing services to refugee survivors of torture: a case description.

There is an increased interest in best practices in the design and implementation of specialized programs for refugee survivors of torture. The processes taking place in the development of such a program also warrant assessment. In particular, this paper addresses the importance of community participation. Using the Host Support Program for Survivors of Torture as a case study, we identify the community participation practices that emerged during stages of program development and describe how these practices have made possible a collaborative service delivery model and facilitated community capacity building that addresses the complex needs of refugee survivors of torture. The process of community collaboration is discussed as central to the process of effective community participation and organizing. The illustrated benefits of community participation position this model as a best practice.

Alberta↗

PubMed2004

Bringing order out of chaos: a culturally competent approach to managing the problems of refugees and victims of organized violence.

The collaborative program of the Transcultural Psychosocial Organization (TPO) provides a community-oriented and culturally sensitive public health response to the psychosocial problems of refugees and victims of organized violence. This paper describes the 9-step model that TPO has developed as a blueprint for each new intervention. Beneficiaries participate in determining priorities and there is an orientation toward culturally competent training, capacity-building, and sustainability. Two cases, one related to Sudanese refugees in Uganda and the other to internally displaced persons and returnees in postwar Cambodia, show how the TPO intervention protocol is adapted to local settings. The paper provides preliminary evaluative comments on the model's performance.

Cambodia↗

PubMed2002

Narrowing the gap between academic professional wisdom and community lay knowledge: perceptions from partnerships.

Community involvement in health through community partnerships (CPs) has been widely advocated. Putting CPs into practice is complex and represents a challenge for all the stakeholders involved in the change process. Employing data from five CPs aiming to bring together communities, academics and health service providers in South Africa, this paper aims to examine and compare the views of the health care professionals with those of the community members with respect to each other's skills and abilities. Five domains of expertise in partnership working are examined: educational competencies; partnership fostering skills; community involvement expertise; change agents proficiencies; and strategic and management capacities. The findings suggest that the community recognizes the expertise and abilities brought by the professional staff to the CPs. Community members have a positive view of the capabilities of the professionals, in particular their abilities as resource persons in the areas of budget management, policy formulation and the introduction and management of change. The professionals, on the other hand, are cautious regarding the level of skill and capability in communities. The limited appreciation of community skills by the professionals covered all the five domains of expertise examined. The findings suggest that if joint working is to survive, the professionals will need to increase their valuation of the indigenous proficiencies inherent in their community partners. We conclude that programme models need to consciously incorporate in their design and implementation, capacity building, skills transfer and empowerment strategies.

Adult↗

PubMed2002

Transgenic crops, biotechnology and ownership rights: what scientists need to know.

Ownership of intellectual and tangible property (IP/TP) rights in agricultural biotechnology (ag-biotech) and transgenic plants has become critically important. For scientists in all institutions, whether industrialized or developing country, public or private sector, an understanding of IP/TP rights is fundamental in both research and development. Transgenic plants and ag-biotech products embody numerous components and processes, each of which may have IP/TP rights attached. To identify these rights, a transgenic plant or ag-biotech product must be dissected into its essential components and processes, with each 'piece' analysed under the IP/TP 'microscope'. This product deconstruction is an integral step in product clearance (PC) analysis leading to freedom to operate (FTO). To facilitate a PC analysis, the following points are important: (1) knowing what one has and where it's from, (2) organizing material transfer agreements and licences, (3) researching scientific and patent databases and relevant literature, (4) instituting a laboratory notebook policy, (5) keeping track of ownership of germplasm and plant genetic resources, and (6) promoting ongoing IP/TP management, awareness and training. However, a FTO opinion does not solve the IP/TP issues of releasing a transgenic plant or ag-biotech product; rather, it is a management tool for assessing the risks of litigation. When transferring transgenic plants or ag-biotech to developing nations, scientists from industrialized countries have the heightened responsibility of verifying that IP/TP issues are fully addressed and documented. Successful technology transfer goes beyond research, development and licensing; it is an holistic package leading to long-term partnerships in international development. Managing IP/TP requires capacity-building in scientists and technology transfer offices, in both industrialized and developing countries.

Biotechnology↗

PubMed2001

Drugs for neglected diseases: a failure of the market and a public health failure?

Infectious diseases cause the suffering of hundreds of millions of people, especially in tropical and subtropical areas. Effective, affordable and easy-to-use medicines to fight these diseases are nearly absent. Although science and technology are sufficiently advanced to provide the necessary medicines, very few new drugs are being developed. However, drug discovery is not the major bottleneck. Today's R&D-based pharmaceutical industry is reluctant to invest in the development of drugs to treat the major diseases of the poor, because return on investment cannot be guaranteed. With national and international politics supporting a free market-based world order, financial opportunities rather than global health needs guide the direction of new drug development. Can we accept that the dearth of effective drugs for diseases that mainly affect the poor is simply the sad but inevitable consequence of a global market economy? Or is it a massive public health failure, and a failure to direct economic development for the benefit of society? An urgent reorientation of priorities in drug development and health policy is needed. The pharmaceutical industry must contribute to this effort, but national and international policies need to direct the global economy to address the true health needs of society. This requires political will, a strong commitment to prioritize health considerations over economic interests, and the enforcement of regulations and other mechanisms to stimulate essential drug development. New and creative strategies involving both the public and the private sector are needed to ensure that affordable medicines for today's neglected diseases are developed. Priority action areas include advocating an essential medicines R&D agenda, capacity-building in and technology transfer to developing countries, elaborating an adapted legal and regulatory framework, prioritizing funding for essential drug development and securing availability, accessibility, distribution and rational use of these drugs.

Communicable Diseases, Emerging↗

PubMed2004

A consultation with Canadian rural women with breast cancer.

OBJECTIVE: Relatively little research has been carried out on the health and supportive care needs of rural women living with breast cancer. In this study, results from a Canadian focus group study are used to highlight issues of importance to rural women. SETTING AND PARTICIPANTS: A total of 276 rural women with breast cancer divided into 17 focus groups participated in the study conducted across Canada. A standardized protocol for discussion was employed. Issues of access to information, support and services were discussed, with women describing their experiences in trying to find appropriate programmes and services. MAIN RESULTS: The major theme identified through analysis of qualitative data was 'becoming aware of and/or gaining access to health care information, support and services.' Other major themes included: (1) dealing with isolation; (2) having to travel; (3) feeling the financial burden and (4) coping with changing work. CONCLUSIONS: Rural women with breast cancer have supportive care challenges related to their circumstances. A series of recommendations were generated through the consultation process which are contributing to the development of a national strategy focusing on the development and extension of programmes for rural women with breast cancer. Although the research on the project was not to specified standards, and suffered from less attention than community capacity building and advocacy, it proved to be of worth and revealed potential benefits from collaborations between researchers and community organizations.

Breast Neoplasms↗

PubMed2004

African countries propose a regional oral health strategy: The Dakar Report from 1998.

It is clear that the African region faces a number of serious oral diseases, either because of their high prevalence or because of the severe tissue damage or death that can occur. Previous approaches to oral health in Africa have failed to recognise the epidemiological priorities of the region or to identify reliable and appropriate strategies to assess them. Efforts have consisted of an unplanned, ad hoc and spasmodic evolution of curative oral health services. This document focuses on the most severe oral problems that people have to live with like noma, oral cancer and the oral consequences of HIV/AIDS infection. It proposes a strategy for assisting member states and partners to identify priorities and interventions at various levels of the health system, particularly at the district level. The strategy aims at strengthening the capacity of countries to improve community oral health by effectively using proven interventions to address specific oral health needs. The strategy identifies five main 'programmatic areas', including (i) the development of national oral health strategies and implementation plans, (ii) integration of oral health in other programmes, (iii) delivery of effective and safe oral health services, (iv) regional approach to education and training for oral health, and (v) development of effective oral health management information systems. Many of the programmatic areas share similar characteristics described as a 'strategic orientation'. These strategic orientations give effect to the concepts of advocacy, equity, quality, partnership, operational research, communication and capacity building. The WHO Regional Committee for Africa (RC) is invited to review the proposed oral health strategy for the African region for the period 1999-2008 and provide an orientation for the improvement of oral health in member states in the region.

Africa↗

PubMedDate not supplied

Incorporating health services research into nursing doctoral programs.

Despite the successes of the US health care system, problems associated with access, affordability, and quality of care remain to be solved. Health services research (HSR) has the potential to aid nurses in addressing these issues; yet the importance of its inclusion in the academic preparation of nurse researchers has not been consistently recognized. This article discusses the relevance of HSR to nursing, provides a brief review of the history of HSR and its imperatives, and presents rationale for nursing's involvement in HSR. Problems identified by the Re-envisioning PhD project conducted by the University of Washington are assessed for relevance to HSR and nursing doctoral preparation. Recommendations are included for integrating HSR into nursing doctoral programs and meeting HSR capacity building needs for the future.

Curriculum↗

PubMed2002

Concept mapping: a tool to bridge the disciplinary divide.

The American College of Women's Health Physicians has been exploring an on-line educational tool-concept mapping-to facilitate the development of an interdisciplinary and woman-centered women's health curriculum, and to implement The Women's Health Care Competencies for Medical Students. By using an on-line concept map of the menstrual cycle, we have built upon a standard piece of curricula that describes a unique aspect of female physiology and transformed it into a knowledge framework that builds capacity. The concept map highlights relationships between concepts and across disciplines, connecting the competencies to enable meaningful learning so that a learner can adapt their knowledge to multiple settings, incorporate new learning, and generate new knowledge to grow the interdisciplinary field of women's health. The on-line format allows access from multiple sites and courses, and allows the curricula to grow organically over time without upsetting current curricular design.

Artificial Intelligence↗

PubMed2005

Evaluating an indigenous sexual health peer education project.

ISSUE ADDRESSED: Many Indigenous Australians are dealing with a wide range of sexual health issues including contraception, HIV/AIDS and other sexually transmitted infections. The Indigenous Peer Education Program provided training to young, marginalised and disadvantaged Indigenous people to become sexual health peer educators within their communities. METHODS: The initiative comprised peer educator training, capacity building, and the development and dissemination of sexual health educational materials through an arts-based strategy. Evaluation involved a retrospective qualitative methodology, including document analysis, interviews and focus groups. RESULTS: The program was successful in training 22 young Indigenous peer educators and developing and disseminating more than 2,600 sexual health education resources to young Indigenous people and their community. CONCLUSIONS: The project had a positive immediate impact upon young Indigenous participants who reported and demonstrated increased knowledge of sexual health issues and skills as peer educators. The evaluation documented the program development and the immediate effects on participants, but did not enable an assessment of long-term effects for participants, service providers or the community. The evaluation identified areas for program improvement and challenges for program sustainability. The initiative was well supported within the local community and peer educators continued to engage in opportunistic sexual health promotion.

Adolescent↗

PubMed2002

What Brazil is doing to promote healthy diets and active lifestyles.

OBJECTIVES: To present the way the Brazilian government is addressing the prevention of nutrition-related non-communicable diseases (NR-NCDs). RESULTS: Innovative legislative and regulatory actions, mass communications and capacity building have been combined to create a comprehensive approach for addressing poor dietary and activity patterns in Brazil that are leading to obesity and NR-NCDs. Included are new nutrition-related initiatives in the labelling area, shifts in the types of food purchased for the school food programme, use of mass media to communicate components of the food guidelines, establishment of a smart shopping initiative, and training of teachers and health workers. CONCLUSIONS: The entire effort has taken several years to get underway. This paper describes the process and some of the initial changes seen.

Brazil↗

PubMed2006

Food insecurity, malnutrition and mortality in Maewo and Ambae Islands, Vanuatu.

CONTEXT: This paper reports on findings from the ex-post evaluation of the Maewo Capacity Building project in Maewo Island, Vanuatu, which was funded by World Vision Australia. OBJECTIVES: To examine the extent to which the infrastructure and systems left behind by the project contributed to the improvement of household food security and health and nutritional outcomes in Maewo Island, using Ambae Island as a comparator. SETTING: Two-stage cluster survey conducted from 6 to 20 July 2004, which included anthropometric measures and 4.5-year retrospective mortality data collection. PARTICIPANTS: A total of 406 households in Maewo comprising 1623 people and 411 households in Ambae comprising 1799 people. MAIN OUTCOME MEASURES: Household food insecurity, crude mortality rate (CMR), under-five mortality rate (U5MR) and malnutrition prevalence among children. RESULTS: The prevalence of food insecurity without hunger was estimated at 15.3% (95% confidence interval (CI): 12.1, 19.2%) in Maewo versus 38.2% (95% CI: 33.6, 43.0%) in Ambae, while food insecurity with hunger in children did not vary by location. After controlling for the child's age and gender, children in Maewo had higher weight-for-age and height-for-age Z-scores than children of the same age in Ambae. The CMR was lower in Maewo (CMR = 0.47/10 000 per day, 95% CI: 0.39, 0.55) than in Ambae (CMR=0.59/10 000 per day, 95% CI: 0.51, 0.67) but no difference existed in U5MR. The major causes of death were similar in both locations, with frequently reported causes being malaria, acute respiratory infection and diarrhoeal disease. CONCLUSIONS: Project initiatives in Maewo Island have reduced the risks of mortality and malnutrition. Using a cross-sectional 'external control group' design, this paper demonstrates that it is possible to draw conclusions about project effectiveness where baseline data are incomplete or absent. Shifting from donor-driven evaluations to impact evaluations has greater learning value for the organisation, and greater value when reporting back to the beneficiaries about project impact and transformational development in their community. Public health nutritionists working in the field are well versed in the collection and interpretation of anthropometric data for evaluation of nutritional interventions such as emergency feeding programmes. These same skills can be used to conduct impact evaluations, even some time after project completion, and elucidate lessons to be learned and shared. These skills can also be applied more widely to projects which impact on the longer-term nutritional status of communities and their food security.

Anthropometry↗

PubMedDate not supplied

Refugee women's health: collaborative inquiry with refugee women in Rwanda.

A collaborative capacity building experience in a Rwandan refugee camp with refugee women from the Democratic Republic of Congo (DRC) is described in this article. In service to the American Refugee Committee, I taught 13 refugee women how to plan and facilitate focus group sessions with the larger community of refugee women. The facilitators then conducted 18 focus group sessions gathering data from 100 refugee women. Thematic results included the health implications of poverty, the struggle to survive, the overburden of daily work, ambivalence about family planning, and the lack of freedom to express themselves.

Adult↗

PubMed2006

Holistic self-management education and support: a proposed public health model for improving women's health in Zimbabwe.

The primary health care model of public health has been implemented in many countries around the globe since the Declaration of Alma Ata in 1978, without pilot testing the primary health care model. Therefore, many public health researchers have sought methods of improving primary health care by creating evidence-based models. Many of these researchers recognize the role of behavioral models in public health. These offshoots of primary health care include the ecological, care, central human capabilities, and the SPECIES models. Holistic self-management education and support is a capacity-building philosophy that ensures active involvement of consumers of health care in the planning and implementation and evaluation of health care services. It helps consumers of health care to achieve the desired improved quality of health and life in managing and sustaining their health at the grassroots level. The care model addresses disease management ideals of the in the original primary health care model. The SPECIES model addresses those aspects of the primary health care model that include the cultural and social factors, as well as individual health education and support in the original primary health care model. The ecological model offers an improvement of the socioeconomic ideal in the original primary health care model. Improving the health of individuals will prevent illness, thereby reducing health care costs and lessening the current strain on an overburdened health care system in Zimbabwe. Holistic self-management education and support links health care delivery systems with social processes. It is a best practices model that could better serve Zimbabwean girls and women by contributing positively to the national challenges in health care, thereby meeting the Zimbabwean primary health care and safe motherhood goals. It is here recommended that holistic self-management education and support must be pilot tested before being adopted as the most appropriate model for ensuring population health.

Community Networks↗

PubMed2007

Establishing a workplace antiretroviral therapy programme in South Africa.

Ways to expand access to antiretroviral treatment (ART) in low income settings are being sought. We describe an HIV care programme including ART in an industrial setting in South Africa. The programme uses guidelines derived from local and international best practice. The training component aims to build capacity among health care staff. Nurses and doctors are supported by experienced HIV clinicians through telephone consultation and site visits. Patients undergo a three-stage counselling procedure prior to starting ART. Drug regimens and monitoring are standardised and prophylaxis against opportunistic infections (isoniazid and cotrimoxazole) is offered routinely. Laboratory and pharmacy services, using named-patient dispensing, are centralized. The programme is designed to ensure that data on clinical and economic outcomes will be available for programme evaluation. Between November 2002-December 2004, ART delivery has been established at 70 ART workplace ART sites. The sites range from 200 to 12000 employees, and from small occupational health clinics and general practitioner rooms to larger hospital clinics. During this period, 2456 patients began ART. Of those on treatment for at least three months, 1728 (78%) have been retained on the programme and only 38 (1.7%) patients have failed the first-line ART regimen. This model for delivery of ART is feasible and successful in an industrial setting. The model may be generalizable to other employment health services in settings of high HIV prevalence, and as a model for implementing ART in other types of health-care settings.

Anti-HIV Agents↗

PubMed2007

Mandatory pre-marital HIV testing in Nigeria: the public health and social implications.

The prevalence of HIV infection among individuals referred from faith-based organizations (FBOs) in south-eastern Nigeria for mandatory pre-marital HIV screening was determined. Of the total of 319 individuals (148 males, 171 females) screened, 25 (7.8%, 95%CI: 4.9-10.7%) were confirmed HIV-positive, comprising 13 (8.8%, 95%CI: 4.2-13.4%) males and 12 (7%, 95%CI: 3.2-10.8%) females. No significant difference was observed in the association between HIV infection and gender (chi2=0.58, df = 1, P < 0.05). The highest prevalence of HIV infection (8.9%) was recorded among individuals in the 21-30 years age category, while the least HIV infection prevalence (5.3%) was observed among persons above 40 years old. There was no significant difference in the association between HIV infection and age (chi2=0.68, df = 3, P < 0.05). Mandatory pre-marital HIV screening could generate social stigmatization and infringement of the fundamental human rights of infected individuals. Voluntary counselling and confidential HIV testing and especially pre- and post-test counselling as the basis of pre-marital HIV testing are more desirable. Guidelines for the management of test-positive individuals and non-concordant couples and the safeguarding of confidentiality should be developed. Training and capacity building for religious leaders, to appropriately manage social issues associated with HIV/AIDS as it affects their organizations, are recommended.

Adolescent↗

PubMedDate not supplied

The mental health country profile: background, design and use of a systematic method of appraisal.

This article describes the construction and use of a systematic structured method of mental health country situation appraisal, in order to help meet the need for conceptual tools to assist planners and policy makers develop and audit policy and implementation strategies. The tool encompasses the key domains of context, needs, resources, provisions and outcomes, and provides a framework for synthesizing key qualitative and quantitative information, flagging up gaps in knowledge, and for reviewing existing policies. It serves as an enabling tool to alert and inform policy makers, professionals and other key stakeholders about important issues which need to be considered in mental health policy development. It provides detailed country specific information in a systematic format, to facilitate global sharing of experiences of mental health reform and strategies between policy makers and other stakeholders. Lastly, it is designed to be a capacity building tool for local stakeholders to enhance situation appraisal, and multisectorial policy development and implementation.

Africa↗