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PubMed2006

Lessons learnt in mental health and psychosocial care in India after disasters.

Different phases of intervention after any disaster bring with them specific issues that policy-makers as well as healthcare deliverers must take into account. There are some specific issues related to aid with dignity and dead-body identification that need to be taken into account. The human and material resources are important in planning and delivering mental healthcare. In India, with each successive disaster, the immediate response in the rescue and relief phase has improved and the administration is able to mobilize a large amount of resources from different sectors quickly, efficiently and in a co-ordinated manner in the immediate and short-term periods after a disaster. That psychological first aid will reduce psychiatric morbidity is now generally accepted as a key principle in interventions immediately after a disaster. In the recent events, large numbers of community-level volunteers have received short-term training and been able to provide effective psychosocial care and support. The paper presents the author's observations and provides an overview of some of the lessons learnt in mental health and psychosocial support care across the several natural and human-made disasters that have taken place in India. While significant progress has been made with respect to the rescue and relief response, there is still a lot to be achieved in the rehabilitation and rebuilding phases that follow a disaster. Disaster prevention and mitigation need global vision combined with local action. Building capacity through careful planning and training potential workers is an important step. The stakeholders must take into account local cultural and social needs.

Culture↗

PubMed2006

Psychosocial support in disaster-affected communities.

The paper outlines psychosocial interventions in providing care and support to disaster-affected communities. Any impact of disaster can be looked at in two ways: firstly by ascertaining the characteristics of the event itself, and secondly, how that event is appraised by those affected. Depending on different phases of the impact of the disaster, individuals will respond in different styles. Psychosocial interventions must be tailored to address the needs of the target population, with special attention paid to vulnerable groups such as children, women and the elderly. These should also be modulated according to the phase of recovery following the event occurrence because each phase will highlight different needs. The four phases of intervention, although determined separately, may show an overlap. In the initial phases, the emphasis is on social intervention that can be delivered by community-level workers. In the later phases, the psychological issues that emerge necessitate the services of trained professionals. Initial social care will need to give way to psychological care, and on occasion both will need to be combined for a considerable period. Since psychosocial care is a long-term, continuous process, disaster management and preparedness programmes must invest in training for capacity building by training community workers and primary care health professionals.

Community Mental Health Services↗

PubMed1999

Aging with a disability: views from the National Institute on Disability and Rehabilitation Research.

As I move toward the completion of my term as Director of the National Institute on Disability and Rehabilitation Research (NIDRR), I see many examples of renewal in our field. For example, disability studies and rehabilitation science are emerging new areas of academic specialization, and we will all be involved in shaping the future of these endeavors. The field is recapturing its identity and relevance locally and internationally. Also, I see a considerable number of challenges that range from acute care in medical rehabilitation to universal design in engineering to overall technology policy. I see a challenge in moving research to practice, a challenge in funding, a challenge in service delivery locations, and a challenge in defining the role of the professional in order to build capacity for the future. I believe that the research field ignores practice at its own peril, including practice in older fields such as vocational rehabilitation and in newer fields such as cognitive science and access engineering. Practice must be determined by today's needs and those we foresee for tomorrow. For the NIDRR family, the Long-Range Plan provides a beacon to direct us into the new millennium.

Aged↗

PubMedDate not supplied

Mental health initiatives as peace initiatives in Sri Lankan schoolchildren affected by armed conflict.

The Health Reach Sri Lanka project (1993-96) is described. It was a school-based assessment of children's exposure to war-related events and the presence of psychological distress, undertaken in six communities in parts of Sri Lanka variously affected by armed conflict. Its objectives, methods and results are presented. The research project aimed to raise national awareness of the psychosocial effects of armed conflict on children, using a community-development approach to local capacity building, based on the 'health initiative as peace initiative' model. As a follow-up to the study, a locally run programme, based on creative play and trauma-healing, was established, initially for the children involved in the study. This was later extended to other children in the district affected by armed conflict.

Child↗

PubMed2004

Introducing a professional development programme to a rural area mental health service: the importance of context.

OBJECTIVE: To describe the introduction of an ongoing professional development programme for clinicians in a rural area mental health service. The programme involved a series of workshops delivered by clinical psychologists. The training component of each workshop focused on discrete cognitive behavioural strategies, targeted at the amelioration of anxiety and mood symptoms. CONCLUSIONS: The paper emphasizes contextual aspects of the programme: its setting, the modality of delivery, resourcing issues and maximizing engagement by the participants. Preliminary evaluation data are reviewed, and it is argued that programmes that focus on local capacity building in rural settings are an important component of redressing the urban-rural imbalance in the availability of evidence-based psychological treatments.

Adolescent↗

PubMed2006

Using participatory action research in a community-based initiative addressing complex mental health needs.

OBJECTIVE: This paper describes the first phase of a larger project that utilizes participatory action research to examine complex mental health needs across an extensive group of stakeholders in the community. METHOD: Within an objective qualitative analysis of focus group discussions the social ecological model is utilized to explore how integrative activities can be informed, planned and implemented across multiple elements and levels of a system. Seventy-one primary care workers, managers, policy-makers, consumers and carers from across the southern metropolitan and Gippsland regions of Victoria, Australia took part in seven focus groups. All groups responded to an identical set of focusing questions. RESULTS: Participants produced an explanatory model describing the service system, as it relates to people with complex needs, across the levels of social ecological analysis. Qualitative themes analysis identified four priority areas to be addressed in order to improve the system's capacity for working with complexity. These included: (i) system fragmentation; (ii) integrative case management practices; (iii) community attitudes; and (iv) money and resources. CONCLUSIONS: The emergent themes provide clues as to how complexity is constructed and interpreted across the system of involved agencies and interest groups. The implications these findings have for the development and evaluation of this community capacity-building project were examined from the perspective of constructing interventions that address both top-down and bottom-up processes.

Adult↗

PubMed2006

Developing new services for eating disorders: an evaluation study.

OBJECTIVE: This paper aims to evaluate the structures and processes of eating disorders services in two regional cities in Australia. METHOD: Stakeholder evaluation undertaken between 2002 and 2005 uses interviews, questionnaires and service delivery data to examine: structure and patient profile of the two services, barriers and success factors and local factors influencing development of the services. RESULTS: The Bendigo service provided secondary consultation and specialist management with upskilling of primary care workers as a key goal. Patients were referred to the service via mental health triage. The Geelong service initially offered assessment only, with direct access for the general public. Treatment was offered from early 2004. The Bendigo service assessed 41 patients, 63% were diagnosed with anorexia nervosa or bulimia nervosa. Most patients had a moderate or severe eating disorder. The Geelong service assessed 186 patients, 55% were diagnosed with anorexia nervosa or bulimia nervosa and 80% of this subset had not previously been treated for an eating disorder. General practitioners identified barriers to development of the services as: problems with capacity building and unrealistic expectations. The success factors were providing a locally based service with credible clinicians and effective communication. CONCLUSIONS: Activity analysis demonstrates that the goals for both services were met. There is a need to measure both short- and long-term patient outcomes in order to fully assess effectiveness and applicability to other settings. Local factors, such as availability of specialist providers, would need to be taken into account.

Anorexia Nervosa↗

PubMed2006

Working with families of patients within an adult mental health service: development of a programme model.

OBJECTIVE: In order to implement and sustain family intervention programmes in clinical settings, there is a need for an organizational change within routine clinical practice. The objective of this paper is to outline the idea behind the development of a programme for working with families of patients within an adult mental health service. METHODS: Capacity building, project management and action research frameworks were the three theoretical frameworks used to inform the implementation of the programme within the mental health service. Extensive literature in the area of working with families informed the programme's content. Sutherland Mental Health Service in New South Wales is used as a model to show that organizational changes are needed to implement a 'family friendly' service. RESULTS: The programme included two main components: (i) a service development component, (ii) a family engagement and support component. Description of the programme plan has been based on key objectives, strategies and activities for implementation at the service delivery level. Individual activities within the programme have achieved their goals. The rate of family contact within the service has doubled. CONCLUSIONS: Issues regarding the effectiveness of such a programme, its limitations, as well as the nature of examining and evaluating such work were discussed. Becoming more 'family friendly' is a realistic goal for adult mental health services.

Adult↗

PubMed2000

Implications of pandemic influenza for bioterrorism response.

The 1918-1919 influenza pandemic (Spanish flu) had catastrophic effects upon urban populations in the United States. Large numbers of frightened, critically ill people overwhelmed health care providers. Mortuaries and cemeteries were severely strained by rapid accumulation of corpses of flu victims. Understanding of the outbreak's extent and effectiveness of containment measures was obscured by the swiftness of the disease and an inadequate health reporting system. Epidemic controls such as closing public gathering places elicited both community support and resistance, and fear of contagion incited social and ethnic tensions. Review of this infamous outbreak is intended to advance discussions among health professionals and policymakers about an effective medical and public health response to bioterrorism, an infectious disease crisis of increasing likelihood. Elements of an adequate response include building capacity to care for mass casualties, providing emergency burials that respect social mores, properly characterizing the outbreak, earning public confidence in epidemic containment measures, protecting against social discrimination, and fairly allocating health resources.

Bioterrorism↗

PubMed2006

Establishing government-operated vaccine programs: an industry perspective.

During 2000-2002, shortages of numerous routinely administered pediatric vaccines occurred. The reasons for these shortages were varied, but they included policy, manufacturing, and regulatory issues. The use of government manufacturing programs has been proposed as a way to stabilize the fragile vaccine supply and to prevent periodic shortages. Although such programs might be useful for defense needs, it is likely that such an approach would have limited value for routinely administered vaccines. Each of the vaccine components would require a dedicated manufacturing facility, and many components are administered in combination vaccines. Timing is also an important consideration. The restarting of an idled manufacturing facility would take many months; in addition, it often takes nearly 12 months to produce and release a single lot of vaccine. Finally, government-owned programs would face the same issues of regulatory changes, technological advancements, and facility updates as non-government-owned programs do--all of which would require sustained operation and investment. A secure and stable vaccine supply is best built by establishing the importance and value of our vaccine programs, which would, in turn, provide incentives to manufacturers to build capacity and inventories.

Drug Industry↗

PubMed2004

Evaluation of HIV/AIDS prevention resources in Liberia: strategy and implications.

The purpose of this preliminary study was to assess the HIV/AIDS prevention needs, services, and resources in Liberia, including the readiness of local providers to conduct HIV/AIDS-related prevention programs based on a set of six key dimensions (prevention needs, knowledge, leadership, environment, risky behaviors, and resources). A valid self-administered qualitative-based health survey, based on a community readiness model, was utilized as the primary data collection source. A cross-sectional design that utilized a convenient sample of key informants such as health coordinators, program directors, and health administrator from both public and private HIV/AIDS-based organizations was used. Furthermore, an extensive review of the National Library of Medicine database of published articles from mid-1980 to 2002 was simultaneously conducted to gauge the extent of scientific publications on HIV/AIDS-related prevention services in Liberia. The findings from this study strongly suggest that Liberia is in a stage of vague awareness, as defined by the Tri-Ethnic Center community readiness framework, regarding HIV/AIDS-related activities, including a significant lack of HIV/AIDS-related resources and scientific publications. Accordingly, there is a critical need to acquire adequate resources and build capacity to implement effective HIV/AIDS-related prevention programming services in order to avert the negative public health consequences associated with HIV/AIDS, including the implementation of relevant evaluation and dissemination strategies. Most importantly, this model has the potential to be utilized in other resource-constraint settings, especially in the developing world, to assess prevention-related resources and programmatic readiness. This is the first published study to evaluate Liberia's HIV/AIDS prevention resources and to systematically document the extent and magnitude of the HIV/AIDS crises in the country.

HIV Infections↗

PubMed2005

Female genital mutilation in the context of migration: experience of African women with the Swiss health care system.

BACKGROUND: In contrast to other European countries, the Swiss health care system does not deal with the specific needs of women with female genital mutilation (FGM) in a consistent manner, though migrants from countries where FGM is commonly practised are living in Switzerland. METHODS: For this study, the interaction of women who had undergone FGM, with the Swiss health services was analysed both from the perspective of the women concerned and that of health care professionals (doctors and midwives). The methods used were mainly qualitative, including focus group discussions with 29 women from Somalia and Eritrea and telephone interviews with 37 health care professionals. RESULTS: It is estimated that some 6000 girls and women with FGM could be living in Switzerland. The fact that health care providers rarely see such patients and the absence of professional guidelines give rise to misunderstandings. Counselling of the women is often inadequate, and there is a striking lack of communication about FGM between health care providers and users, as well as within the women's communities. As a surprising finding, reinfibulation is carried out in Switzerland when requested by the patient. CONCLUSIONS: This study shows that at present the specific gynaecological and obstetric health care needs of migrant women who have undergone FGM are not adequately addressed in the Swiss health system. The situation could be easily improved by taking into consideration the fairly simple measures suggested by the women and the health care providers taking part in this study. KEY POINTS: Due to international migration, female genital mutilation (FGM) has become an issue of increasing concern in host countries such as Switzerland. Objectives of this study were to analyze how immigrant women with FGM experience gynaecological/obstetrical care in the Swiss health care system, and to investigate if gynaecologists/obstetricians and midwives treat and counsel FGM related complications adequately. Specific health care needs of women with FGM should--and easily could--be better considered by the Swiss health care system. Recommended measures include capacity building and professional guidelines on FGM for health care providers; and access to culturally appropriate information and self-help groups for the communities concerned.

Adolescent↗

PubMed2005

General practices as emergent research organizations: a qualitative study into organizational development.

BACKGROUND: An increasing proportion of research in primary care is locally undertaken in designated research practices. Capacity building to support high quality research at these grass roots is urgently needed and is a government priority. There is little previously published research on the process by which GP practices develop as research organizations or on their specific support needs at organizational level. METHODS: Using in-depth qualitative interviews with 28 key informants in 11 research practices across the UK, we explored their historical accounts of the development of research activity. We analysed the data with reference to contemporary theories of organizational development. RESULTS: Participants identified a number of key events and processes, which allowed us to produce a five-phase model of practice development in relation to research activity (creative energy, concrete planning, transformation/differentiation, consolidation and collaboration). Movement between these phases was not linear or continuous, but showed emergent and adaptive properties in which specific triggers and set-backs were often critical. CONCLUSION: This developmental model challenges previous categorical taxonomies of research practices. It forms a theory-driven framework for providing appropriate support at the grass roots of primary care research, based on the practice's phase of development and the nature of external triggers and potential setbacks. Our findings have important implications for the strategic development of practice-based research in the UK, and could serve as a model for the wider international community.

Family Practice↗

PubMed2000

Vaccine procurement and self-sufficiency in developing countries.

This paper discusses the movement toward self-sufficiency in vaccine supply in developing countries (and countries in transition to new economic and political systems) and explains special supply concerns about vaccine as a product class. It traces some history of donor support and programmes aimed at self-financing, then continues with a discussion about self-sufficiency in terms of institutional capacity building. A number of deficiencies commonly found in vaccine procurement and supply in low- and middle-income countries are characterized, and institutional strengthening with procurement technical assistance is described. The paper also provides information about a vaccine procurement manual being developed by the United States Agency for International Development (USAID) and the World Health Organization (WHO) for use in this environment. Two brief case studies are included to illustrate the spectrum of existing capabilities and different approaches to technical assistance aimed at developing or improving vaccine procurement capability. In conclusion, the paper discusses the special nature of vaccine and issues surrounding potential integration and decentralization of vaccine supply systems as part of health sector reform.

Developing Countries↗

PubMed2001

Research in action: the training approach of the Joint Health Systems Research Project for the Southern African Region.

Over the last two decades, capacity-building in health research has been recognized as a priority by the international research community. Since 1987 the Joint Health Systems Research (HSR) Project for the Southern African Region has been making efforts to increase the national expertise for operational health research, starting in ten Southern African countries, in order to strengthen decision-making in health care at all levels. Initially, its targets were health managers and public health staff. Step-by-step, staff of different levels and disciplines have, in small groups, developed and implemented research protocols on problems experienced in their own working environment. The recommendations resulting from over 200 studies could, to a large extent, be implemented by the teams themselves. The Project was characterized by a flexible approach, allowing countries to participate at their own speed and to determine their own activities and the support they needed. As Ministries of Health as well as research institutions, in an increasing number of Southern and Eastern African countries, choose to actively participate in HSR, this has contributed to bridge the gap between the academic world and the health field. Still, sustainability of HSR activities remains a challenge. This paper describes the approach of the Joint HSR Project over the first 10 years of its operation, and its major strengths and limitations.

Africa, Southern↗

PubMed2004

The cost-effectiveness of technology transfer using telemedicine.

The high burden of disease in developing countries often makes it difficult for health systems in these countries to attain the same level of specialist skills as industrialized countries. Technology transfer is one way to improve specialist skills whilst at the same time reducing the burden of disease. This paper describes the use of teleophthalmology, a form of telemedicine, as a mode of technology transfer between the United Kingdom and South Africa. As the burden of eye disease in South Africa is high, the country cannot afford the level of ophthalmic specialization achieved in the UK. The paper estimates the cost-effectiveness of the technology transfer project in terms of a cost per Disability Adjusted Life Year (DALY) averted. We found the technology transfer project to be cost-effective in reducing the burden of eye disease, and that practitioners in South Africa also learned novel procedures that could help future patients and improve cost-effectiveness. Technology transfer using telemedicine is a cost-effective method that richer countries can employ to aid capacity building in the health care systems of poorer countries.

Cost of Illness↗

PubMed2004

Service accountability and community participation in the context of health sector reforms in Asia: implications for sexual and reproductive health services.

This paper examines the concept and practice of community participation in World Bank-supported health sector reforms in Asia, and how far such participation has strengthened accountability with regard to provision of sexual and reproductive health (SRH) services. It argues that the envisaged scope of community participation within a majority of reforms in Asia has been limited to programme management and service delivery, and it is occurring within the boundaries of priorities that are defined through non-participatory processes. Setting up of community health structures, decentralization and community financing are three important strategies used for promoting participation and accountability within reforms. The scant evidence on the impact of these strategies suggests that marginalized groups and sexual and reproductive rights based groups are poorly represented in the forums for participation, and that hierarchies of power between and amongst health personnel and the public play out in these forums. Community financing has not lead to enhanced service accountability. As a result of the above limitations, community participation in health sector reforms has rarely strengthened accountability with respect to provision of comprehensive SRH services. In this context, rights (including sexual and reproductive) based groups and researchers need to engage with design, monitoring and evaluation of health sector reforms, both from inside as participants and outside as pressure groups. Participation contracts enhancing powers of civil society representatives, quotas for participation (for women, other marginalized groups and rights-based organizations), and investment in capacity building of these stakeholders on leadership and sexual reproductive rights and health are pre-requisites if participation is to lead to health and SRH service accountability. Community participation and service accountability hence requires more and not less investment of resources by the state.

Asia↗

PubMed2001

Setting standards in the evaluation of community-based health promotion programmes--a unifying approach.

Community-based health promotion often emphasizes elements of empowerment, participation, multidisciplinary collaboration, capacity building, equity and sustainable development. Such an emphasis may be viewed as being in opposition to equally powerful notions of evidence-based decision making and accountability, and with funders' and government decision-makers' preoccupation with measuring outcomes. These tensions may be fuelled when community practitioners and lay participants feel evaluations are imposed upon them in a manner that fails to appreciate the uniqueness of their community, its programme, and practitioners' skills and experience. This paper attempts to provide an approach that depicts evaluation as being mutually beneficial to both funders/government and practitioners. First, a values stance for health promotion, termed a 'salutogenic' orientation, is proposed as a foundation for the evaluation of community-based health promotion. Secondly, we discuss possible objects of interest, the first component of an evaluation. We then discuss the spirit of the times and its implications for community-based health promotion. Finally, we address the key question of setting standards. A typology of standards is presented. Arbitrary, experiential and utility standards are based on perceived needs and priorities of practitioners, lay participants or professional decision-makers. Historical, scientific and normative standards are driven by empirical, objective data. Propriety and feasibility standards are those wherein the primary concern is for consideration of resources, policies, legislation and administrative factors. The 'model' standards approach is presented as an exemplar of a combined approach that incorporates elements of each of the other standards. We argue that the 'optimal' standard for community-based health promotion depends on the setting and the circumstances. There is no 'magic bullet', 'one-size-fits-all' or 'best' standard. Further, we argue that standards should be set from an inclusive, salutogenic orientation. This approach offers a means of creating a situation in which policy-makers and funders are more supportive of evaluation designs that fit with community realities, and community stakeholders are more capable and consistent in rigorously evaluating community-based health promotion programmes and policies.

Canada↗