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PubMed2002

Working together to reduce health inequalities: reflections on a collaborative participatory approach to health research.

With mounting evidence that health problems are related to social inequalities, health researchers increasingly need to engage with disadvantaged and marginalised groups. These groups can present specific challenges to conventional research method. This paper reflects on the need for health researchers to meet these challenges in order to gain a deeper understanding of the ways in which social disadvantage affects people's health, and to develop appropriate interventions for those groups. Models of collaborative, participatory and action research are defined on a continuum. The value of a collaborative participatory approach to health research is discussed. Key processes in collaboration are outlined, and some of the methodological tensions and ethical issues that arise when using such an approach are addressed. The recognition that power is directly related to knowledge lies at the heart of the collaborative participatory research project. Collaborative participatory research offers a strategy that embraces self-determination, encourages and even demands ongoing consultation and negotiation, and provides opportunities for capacity-building and empowerment in the communities involved in the research. Nowhere is such a strategy more needed in Australia today than for research with Indigenous communities.

Australia↗

PubMed2006

Climate change and disaster management.

Climate change, although a natural phenomenon, is accelerated by human activities. Disaster policy response to climate change is dependent on a number of factors, such as readiness to accept the reality of climate change, institutions and capacity, as well as willingness to embed climate change risk assessment and management in development strategies. These conditions do not yet exist universally. A focus that neglects to enhance capacity-building and resilience as a prerequisite for managing climate change risks will, in all likelihood, do little to reduce vulnerability to those risks. Reducing vulnerability is a key aspect of reducing climate change risk. To do so requires a new approach to climate change risk and a change in institutional structures and relationships. A focus on development that neglects to enhance governance and resilience as a prerequisite for managing climate change risks will, in all likelihood, do little to reduce vulnerability to those risks.

Disaster Planning↗

PubMed2005

A strategic approach to developing e-learning capability for healthcare.

OBJECTIVES: This article examines a strategic approach to developing e-learning capability to enhance learning opportunities for the workforce of a healthcare organization. Emphasis is given to the procurement of a bespoke Managed Learning Environment (MLE). Strategic organizational issues impacting on future e-learning developments are considered. METHODS: The 2-year implementation plan was evaluated through a two phase external research project. The first phase focused on the effectiveness of a training programme designed to build capacity for e-learning within the Northern area and also included a virtual learning environment usability study which informed the MLE specification. The second phase evaluation is ongoing during 2005 and interim findings are presented. RESULTS: The MLE has been piloted and on-line learning packages have been acquired. There has been a phased take-up of e-learning opportunities and e-tutor training. Some virtual Communities of Practice have been established. Key organizational issues have been identified and ongoing findings are informing strategic planning. CONCLUSIONS: The healthcare MLE is offering enhanced learning opportunities and assisting area healthcare providers in training their dispersed workforces. Blended learning strategies are most successful. The need for protected time for e-learning is a key issue, financial savings are available. Progress has been slowed by identified organizational constraints-the MLE's benefits are widely recognized.

Community Networks↗

PubMed2006

Conservation biology, genetically modified organisms, and the biosafety protocol.

Concerns have been raised regarding the potential adverse effects on biological diversity of the use of living modified organisms (LMOs, which are commonly known by similar terms such as genetically modified organisms). At the international level these concerns are addressed in part by an agreement known as the Cartagena Protocol on Biosafety and include potential toxic effects of insect-resistant crops on nontarget organisms and potential ecological effects of gene flow from modified crops, fish, microorganisms, or insects to wild species or counterparts. We reviewed the protocol's main provisions, including those dealing with risk assessment and risk management, decision making on imports, documentation accompanying shipments, and liability resulting from damages caused by LMOs. A medium-term program of work has been adopted by the parties, which includes the potential contribution of conservation biologists to delivering capacity building, developing risk assessment guidance, evaluating mechanisms of potential ecological damages from LMOs, and other issues. Conservation biologists and other experts have opportunities to influence the negotiations and implementation of the protocol by providing inputs at meetings, offering expertise to governments and organizations, and participating in or developing relevant projects and initiatives. Involvement of conservation biologists in the implementation and further development of the protocol would contribute to its effectiveness.

Animals↗

PubMed2005

Improving the oral health of older people: the approach of the WHO Global Oral Health Programme.

The proportion of older people continues to grow worldwide, especially in developing countries. Non-communicable diseases are fast becoming the leading causes of disability and mortality, and in coming decades health and social policy-makers will face tremendous challenges posed by the rapidly changing burden of chronic diseases in old age. Chronic disease and most oral diseases share common risk factors. Globally, poor oral health amongst older people has been particularly evident in high levels of tooth loss, dental caries experience, and the prevalence rates of periodontal disease, xerostomia and oral precancer/cancer. The negative impact of poor oral conditions on the quality of life of older adults is an important public health issue, which must be addressed by policy-makers. The means for strengthening oral health programme implementation are available; the major challenge is therefore to translate knowledge into action programmes for the oral health of older people. The World Health Organization recommends that countries adopt certain strategies for improving the oral health of the elderly. National health authorities should develop policies and measurable goals and targets for oral health. National public health programmes should incorporate oral health promotion and disease prevention based on the common risk factors approach. Control of oral disease and illness in older adults should be strengthened through organization of affordable oral health services, which meet their needs. The needs for care are highest among disadvantaged, vulnerable groups in both developed and developing countries. In developing countries the challenges to provision of primary oral health care are particularly high because of a shortage of dental manpower. In developed countries reorientation of oral health services towards prevention should consider oral care needs of older people. Education and continuous training must ensure that oral health care providers have skills in and a profound understanding of the biomedical and psychosocial aspects of care for older people. Research for better oral health should not just focus on the biomedical and clinical aspects of oral health care; public health research needs to be strengthened particularly in developing countries. Operational research and efforts to translate science into practice are to be encouraged. WHO supports national capacity building in the oral health of older people through intercountry and interregional exchange of experiences.

Aged↗

PubMed2005

The India Local Initiatives Program: a model for expanding reproductive and child health services.

The India Local Initiatives Program adapted a model used in Indonesia and Bangladesh to implement the government's reproductive and child health strategy. From 1999 to 2003, three Indian nongovernmental organizations (NGOs) provided services for 784,000 people in four northern states. The program established health committees in 620 villages, recruited and trained 1,850 community health volunteers, and added 232 sites to extend government services. Using three strategies--demand creation, increased access to services, and local capacity building--the NGOs increased contraceptive-use rates by 78 percent, on average; child immunizations by 67 percent; and antenatal care by 78 percent among the populations served. Community resources--such as local health personnel, community-supplied clinic sites, and community drug funds--added 40 cents to every dollar provided by donors. This model proved to be a suitable platform upon which to build health-care service delivery and create behavioral change, and the NGOs quickly found ways to sustain and expand services.

Adult↗

PubMed2003

Southern Rural Access Program: an overview.

Rural residents experience significant disparities in health status and access to care. These disparities and access barriers are particularly prevalent in rural communities in the South. The Southern Rural Access Program, a national program of the Robert Wood Johnson Foundation, was designed as a long-term effort to improve access to basic health care in 8 of the most underserved states in the country. The program was launched in 1998 with 3 goals: (1) to increase the supply of providers in underserved areas, (2) to strengthen the health care infrastructure, and (3) to build capacity at the state and community level to solve problems. The first 3-year phase of the program made $13.8 million available to communities in the 8 target states, and a January 2002 reauthorization of the program will make an additional $18.9 million available in the next 4 years. This article will provide an overview of the Southern Rural Access Program, focusing on the development and evolution of the program during its first 3-year phase. The article will also highlight some of the refinements that the foundation has made during the 2002-2006 second phase of the program.

Community Health Planning↗

PubMed2003

Lessons learned in phase I of the Southern Rural Access Program.

The Robert Wood Johnson Foundation's Southern Rural Access Program has been an important investment of philanthropic funds to augment resources and improve health care access in underserved rural communities. The program's first phase has taught important lessons about building capacity in rural health care. This article uses a variety of data to document the program's major accomplishments and most significant challenges to date. The program's revolving loan fund efforts are promising. The program has also played a catalytic role in stimulating rural health network development in the South and has helped stimulate partnerships with Southern philanthropies and multiple local, state, and federal agencies. Challenges have included the broad geographic and programmatic focus of the initiative as well as changing and often difficult state policy environments. Additional challenges include maintaining interagency coordination over time and managing staff and lead agency turnover. Overall, the experience suggests that a concentrated regional approach has merit.

Community Health Planning↗

PubMed1995

WHO fellowships--what do they achieve?

Training health professionals is one of WHO's major strategies for improving health care in the developing world. The aim, to strengthen a country's own capacity rather than injecting expertise from outside, is in the best tradition of sustainable development. But how effective is this so called "capacity building in human resources"? Since it accounted for $43m of WHO's budget in 1992-3 and is considered by WHO to be a major contribution to health in individual countries, it deserves detailed examination.

Developing Countries↗

PubMed2003

Current targets: where are we going?

Clinical targets are relatively easy to set but can be extremely difficult to implement. It is important to have organisational targets, in addition to clinical targets. The National Service Framework (NSF) for coronary heart disease sets national standards, defines service models, and establishes performance indicators for clinicians to meet. The new National Health Service ethos, in which front line staff are being empowered to develop innovative services tailored to local needs, is helping health professionals in primary care to deliver better care and improved "patient pathways" as promised in the NSF. However, there is still a need for additional resources in order to build capacity and provide support to the health care staff who are delivering the service.

Coronary Disease↗

PubMed2004

Evidence based practice in population health: a regional survey to inform workforce development and organisational change.

STUDY OBJECTIVE: To assess current capacity to implement evidence based practice (EBP) in population health. DESIGN: Postal survey of a regional population health workforce in Sydney, Australia. SETTING: Division of Population Health, South Western Sydney Area Health Service. PARTICIPANTS: 104 population health staff (response rate: 73%). MAIN RESULTS: In the sample of regional population health practitioners, views about the current promotion of EBP were positive. Non-medical respondents with less that Masters degree were more likely to report "high self assessed need" to increase their capacity in EBP (p = 0.022). Confidence in understanding of EBP terminology was not associated with seniority but with highest level of education reached (p<0.000) and having medical qualifications (p<0.000). Occupational category was not associated with respondents' self assessed "need for evidence", "need for EBP skills" or "need to increase their capacity in EBP" in their current position. The proportion of participants "strongly" supporting implementation of a colorectal cancer screening programme whose benefit was expressed as relative risk reduction was greater than that so supporting a programme whose benefit was expressed as number needed to screen (p = 0.008). Most respondents referred to their immediate managers when seeking support for EBP. CONCLUSIONS: The findings provide a quantitative baseline for capacity building through workplace programmes. Managerial commitment has been increased and performance development is now underway.

Adult↗

PubMed2002

Outreach and improved access to specialist services for indigenous people in remote Australia: the requirements for sustainability.

STUDY OBJECTIVE: To examine the role of specialist outreach in supporting primary health care and overcoming the barriers to health care faced by the indigenous population in remote areas of Australia, and to examine issues affecting its sustainability. DESIGN: A process evaluation of a specialist outreach service, using health service utilisation data and interviews with health professionals and patients. SETTING: The Top End of Australia's Northern Territory, where Darwin is the capital city and the major base for hospital and specialist services. In the rural and remote areas outside Darwin there are many small, predominantly indigenous communities, which are greatly disadvantaged by a severe burden of disease and limited access to medical care. PARTICIPANTS: Seventeen remote health practitioners, five specialists undertaking outreach, five regional health administrators, and three patients from remote communities. MAIN RESULTS: The barriers faced by many remote indigenous people in accessing specialist and hospital care are substantial. Outreach delivery of specialist services has overcome some of the barriers relating to distance, communication, and cultural inappropriateness of services and has enabled an over fourfold increase in the number of consultations with people from remote communities. Key issues affecting sustainability include: an adequate specialist base; an unmet demand from primary care; integration with, accountability to and capacity building for a multidisciplinary framework centred in primary care; good communication; visits that are regular and predictable; funding and coordination that recognises responsibilities to both hospitals and the primary care sector; and regular evaluation. CONCLUSIONS: In a setting where there is a disadvantaged population with inadequate access to medical care, specialist outreach from a regional centre can provide a more equitable means of service delivery than hospital based services alone. A sustainable outreach service that is organised appropriately, responsive to local community needs, and has an adequate regional specialist base can effectively integrate with and support primary health care processes. Poorly planned and conducted outreach, however, can draw resources away and detract from primary health care.

Community-Institutional Relations↗

PubMed2006

Ethical issues in screening for hearing impairment in newborns in developing countries.

Screening of newborns for permanent congenital or early-onset hearing impairment has emerged as an essential component of neonatal care in developed countries, following favourable outcomes from early intervention in the critical period for optimal speech and language development. Progress towards a similar programme in developing countries, where most of the world's children with hearing impairment reside, may be impeded by reservations about the available level of support services and the possible effect of the prevailing healthcare challenges. Ethical justification for the systematic introduction of screening programmes for hearing in newborns based on the limitations in current primary prevention strategies, lack of credible alternative early-detection strategies and the incentives for capacity-building for the requisite support services is examined.

Cost-Benefit Analysis↗

PubMed2005

Cross-sector leadership development for preparedness.

After fall 2001, scientists and professionals recognized the importance of integrating public health with traditional first-response professions in planning and training for disasters. However, operationalizing this approach among professionals in the field confronted barriers that were both inter-cultural and jurisdictional. The Pennsylvania Preparedness Leadership Institute (PPLI) is a collaboration of the Pennsylvania Department of Health and the University of Pittsburgh Center for Public Health Preparedness. Team members are recruited from public health, emergency medicine, emergency management, hospitals, and public safety agencies from each of nine multi-county regions in Pennsylvania. Each team takes on a year-long project that addresses a strategic problem as a focus for capacity-building within its region. Unexpectedly during PPLI's first year in operation, a hepatitis-A outbreak tested whether one regional team could successfully mount the necessary integrated response. This experience, as well as the planned evaluation for PPLI, demonstrated both the successful processes and the positive impact of this integrated leadership training initiative.

Curriculum↗

PubMed2004

The concept of health promoting schools to enhance positive youth development.

The concept of Health Promoting Schools improves the school's physical and social environment, its curriculum, teaching and learning methods, and the personal and social development of students. It will enable the participating schools create a 'learning perspective', 'community perspective', and 'capacity building' environment to improve both educational and health outcomes of students. As the scheme promotes self-esteem of students, staff development, parental education, involvement of the whole school community and linkage with different stakeholders, it will also enhance positive youth development. It will help to shift the paradigm from handling crisis to prevention approaches emphasizing on youth support before problem behaviours occur, and also address the circumstances (families, schools, communities, peer groups) of youth's lives.

Adolescent↗

PubMed2005

An innovative geographical approach: health promotion and empowerment in a context of extreme urban poverty.

This article describes and analyses a territorial intervention, the Vila Paciencia Initiative--a local development/health promotion programme implemented in a context of extreme poverty in the western district of Rio de Janeiro. The main goal of the programme was to empower individuals and communities. We emphasise the lessons learned and the potential for integrating them into local and regional health services, which could strengthen community participation and capacity-building and improve the effectiveness and community orientation of primary health care and other public policies directed to geographical development.

Brazil↗

PubMed2006

Implementing national population-based action on physical activity--challenges for action and opportunities for international collaboration.

This paper summarises recent past and current international developments on physical activity looking at the challenges and opportunities they pose. Key elements of the WHO's Global Strategy on Diet, Physical Activity and Health (GSDPAH) are summarised, focusing specifically on the physical activity components, and by drawing upon recent fora (Atlanta, October 2002; Miami, December 2004; Cascais, February 2005; Beijing, October 2005; Bogotá, November 2005), we outline the barriers and areas of support required for successful development and implementation of national, population-based action on physical activity. These gatherings focused particularly on the needs of developing countries, where to date little has been done to augment physical activity at a population level. Unless swift action is taken, these countries will soon suffer significantly from an increased prevalence of non communicable diseases (NCD). Existing initiatives and opportunities for national and international action on physical activity are identified. Specific actions are proposed for advocacy, communication and dissemination, networks and partnerships, fundraising, policy development and implementation, programme implementation and evaluation, surveillance and capacity building. The development of the Global Alliance for Physical Activity (GAPA) provides a structure for international collaboration.

Developing Countries↗

PubMed2006

Community transformation through culturally competent nursing leadership: application of theory of culture care diversity and universality and tri-dimensional leader effectiveness model.

Transcultural knowledge and competency have become a critical need for nurses to accommodate the global trends in cultural diversity and health care disparities. Today, nurses are increasingly taking on leadership roles in community settings. This article addresses the application of Leininger's culture care theory with the sunrise model and Hersey and Blanchard's tri-dimensional leader effectiveness model as potential collaborating theories for capacity building and community transformation from a global, transcultural nursing perspective. The two theories, used in collaboration, view the provision of competent leadership as the delivery of effective, culturally congruent nursing care in promoting health and health equity at the community level.

Community Participation↗