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PubMed1981

Changing models of community mental health services.

The various comprehensive community mental health centers developed at the same time as the free clinics intended to provide an alternative form of service. The origins and contributions of each of these directions of service are compared on such matters as funding, political orientation, relation to local government, the composition and functions of their boards, and their models of service delivery. The case is made that the two forms have shown a degree of convergence that shapes the present reality of what is or is not a legitimate part of mental health services.

Community Mental Health Services↗
PubMed1992

Workshops are not enough: making Right-to-Know training lead to workplace change.

The underlying intent of Right-to-Know laws and regulations is to improve workplace conditions through worker empowerment. These regulations require employers to educate their employees about the nature and hazards of toxic substances found in the workplace, and methods to reduce exposure. This paper describes a Right-to-Know training program for over 4,000 local government employees which involved workers, their union, and management in the planning, implementation, and evaluation of the program. A combination of quantitative and qualitative evaluation determined the program was successful at individual, group, and structural levels. The evaluation results suggest that Right-to-Know training programs can make an important contribution to improving workplace health and safety when they are a well-integrated component of a comprehensive safety and health program: they use participatory training methods, they are tailored to address specific conditions faced by the participants, and there is active labor-management collaboration.

Curriculum↗
PubMedDate not supplied

Quality assurance management methods applied to a local-level primary health care system in rural Nigeria.

Introduction. Management of primary health care (PHC) systems in less developed countries is often impeded by factors such as poorly trained personnel, limited financial resources, and poor worker morale. This study explored the ability of local-level PHC supervisors in rural Nigeria to use quality assurance (QA) management methods to improve the quality of the PHC system. Methods. PHC supervisors from Bama Local Government Area were trained for 3 days in the use of QA methods and tools. The supervisors targeted the supervisory system and the health information system (HIS) for improvement. Health worker performance in diarrhoea case management was assessed, using a simulated case, to measure the impact of supervision. A HIS audit assessed data collection forms used by 17 PHC facilities. Gaps in quality were monitored over a 2-month study period and flaws in work processes were modified. Results. PHC supervisors introduced a checklist during monthly visits to facilities to monitor how workers managed cases of diarrhoea. Performance in history-taking, physical examination, disease classification, treatment and counselling improved over the evaluation period. The HIS audit found that a variety of reporting forms were used at PHC facilities. After HIS reporting was standardized, the number of health facilities using a daily disease registry significantly improved during the study period. Conclusions. QA management methods were used by PHC supervisors in Nigeria to improve supervision and the HIS. QA management methods are appropriate for improving the quality of the PHC in Nigeria and in other less developed countries where at least a minimal PHC infrastructure exists.

Developing Countries↗
PubMedDate not supplied

The management of health services in Tanzania: a plea for health sector reform.

There are essentially four main approaches used in attempts to strengthen the management of health services in developing countries. These are: information system development; management training; use of planning and evaluation methodologies; and, health sector reform. As part of a collaborative research project based in Kisarawe District, Tanzania, we tested the hypothesis that a combination of the first three of these approaches would be sufficient to ensure that decisions and actions were taken to bring about major improvements in the management of health services. It was assumed that the decentralization, which took place as part of the 1982 reorganization of local government responsibilities, had provided managers with sufficient decision-making autonomy to allow them to bring about improvement in health service performance, provided that the other conditions were met. In fact, it was found that despite being presented with clear evidence of serious inefficiencies and inequities in the allocation of health resources, managers were often highly reluctant to decide upon actions which would alleviate the problems in situations where there were potential losers as well as winners, even if the benefits greatly outweighed the costs. This article argues that interventions based solely on training, information systems, or planning and evaluation protocols will make only marginal improvements to health service management, and that changes to the system as a whole are needed in order to provide managers and health professionals with incentives to rectify performance failings. Some ideas for health sector reform, to give managers power and incentives for improving efficiency and quality of care, are put forward. Since it is likely that the systemic problems of the health sector in Tanzania are shared by many other developing countries, the lessons drawn from this study probably have more general applicability.

Administrative Personnel↗
PubMedDate not supplied

Malaria control through municipalities in the Philippines: struggling with the mandate of decentralized health programme management.

This is a study on the management of the decentralized malaria control programme in Maharlika, Lipunan, a municipality in rural Philippines. The theoretical assumption is that the malaria control programme must be viewed as a system and that success of reform in malaria control depends upon the understanding of management issues by municipal officials. Through interviews, and documents and archival reviews, a framework for describing the dynamics of municipal management of the malaria control programme was developed. The overall finding was that the administrative management system was not functioning optimally: (a) planning and budgeting systems are not helpful; (b) malaria data do not inform planning; and (c) local financial resources are not utilized for malaria control. The underlying causes were: the absence of a clear statement from national offices regarding decentralization of health services, and the management processes, as stipulated in the Local Government Code, were not responsive to the needs of the municipality.

Communicable Disease Control↗
PubMedDate not supplied

The impacts of decentralization on health care seeking behaviors in Uganda.

This paper examines the impacts of a public sector decentralization program on health care seeking behaviors in Uganda in the 1990s. Shifting priorities by local governments in Uganda's decentralized health system away from provision of primary health care, in particular the provision of public goods or goods with substantial consumption externalities, and toward provision of private health goods such as curative care are linked to shifts in individual-level care utilization behaviors. This analysis finds that, while the country has been undergoing a multitude of changes in recent years, decentralization appears to have led to increases in the use of curative services with largely private benefits, perhaps at the expense of the use of primary health care services and services with consumption externalities. A longer period of analysis is required to determine the persistence of these effects.

Health Care Reform↗
PubMed2005

Schools uniting neighborhoods: the SUN initiative in Portland, Oregon.

The SUN Community Schools Initiative is a community-driven model that allows each school community to design the programs that fit neighborhood needs in Portland, Oregon. County and city governments, local school districts, and community agencies have jointly leveraged resources to support fifty-one community schools. The program is managed by the Multnomah County Department of School and Community Partnerships. The City Parks and Recreation Bureau oversees twelve sites staffed by city employees. Strong support across political systems aligns funding and reduces the fragmentation in existing funding patterns.

Adolescent↗
PubMed2005

Building the community school movement: vision, organization, and leadership.

On a local level, creating and sustaining community schools requires leadership from local government, schools, businesses, and nonprofit organizations. These groups must provide the fuel and direction to move the community school strategy forward along a common vision and with strategic methods for financing. At the federal level, it must continue to build constituency for community schools if it is to succeed, although the community school movement has made great strides in recent years. There is not now a coherent federal framework to support the community school vision. The proposed Full Services Community Schools legislation would build a national constituency and legislate key principles advocated by the Coalition for Community Schools: developing districtwide community school strategies, focusing on results, and improving coordination of funding streams.

Child↗
PubMed2001

Evaluating the accuracy of the benefit transfer method: a rural water supply application in the USA.

Due to declining federal, state, and local government budgets, there is an increasing need to analyze the benefits of government funded programs to determine where increasingly limited funds would best be spent. The benefits transfer technique is analyzed for the development of a rural water supply system and guidelines for successful benefits transfer are presented. Benefit transfer appears to provide reasonably accurate estimates of natural resource benefits if a broad based benefit model is used. The benefits-transfer-based estimates are accurate as long as a model based on data from a wide variety of conditions is used or the model is based on data from a very similar region. The wide-based data modeling approach has the greatest practical application. These findings are based upon contingent valuation data obtained from four sites in the western USA.

Conservation of Natural Resources↗
PubMed2002

Refuse treatment options: a case study.

Records in public archives were evaluated for the period 1981-1991. Simple surveys of peoples and of technology and physical premises provided insight to gauge the attitudes of a local community in the Melbourne municipality and the Melbourne City Council towards composting of organic waste materials. There is a lag in perception and attitudes between the local community and the local government towards composting of organic refuse as a solid waste treatment option. The simple methodology of the study still made it possible to verify past and present perceptions and attitudes.

Attitude↗
PubMed1999

Influence factors on the development of obesity in 3-year-old children based on the Toyama study.

BACKGROUND: Obesity in childhood increases the risk of obesity in adulthood. Obesity in adulthood is a risk factor for chronic diseases such as hypertension and atherosclerosis. Therefore, it is important to eliminate factors influencing the development of obesity in children from the viewpoint of preventive medicine. The purpose of this study is to elucidate the relationship between obesity and lifestyle in 3-year-old children in a case-control study. METHODS: Subjects were selected from the Toyama study at health checkups for 3-year-old children which are done routinely by local governments in Japan on all children of that age. A special questionnaire consisting of items on lifestyle and environmental factors of the children and past histories of parents was distributed to the Toyama study participants beforehand and was collected at the checkup. Matched-pair comparisons were performed between obese children whose body mass index was 18 or more (N = 427) and control children (N = 854) matched by sex and birth month. Multivariate stepwise conditional logistic regression analysis was also applied to assess the influence of confounding factors. RESULTS: The following six factors significantly influenced the development of obese 3-year-old children using the Mantel-Haenszel method: the mother's job, limited playtime outdoors (1 hour or less), snacking irregularity, an overweight father (body mass index >/= 24), an overweight mother (body mass index >/= 24), and overweight at birth (birth weight >/= 3,500 g). An overweight mother or father, limited playtime outdoors, overweight at birth, and snacking irregularity were significantly related to obesity in 3-year-old children after adjusting for confounding factors by multivariate stepwise conditional logistic regression analysis. CONCLUSIONS: We have suggested several factors influencing the development of obesity in 3-year-old Japanese children: parental overweight and overweight at birth as host factors, physical inactivity and snacking irregularity as behavioral factors, the mother's job as an environmental factor.

Body Mass Index↗
PubMed1975

The 1974 reorganization of the British National Health Service: an analysis.

The British National Health Service was reorganized on April 1, 1974, for the first time since its formation in 1948. The Reorganization attacked one serious problem: the anomalous separation of the general practitioners (and other nonhospital, non-local authority ambulatory services), hospitals, local government authority public health services, and teaching hospitals into different administrative units with different boundaries. These services are now integrated into one structure. However, other important problems will not be affected substantially.

Community Participation↗
PubMed1982

An evaluation of program implementation strategies for a rural first-responder system.

An experimental emergency first-responder system was introduced in 36 small rural Georgia communities as a means for addressing inadequate access to emergency medical services for these communities. A prospective evaluation was designed to address the most efficient and effective means to organize, implement, and administrate such a program on a regional basis. Key to the program were community-selected residents who served as Emergency Medical Coordinators (EMCs) and performed as first responders, information sources on emergency care, and system organizers. The evaluation examined the process of organizing the program through local government versus voluntary group sponsors in terms of response and participation by communities and their ability to select effective EMCs. It assessed the effectiveness of a set of criteria for selecting residents as EMCs against three sets of performance measures encompassing first-responder skills and activities which maintained public awareness and program visibility. Critical to program success was the degree of sponsor involvement in selecting EMCs.

Community Health Services↗
PubMed1996

The political development of "Program Realignment": California's 1991 mental health care reform.

This article reviews the legislative process that resulted in the most significant reform of California's public mental health system in nearly 25 years. The reform, termed "Program Realignment," decentralized administrative and fiscal control of the mental health system from the state to the county level. The system prior to Program Realignment is discussed here to reveal an already diverse and decentralized county mental health system, fiscal distress, and general dissatisfaction with the system. From these conditions, the objectives of the relevant political actors arose. By tracing the policy development process of Program Realignment, several independent variables are revealed that help explain how and why this legislation came into being and allow generalization of this case to other states' experiences. These independent variables are an urgent need for action within a limited timeframe, a preexisting knowledge base and well-developed policy networks, a spirit of bipartisan cooperation, and the presence of strong leadership. Preliminary evidence suggests that consolidation of fiscal and programmatic authority at the local level has reduced fragmentation of services and increased fiscal flexibility. However, there is concern that the quality of care offered by the state's 59 local mental health programs will become increasingly disparate and that increased financial flexibility may not be used to improve services for clients but to save money for local governments. Lessons from California's experience can alert other states to the pros and cons of this policy approach to providing mental health services and inform policymakers in other states of the steps involved in bringing about such a policy change.

Budgets↗
PubMed1990

Synthesis of research on the costs of institutional and community-based care.

Cost studies in the long-term care field are reviewed, with emphasis on those relating to people with developmental disabilities. Studies frequently stressed the cost-effectiveness of community programs but often had significant methodological problems. Among the predominant findings in the literature were: 1) the generally lower average costs per client in community programs versus institutional programs; 2) unexplained wide cost ranges in similar community programs; and 3) significant cost shifts among federal, state, and local governments associated with deinstitutionalization initiatives. The implications of these findings for public officials and the advocacy community are discussed.

Community Mental Health Services↗
PubMed2003

International collaboration on childhood leukemia.

The current cure rate of childhood acute lymphoblastic leukemia has reached 80% in many industrialized countries, but in developing countries the rate is often less than 10%. To advance the cure rate, investigators have formed several parallel initiatives in both industrialized and developing countries through international collaboration and partnership. Among industrialized countries, investigators have combined data to conduct in-depth studies of the biology and heterogeneity of high-risk or drug-resistant subgroups of leukemia to identify optimal or novel treatments. Alliances have been established among government, local nongovernmental organizations, health care providers, and international groups to improve the survival rate of childhood leukemia in developing countries. "Twinning" partnerships between a well-established individual institution or study group and a pediatric cancer unit in a developing country has proved to be the most successful strategy to date.

Adolescent↗
PubMed1993

Liver transplantation in Italy and the scarcity of donors: causative factors and ethical considerations.

We analyze the current state of liver transplantation (OLTx) in Italy that in the last few years had reached approximately 150 OLTx per year for a population of 58 millions of inhabitants. The need for OLTx in Italy is high and mainly due to the incidence of post-hepatitis and post-alcoholic liver cirrhosis, which are the prevalent indication for OLTx. On the contrary the availability of donor organs in Italy is very low as compared with other European countries, and as a consequence the gap between need and performed OLTx is widening. The reasons for poor donations are multifactorial among which; lack of organization, insufficient ICU care beds, poor knowledge of health personnel. General attitudes of the society and brain death concepts are also involved as a recent survey has demonstrated. Under certain circumstances the patient who cannot be transplanted on time in Italy is allowed to seek for care abroad under the local government economical assistance. Finally some ethical considerations and the proposal for better education of both population and health care providers are advocated.

Adult↗