National health service. Management and community participation.
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Community Participation↗
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Community participation within an Irish Health Board area.
This article gives a brief analysis of the concept of community participation followed by an account of a small study exploring the views and practices of two populations. Public health nurses have implemented their 'community as client' role and under favourable conditions would wish to develop further this aspect of their work. Women in the community are aware of the primary healthcare services available to them and as demonstrated by their comments have a holistic understanding of health. The study shows that both public health nurses and women in the community are interested and willing to take part in actions to improve health and welfare. Before genuine community partnership is developed a more defined leadership role which incorporates the skills of both community empowerment and community organization is needed.
Community Participation↗
Minority ethnic community participation in needs assessment and service development in primary care: perceptions of Pakistani and Bangladeshi people about psychological distress.
OBJECTIVES: To promote community participation in exploring perceptions of psychological distress amongst Pakistani and Bangladeshi people, in order to develop appropriate services. DESIGN: Training and facilitation of resident community members (as community project workers), to define and conduct qualitative research involving semistructured interviews in their own communities, informing primary care led commissioning and service decision making. Setting A socio-economically disadvantaged inner-city locality in the UK. Participants One-hundred and four South Asian people (49 of Pakistani and 55 of Bangladeshi origin), interviewed by 13 resident community members. RESULTS: All community project workers completed training leading to a National Vocational Qualification, and successfully executed the research. Most study respondents located their main sources of stress within pervasive experience of racism and socio-economic disadvantage. They were positive about 'talking' and neutral listening as helpful, but sought strategies beyond non-directive counselling services that embraced practical welfare advice and social support. The roles of primary health care professionals were believed to be restricted to physical ill health rather than personal distress. The importance of professionals' sex, age, ethnicity and social status were emphasized as affecting open communication. Practical recommendations for the re-orientation and provision of services were generated and implemented in response to the findings, through dialogue with a primary care commissioning group, Health and Local Authority, and voluntary agencies. CONCLUSIONS: The work illustrates the feasibility and value of a community participation approach to research and service development in addressing a challenging and neglected area of minority ethnic health need. It offers one model for generating responsive service change in the context of current health policy in the UK, whilst also imparting skills and empowering community members. The study findings emphasize the need to recognize the social contexts in which distress is experienced and have implications for effective responses.
Journal Article↗
Impact of community participation on treatment outcomes and compliance of DOTS patients in Iraq.
We assessed the effect of community participation on treatment outcomes for tuberculosis patients undergoing directly-observed therapy, short course (DOTS). From February to December 2001 172 newly diagnosed patients in Baghdad were allocated into 2 treatment groups. The intervention group were visited daily at home for the 2-month initial phase by trained members of the Iraqi Women's Federation while the control group attended the local health centre for treatment. Cure rates for patients treated at home were significantly better than controls (83.7% versus 68.6%), so too was compliance (100.0% versus 14.0%). Smear conversion rates were significantly better in intervention cases compared with controls at all stages. Default rates were similar in both groups (11.6% versus 10.5%), as was mortality (1 patient each).
Adult↗
Towards the measurement of community participation.
A description is given of the initial stages in the development of a methodology for assessing community participation in health schemes. A study in Nepal indicates that the approach adopted will be useful to planners who wish to evaluate involvement in primary care programmes.
Community Health Services↗
Sri Lanka's tradition of community participation revitalized.
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Community Participation↗
Crime, social capital, and community participation.
Social disorganization at the neighborhood and community levels has been consistently linked to various forms of criminal activity. However,a very much smaller body of literature addresses the effects of crime on community organizations. In some studies, crime appears to energize communities while in others, crime leads to withdrawal from community life. Using department of health crime victimization data and interviews with 2,985 low-income inner city residents living in 487 multi-family dwellings, a multi-level model examined the relationships among crime victimization, social organization, and participation in neighborhood organizations. Social organization at the individual and building levels was measured using recent formulations of social capital theory. Findings regarding crime suggested more signs of a chilling effect on participation than of an energizing effect, especially at the building level. Social capital at the building level was more strongly and consistently related to participation in community organizations than was crime.
Adult↗
Influence of health education on community participation in rapid assessment of onchocerciasis prior to distribution of ivermectin.
OBJECTIVE: To investigate the impact of health education on community participation in the rapid assessment of onchocerciasis prior to distribution of ivermectin in Nigeria. DESIGN: There was health education with use of pictorial monographs to an adult population and school children in Umulumgbe and Okpatu communities, respectively. The school children in turn transferred the knowledge acquired to their parents through a health club, and a third community (Awhum) had no health education. Randomly selected subjects in each community were then assessed for their ability to recognise clinical manifestations of disease. SETTING: The study took place in three onchocerciasis-endemic, autonomous communities in Udi local government area of Enugu state in eastern Nigeria. SUBJECTS: Fifty, thirty seven, and thirty three male subjects, aged 20 years and above in Umulumgbe, Okpatu and Awhum respectively were involved in the study. RESULTS: 89.3%, 100% and 25.6% of the total number of onchocercal nodules were rightly indicated by the subjects in Umulumgbe, Okpatu and Awhum respectively. 100% of skin depigmentation was also reported in Umulumgbe and Okpatu each, and 50% in Awhum. Although some of the clinical manifestations (onchocercal nodules and skin depigmentation) were wrongly indicated, others (hanging groin and enlarged scrotum) were not reported by the subjects at all. CONCLUSION: This study clearly shows that health education is necessary for control programmes that are meant to be sustainable, especially the WHO-supported community-directed treatment with ivermectin (CDTI).
Adult↗
Community participation in local health boards in a decentralized setting: cases from the Philippines.
Decentralization has been associated traditionally with participation and empowerment in local decision-making. This study of four cases analyzed the role of local health boards in enhancing community participation and empowerment under a decentralized system in the Philippines. Local government units (LGUs) with functioning local health boards were compared with LGUs whose health boards were not meeting regularly as mandated by law. The study found that there were more consultations with the community, fund-raising activities, health initiatives and higher per capita health expenditure in LGUs with functioning local health boards. Only the mayors and municipal health officers felt empowered by devolution. In general, awareness of devolution and their potential roles in health decision-making was low among members of the community. These findings can be attributed to the socio-cultural and historical traditions of centralized governance with little popular participation, overall attitudes of the community and board members, perceptions of health as primarily a medical matter, economic circumstances of LGUs, and insufficient preparation for devolution. Recommendations are suggested in response to these findings.
Community Participation↗
[Community participation in health agencies in an urban health district of Bukavu (Democratic Republic of the Congo)].
We sought to evaluate the level of community participation in health agencies in the Bukavu urban health district, an alternative approach to assessing primary health care that can be especially useful in combating poverty. Accordingly we conducted a transversal survey of a population including 113 members of 12 functional health committees and the chief of the Bukavu Urban Health District, a physician. Subjects were most often 35 to 65 years of age, male, salaried employees, married, and Roman Catholic, and had not completed secondary school. Means were compared with Anova (analysis of variance). The level of participation by these health committee members is poor (29.0%), and very similar regardless of the health sector: Bagira (26.5%), Ibanda (25.9%), and Kadutu (32.6%). Relevant factors include the weak commitment of district health authorities, the poor participation by committee members in performing their roles, and their low level of motivation to participate. The results showed no significant difference between the three health sectors in the motivating power of roles and attributions. The authors recommend that health district authorities commit themselves to the selection, training and supervision of health committees.
Adult↗
From rhetoric to action: establishing community participation in AIDS-related research.
Acquired Immunodeficiency Syndrome (AIDS) has been described as the most challenging disease in modern history. For many people with HIV/AIDS (PWA), issues of appropriate respite care and supported housing are a pressing concern. To meet the housing requirements for PWAs, it is essential to engage this community in determining its own housing needs. To that end, a participatory action research (PAR) investigation was undertaken with the PWA community to ascertain the desirability and feasibility of a supported-living/respite-care community home. PAR has been heralded as an important research methodology in ensuring research relevance and community participation leading to effective change. Although nursing interest in PAR is increasing, there are few nursing examples that describe the process of undertaking PAR. The purpose of this article is to describe, explain, and critique the use of PAR in the case of a supported-living/respite-care home. A PAR framework is presented and the process of conducting PAR is outlined.
Acquired Immunodeficiency Syndrome↗
A new approach to community participation in tsetse control in the Busoga sleeping sickness focus, Uganda. A preliminary report.
A process is described by which trapping technology is being taught to a rural community which has been affected continuously by an epidemic of sleeping sickness for over a decade. Through a systematic health education programme, people are actively involved in making and setting traps and in learning about the general characteristics of the tsetse fly and the disease. A mono-screen trap has been developed for community use and is being used to trap flies. This is the first time that this kind of community participation has been attempted in tsetse control--and this approach is discussed in relation to other approaches.
Animals↗
Community participation in the control of tsetse flies. Large scale trials using the pyramid trap in the Congo.
An experiment of Glossina palpalis control was carried out by rural communities in 55 villages of the Niari river sleeping sickness focus (Bouenza region, Republic of the Congo). It was based on the use of a new trap, not requiring insecticide impregnation, in which the captured Glossina are preserved. The results show that this simple, cheap trap is an effective method of control, resulting in a considerable decrease in the tsetse population and is easily operated by the villagers. Screening surveys, using the indirect immunofluorescent test, conducted regularly in this focus, showed a decrease in the prevalence rate after the elimination of the flies. Long-term community participation is limited and must be improved by a better understanding of socio-cultural aspects and in certain cases must be associated with the work of a specialized team.
Animals↗
Towards active community participation in dengue vector control: results from action research in Santiago de Cuba, Cuba.
Community participation is advocated as essential for attaining effective dengue prevention, but knowledge of how to foster this is limited. In Santiago de Cuba, multiple small task forces were created at the neighbourhood level that included all stakeholders in the control of Aedes aegypti. The task forces assessed the perceived needs and elaborated action plans to promote specific behavioural change and to reduce environmental risks through social communication strategies and intersectoral local government activities. We monitored five dimensions of the participation process and assessed behavioural and environmental results and entomological outcomes. Participation was weak to good. At the household level, uncovered water storage containers decreased from 49.3% to 2.6% between 2000 and 2002, and removing larvicide from them dropped from 45.5% to 1%. There was a reduction of 75% in the absolute number of positive containers and a significant decrease from 1.23% to 0.35% in the house index. Local task forces, in which the interests of householders as well as vector control workers are directly represented, can lead to effective government-community partnerships that resolve problems of mutual concern.
Animals↗
Community participation in veterinary public health and animal health in the Caribbean--results of a preliminary survey.
Veterinary public health and animal health activities are said to be a good entry point to get the community interested in their own health. Because of the pastoral traditions of veterinary medicine and the accompanying privilege of an intimate link with agricultural community life, veterinary public health and animal health workers are in and ideal strategic position to spearhead community organization and education across a much broader spectrum of health issues. A preliminary study on community participation in veterinary public health (VPH) and animal health (AH) in the Caribbean is herein presented. This study was conducted to pre-test two questionnaires which were developed to determine the extent to which the community is participating in VPH and AH programs in the Caribbean, and to identify ways and means to strengthen intersectoral collaboration between the Ministries of Agriculture, Health and Local Governments. Two questionnaires were designed to collect primary data. Eighty-two staff profile questionnaires were completed by staff belonging to six categories from 12 Caribbean countries and political units. The categories included Animal Health Assistants, Veterinary Public Health Assistants, Veterinarians, Extension Officers, Public Health Inspectors, and Artificial Insemination Officers. This questionnaire sought to obtain basic information on services provided, participation of staff in farmers organization, coordination between agencies, and training. Eighty-seven (87) farm profiles were completed by livestock farmers from eleven Caribbean countries and political units. This questionnaire sought to obtain basic information as to number and types of animals raised, role and services of Government staff, and farmers participation. Analysis of the different responses between the two groups demonstrated the potential value and application of the information that could be obtained from such a study. The results are discussed.
Animal Husbandry↗
How do health workers see community participation?
A survey of health workers in Rwanda suggested that they were somewhat reluctant to accept the involvement of lay people in the promotion and implementation of primary care programmes. Various obstacles to community participation were identified by the health workers, who, however, suggested general rather than specific remedies for the situation as they saw it.
Attitude of Health Personnel↗
[Community participation in health promotion: an experience from hygiene and sanitation committees in the district of Touba (Senegal)].
This qualitative exploratory study carried out in November 2000 describes and analyzes health promotion by community participation in the health district of Touba, in Senegal. The committees were primarily made up of women with an implication of local religious authorities which represented the moral responsible. The promotional activities regularly carried out were: health education, distribution of insecticide treated nets, police in waste management and hygiene, and cleaning. Theses activities were supported through the development of income generating activities. The success of the communities is based on the favorable socio-religious environment, strengthened by the particular commitment of the women. The diversity of activities undertaken by the committees is a proof that the identification of people's needs was not limited to health care questions. The community leadership was stimulated by the district, to enhance the dynamics of participation. The financial autonomy of the majority of communities is a guarantee of their sustainability within the district health system. Extremely encouraging results obtained, two essential recommendations were made to strengthen the experience of sanitation committees in health promotion.
Attitude of Health Personnel↗
Community participation in determining the needs of users and carers of rural community care services. Highland Community Care Forum.
In this paper we present the methods and key outcomes of a community led needs assessment exercise. The needs assessment sought to enhance the development of rural community care services by ensuring the views of users and carers were secured and considered in joint planning processes. The research was developed by members of the North and West Sutherland Community Care Forum. A community profiling template was developed and employed in five parish areas of Sutherland. This was drawn from 45 interviews with key informants and 2 community workshops, In addition 54 users and carers were interviewed. The outcomes of the needs assessment exercise identified geographical and cultural factors which present difficulties in developing services as well as posing barriers to user involvement.
Community Health Services↗