scholarly journals Community-managed Health Programs for Better Health outcomes: Preliminary results of a community Participatory research in Murcia and Isabel, negros occidental, Philippines

2018 ◽  
Vol 52 (2) ◽  
Author(s):  
Hilton Y. Lam ◽  
Isidro C. Sia ◽  
Jaifred Christian F. Lopez ◽  
Ruben N. Caragay ◽  
Leonardo R. Estacio, Jr. ◽  
...  
Keyword(s):  
Local Government ◽  
Health Outcomes ◽  
Health System ◽  
Community Participation ◽  
Participatory Research ◽  
National Health System ◽  
Control Area ◽  
Health Needs ◽  
Health Programs ◽  
Community Participatory Research

Background. Community-managed health programs (CMHPs) were designed to promote community selfdetermination in addressing health needs, but there is a need to evaluate how CMHPs can lead to better outcomes while accommodating changes in the national health system, which requires analysis of current CMHP interventions, institutional and community readiness, and points of interface with other health facilities. Objective and Methods. This preliminary study aimed to guide an eventual effort to develop a framework to ensure CMHPs sustainably improve health outcomes. A preliminary analysis of results from a community participatory research was done in which baseline health characteristics, related social determinants, level of involvement of CMHPs with the local government health system, and quality of life were documented through surveys, focus group discussions and key informant interviews, both in a community with an established CMHP (Murcia, Negros Occidental, Philippines), and a control area without a similar NGO sector (Isabela, Negros Occidental). Results. There was higher NGO and local government involvement among respondents in Murcia, use of traditional medicine, and sense of awareness of the need to improve the water quality in Murcia, with noted persistence of sanitation concerns, pinpointing the need to assess community participation and the efficiency of CMHPs. Conclusion. Further study is needed in measuring community participation while considering its underlying cultural and socioeconomic contexts, in order to facilitate planning and implementation of strategies that intend to address community-recognized health needs while sustainably improving health outcomes.

Looking forward to the next 70 years: from a National Ill-Health Service to a National Health System

2018 ◽  
Vol 14 (1) ◽  
pp. 11-14
Author(s):  
David J. Hunter
Keyword(s):  
National Health Service ◽  
Local Government ◽  
Health Service ◽  
Health System ◽  
21St Century ◽  
National Health ◽  
National Health System ◽  
Well Being ◽  
Tipping Point ◽  
Health And Well Being

AbstractAmidst the NHS’s (National Health Service) success lies its major weakness, although one that Klein overlooks in his reflections on the NHS as it approaches 70. The focus on, and investment in, curing ill-health has been at the expense of attending to the public’s overall health and well-being. This preoccupation poses a greater threat to the NHS’s future than privatisation. Despite the weakness having been diagnosed decades ago, redressing the imbalance has proved stubbornly hard to achieve. Rhetoric has not been translated into reality. Yet, we may be on the cusp of a tipping point where in order to ensure a sustainable NHS, and one that is capable of meeting the 21st century challenges facing it, there is a renewed and overdue interest in promoting health and well-being in communities. But for this to succeed, the NHS will need to embrace its bete noire, local government.

scholarly journals Community-Based Participatory Intervention Research with American Indian Communities: What is the State of the Science?

2019 ◽  
Vol 3 (Supplement_2) ◽  
pp. 39-52 ◽  
Author(s):  
Jordan B Hearod ◽  
Marianna S Wetherill ◽  
Alicia L Salvatore ◽  
Valarie Blue Bird Jernigan
Keyword(s):  
Health Outcomes ◽  
Community Participation ◽  
Participatory Research ◽  
Community Based Participatory Research ◽  
Community Based ◽  
Observational Study Design ◽  
Study Characteristics ◽  
Community Outcomes ◽  
State Of The Science ◽  
The Impact

ABSTRACT We conducted a 2-phase systematic review of the literature to examine the nature and outcomes of health research using a community-based participatory research (CBPR) approach with AI communities to assess both the value and the impact of CBPR, identify gaps in knowledge, and guide recommendations for AI research agendas. Using PRISMA guidelines, we searched the peer-reviewed literature published from 1995 to 2016 and identified and reviewed 42 unique intervention studies. We identified and catalogued key study characteristics, and using the Reliability-Tested Guidelines for Assessing Participatory Research Projects, we quantified adherence to participatory research principles across its four domains. Finally, we examined any association between community participation score and health outcomes. The majority of studies (76.7%) used an observational study design with diabetes, cancer, substance abuse, and tobacco being the most common topics. Half of the articles reported an increase in knowledge as the primary outcome. Our findings suggest that a CBPR orientation yields improved community outcomes. However, we could not conclude that community participation was directly associated with an improvement in health outcomes.

scholarly journals Implementing Federalism in the Health System of Nepal: Opportunities and Challenges

2018 ◽  
Vol 8 (4) ◽  
pp. 195-198 ◽  
Author(s):  
Rajshree Thapa ◽  
Kiran Bam ◽  
Pravin Tiwari ◽  
Tirtha Kumar Sinha ◽  
Sagar Dahal
Keyword(s):  
Health System ◽  
Local Governments ◽  
Health Sector ◽  
National Health System ◽  
Health Needs ◽  
Federal System ◽  
National Healthcare ◽  
Speed Up ◽  
Local Healthcare ◽  
Improve Health

Nepal moved from unitary system with a three-level federal system of government. As federalism accelerates, the national health system can also speed up its own decentralization process, reduce disparities in access, and improve health outcomes. The turn towards federalism creates several potential opportunities for the national healthcare system. This is because decision making has been devolved to the federal, provincial and local governments, and so they can make decisions that are more representative of their localised health needs. The major challenge during the transition phase is to ensure that there are uninterrupted supplies of medical commodities and services. This requires scaling up the ability of local bodies to manage drug procurement and general logistics and adequate human resource in local healthcare centres. This article documents the efforts made so far in context of health sector federalization and synthesizes the progress and challenges to date and potential ways forward. This paper is written at a time while it is critical to review the federalism initiatives and develop way forward. As Nepal progress towards the federalized health system, we propose that the challenges inherent with the transition are critically analysed and mitigated while unfolding the potential of federal health system.

Nicaragua: A Health System Developing under Conditions of War

1987 ◽  
Vol 17 (1) ◽  
pp. 169-178 ◽  
Author(s):  
Paula Braveman ◽  
David Siegel
Keyword(s):  
Health Care ◽  
Health System ◽  
Latin American ◽  
Rural Areas ◽  
National Health System ◽  
Universal Coverage ◽  
Health Programs ◽  
Community Based ◽  
Military Conflict ◽  
Preventive Health Programs

Since its inception in 1979, the Nicaraguan National Health System has dramatically improved health care in Nicaragua through the provision of universal coverage, emphasis on preventive community-based primary care, and community participation in health activities. Of major importance in the development of the health system has been the decentralization of the administration, planning, and implementation of health programs. The war in Nicaragua has had a major impact on the development of the health system. Nicaraguan health personnel and facilities have been the objects of attack by the contras and scarce resources have been diverted from the development of social programs to military activities. A large refugee population has been created which further strains existing resources. Community-based preventive health programs have been adversely affected, particularly in rural areas where military activity is the most intense. Because of the war, efforts to optimize regionalization of the health system have been retarded. Economic pressures both within Nicaragua resulting from the war and within the entire Latin American area have further hampered efforts for development. Continued major improvements in health care in Nicaragua will depend on a settlement of the present military conflict which is draining resources in all sectors of development, including health.

scholarly journals Health needs: a temporary analysis of the social representations of the concept

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Winckler ◽  
F Zioni ◽  
G Johson
Keyword(s):  
Political Participation ◽  
Health System ◽  
Social Representations ◽  
Public Policies ◽  
Civil Society Organizations ◽  
Health Needs ◽  
The Social ◽  
The Right ◽  
Brazilian Health System ◽  
Universal Health

Abstract Background This study aims to analyse the social representations of health needs in a Brazilian municipality, questioning the capacity that public policies developed and implemented by the Brazilian Health System (SUS) had to meet these needs. Methods Qualitative case study in which the data were analysed by: 1) the Health Needs Taxonomy (Matsumoto, 1999), as an instrument for assessing health needs, formatting the interview guide and organizing the empirical data; 2) the Theory of Social Representations (Jovchelovitch, 2000), to capture health needs; 3) Content Analysis (Bardin, 2004), as an instrument of analysis and comparison of perceived needs. The methodological path used was the same in the two moments in which this research is based (2009 and 2016). The entire municipal territory was analyzed and 26 representatives of civil society organizations were interviewed. Results Based on the results given, we state that health is a permanent and timeless need, but the mediations for its satisfaction have changed historically. The interface between quantitative indicators and subjectivity in assessing needs reveals the authoritarian architecture of its decision-making process, which has ruined the necessary democracy for prioritising and meeting those needs. The asymmetrical relationships present in the Brazilian society have both undermined the collective character of health needs and promoted the distance between who care and who are cared for. Most of the priorities listed by the interviewees in 2009 remain composing the social context of the municipality in 2016. Conclusions The challenges for comprehensive health care remain critical given both the decrease in popular political participation and in institutional spaces, which leads to the annulment of the right to a universal health. Interdisciplinary and participatory diagnostics remain essential to understand the complexity of social changes and the challenges for the consolidation of meeting health needs. Key messages The capacity that public policies developed and implemented by the Brazilian Health System (SUS) had to meet these needs. The challenges for meeting health needs remain critical given both the decrease in political participation and in institutional spaces, which leads to the annulment of the right to a universal health.

scholarly journals The impact of economic sanctions on health and health systems in low- and middle-income countries

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Suhrcke ◽  
M Pinna Pintor ◽  
C Hamelmann
Keyword(s):  
Health Outcomes ◽  
Health System ◽  
Health Systems ◽  
Grey Literature ◽  
Economic Sanctions ◽  
Political Crisis ◽  
Middle Income ◽  
Financial Flows ◽  
Adverse Health ◽  
The Impact

Abstract Background Economic sanctions, understood as measures taken by one state or a group of states to coerce another into a desired conduct (eg by restricting trade and financial flows) do not primarily seek to adversely affect the health or health system of the target country's population. Yet, there may be indirect or unintended health and health system consequences that ought to be borne in mind when assessing the full set of effects of sanctions. We take stock of the evidence to date in terms of whether - and if so, how - economic sanctions impact health and health systems in LMICs. Methods We undertook a structured literature review (using MEDLINE and Google Scholar), covering the peer-reviewed and grey literature published from 1970-2019, with a specific focus on quantitative assessments. Results Most studies (23/27) that met our inclusion criteria focus on the relationship between sanctions and health outcomes, ranging from infant or child mortality as the most frequent case over viral hepatitis to diabetes and HIV, among others. Fewer studies (9/27) examined health system related indicators, either as a sole focus or jointly with health outcomes. A minority of studies explicitly addressed some of the methodological challenges, incl. control for relevant confounders and the endogeneity of sanctions. Taking the results at face value, the evidence is almost unanimous in highlighting the adverse health and health system effects of economic sanctions. Conclusions Quantitatively assessing the impact of economic sanctions on health or health systems is a challenging task, not least as it is persistently difficult to disentangle the effect of sanctions from many other, potentially major factors at work that matter for health (as, for instance, war). In addition, in times of severe economic and political crisis (which often coincide with sanctions), the collection of accurate and comprehensive data that could allow appropriate measurement is typically not a priority. Key messages The existing evidence is almost unanimous in highlighting the adverse health and health system effects of economic sanctions. There is preciously little good quality evidence on the health (system) impact of economic sanctions.

Vernal keratoconjunctivitis: An update

2021 ◽  
pp. 112067212110221
Author(s):  
Daniele Giovanni Ghiglioni ◽  
Anna Maria Zicari ◽  
Giuseppe Fabio Parisi ◽  
Giuseppe Marchese ◽  
Cristiana Indolfi ◽  
...  
Keyword(s):  
Health System ◽  
Rare Diseases ◽  
Complex Disease ◽  
National Health System ◽  
Eye Diseases ◽  
Vernal Keratoconjunctivitis ◽  
International Level ◽  
Safety And Efficacy ◽  
Essential Step ◽  
Definition Of

Vernal keratoconjunctivitis (VKC) and atopic keratoconjunctivitis (AKC) are potentially severe and complex disease in its management among the various allergic eye diseases. In this regard, studies clarified the etiopathogenetic mechanisms. The workup should be multidisciplinary. The treatment includes topical and systemic medications with anti-inflammatory and immunosuppressant activity. However, a definition of nationally- and internationally-shared diagnostic protocols would also be needed and validated access to therapeutic options of proven safety and efficacy to avoid the use of galenic preparations, up to now still essential in the management of moderate-severe VKC. Finally, recognizing VKC and AKC, among rare diseases, at a national and international level would be an essential step to allow the management of VKC with adequate timings and settings within the National Health System.

scholarly journals What do you mean by engagement? – evaluating the use of community engagement in the design and implementation of chronic disease-based interventions for Indigenous populations – scoping review

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Sahr Wali ◽  
Stefan Superina ◽  
Angela Mashford-Pringle ◽  
Heather Ross ◽  
Joseph A. Cafazzo
Keyword(s):  
Chronic Disease ◽  
Health Outcomes ◽  
Community Engagement ◽  
Participatory Research ◽  
Scoping Review ◽  
Indigenous Health ◽  
Well Being ◽  
Indigenous Populations ◽  
Local Context ◽  
Engagement Strategies

Abstract Background Indigenous populations have remained strong and resilient in maintaining their unique culture and values, despite centuries of colonial oppression. Unfortunately, a consequential result of facing years of adversity has led Indigenous populations to experience a disproportionate level of poorer health outcomes compared to non-Indigenous populations. Specifically, the rate of Indigenous chronic disease prevalence has significantly increased in the last decade. Many of the unique issues Indigenous populations experience are deeply rooted in their colonial history and the intergenerational traumas that has subsequently impacted their physical, mental, emotional and spiritual well-being. With this, to better improve Indigenous health outcomes, understanding the local context of their challenges is key. Studies have begun to use modes of community engagement to initiate Indigenous partnerships and design chronic disease-based interventions. However, with the lack of a methodological guideline regarding the appropriate level of community engagement to be used, there is concern that many interventions will continue to fall short in meeting community needs. Objective The objective of this study was to investigate the how various community engagement strategies have been used to design and/or implement interventions for Indigenous populations with chronic disease. Methods A scoping review guided by the methods outlined by Arksey and O’Malley was conducted. A comprehensive search was completed by two reviewers in five electronic databases using keywords related to community engagement, Indigenous health and chronic disease. Studies were reviewed using a descriptive-analytical narrative method and data was categorized into thematic groups reflective of the main findings. Results We identified 23 articles that met the criteria for this scoping review. The majority of the studies included the use a participatory research model and the procurement of study approval. However, despite the claimed use of participatory research methods, only 6 studies had involved community members to identify the area of priority and only five had utilized Indigenous interview styles to promote meaningful feedback. Adapting for the local cultural context and the inclusion of community outreach were identified as the key themes from this review. Conclusion Many studies have begun to adopt community engagement strategies to better meet the needs of Indigenous Peoples. With the lack of a clear guideline to approach Indigenous-based participatory research, we recommend that researchers focus on 1) building partnerships, 2) obtaining study approval and 3) adapting interventions to the local context.

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