Medicare Without a Strong Community Health Sector Is a Loss to the Australian Health System

Institutionalising community health programmes into the Palestinian health-care system: a qualitative study

This paper examines the social movements that influenced the development and implementation of the original Whitlam Government Community Health Program, the community health movement that emerged, and the opportunities it created for people to develop and deliver health programs in new ways. Oral history interviews with 93 people involved in community health in South Australia, Victoria and New South Wales, and 212 community health policy and archival documents were collected as a part of an Australian Research Council study documenting the history of community health services in Australia since the 1970s. Ideas about community health in Australia were influenced by several social movements that had overlapping, but distinctive, contributions: (1) left-wing movements: political parties, workers' health; trade unions, anti-war and anti-establishment; (2) international social medicine and community-oriented primary care; (3) Indigenous rights/Black Power; (4) feminist; and (5) community development/community power. These movements influenced Australian community health to embrace community management, advocacy and community development strategies in addition to multi-disciplinary care. However, these progressive elements were undermined by neo-liberal management reforms and medical opposition to elements of the Community Health Program. The early passion for community health in the 1970s and 1980s was fuelled by social movements, but the inconsistent support from the federal and most state governments limited progressive and innovative community health practice. The window of opportunity for the Community Health Program was supported by progressive social movements, but restricted from the 1990s onwards.

Responding to intersectional needs of the people/communities it serves, the Canadian Red Cross adapted its Community Health model to provide support across the continuum of care. Enhanced collaboration, integration of Indigenous Ways of Knowing, and inclusion of promising practices like social prescribing, resulted in measured impact on volunteers and participants. Background: CRC expanded its Community Health vision to provide culturally safe, trauma-informed, low-barrier access to support across the continuum of care and better address social determinants of health and health inequities. The approach is based on promising practices identified through greater collaboration among national and provincial programs, interoperability during community/climate crises, incorporation of social prescribing and community connectors, and adapting international training through a community health lens. Impact of these efforts on participant and volunteer health and well-being, sense of connection and meaning, capacity to cope and heightened healthy habits has been measured. Promising practices will be shared with the audience to apply to their own context. Audience: This workshop will engage with sectors playing a role in advancing better health and wellbeing through integrated care. We would like to engage with the following groups: government/policy influencers, health and clinical care providers, social and community care providers, researchers and academics, and recipients of care and caregivers. Approach: The workshop will engage participating groups in a collaborative overview of pan-Canadian continuum of care approach to community health programming, explore promising practices, community health tools for training and evaluation, and lessons learned. In this manner, the audience will have the opportunity to collaboratively explore and apply integrated community health approach, promising practices and tools to their own context. The following structure will be followed. Introduction of Organizational Approach (0mins): The Canadian Red Cross (CRC) will share the continuum of care approach taken to better integrate community health programming across diverse contexts, engage partnerships, identify referral pathways, and strengthen personal and community resilience. Programming highlights include pan-Canadian Friendly Calls (first national Community Health program of the CRC), Health Equipment Loan Program, Hospital-to-Home, Social Prescribing and Community Connectors, and collaboration with Indigenous Relations team. Presentation to explore Promising Practices Learnings from the model/approach (5 mins): CRC will share key learnings in the evolution of the vision and continuum of care approach to address social determinants of health and health inequities through community health programming as part of an integrated care team. Includes the expanded integration of Indigenous Relations department, development of new tools, interoperability within community/climate crises, and capacity building among CRC community health participants and personnel to strengthen resilience, improve health well-being, and better navigate the stressors and intersectional needs. Interactive Group Exercise (20 min): The audience will have the opportunity to explore the approach and tools by dividing into small groups to engage case studies and brainstorm opportunities to integrate continuum and tools across health and community care needs in their own context. Share back (0 mins): Each group will share their experience, highlight opportunities for further integration and key take-aways. Closing and final remarks (5mins): CRC will share final remarks on next steps and links to shared toolkits. Outcomes: After attending the workshop, the audience will have; - A community health model to enhance participant outcomes in addressing social determinants of health and health inequities; - Awareness of barriers experienced in integrating community health and resulting learnings; - Interactive experience with promising practices in creating accessible and integrated community health programs, and evaluating their impact. A virtual toolkit will be shared with broader NACIC24 audience based on the initial promising practices and the workshop audience experiences.

BackgroundArising from the Ebola virus disease (EVD) outbreak, the 2015-2021 Investment Plan aimed to improve the health status of the Liberian population through building a resilient health system that contributes to achieving equitable health outcomes. Recognizing the significance of community participation in overcoming the EVD outbreak, strengthening community systems emerged as one of the most important strategies for bridging the gap in accessing primary health care (PHC) services. This study reviewed the community health policy development process in order to draw lessons from the health system strengthening efforts in Liberia post-EVD crisis.MethodsA government-led health system analysis approach was applied to assess, review and revise the community health program in Liberia. The mixed method approach combines the use of an adapted tool to assess bottlenecks and solutions during workshops, a qualitative survey (key informant interviews and focus group discussions) to assess perceptions of challenges and perspectives from different stakeholders, and an inter-agency framework – a benchmarks matrix – to jointly review program implementation gaps using the evidence compiled, and identify priorities to scale up of the community program.ResultsStakeholders identified key health system challenges and proposed policy and programmatic shifts to institutionalize a standardized community health program with fit for purpose and incentivized community health assistants to provide PHC services to the targeted populations. The community health program in Liberia is currently at the phase of implementation and requires strengthened leadership, local capacities, and resources for sustainability. Lessons learned from this review included the importance of: establishing a coordination mechanism and leveraging partnership support; using a systems approach to better inform policy shifts; strengthening community engagement; and conducting evidence-based planning to inform policy-makers.ConclusionsThis article contributes toward the existing body of knowledge about policy development processes and reforms on community health in Liberia, and most likely other African settings with weak health systems. Community-based systems will play an even bigger role as we move toward building resilience for future shocks and strengthening PHC, which will require that communities be viewed as actors in the health system rather than just clients of health services.

Aims: To examine how data-driven strategies can be integrated into community health programs as innovative approaches for effective operation. Problem Statement: Numerous government engagements in different crucial sectors have limited her concerns about health provision and distribution to many citizens living in remote communities. Health provision characterized with easy accessibility and low cost should not be marginalized and should be the right of every citizen. However, many lives have been lost due to lack of this in some communities. Significance of Study: To curb this, non-profit sectors are now engaging in community health programs to ameliorate the difficulties faced by distanced citizens living in remote localities. With the advent of this program, it is imperative to incorporate data-driven strategies as innovative approaches to improve and enhance the current state of operations in community health programs. Discussion: A medical practice that addresses the well-being of people within a particular geographical location is referred to as community health. This technical review paper discusses the concepts, roles and mode of operations of community health workers and the programs that are embedded. The attributes of a robust well-functioning health system as stated by World Health Organisation (WHO) were discussed alongside program components that are often executed by village workers. Value-based care, patient-centered care and P4 medicine were identified as the major ideologies behind data-driven strategies and the characteristic features of each were adequately discussed. Conclusion: A data-driven healthcare innovative approach must put into consideration the real definition of data management policies, organize training for health care workers who are handling health data and also support the implementation in order to secure the designed information systems.

Low- and middle-income countries (LMICs) are rapidly urbanizing, and in response to this, there is an expansion in the body of scholarship and significant policy interest in urban healthcare provision. The idea and the reality of 'urban advantage' have meant that health research in LMICs has disproportionately focused on health and healthcare provision in rural contexts and is yet to sufficiently engage with urban health as actively. We contend that this research and practice can benefit from a more explicit engagement with the rich conceptual understandings that have emerged in other disciplines around the urban condition. Our critical review included publications from four databases (MEDLINE, EMBASE, CINAHL, and Social Sciences Citation Index) and two Community Health Worker (CHW) resource hubs. We draw upon scholarship anchored in sociology to unpack the nature and features of the urban condition; we use these theoretical insights to critically review the literature on urban community health worker programs as a case to reflect on community health practice and urban health research in LMIC contexts. Through this analysis, we delineate key features of the urban, such as heterogeneity, secondary spaces and ties, size and density, visibility and anonymity, precarious work and living conditions, crime, and insecurity, and specifically the social location of the urban CHWs and present their implications for community health practice. We propose a conceptual framework for a distinct imagination of the urban to guide health research and practice in urban health and community health programs in the LMIC context. The framework will enable researchers and practitioners to better engage with what entails a 'community' and a 'community health program' in urban contexts.

Background Medicare, Australia's universal healthcare coverage system, has been described as unfit for modern purposes. Its predominantly fee-for-service payment model penalises longer, more complex consultations, and does not adequately remunerate non-physician healthcare workers. To address issues of access for marginalised groups, the Community Health Program was introduced by the Whitlam government in 1973. After federal funding was withdrawn, Victoria remained the only state to continue generalist, non-government, community health centres. Notwithstanding the success of the community health model in Victoria, primary care nationally predominantly occurs in private general practices with no programmatic funding from state governments. The federal government has recently brought to the table a swathe of proposals to modernise Medicare to make it accessible for society's most vulnerable, regardless of whether they receive their care in a community health centre or not. Methods This paper presents a case study of a private, not-for-profit primary care centre. The clinic aims to replicate elements of the community health model within the private sector. The case study will examine interventions implemented by the clinic to provide primary care for groups living in vulnerable circumstances. Results The case study demonstrates innovations usually seen in community health centres adopted in a private primary care service such as use of navigators, improved primary-secondary care interface, purpose-driven care, task-shifting, trust-building, tailored services and community engagement. Conclusions The case study represents a unique model of care that replicates elements of community health services in a private setting. Medicare reform must support multi-disciplinary care, rebates that actually reflect the cost of providing care, adequate remuneration for non-physician healthcare professionals and address the pay disparity between primary care physicians and non-GP specialists.

Primary health care in Southeast Asia: Attitudes about community participation in community health programmes

INTRODUCTION Guinea’s Ministry of Health has proposed a standardized national community health program, including health promotion, case management, and referral; historically however the system has been implemented piecemeal by various actors. MSF has been present in Kouroussa, northern Guinea, since 2017. MSF activities there have been focused on community healthcare, through training and support for community health workers, or “recos”. Before exiting, MSF conducted a mixed-methods study to understand differences in the models and effects of MSF community health program, as compared to those implemented by other actors. METHODS We implemented an explanatory, sequential, mixed-methods study in Kouroussa and in three other zones, Mandiana, Télimélé, and Boussou; sites were selected to represent a diversity of situations, and those outside Kouroussa are supported by non-MSF actors. During the quantitative phase, 137 recos and 13 supervisory community health agents were interviewed about their demographic and professional details, availability of tools, the package of activities, activity levels, and practical knowledge. A qualitative phase, including 24 focus group discussions and 65 individual interviews followed, aiming to better understand the community and local health professional perceptions of community health programmes in each of the four zones. Quantitative data were analyzed using R (Vienna, Austria) to calculate descriptive measures; differences were compared between zones using chi-square and t-tests. Qualitative data audio recordings were translated and transcribed, read, and re-read to identify codes and themes. ETHICS This study was approved by the MSF Ethics Review Board and by the Comité National de la Recherche, Guinea. RESULTS Overall, recos in Mandiana and Télimélé were primarily involved in health promotion and referral, while recos in Kouroussa (supported by MSF), and some in Boussou, additionally conducted case management. In Kouroussa, recos conducted a median of 16.5 malaria consultations per month, compared to 8.0 in Boussou, 2.1 in Télimélé, and 0 in Mandiana (p<0.0005). The zones where recos conducted case management were those where medicines were more available, with 92% of recos in Kouroussa possessing anti-malarials at the time of visit, compared to 38% in Boussou, 3% in Télimélé, and 7% in Mandiana (p<0.0005). Qualitative data revealed that for recos to expand from health promotion into case management, medicines must be available, and in Kouroussa the community emphasized the importance of free care. Moreover, qualitative data showed the primary motivation for recos was their loyalty to their community, and that recos were better accepted and more effective when they came from the same community they served, or were a “child” of the village. CONCLUSION To consistently achieve stated national ambitions of having recos that conduct case management, including in Kouroussa after MSF exits, medicine availability must be assured through appropriate resourcing. Additionally, our data suggest that each community should continue to have the power to choose their own reco. CONFLICTS OF INTEREST None declared.

<p>INTRODUCTION</p><p>Guinea’s Ministry of Health has proposed a standardized national community health program, including health promotion, case management, and referral; historically however the system has been implemented piecemeal by various actors. MSF has been present in Kouroussa, northern Guinea, since 2017. MSF activities there have been focused on community healthcare, through training and support for community health workers, or “recos”. Before exiting, MSF conducted a mixed-methods study to understand differences in the models and effects of MSF community health program, as compared to those implemented by other actors.</p><p></p><p>METHODS</p><p>We implemented an explanatory, sequential, mixed-methods study in Kouroussa and in three other zones, Mandiana, Télimélé, and Boussou; sites were selected to represent a diversity of situations, and those outside Kouroussa are supported by non-MSF actors. During the quantitative phase, 137 recos and 13 supervisory community health agents were interviewed about their demographic and professional details, availability of tools, the package of activities, activity levels, and practical knowledge. A qualitative phase, including 24 focus group discussions and 65 individual interviews followed, aiming to better understand the community and local health professional perceptions of community health programmes in each of the four zones. Quantitative data were analyzed using R (Vienna, Austria) to calculate descriptive measures; differences were compared between zones using chi-square and t-tests. Qualitative data audio recordings were translated and transcribed, read, and re-read to identify codes and themes.</p><p></p><p>ETHICS</p><p>This study was approved by the MSF Ethics Review Board and by the Comité National de la Recherche, Guinea.</p><p></p><p>RESULTS</p><p>Overall, recos in Mandiana and Télimélé were primarily involved in health promotion and referral, while recos in Kouroussa (supported by MSF), and some in Boussou, additionally conducted case management. In Kouroussa, recos conducted a median of 16.5 malaria consultations per month, compared to 8.0 in Boussou, 2.1 in Télimélé, and 0 in Mandiana (p<0.0005). The zones where recos conducted case management were those where medicines were more available, with 92% of recos in Kouroussa possessing anti-malarials at the time of visit, compared to 38% in Boussou, 3% in Télimélé, and 7% in Mandiana (p<0.0005). Qualitative data revealed that for recos to expand from health promotion into case management, medicines must be available, and in Kouroussa the community emphasized the importance of free care. Moreover, qualitative data showed the primary motivation for recos was their loyalty to their community, and that recos were better accepted and more effective when they came from the same community they served, or were a “child” of the village.</p><p></p><p>CONCLUSION</p><p>To consistently achieve stated national ambitions of having recos that conduct case management, including in Kouroussa after MSF exits, medicine availability must be assured through appropriate resourcing. Additionally, our data suggest that each community should continue to have the power to choose their own reco.</p><p></p><p>CONFLICTS OF INTEREST</p><p>None declared.</p>

The central role of the community and its place in both healthcare planning and service delivery is increasingly seen as a vital foundation for global health. The fourth edition of Setting up Community Health Programmes in Low and Middle Income Settings provides a practical introductory guide to the initiation, management, and sustaining of health care programmes in developing countries. The book has been fully revised to take into account the Millennium Development Goals, Sustainable Development Goals, and Universal Health Coverage. Taking an evidence-based approach the book provides rationales and contextualized examples of health at the community level. Key topics include non-communicable diseases, disability, addiction, abuse and mental health. This book provides a practical guide for community health workers including field workers, programme managers, medical professionals involved in front line health care, administrators, health planners and postgraduate students

A Community Health Programme in Rural Tamil Nadu, India: The Need for Gender Justice for Women

Community health programs are gaining relevance within national health systems and becoming inherently more complex. To ensure that community health programs lead to equitable geographic access to care, the WHO recommends adapting the target population and workload of community health workers (CHWs) according to the local geographic context and population size of the communities they serve. Geographic optimization could be particularly beneficial for those activities that require CHWs to visit households door-to-door for last mile delivery of care. The goal of this study was to demonstrate how geographic optimization can be applied to inform community health programs in rural areas of the developing world. We developed a decision-making tool based on OpenStreetMap mapping and route optimization algorithms in order to inform the micro-planning and implementation of two kinds of community health interventions requiring door-to-door delivery: mass distribution campaigns and proactive community case management (proCCM) programs. We applied the Vehicle Routing Problem with Time Windows (VRPTW) algorithm to optimize the on-foot routes that CHWs take to visit households in their catchment, using a geographic dataset obtained from mapping on OpenStreetMap comprising over 100,000 buildings and 20,000 km of footpaths in the rural district of Ifanadiana, Madagascar. We found that personnel-day requirements ranged from less than 15 to over 60 per CHW catchment for mass distribution campaigns, and from less than 5 to over 20 for proCCM programs, assuming 1 visit per month. To illustrate how these VRPTW algorithms can be used by operational teams, we developed an "e-health" platform to visualize resource requirements, CHW optimal schedules and itineraries according to customizable intervention designs and hypotheses. Further development and scale-up of these tools could help optimize community health programs and other last mile delivery activities, in line with WHO recommendations, linking a new era of big data analytics with the most basic forms of frontline care in resource poor areas.

Community health programs are gaining relevance within national health systems and becoming inherently more complex. To ensure that community health programs lead to equitable geographic access to care, the WHO recommends adapting the target population and workload of community health workers (CHWs) according to the local geographic context and population size of the communities they serve. Geographic optimization could be particularly beneficial for those activities that require CHWs to visit households door-to-door for last mile delivery of care. The goal of this study was to demonstrate how geographic optimization can be applied to inform community health programs in rural areas of the developing world. We developed a decision-making tool based on OpenStreetMap mapping and route optimization algorithms in order to inform the micro-planning and implementation of two kinds of community health interventions requiring door-to-door delivery: mass distribution campaigns and proactive community case management (proCCM) programs. We applied the Vehicle Routing Problem with Time Windows (VRPTW) algorithm to optimize the on-foot routes that CHWs take to visit households in their catchment, using a geographic dataset obtained from mapping on OpenStreetMap comprising over 100,000 buildings and 20,000 km of footpaths in the rural district of Ifanadiana, Madagascar. We found that personnel-day requirements ranged from less than 15 to over 60 per CHW catchment for mass distribution campaigns, and from less than 5 to over 20 for proCCM programs, assuming 1 visit per month. To illustrate how these VRPTW algorithms can be used by operational teams, we developed an "e-health" platform to visualize resource requirements, CHW optimal schedules and itineraries according to customizable intervention designs and hypotheses. Further development and scale-up of these tools could help optimize community health programs and other last mile delivery activities, in line with WHO recommendations, linking a new era of big data analytics with the most basic forms of frontline care in resource poor areas.

The faculty of Medicine of Mahidol University in Bangkok organized a community health program for medical students composed of 5 courses: health and demographic survey; analysis of community health programs; planning of community health care; clerkship in community health and internships in community health. These courses are organized to provide first hand experience for the student by enabling him to do field work. This consists of actually analyzing population problems, understanding the characteristics of the people whom the programs are designed to serve, and providing realistic solutions rather than theoretical ones. The effectiveness of this approach is best measured by the number of students who are engaged in voluntary projects designed to contribute to a solution of the population problem, and the interest they show in the community health program.