Community-level System Research Articles

Community-Level Service Integration Within Home Visiting Programs

National surveys were obtained from 193 programs serving children eligible for Part H who were identified by state-level administrators as demonstrating successful efforts in integrating services for families. Descriptive analyses were conducted to determine the service system models in place, the strategies used to facilitate service integration, the perceived barriers, and the relationship between the state-level systems and the community-level systems. A variety of successful strategies to facilitate integrated services were reported as being implemented at the community level, although there was limited coordination with hospitals, medical specialists, and mental health services. Insufficient funding for lower caseloads and compensation for service coordination efforts were perceived as the greatest barriers to system integration efforts. States supported communities primarily through the provision of information concerning policies and regulations; the use of other support strategies (e.g., needs assessments for obtaining community input) was less prevalent.

Marketing Medicines: Pharmaceutical Services in a Salvadoran Community

The impact of multinational corporations on economic development in Third World countries has been a subject of attention in a growing number of social science investigations. The multinational pharmaceutical industry, in particular, has received considerable study. In the last decade numerous investigations of the effects of these companies on Third World pharmaceutical industries and public-sector health-care services have been published.' Very little is known, however, about the impact of modern pharmaceutical products and the agents who dispense them on community-level systems of health care. This article reports on an anthropological investigation of privatesector policies and practices regarding the distribution and sale of prepackaged pharmaceutical products in El Salvador. Specifically, it examines the effects of different distributional networks on health-care services provided at pharmacies in a medium-sized town. While the focus is on pharmacies, the effects of the penetration of pharmaceutical products on other sources of health care in the town will also be discussed. The research was conducted in Asuncion,2 El Salvador, from August 1978 through July 1979. The community, located in the western part of the country, is predominantly mestizo, much of the Nahautl-Indian-speaking population and social structure having been eliminated as a consequence of the 1932 peasant uprising and subsequent government repression. In 1979 Asuncion had a population of approximately 11,300 and, as the municipal seat and commercial center for the surrounding agricultural region, offered a range of Western and alternative sources of