Health Services Project Research Articles

New Ways of Working in child and adolescent mental health services ‐ 'keep the baby but throw out the bathwater'

This paper focuses on the policy context that led to the development of the New Ways of Working in child and adolescent mental health services (NWW CAMHS) project and the future direction of change that is its legacy. NWW CAMHS represents a merging of policy and practice across what is sometimes a divide between adult and child services. In some aspects, CAMHS had already adopted what became known as a NWW in adult mental health with multidisciplinary teams characterised by dispersed patterns of responsibility and leadership. In other areas, particularly the involvement of service users and carers, CAMHS has been less forward‐thinking. There continues to be a significant workforce challenge for children's services and a risk that innovation and development will not be fully inclusive of the full range of service users' needs. It is important that the lessons learned from the national workforce programme are kept while the usual boundaries to development across services are broken down.

IDS Practice Paper Research Summary 2: A Partnership for Health in China: Reflections on the Partnership Between the Government of China, the World Bank and DFID in the China Basic Health Services Project

IDS Practice PapersVolume 2009, Issue 2 p. i-ii Free Access IDS Practice Paper Research Summary 2: A Partnership for Health in China: Reflections on the Partnership Between the Government of China, the World Bank and DFID in the China Basic Health Services Project First published: 23 October 2009 https://doi.org/10.1111/j.2040-0225.2009.00002_1.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume2009, Issue2Special Issue: A Partnership for Health in China: Reflections on the Partnership Between the Government of China, the World Bank and DFID in the China Basic Health Services ProjectMay 2009Pages i-ii RelatedInformation

A Partnership for Health in China: Reflections on the Partnership Between the Government of China, the World Bank and DFID in the China Basic Health Services Project

SummaryThis practice paper is one of a series, in which development practitioners reflect on their own experiences. Its aim is to contribute to efforts to understand China's successful management of very rapid change and development. It explores the relationship between central and local governments in the implementation of change and the role of partnerships between the Chinese government and international and bilateral organisations. It focuses on the health sector, which has experienced major challenges in adapting to the many changes associated with the transition to a market economy. By the mid‐1990s, policymakers had recognised the need to address these challenges, but they did not have a clear understanding of a practical way forward. One government strategy to build this understanding was to collaborate with the World Bank and the Department of International Development of the UK in the design and implementation of a project which encouraged a large number of poor rural counties to test strategies for strengthening their health service. The end‐of‐project evaluations documented the many changes they had put into place and the contribution this project made to national policy processes.The authors played different roles in the project. This enabled them to gain first‐hand knowledge of the relationship between levels of government and between officials of the government and the international agencies. When the project came to an end they decided to reflect on what they had learned. This practice paper presents the results of this reflection. It provides unique insights into the way China is managing health system change and into the working of partnerships between the Government of China, the World Bank and bilateral donor agencies.

The evaluation of public health in South Eastern Europe: from transition to progress

Background: The public health services project of the South-eastern Europe health network has undertaken an evaluation of public health services in its nine member countries. The purpose of the evaluation of public health services provision in the South-eastern European (SEE) countries is to understand where these countries now stand in public health, the institutional, organisational, legislative and service delivery developments that are taking place and to identify strengths and weaknesses in their public health systems and services in order to inform decision making about investment and future reform. Methods: The evaluation was orientated around “essential public health operations” that are deemed to form the core of public health activities and services and to be indispensable to the delivery of modern public health services in any country. The evaluation analysed these activities and services within the structure of the health system functions of stewardship, resource generation, financing and service delivery, as developed by WHO. Results: The results demonstrate a mixed picture of strengths and weaknesses within the context of significant social, economic and political challenges in the region. Among the many visible and significant strengths in public health services in the region are well developed networks of public health institutes with well defined surveillance systems, highly experienced and well educated public health professionals as well as many positive examples of service delivery. But there are also many concerns and challenges, not the least of which is political focus, direction and support for modern public health services, as well as funding. Collaboration and partnership among sectors is weak and information and communication systems are inadequate and not sufficiently integrated. Conclusions: Having emphasized the main weak and challengeable points in the Public Health systems and services in the SEE countries, the evaluation is also a first step to defining a way forward in the SEE countries to ensure that the turmoil of ‘transition’ is only a prelude to the comprehensive modernisation of public health services.

Unmet family planning need: Differences and levels of agreement between husband-wife, Haryana, India

Research question:Is there agreement between husbands and wives regarding unmet need of family planning?Hypothesis:The unmet need of family planning is perceived more by women then their husbands.Objective:1) To ascertain the unmet needs of family planning for husbands and wives. 2) To ascertain the level of agreement between husbands and wives regarding unmet needs of family planning.Design:A cross-sectional surveySetting:Dayalpur village in Intensive field practice area of Comprehensive Rural Health Services project (CRHSP), Ballabgarh, Haryana.Study Period:July 2003- June 2005.Participantsincluded 200 married couples selected by simple random sampling.Statistical Analysis:Level of agreement between husbands and wives was analyzed using Kappa statistics.Results:Unmet need for family planning was 11% (22 out of 200) for husbands and 17.5% (35 out of 200) for wives. The difference was seen both in unmet need for spacing (M-3.5% vs. F-6%) as well as limiting family size (M-7.5% vs. F-11.5%). Overall, 93.5% concordance was observed amongst husbands and wives. In all the cases where disagreement was seen (6.5%), wives reported having unmet need for contraception whereas their husbands perceived none. The unadjusted Kappa statistic was 0.73 and prevalence adjusted Kappa was 0.88.Conclusion:Unmet need for family planning was significantly higher for wives compared to husbands. Despite high degrees of agreement amongst the couples, the nature of disconcordance reinforces the need for policy makers to take into account the perspective of men.

Managing with maps? The development and institutionalization of a map-based health management information system in Madhya Pradesh, India

This paper presents the development of a map-based health management information system (mHMIS) in the central Indian province of Madhya Pradesh. Sample outputs and statistics from the system for one district are presented. The implementation dynamics and the preliminary performance of the system are discussed. The development of the mHMIS was a collaborative effort between the provincial Department of Health, the medical university and the Danidasupported Madhya Pradesh Basic Health Services project. One of India's most socioeconomically backward provinces, Madhya Pradesh is spread over an area of 304,000 km(2), and has a population of 60.4 million distributed in its 55,392 villages and 394 towns. A primary survey of all healthcare providers (public and private) in the province was done to map these. Secondary data sources for sociodemographic information (census of India), vital statistics and health program indicators (health worker records) were used in developing the system. The process of mapping from obtaining hand-drawn maps of the villages from the commissioner, land records, to final digitizing is also described. Sample outputs and statistics for one district (Chindwara) from the system are presented. There were 20.35 trained doctors in rural areas and 72.78 in urban areas per 100,000 population. Preliminary experience after a year, advantages, constraints (both systemic limitations and weakness in the mHMIS) to optimal usage, and future prospects for use in this setting are discussed.

Are Quality Indicators for Radiotherapy Useful in the Evaluation of Service Efficacy in a New Based Radiotherapy Institution?

A number of documents assess the need for quality assurance in radiotherapy, which must be constantly monitored and possibly improved. In this regard, a system that confirms the quality of a department has been suggested and quality indicators have been used to improve the quality of the service. The National Health Service (Istituto Superiore di Sanità) approved a National Research Project to increase the quality of radiotherapy. The aim of the present study was to analyze the practical feasibility and efficacy of the quality indicators elaborated by the National Health Service study group in a radiotherapy unit. The voluntary accredited program was carried out by the Radiotherapy Department of IRCC in Candiolo from June to August 2002. We analyzed 8 of the 13 indicators according to the National Health Service Project. For this purpose, 133 consecutive patients treated in our Unit were analyzed, and the results are reported according to the appropriate indicator (number of staff related to patients treated, waiting list, case history accuracy, multidisciplinary approach, number of treatment plans performed by CT, number of fields per fraction, number of portal imaging performed per overall treatment, and patient satisfaction). The number of professional staff related to the number of patients treated was easy to calculate and it could be the basis for further evaluation. The overall waiting time was 55.4 days, and it changed for different radiotherapy goals. We obtained 80% conformity in case-history accuracy. The number of multidisciplinary consultations performed ranged between 50% and 100%. The number of CT plans was about 1.6 +/- 0.9 plans per patient. The mean number of fields performed per day and per patient is 3.5 +/- 1.7 and was in agreement with the fact that more than 50% of treatments in our Center were performed with conformal radiotherapy. An average of 16.7 +/- 10.0 portal imaging per case was performed. The percentage of patient satisfaction with the staff obtained a very high compliance. The self evaluation promoted by the National Health Service Project allows the monitoring of the activities of the service in order to asses critical factors and it can be the starting point to improve the quality of the service and to compare national and international quality assurance results.

SPECIALIST SURGICAL TRAINING IN PAPUA NEW GUINEA: THE OUTCOMES AFTER 10 YEARS

Surgical training commenced in 1975, the year that Papua New Guinea (PNG) gained independence. The training involves a 4-year programme leading to a Master of Medicine (MMed), awarded by the University of Papua New Guinea. In the past 30 years just over 50 general surgeons have graduated. There have also been 9 graduates in the area of ear nose and throat, 10 in ophthalmology and 2 in oral surgery. The subspecialization of general surgeons began in 1994 with four trainees, two orthopaedic, one head and neck and one urological. The model used was to develop specialist skills over 2-3 years only qualified (MMed) general surgeons so that their ability to carry out general surgical procedures and work in a remote hospital was not lost. The different specialties required different balances of in-country and out-of-country training depending on the local ability to provide training in PNG. An important sponsor has been the PNG National Department of Health, which has funded the training posts by using existing general surgical positions and covering the loss of manpower while surgeons are training overseas, sometimes for up to 2 years. Medical education and tertiary health service projects, funded by Aus-Aid, have also contributed significantly to the teaching and training. These projects have provided visiting specialists to teach and hospital attachments for national surgeons to train in Australasia. Various individual surgeons and their specialist societies in Australasia have also provided invaluable support. Three surgeons have been recipients of the Rowan Nicks scholarship. Twelve surgeons have been awarded a specialist diploma and a further five are in training. The posting of national specialist surgeons to Port Moresby has resulted in all modules of the General surgery MMed programme being taught by Papua New Guineans, which would have been hard to imagine back in 1993. The MMed is now a sustainable programme and can be provided without external support. National surgeons carry out a wide range of specialist procedures, formerly carried out only by visiting teams. They are also able to make outreach visits within PNG and specialist visits to neighbouring Pacific Island countries.

AIMS and its aims

Clinical Psychology Forum talks to John Hanna about the Accreditation for Acute Inpatient Mental Health Services (AIMS) project.

A Mental Health Program for Ground Zero Rescue and Recovery Workers: Cases and Observations

A Mental Health Program for Ground Zero Rescue and Recovery Workers: Cases and Observations

The dynamics of control and mobile computing in distributed activities

Mobile technologies are increasingly finding a place in a multitude of organisational settings. As they are intimately associated with the individuals carrying them, they can potentially play a significant role in the remote control of activities. The aim of this paper is to analyse how the balance of control between local and remote authorities shapes the use of mobile technology in a distributed activity. Based on 1-year action research study of work-integrated learning within a British National Health Service (NHS) project, we discuss the use of mobile technology as a function of control and human mobility. The aim of the project was to pilot the establishment of a new NHS profession, the Perioperative Specialist Practitioner (PSP). The article explores how the contradicting goals of the London-based project management team and of the everyday activities of the surgical teams across Great Britain hosting the PSP trainees critically shaped the unsuccessful use of mobile technology in the project. Based on a theoretical analysis using Activity Theory we outline four analytical categories of local-remote control configurations; (1) territorial dispute; (2) strong local control; (3) strong remote control; and (4) shared harmonious control. We apply these in a discussion of how the use of mobile technology is shaped by contradicting or harmonious motives between object and advanced activities.

Medical Schools Win Grants For Community Projects

Back to table of contents Previous article Next article Association NewsFull AccessMedical Schools Win Grants For Community ProjectsTara BurkholderTara BurkholderSearch for more papers by this authorPublished Online:21 Apr 2006https://doi.org/10.1176/pn.41.8.0024The American Psychiatric Foundation (APF) has selected three universities to receive the first annual Helping Hands Grants. Each school will receive a $5,000 grant for a community mental health service project initiated and managed by medical students under the supervision of medical faculty. The awards are made possible through an unrestricted educational grant from Otsuka America Pharmaceutical Inc.The foundation, which is dedicated to advancing public understanding that mental illnesses are real and can be effectively treated, approved the following grants:Case Western Reserve University, Cleveland Clinic Lerner College of Medicine, is receiving a grant for Bustin' Loose About Sharing Thoughts: A Student Mental Health Education Initiative (BLAST!). The initiative will establish an innovative intervention for fifth graders in East Cleveland to improve their awareness and understanding of mental health issues and help them learn coping strategies. Medical students Beverly Jong, Christine Baran, Leonid Cherkassky, Julia Head, Carl Koch, and Sherwin Yen are participating in the initiative.University of Medicine and Dentistry of New Jersey is receiving a grant to develop, design, and produce culturally competent informational materials for the community that focus on mental health literacy and education with the incorporation of routine screening for mental disorders at the New Jersey Medical School Family Health Care Center. The center is a free student-run community health center for uninsured and underinsured people of Newark. Medical student Christian Reusche is leading the initiative.University of Illinois at Chicago College of Medicine is receiving a grant for the Maternal Obstetric Outreach and Depression Screening program (MOODS), which will improve identification and treatment of women with postpartum mood disorders in underserved populations. Medical students Nicole James, Andree Leroy, and Jennifer Rhee are participating in the initiative.“We are pleased to provide funding to these schools for the valuable community mental health activities being undertaken by students,” said APF President Altha Stewart, M.D. “These students are the future of our profession, and I am proud that they are taking the initiative to work with underserved populations.”The Helping Hands Grant Program raises awareness of mental illness and the importance of early recognition and builds an interest among medical students in psychiatry and service in underserved communities.More information is posted online at<www.psychfoundation.org>.▪Tara Burkholder is the marketing communications manager of the American Psychiatric Foundation. ISSUES NewArchived

What's in a service? Consumers' views of Australian mental health services.

This paper reports on a series of interviews with consumers of mental health services, conducted as part of the Consumer Evaluation of Mental Health Services project (CEO-MHS). With one of our overarching aims being to develop a consumer oriented and consumer directed method of evaluating mental health services, we considered seeking consumers' views of mental health services, using qualitative interviews, to be essential. Consumer Researchers from the team conducted 33 interviews in NSW, Australia. Eleven themes emerged from analysis of the interview data and these themes are described in detail.

Community mapping as a research tool with youth

This article provides a detailed description of the in-field experience of using community mapping as a participatory action research tool with youth. It describes a case study, the Youth Friendly Health Services project (YFHS project), in which a team of Vancouver youth carried out a participatory evaluation of health clinics by mapping out criteria for evaluation and then creating an evaluation tool based on the maps that were created. Community mapping proved to be an inclusive and appropriate tool to engage youth perspectives. The major challenges faced in the process were in determining how to represent and act upon the findings of the mapping process. Their experience suggests that while such innovative data collection tools such as community mapping can successfully engage youth, not just as participants, but as facilitators of research, they must be accompanied by equally creative and innovative approaches to formulating research results and outcomes.

Tobacco and alcohol use in rural elderly Indian population.

Background:Tobacco and alcohol use are serious health problems. Studies focusing on problems associated with tobacco and alcohol use in the elderly are limited.Aim:To find out the prevalence of tobacco and alcohol use among rural elderly population.Methods:This cross-sectional study was conducted in the intensive field practice area of the Comprehensive Rural Health Services Project in Ballabgarh in Faridabad, Haryana, a rural field practice area of the Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi. The sample was selected using stratified random cluster sampling. The participants were ≥60 years of age at the time of interview. Data on tobacco and alcohol use pattern of 1117 elderly were collected during the interview.Results:The prevalence of smoking was 71.8% in men (n=490) and 41.4% in women (n=497). Among men smokers, 41.5% were light smokers (≤5 beedis/day), 42.9% were moderate smokers (6–20 beedis/day) and 15.6% were heavy smokers (>20 beedis/day). Among women smokers, 71.8% were light smokers, 23.8% were moderate smokers and 4.4% were heavy smokers. Regular alcohol intake was seen in 16.3% of the men compared with 0.8% of the women.Conclusion:The finding of a high prevalence of smoking and alcohol consumption among men in this rural population of India is of serious concern and therefore needs remedial measures.

ミャンマー連邦におけるハンセン病対策を通したリハビリテーションスタッフの育成

I participated in "Leprosy Control and Basic Health Service Project in Myanmar" by JICA from 2002 to 2004. I went to Myanmar three times as a short-term expert of physiotherapy. I carried out evaluation training for physio staffs in national Yenanthar leprosy hospital. They learned how to evaluate activity of daily living. And they were able to make modified spoons and the canes. Later, they looked for the contents to evaluate by themselves. And they evaluated and decided by themselves what they should do. They felt the necessity for toilet chairs, modified beds and etc. They formed the plan and manufactured them. They were able to perform by themselves. It is thought that evaluation was fixed to staffs. This knowledge will surely be helpful to patients. I expect that this knowledge will be put to evaluations and exercises of many diseases. The physio staffs of this hospital will surely perform. Cooperation of the shoemaker and nursing staffs is very secure. I hope that it may become the model of saying [working in cooperation with other occupational descriptions] from now on.

途上国におけるハンセン病の病理診断

In the developing countries where leprosy is prevalent, diagnosis of leprosy is made from clinical signs and symptoms. However, when difficult and doubtful cases increase after the advance of leprosy control programs, definitive diagnosis of leprosy by histopathology become necessary. This report describes our experience of technical support to re-establish histopathology service and introduction of immunohistochemistry in the leprosy referral center of Myanmar, and we discuss the ideal way of international technical support. This activity was performed as a part of leprosy control and basic health services project of Japan International Cooperation Agency (JICA) since 2000 to 2005.

ミャンマー・サンダル開発の経緯とその効果（ミャンマー連邦・ハンセン病対策・基礎保健サービス改善プロジェクトに於ける活動）

"Leprosy control and Basic health service Project" was terminated at March 2005 within the scope of the period. I was assigned to develop the Plantar protect footwear for neuropathic feet, which called "Myanmar Sandals" in common. These sandals are not made by new technologies but made by basic knowledge. I would like to report about this activity as which is a part of distinguished strategy of ODA (Official Development Assistance) for developing country, but not as the technical report of these sandals. There is only one National Leprosy Hospital in Myanmar. At the time this project started, there were only two footwear technicians for the people who had disabilities by after effect of Hansen's disease in this country. And, it would appear that the number of the people is over 50,000. Furthermore, the budget of national hospital is not enough to refill necessary consumable supplies and materials. Although, I should instruct new technique which like making in Japan in ordinary circumstances, I could not think that such technical transfer by using costly imported materials woud bring beneficial effect and be continued. We were bound to be anxious about such situations when we made the plan. As a result of examining a plan based on these situations, we reached the conclusion that development of the simplified ready-made footwear was pressing need.

ミャンマーにおける「ＪＩＣＡハンセン病対策・基礎保健サービス改善プロジェクト」

Japan International Cooperation Agency (JICA) implemented a 5-year long bilateral technical cooperation project, "Leprosy Control and Basic Health Services Project" in Myanmar. The project was implemented by National Leprosy Control Program, Department of Health with close technical collaboration of JICA experts mainly from International Medical Center of Japan (IMCJ) and National Sanatoriums of leprosy in Japan. It accelerated to achieve the elimination of leprosy at national level, which was declared in January 2003, and at sub-national level onward. It also developed the appropriate technologies for prevention of disability and prevention of worsening of disability (POD/POWD), which were introduced in 9 townships as a pilot service program. The Government stratified the POD/POWD services as a national program since 2005 by taking up the former pilot area to start with. The project also strengthened the function of referral system of leprosy control (Diagnosis and treatment), POD/POWD and physical rehabilitation. Beside leprosy, the project conducted a series of refresher trainings for primary health care givers, Basic Health Service Staff (BHS), of project areas (48 townships) to improve the services on tuberculosis, Malaria, Leprosy, Trachoma and HIV/AIDS for 3 years (2001-2003), which was evaluated in 2004. It contributed to improve the services at township level hospitals in procurement of audio-visual equipments and in conducting microscope training on leprosy, Malaria and tuberculosis at project areas.

Comparison of field olfactometers in a controlled chamber using hydrogen sulfide as the test odorant

A standard method for measuring and quantifying odour in the ambient air utilizes a portable odour detecting and measuring device known as a field olfactometer (US Public Health Service Project Grant A-58-541). The field olfactometer dynamically dilutes the ambient air with carbon-filtered air in distinct ratios known as "Dilutions-to-Threshold" dilution factors (D/Ts), i.e. 2, 4, 7, 15, etc. Thirteen US states and several cities in North America currently utilize field olfactometry as a key component of determining compliance to odour regulations and ordinances. A controlled environmental chamber was utilized, with hydrogen sulfide as the known test odorant. A hydrogen sulfide environment was created in this controlled chamber using an Advanced Calibration Designs, Inc. Cal2000 Hydrogen Sulfide Generator. The hydrogen sulfide concentration inside the chamber was monitored using an Arizona Instruments, Inc. Jerome Model 631 H2S Analyzer. When the environmental chamber reached a desired test concentration, test operators entered the chamber. The dilution-to-threshold odour concentration was measured using a Nasal Ranger Field Olfactometer (St Croix Sensory, Inc.) and a Barnebey Sutcliffe Corp. Scentometer. The actual hydrogen sulfide concentration was also measured at the location in the room where the operators were standing while using the two types of field olfactometers. This paper presents a correlation between dilution-to-threshold values (D/T) and hydrogen sulfide ambient concentration. For example, a D/T of 7 corresponds to ambient H2S concentrations of 5.7-15.6 microg/m3 (4-11 ppbv). During this study, no significant difference was found between results obtained using the Scentometer or the Nasal Ranger (r = 0.82). Also, no significant difference was found between results of multiple Nasal Ranger users (p = 0.309). The field olfactometers yielded hydrogen sulfide thresholds of 0.7-3.0 microg/m3 (0.5-2.0 ppbv). Laboratory olfactometry yielded comparable thresholds of 0.64-1.3 microg/m3 (0.45-0.9 ppbv). These thresholds are consistent with published values.