Local Health Priorities Research Articles

Japanese neonatal nursing with a historic perspective

Neonatal Nurses' scope of practice and scope of knowledge varies widely across the globe. The development of professional roles is unique to specific regions and is often driven by a number of factors, including local culture and health priorities. Japanese neonatal nurses have traditionally practiced with limited scope compared to the other parts of the world. However, the present climate in Japan presents an opportunity for the innovative developments. An exploration into advancing the role of neonatal nurses revealed complexities that impacted on current Japanese nursing practice. This article will discuss the legal and historic influences that have shaped current neonatal nursing practice, the training, educational opportunities for nurses pursuing neonatal nursing, and the challenges for those who wish to practice beyond the scope of traditional practice in Japan today.This report regarding the legal and historic influences on Neonatal Nursing in Japan aims to provide a backdrop to future reports from Japan. It is hoped that this knowledge will add clarity to future discussions on issues surrounding Neonatal Nursing globally.

New Mexico Community Health Councils: Documenting Contributions to Systems Changes.

Coalition research has shifted from delineating structures and processes to identifying intermediate, systems changes (e.g., changes in policies) that contribute to longterm community health improvement. The University of New Mexico, the New Mexico Department of Health, and community health councils entered a multiyear participatory evaluation process to answer: What actions did health councils take that led to improving health through intermediate, systems changes? The evaluation system was created over several phases through an iterative, participatory process. Data were collected for councils' health priority areas (e.g., substance abuse) from 2009 to 2011. Twenty-three community health councils participated. Intermediate systems changes were measured: 1) networking and partnering, 2) joint planning of strategies, programs, and services, 3) leveraging resources, and 4) policy initiatives. Health councils reported data for each intermediate outcome by health priority area. Data showed councils identified local public health priorities and addressed those priorities through strengthening networks and partnerships, which lead to the creation and enhancement of strategies, services, and programs. Data also showed councils influenced policies in several ways (e.g., developing policy, identifying new policy, or sponsoring informational forums). Additionally, data showed councils leveraged $1.10 for every dollar invested by the state. When funding was suspended in July 2010, data showed dramatic decreases in activity levels from 2010 to 2011. The data demonstrate the feasibility and utility of an Internet-based system designed to gather intermediate systems changes evaluation data. This process is a model for similar efforts to capture common outcomes across diverse coalitions and partnerships.

‘A plague of our times’: Addressing health-related lifestyle choices in England

Recently, responsibility for public health commissioning in England was placed within local authorities and councillors in local authorities are now seen as key figures; ‘‘tak[ing] on leadership for public health at the local level’’ (Dept. of Health, 2012:6–7). It is critical that councillors, in their new leadership roles within public health, are consulted to establish their local health priorities. This study aimed to engage with councillors to identify health priorities, relating to the needs of local populations. This research reveals councillors perspectives on the health care needs of their local populations.

How to do (or not to do) … translation of national health accounts data to evidence for policy making in a low resourced setting.

For more than a decade, the Organization for Economic Co-operation and Development (OECD), the World Health Organization (WHO) and the World Bank have promoted the international standardization of National Health Accounts (NHA) for reporting global statistics on public, private and donor health expenditure and improve the quality of evidence-based decision-making at country level. A 2010-2012 World Bank review of NHA activity in 50 countries found structural and technical constraints (rather than cost) were key impediments to institutionalizing NHA in many low- and middle-income countries (LMICs). Pilot projects focused resources on data production, neglecting longer-term capacity building for analysing the data, developing ownership among local stakeholders and establishing routine production, utilization and dissemination of NHA data. Hence, genuine institutionalization of NHA in most LMICs has been slow to materialize. International manuals focus on the production of NHA data and do not include practical, incremental and low-cost strategies to guide countries in translating the data into evidence for policy-making. The main aim of this article is to recommend strategies for bridging this divide between production and utilization of NHA data in low-resource settings. The article begins by discussing the origins and purpose of NHA, including factors currently undermining their uptake. The focus then turns to the development and application of strategies to assist LMICs in 'unlocking' the hidden value of their NHA. The article draws on the example of Fiji, a country currently attempting to integrate their NHA data into policy formulation, despite minimal resources, training and familiarity with economic analysis of health systems. Simple, low cost recommendations such as embedding health finance indicators in planning documents, a user-friendly NHA guide for evaluating local health priorities, and sharing NHA data for collaborative research have helped translate NHA from raw data to evidence for policymaking.

Does a local financial incentive scheme reduce inequalities in the delivery of clinical care in a socially deprived community? A longitudinal data analysis.

BackgroundSocioeconomic deprivation is associated with inequalities in health care and outcomes. Despite concerns that the Quality and Outcomes Framework pay-for-performance scheme in the UK would exacerbate inequalities in primary care delivery, gaps closed over time. Local schemes were promoted as a means of improving clinical engagement by addressing local health priorities. We evaluated equity in achievement of target indicators and practice income for one local scheme.MethodsWe undertook a longitudinal survey over four years of routinely recorded clinical data for all 83 primary care practices. Sixteen indicators were developed that covered five local clinical and public health priorities: weight management; alcohol consumption; learning disabilities; osteoporosis; and chlamydia screening. Clinical indicators were logit transformed from a percentage achievement scale and modelled allowing for clustering of repeated measures within practices. This enabled our study of target achievements over time with respect to deprivation. Practice income was also explored.ResultsHigher practice deprivation was associated with poorer performance for five indicators: alcohol use registration (OR 0.97; 95 % confidence interval 0.96,0.99); recorded chlamydia test result (OR 0.97; 0.94,0.99); osteoporosis registration (OR 0.98; 0.97,0.99); registration of repeat prednisolone prescription (OR 0.98; 0.96,0.99); and prednisolone registration with record of dual energy X-ray absorptiometry (DEXA) scan/referral (OR 0.92; 0.86,0.97); practices in deprived areas performed better for one indicator (registration of osteoporotic fragility fracture (OR 1.26; 1.04,1.51). The deprivation-achievement gap widened for one indicator (registered females aged 65–74 with a fracture referred for a DEXA scan; OR 0.97; 0.95,0.99). Two other indicators indicated a similar trend over two years before being withdrawn (registration of fragility fracture and over-75 s with a fragility fracture assessed and treated for osteoporosis risk). For one indicator the deprivation-achievement gap reduced over time (repeat prednisolone prescription (OR 1.01; 1.01,1.01). Larger practices and those serving more affluent areas earned more income per patient than smaller practices and those serving more deprived areas (t = −3.99; p =0.0001).ConclusionsAny gaps in achievement between practices were modest but mostly sustained or widened over the duration of the scheme. Given that financial rewards may not reflect the amount of work undertaken by practices serving more deprived patients, future pay-for-performance schemes also need to address fairness of rewards in relation to workload.

Swedish public health policy: Impact on regional and local public health practice and priorities.

We evaluated the Swedish National Public Health Policy to determine its impact on public health priorities and practice at regional and local levels between 2004 and 2013. We conducted a survey by questionnaire in February 2013 among Swedish county councils/regions (n=19/21), and municipalities (n=219/290). The National Public Health Policy facilitated systematic public health practice, particularly for planning, for high priority concerns, including conditions during childhood and adolescence, physical activity, and tobacco prevention. Respondents expressed need for a comprehensive monitoring system with comparable indicators nationwide and explicit measurable objectives. To ensure effective monitoring and follow-up, the measurable outcomes need direct relevance to decision making and high-priority public health issues addressing Sweden's "overarching public health goal" - to create societal conditions for good health on equal terms for the entire population.

Impact of selection strategies on representation of underserved populations and intention to practise: international findings.

Socially accountable medical schools aim to reduce health inequalities by training workforces responsive to the priority health needs of underserved communities. One key strategy involves recruiting students from underserved and unequally represented communities on the basis that they may be more likely to return and address local health priorities. This study describes the impacts of different selection strategies of medical schools that aspire to social accountability on the presence of students from underserved communities in their medical education programmes and on student practice intentions. A cross-sectional questionnaire was administered to students starting medical education in five institutions with a social accountability mandate in five different countries. The questionnaire assessed students' background characteristics, rurality of background, and practice intentions (location, discipline of practice and population to be served). The results were compared with the characteristics of students entering medical education in schools with standard selection procedures, and with publicly available socio-economic data. The selection processes of all five schools included strategies that extended beyond the assessment of academic achievement. Four distinct strategies were identified: the quota system; selection based on personal attributes; community involvement, and school marketing strategies. Questionnaire data from 944 students showed that students at the five schools were more likely to be of non-urban origin, of lower socio-economic status and to come from underserved groups. A total of 407 of 810 (50.2%) students indicated an intention to practise in a non-urban area after graduation and the likelihood of this increased with increasing rurality of primary schooling (p = 0.000). Those of rural origin were statistically less likely to express an intention to work abroad (p = 0.003). Selection strategies to ensure that members of underserved communities can pursue medical careers can be effective in achieving a fair and equitable representation of underserved communities within the student body. Such strategies may contribute to a diverse medical student body with strong intentions to work with underserved populations.

Health research in the Western Cape province, South Africa: lessons and challenges.

BackgroundHealth research can play a critical role in strengthening health systems. However, little monitoring of health research is conducted in African countries to identify whether research contributes to addressing local health priorities.Aim/SettingTo review the profile of research on the health service platform in the Western Cape province of South Africa which was approved by the health authorities over the period January 2011 to December 2012.MethodsDatabases held by both the Provincial and City of Cape Town health departments were reviewed. Descriptions of research institution, location of research, topic and funding size and source were analysed.ResultsOf the health research approved in the province, 56% of projects were located on the District Health Services platform and 70% were based in the Cape Metropolitan area. For projects reporting budgetary information, the total funding was US $29.2 million. The primary focus of research was on HIV and tuberculosis (TB), whilst relatively few studies addressed nutrition, mental health or injury and there was little health systems research. Research funding was dominated by very large grants from foreign funders for HIV and/or TB research. South African government sources comprised less than 8% of all health research funding.ConclusionThere is a partial mismatch of donor funding to local health priorities. Greater focus on neglected areas such as mental health, trauma, nutrition and non-communicable disease, as well as greater investment in health systems research, is needed. Unless governments increase funding for research and a culture of research translation is achieved, health research will have limited impact on both local and national priorities.

A critical discussion of the Community Readiness Model using a case study of childhood obesity prevention in England.

Recent reforms to the public health system in England aim to generate co-ordinated action between local authorities, healthcare systems and communities to target local health priorities. To support this effort, researchers must contribute and evaluate appropriate strategies for designing interventions tailored to community-specific needs. One strategy is to apply the Community Readiness Model (CRM), which uses key informant interviews to assess a community's readiness to address local issues. This article presents a critical discussion of the CRM developed from a case study of obesity prevention in pre-adolescent girls within a community in the United Kingdom. Data were collected between February and November 2011. We offer lessons learnt and recommendations relating to (i) modifications to the interview guide; (ii) key informant identification; (iii) conducting interviews to theoretical saturation; (iv) using key informants to define their community; (v) key informant's ability to respond on behalf of the community; (vi) using a qualitative model with a quantitative scoring system; and (vii) the optimum application of transcript scoring. In conclusion, the CRM can help researchers, health professionals and local authorities identify the priorities of a community. It is recommended that users of the model be careful to identify and recruit suitable key informants with the help of the community under study, select an appropriate 'community' and utilise the qualitative findings to strengthen the interpretation of the readiness score.

Linking community groups to primary health care services

Introduction: Since 2007, project Sino has been developing a concept for community participation and health promotion. The concept includes direct community activities and also covers institutional aspects [1]. The ‘bottom-up’ approach to community involvement has proved to be appropriate for the rural contexts in which project Sino is active. This approach responds to community-defined health needs and concentrates on establishing community groups of “active individuals”. The bottom-up approach empowers ownership of health services within the village communities. Aims: The current model links community groups to primary health care and healthy lifestyle services (in Healthy Lifestyle Centres) to encourage health promotion and disease prevention activities. The prospects for such integration are generally good, especially in the pilot districts in which the project has worked over the past years. Results: Local primary health care, family medicine and Healthy Lifestyle Centre staff is well aware of the importance of village communities defining their own needs. In this regard, conducting “Participatory Reflection and Action” sessions and providing information on, as well as prevention measures against priority diseases have already become a standard practice for many of the Centers’ staff. Priority health issues, identified by the community groups through a participatory approach, relate to non-communicable diseases, infectious diseases, mother and child health, immunization, breastfeeding, and reproductive health, among others. Using Family Medicine (FM) services gives communities the chance to be actively involved in their own health care and in the health of surrounding people. It promotes increased involvement of community groups, which in turn further strengthens FM services. FM teams work collaboratively with their communities to address local health priorities. Their role is to increase the knowledge of communities about the needs and importance of Primary Health Care/FM services, to support community groups in identifying and bringing forward health problems at local level and to develop locally sensitive responses and generate solutions. Furthermore, they aim to provide communities with health information on identified health topics, to improve the packages of primary health care/family medicine services provided, and to understand that communities are an important resource and partner in family medicine and health promotion. Increased health awareness increases the use of FM services. “It is important to ensure community support [for] and use [of] services through activities which ... increase demand. Success of family medicine services will also depend on bringing services closer to the population and giving users a certain feeling of ownership over services” [2, p.53-55]. Community Integrated Care and Social Services, Romania, February 21, 2014. International Journal of Integrated Care – Volume 14, 26 May – URN:NBN:NL:UI:10-1-116231– http://www.ijic.org/ Conclusions: The approach is well-received, entails relatively low cost, meets demand and increases the credibility of family medicine, offering sustainable solutions at a local level if accepted by and integrated into state structures.

Health priorities in an Australian mining town: an intercept survey

In developed countries men's health is poorer than women's for a range of key indicators, and being an Indigenous man in Australia widens the gap substantially. Establishing the rates of mortality and health inequality between the sexes is useful for identifying that men's health needs attention and Indigenous men need particular attention. Men's health-seeking behaviour has been suggested as one of the causes of poor outcomes. This study aimed to identify differences in health concerns between men and women, and Indigenous and non-Indigenous people in an Australian mining town with the aim of targeting health promotion activities more effectively. An intercept survey was conducted of residents of the Pilbara region towns Port Hedland and South Hedland in 2010. Settings included the main shopping centres and precincts in the towns and at community event venues. Interviewers recorded gender, age, Aboriginal or Torres Strait Islander self-identification status, whether people worked in the mining industry or not and in what capacity and occupation. Participants were asked a series of questions about health issues of concern from a list of 13 issues which included national and local health priorities. They were then asked to prioritise their choices. Three hundred and eighty participants completed the survey, 48% were male; 18.4% identified as an Indigenous person and 21% worked in the local mining industry. Men's and women's health priorities were generally similar but women prioritised 'sick kids' as their number one priority and men prioritised heart disease (χ² =28.75 df=12 p = 0.004). More than half of the Aboriginal men identified diabetes as a priority (53%) compared with the non-Aboriginal men (24%). This was significantly different (χ²=10.04 df=1 p = 0.002). Approximately one-third of Aboriginal women identified alcohol misuse as a priority (32.4%) compared with non-Aboriginal women (6%). This was also significantly different (χ²= 19.45 df=1 p = 0.001). Health promotion in the Pilbara region needs to be re-evaluated for areas such as injury prevention, which remains the commonest cause of hospitalisations after renal dialysis, yet is a low health priority in the community mindset, especially among Indigenous people.

Forum on Science and Health Training Program for Neglected and Re-Emerging Diseases

This paper analyzes the impact of initiatives toward raising awareness, refreshing and training by organizing and conducting forums and training courses aimed at health care professionals and community leaders who work in some cities of Rio de Janeiro (extending that initiative to a city in Minas Gerais). It addresses the topic of “neglected and reemerging diseases”, which has been previously deemed of interest to interlocutors involved in that proposal, especially representatives of municipal health secretariats and civil associations of a communal nature. It should be noted that thematic contents and methodological and pedagogical strategies value objective communication that is easy to understand, without compromising scientific quality. Another aim was to expand scientific information as support to amplify communication with the government in order to help develop public policies, which translate as healthcare actions targeting neglected diseases. Our conclusion is that it is vital for healthcare professionals, community leaders and government representatives to take part in such events in order to discuss and develop collective proposals based on qualified information about the identified themes as local health priorities to minimize the impact and progress of those diseases.

African leadership for sustainable health policy and systems research

The African Health Initiative (AHI) is the Doris Duke Foundation’s (DDCF) response to the need to improve the knowledge base on how to strengthen health systems. As this Initiative began, African leaders already had set the stage for a focus on the health system through a series of high level meetings, all with accompanying declarations, beginning in 2004. African leadership, in committing governments to strengthening health systems, seemed likely to support AHI efforts to improve population health in ways that could be sustained by governments in the focus countries after the program ends. Elements of the program designed to assure sustainability included alignment with national and local health priorities, ownership and participation by the national Ministry of Health and affected communities, building of local capacity, and effective African leadership. But, as is often the case, challenges to African leadership and sustainability continue to emerge. This comment reviews progress and prospects in achieving sustainability. I argue that sustainability lies at the core of country ownership and will require a reshaping of how both countries and funders engage to improve population health.

'The dangers attending these conditions are evident': Public Health and the Working Environment of Lancashire Textile Communities, c.1870-1939.

This article examines the position of the working environment within public health priorities and as a contributor to the health of a community. Using two Lancashire textile towns (Burnley and Blackburn) as case studies and drawing on a variety of sources, it highlights how, while legislation set the industry parameters for legal enforcement of working conditions, local public health priorities were pivotal in setting codes of practice. The complexities entwined with identifying the working environment as a cause of ill health and with improving it were entangled within the local community health context. In addition, the multiple understandings of Medical Officers of Health surrounding the remit of their responsibilities impacted the local health context. These did not always parallel national regulations. Indeed, it was these local, community specific forces that set the public health agenda, determined its path and the place of the working environment within this.

Health Care Commissioning: The UK Health Policy Reforms

In 2013/14, the first year of the UK’s reformed health service, area health authorities known as Primary Care Trusts (PCTs) and Strategic Health Authorities (SHAs) who were largely responsible for the determination of local health challenges and priorities and for the design and delivery of strategies to tackle these challenges, will be abolished from April 2013, and service improvements will be driven by a clinically-led local commissioning system. In this new system, groups of geographically aligned primary care practitioners will come together to create new statutory organisations known as Clinical Commissioning Groups (CCGs) who will take on the responsibility for the direct commissioning of the majority of NHS services with oversight from an umbrella body at the national level, the NHS Commissioning Board (NHSCB) responsible for the effective and economical running of the NHS [7]. The public health function will be transferred from the PCTs to the local governments under the auspicious of Health and Wellbeing Boards (HWBs). The new structure builds on the centrality of practicebased commissioning, taking it a great deal further in primary care with a greater local control of decision-making to improve patient care and outcomes. One school of thought was that the new structure in place would bring ‘patient empowerment, local professional judgement and greater provider dynamisms’ [6].

Development of a new platform for neglected tropical disease surveillance

An expanded global focus on the control and elimination of neglected tropical diseases (NTDs) has called attention to the need to develop and validate surveillance strategies that are cost effective and can be integrated across diseases. Here, we describe a multiplex tool for the sensitive detection of antibody responses to NTDs as well as vaccine preventable diseases, malaria, and waterborne and zoonotic infections. The assay platform is robust, can be performed with either serum or dried blood spots and can be adapted to local epidemiological conditions and public health priorities. Multiplex assays open the door to conducting routine serosurveillance for NTDs through demographic health surveillance or malaria indicator surveys.

Commentary on Greig et al, "Similar Mortality and Reduced Loss to Follow-Up in Integrated Compared With Vertical Programs Providing Antiretroviral Treatment in Sub-Saharan Africa"

Commentary on Greig et al, "Similar Mortality and Reduced Loss to Follow-Up in Integrated Compared With Vertical Programs Providing Antiretroviral Treatment in Sub-Saharan Africa"

Interventions for families affected by HIV

Family-based interventions are efficacious for human immunodeficiency virus (HIV) detection, prevention, and care, but they are not broadly diffused. Understanding intervention adaptation and translation processes can support evidence-based intervention (EBI) diffusion processes. This paper provides a narrative review of a series of EBI for families affected by HIV (FAH) that were adapted across five randomized controlled trials in the US, Thailand, and South Africa over 15 years. The FAH interventions targeted parents living with HIV and their children or caregiver supports. Parents with HIV were primarily mothers infected through sexual transmission. The EBIs for FAH are reviewed with attention to commonalities and variations in risk environments and intervention features. Frameworks for common and robust intervention functions, principles, practice elements, and delivery processes are utilized to highlight commonalities and adaptations for each location, time period, and intervention delivery settings. Health care, housing, food, and financial security vary dramatically in each risk environment. Yet, all FAH face common health, mental health, transmission, and relationship challenges. The EBIs efficaciously addressed these common challenges and were adapted across contexts with fidelity to robust intervention principles, processes, factors, and practices. Intervention adaptation teams have a series of structural decision points: mainstreaming HIV with other local health priorities or not; selecting an optimal delivery site (clinics, homes, community centers); and how to translate intervention protocols to local contexts and cultures. Replication of interventions with fidelity must occur at the level of standardized functions and robust principles, processes, and practices, not manualized protocols. Adopting a continuous quality improvement paradigm will enhance rapid and global diffusion of EBI for FAH.

Global health or global wealth?

As health biotech enterprises in emerging economies move from imitation to innovation, will they become less relevant to local global health priorities?

Improving public health training and research capacity in Africa: a replicable model for linking training to health and socio-demographic surveillance data

Background: Research training for public health professionals is key to the future of public health and policy in Africa. A growing number of schools of public health are connected to health and socio-demographic surveillance system field sites in developing countries, in Africa and Asia in particular. Linking training programs with these sites provides important opportunities to improve training, build local research capacity, foreground local health priorities, and increase the relevance of research to local health policy.Objective: To increase research training capacity in public health programs by providing targeted training to students and increasing the accessibility of existing data.Design: This report is a case study of an approach to linking public health research and training at the University of the Witwatersrand. We discuss the development of a sample training database from the Agincourt Health and Socio-demographic Surveillance System in South Africa and outline a concordant transnational intensive short course on longitudinal data analysis offered by the University of the Witwatersrand and the University of Colorado-Boulder. This case study highlights ways common barriers to linking research and training can be overcome.Results and Conclusions: This collaborative effort demonstrates that linking training to ongoing data collection can improve student research, accelerate student training, and connect students to an international network of scholars. Importantly, the approach can be adapted to other partnerships between schools of public health and longitudinal research sites.