Organized Community Groups Research Articles

The contribution of community health systems to resilience: Case study of the response to the drought in Ethiopia.

BackgroundEthiopia’s exposure to the El Niño drought (2015-2016) resulted in high malnutrition, internally displaced people, and epidemics of communicable diseases, all of which strained the health system. The drought was especially challenging for mothers and children. We aimed to identify salient factors that can improve health system resilience by exploring the successes and challenges experienced by a community-based health system during the drought response.MethodsWe collected data via key informant interviews and focus group discussions to capture diverse perspectives across the health system (eg, international, national, district, facility, and community perspectives). Data were collected from communities in drought-affected regions of: 1) Somali, Sitti Zone, 2) Hawassa, Southern Nations, Nationalities, and Peoples’ Region (SNNPR), and 3) Tigray, Eastern Zone. Data were analysed using a deductive-inductive approach using thematic content analysis applied to a conceptual framework.ResultsA total of 94 participants were included (71 from the communities and 23 from other levels). Key themes included the importance of: 1) organized community groups linked to the health system, 2) an effective community health workforce within strong health systems, 3) adaptable human resource structures and service delivery models, 4) training and preparedness, and 5) strong government leadership with decentralized decision making.ConclusionsThe results of this study provide insights from across the health system into the successes and challenges of building resilience in community-based health systems in Ethiopia during the drought. As climate change exacerbates extreme weather events, further research is needed to understand the determinants of building resilience from a variety of shocks in multiple contexts, especially focusing on harnessing the power of communities as reservoirs of resilience.

QUALITY MANAGEMENT OF DENTAL AND ORAL HEALTH SERVICES WITH PATIENT VISITS

Health development in the 2015-2019 period is the Healthy Indonesia Program with the aim of improving the health status of the community through health efforts and community empowerment supported by financial protection and equitable distribution of health services. The health development agenda for 2015-2019 is to achieve better access and quality of health services. Good and quality services will increase patient visits which in turn will increase the total income of the puskesmas. The purpose of the study was to determine the relationship between the quality management of dental and oral health services with patient visits at the Sukasuka Health Center, Garut Regency. The research method used cross sectional. The population of all patients who visited the Sukasuka Health Center was 25 people with purposive sampling technique. Measuring tools using questionnaires and patient visit data. Data were analyzed using Chi-Square statistical test. The results showed that the quality management of dental and oral health services was mostly in the good category (72%), most of the patient visits were in the good category (52%). The results of the Chi-Square test showed that there was a relationship between the quality management of dental and oral health services with the number of patient visits at the Sukabagus Health Center, Garut Regency with a value (ρ-value) = 0.002 (< : 0.05). The conclusion is that there is a relationship between the quality management of dental and oral health services with the number of patient visits at the Sukasuka Health Center, Garut Regency, it is hoped that the Sukasuka Health Center will improve the quality of health services for dental health workers both by increasing competence and work motivation and increasing community participation development through groups. -organized community groups.

A Study of Local Government in Africa through Participatory Action Research (PAR)

A Study of Local Government in Africa through Participatory Action Research (PAR)

Environmental Sanitation Planning: Feasibility of the CLUES Framework in a Malawian Small Town

Compared to the growing mega-cities or the languishing rural areas, small towns are generally less prioritized by governments and donors, both because they appear less immediately troublesome and because they defy easy classification. However, small towns bear the problems of both density extremes: on one hand, small towns face rapid population growth and struggle to collect revenue from the growing tax base, but on the other hand, do not have the political might or institutional capacity to lobby for services and resources from central government and as a result, must find ways of providing big-city services, with rural-area means. The Community-Led Urban Environmental Sanitation (CLUES) tool was developed to assist small towns with the planning and implementation of environmental sanitation infrastructure and services; through a participatory, action-research project, this work tested the financial, social, and technical feasibility of following the CLUES framework in Luchenza, a Malawian small town. Results obtained over the 2 year, 7-step process revealed that the high turnover of government staff affected institutional knowledge retention, acceptance and continuity and ultimately the potential to engage in a successful planning exercise. Because baseline data was outdated or non-existent, data collection activities consumed unexpected amounts of time, and the results were, because of internal movement and politics, difficult to disseminate and leverage. Most importantly, stakeholder participation was limited and relied on participation and transportation payments, which have become a permanent feature of “community development” in Malawi. Following the CLUES process was expensive, time consuming and politically fraught; it is unlikely that any small town in Malawi would be able to follow the process as outlined. A simplified version, making use of available data and followed only by small towns with a functioning planning department, adequate tax collection, organized community groups and a budget for final implementation would have a greater potential to succeed.

Dengue occurrence relations and serology: cross-sectional analysis of results from the Guerrero State, Mexico, baseline for a cluster-randomised controlled trial of community mobilisation for dengue prevention

BackgroundThe Mexican arm of the Camino Verde trial of community mobilisation for dengue prevention covered three coastal regions of Guerrero state: Acapulco, Costa Grande and Costa Chica. A baseline cross-sectional survey provided data for community mobilisation and for adapting the intervention design to concrete conditions in the intervention areas.MethodsTrained field teams constructed community profiles in randomly selected clusters, based on observation and key informant interviews. In each household they carried out an entomological inspection of water containers, collected information on socio-demographic variables and cases of dengue illness among household members in the last year, and gathered paired saliva samples from children aged 3–9 years, which were subjected to ELISA testing to detect recent dengue infection. We examined associations with dengue illness and recent dengue infection in bivariate and then multivariate analysis.ResultsIn 70/90 clusters, key informants were unable to identify any organized community groups. Some 1.9% (1029/55,723) of the household population reported dengue illness in the past year, with a higher rate in Acapulco region. Among children 3–9 years old, 6.1% (392/6382) had serological evidence of recent dengue infection. In all three regions, household use of anti-mosquito products, household heads working, and households having less than 5 members were associated with self-reported dengue illness. In Acapulco region, people aged less than 25 years, those with a more educated household head and those from urban sites were also more likely to report dengue illness, while in Costa Chica and Costa Grande, females were more likely to report dengue illness. Among children aged 3–9 years, those aged 3–4 years and those living in Acapulco were more likely to have evidence of recent dengue infection.ConclusionsThe evidence from the baseline survey provided important support for the design and implementation of the trial intervention. The weakness of community leadership and the relatively low rates of self-reported dengue illness were challenges that the Mexican intervention team had to overcome. The higher dengue illness occurrence among women in Costa Grande and Costa Chica may help explain why women participated more than men in activities during the Camino Verde trial.

Geriatric medicine in Costa Rica

Dr Fernando Morales-Martinez spent over 30 years initiating, fostering, and guiding the education of geriatric medicine in Costa Rica as well as Latin America for medical students, residents, fellows, practicing general physicians and the general public. Currently, all medical students (since 1988) and all family residents rotate through a well-established geriatric medicine section. This section has an established medical staff and a geriatric fellowship-training program of 5 years duration that Dr. Morales initiated in 1992. This fellowship training is incorporated into an extended 4-year family medicine program (1987). Training sites are at the National Hospital of Geriatrics and Gerontology in the capitol, San Jose, as well as outlying community clinics and facilities. Dr Morales is both the general director and the academic director of the Department of Medicine at this hospital. EAMA inspires the model of excellence on his academic career ( Table 1 ). Progressive Care Network For Comprehensive Care Of Older Persons In Costa Rica Introduction The increase in the population aged 65 years and over in Costa Rica is a reality that must be considered by the entire society and particularly by the government and its institutions. What is the Care Network? Is defined as: “Is a social structure composed of individuals, families, organized community groups, non-governmental and state institutions, articulated by actions, interests and programs, to ensure the proper care and satisfaction of needs for older people in the country, thereby promoting quality of life in aging”. Beneficiary Profile/As The Network of Care program aims to support the sector of adult population that is in poverty, extreme poverty and social risk. Some Achievements This program runs since 2011, reporting significant achievements for the benefit of the older population. In December 2013, stands out: – the program has attended 8249 older persons at home; – the program was implemented by 50 community networks of care for older people. The flexibility offered by the program, is valued as an important feature, considering that the actors and the communities have very different running condition, as are the needs of the older population.

IWitness Pollution Map: Crowdsourcing Petrochemical Accident Research

Community members living near any one of Louisiana's 160 chemical plants or refineries have always said that accidents occurring in these petrochemical facilities significantly impact their health and safety. This article reviews the iWitness Pollution Map tool and Rapid Response Team (RRT) approach led by the Louisiana Bucket Brigade, an environmental nonprofit group, and their effectiveness in documenting these health and safety impacts during petrochemical accidents. Analysis of a January 2013 RRT deployment in Chalmette, LA, showed increased documentation of current petrochemical accidents and suggested increased preparedness to report future accidents. The RRT model encourages government response and enforcement agencies to integrate with organized community groups to fully document the impacts during ongoing accidents, lead a more timely response to the accident, and prevent future accidents from occurring.

Integrated approaches to promoting sanitation: A case study of Faridpur, Bangladesh

This paper summarises the experience of Practical Action in promoting water, sanitation, waste and hygiene-related infrastructure and services in the town of Faridpur, Bangladesh. In addition to the improvement in health and local environment, the project attempted to increase income and employment through the provision and operation of services. Practical Action and its partners have organized community groups and developed participatory slum improvement plans. This then leads to the prioritisation of immediate needs and agreeing roles and responsibilities in the delivery. To address other needs identified in the plans, slum dwellers were encouraged to develop partnerships with the municipality and other service providers. The involvement of people and their empowerment has lead to better use and maintenance of water and sanitation-related infrastructure and services. Community members, once organized have also negotiated better deals with the municipality. However, income and employment from the services, appears to be a more complicated issue in practice as compared to what was planned in the project. This is because of social structures in the slum areas and community expectations. Overall, the Faridpur model appears as a potential model to improve access to services in urban slums of Asia to achieve health, environment and well-being outcomes.

Possible Outcomes of Comparative Effectiveness Research

WITH SUBSTANTIAL SUPPORT ACROSS THE POLITIcal spectrum, the Obama administration has included in the American Recovery and Reinvestment Act more than $1 billion to support comparative effectiveness research. At the same time, the president has demanded reforms in the US health care system to make health care more affordable for all US citizens. This Commentary focuses on the interaction of these 2 initiatives: what will be the cost effect of spending $1 billion on comparative effectiveness research? First, it is important to understand what comparative effectiveness research will include. Discussions to date suggest that most of the funds will be spent comparing one clinical procedure, device, or drug with another. The funds are less likely to be spent testing the comparative effectiveness of one way of paying for care vs another, of organizing care using a chronic disease model vs another organizational principle, or of implementing aggressive disease management programs. Countless studies could be conducted to assess the comparative effectiveness of clinical procedures, devices, or drugs. Consider, for instance, a company that manufactures an improved surgical needle. Comparing that needle to the needle currently used could be included in comparative effectiveness research. A nearly infinite number of studies could be conducted to determine how often a person with back pain should receive chiropractic treatment, how often a patient with hypertension should receive follow-up care, how often a patient should obtain a dental checkup, or what form of radiation and chemotherapy will achieve the best outcome for a patient with cancer. Since the government is using taxpayer dollars to fund the comparative effectiveness initiative, it would be appropriate to have an organizing principle to guide the selection of which aspects of medical care to examine. Without some overarching principle, the program is likely to become a free-for-all or a full employment program for health services researchers and epidemiologists. Researchers would submit proposals to study drug A vs B, or procedure A vs drug B. A study section would assess the proposals and decide which ones to fund, using the standard framework: the comparison should be important, the design should answer the question, and the study should be feasible to conduct. But such an approach pays no attention to achieving the president’s objective of making care more affordable or to insisting that the results of the comparative effectiveness studies be implemented quickly. So it is conceivable that most of the $1 billion could be allocated, for example, to testing a treatment that is more expensive than standard therapy to determine if the new treatment produces slightly better health. There is nothing wrong with such studies; the question is whether the scarce resources allocated in the stimulus package should be used in this way. It is clearly in the interest of companies that develop new treatments (eg, devices, drugs) to compare them with current or standard therapy. Why should taxpayer dollars subsidize that comparison and facilitate rapid entrance into the market of treatments that are slightly better but substantially more costly? The comparative effectiveness funds should be allocated according to a framework designed to identify procedures, devices, and drugs that would reduce cost but not diminish health. This would help achieve the goal of making health care more affordable. Such a framework would have 2 new required features. First, a grant or contract to spend public money must include an initial analysis to establish a business case that implementing whatever is being proposed would reduce the cost of care by a certain percentage. Second, it would not be enough to establish that implementing thenewdrug,device,orother therapywill savemoney. The history of science shows that it takes a long time for new knowledge to be incorporated into day-to-day practice. So a second requirement for work funded under the stimulus package should be that successful innovations are implemented immediately. Thus, a successful application under the comparative effectiveness initiative must include constituents, such as health care organizations, hospitals, physicians, or organized community groups, that would agree to adopt the new therapy immediately if it were shown to be as safe as the old therapy but substantially less expensive. If such constituent letters were not contained in the grant proposal or contract under which the research would be conducted, the money should be spent investigating other topics. Using comparative effectiveness funds correctly could foster a sea change in the way industry looks at product development. To return to the example of the new needle, the goal would no longer be to conduct a study to convince practitioners to pay more for a better needle. Rather, the goals would be to make better and safer needles, reduce the price of needles, and ensure that the new needles are adopted im-

A transformação da paisagem: planos diretores em onze municípios do Espírito Santo, um estudo de caso

This paper discusses the feasibility of procedures related to the landscape changes, as analysed by the method of participatory planning. We believe that the environmental themes depend upon the development of work methods for the stablishment of concrete strategies to consolidate a new urban reality and a new landscape. We believe that any coordinate action in the direction of preserving or regenerating natural resources as well as minimizing the impact of human settlements needs an inclusive debate, understanding and participation of different groups in society, when reading and studying the territory. Taking this insights into account, we decided to present a case study - the consultantship for eleven municipal committees training activities related to the development of Municipal Directive Plans in the Espirito Santo State mountains region. In this project, we had the opportunity to coordinate the technical works with the local comittees, composed by representatatives from the public legislative sector, the public executive sector and from the organized community groups.

Labor Unions and Affordable Housing

Labor unions in the United States were involved in producing and advocating for affordable housing in the period after World War II, when labor wielded legislative, electoral, and economic power both nationally and locally. That involvement now has ceased almost completely. This article uses historical analysis to explore how labor unions influenced national housing policies and programs in the postwar United States, and considers how the labor and housing movements do and could collaborate today to meet the current pressing need for affordable housing, through alliances between organized labor and community groups in support of better housing and more unionized construction jobs.

Public Education in Philadelphia: The Crucial Need for Civic Capacity in a Privatized Environment

A broad coalition of educators and community groups is necessary to achieve equity and excellence in urban schools, Ms. Blanc and Ms. Simon argue. But the Philadelphia schools' system of privatization and strict contractual obligations presents obstacles to those goals. ********** LIKE MANY other U.S. cities, Philadelphia experienced a prolonged period of deindustrialization and job loss during the second half of the 20th century. As in other northern cities, the process of suburbanization went hand in hand with white flight, increased racial segregation of the city and its schools, and increasingly inadequate funding of the school system. During this period, education activists and school reformers were unable to rally the civic community in support of policies that would have helped to maintain equitable or high-quality education in Philadelphia's public schools. Today, the city's long-term trends of job loss and depopulation appear to be reversing. school district has also made rapid changes and has been at the forefront of a national trend toward private-sector involvement in urban education. However, there are reasons to question whether the form of public/private collaboration pursued in the School District of Philadelphia is an adequate basis for a policy agenda that can reverse the city's long-standing history of educational inequity based on race and social class. PUBLIC ENGAGEMENT WITH URBAN SCHOOLS In the 1990s, the work of Clarence Stone and his colleagues affirmed the importance of public participation in education, arguing that only broad-based public engagement with urban schools can overcome the problems stemming from underinvestment in the children of the poor. According to this line of research, individual decision making and market forces create a radically uneven distribution of educational resources in the United States. However, Stone and his colleagues argued that underinvestment in urban children is not inevitable: The combined actions of the government and nongovernmental sectors can provide a compensatory response to underinvestment in children in urban school systems. (1) In an empirical investigation of 11 cities undertaking school reform efforts, these researchers found that school reform was more successful in cities with higher levels of civic capacity. In the more successful sites, representatives of a range of sectors--including grassroots and community groups as well as the business community and traditional civic leadership--were willing to go beyond conventionally conceived self-interest. They worked together to develop a shared vision and plan for action, and they created a context in which ongoing collective problem solving could take place. Other researchers have also argued that independent, locally based organizations familiar with local schools and school policies play critical roles in addressing issues related to educational equity. For example, in a national study of community organizing for urban school reform, Eva Gold and Elaine Simon demonstrated that organized community groups were able to mobilize their constituencies and develop networks of relationships in order to overcome persistent obstacles to school reform, such as continual turnover of leadership and competing priorities of local and state politicians. (2) Several examples from Philadelphia's history suggest that in the second half of the 20th century, community and civic groups, as well as educators, identified viable solutions to key challenges facing the schools. However, none of these efforts was able to leverage the sustained civic capacity needed to address the critical issues of urban public education. Challenges of racism, equity, and accountability. As African American migration to Philadelphia and other cities around the country increased after World War II, Philadelphia rapidly developed a highly segregated school district. …

Delivery of insecticide‐treated net services through employer and community‐based approaches in Kenya

Many approaches have been used to deliver insecticide-treated nets (ITNs) to African communities in different settings. Between 1992 and 2002, the African Medical and Research Foundation (AMREF), Kenya, used two ITN delivery models: the employer-based approach and the community-based approach. These two approaches have never been compared in order to inform their potential for future ITN delivery. We aimed to (1) compare the extent of ITN ownership, use and retreatment coverage in different population groups in the employer and community-based models and (2) identify options for improving people's acceptance and use of treatment/retreatment services. Qualitative and quantitative methods for data collection and analysis. A total of 2095 household heads were interviewed in the quantitative study, while purposively selected groups and key informants participated in the qualitative study. Net coverage (both treated and untreated nets) and retreatment rates with insecticides were significantly higher at employer-based sites (54.3%) than at community-based sites (35.0%). Bed net ownership has increased significantly since the start of AMREF interventions in 1998 in employer-based sites (from 27% to 61.1%); in community-based sites, it has either decreased (urban area, from 29.0% to 16.5%) or increased (rural area, from 17.0% to 49.1%). Retreatment rates in all sites were negatively influenced by the lack of information, cash and availability of insecticides. Satisfaction with the form of payment and services delivered was higher in employer-based sites. This was attributed to employers providing credit for the purchase of nets and retreatment kits and the employers' medical teams giving information on malaria and making follow-up visits on workers who fell ill. Employer-based delivery of ITNs was more successful than community-based delivery in attaining both high coverage with ITNs and higher rates of net retreatment. Methods used for the retreatment of nets, forms of payment and communication strategies should be convenient to communities. Organized community groups may continue to play an important role in remote rural areas.

Moral Dilemmas of Community Leaders and Sense of Community

This paper draws on Kohlberg's tiieory of moral development, and on an empirical research conducted with leaders (two women, two men) in Venezuelan urban working-class communities. The leaders were repeatedly interviewed during a two-year period, about their experiences leading their communities. Those narratives were analyzed and discussed with them. Based on these grounds, two interrelated products were constructed: (1) Three moral dilemmas to be used in educational discussions with community leaders such as members of organized community groups; civic volunteers, officers from non-governmental organizations working with communities, and (2) A developmental approach to the sense of community in urban working-class communities. Finally, it argues about the need of balancing the current approaches of moral development, through a stronger emphasis on the community dimensions of that sense and its consequences on leadership.

A cost analysis of the employer-based bednet programme in Coastal and Western Kenya.

Malaria remains a major health problem in Africa. One preventative strategy currently advocated is the use of bednets, preferably treated with insecticide. Many approaches to bednet delivery have been adopted in Kenya, including an employer-based malaria control strategy (EBMC). The cost and sustainability of this approach have not previously been assessed. This paper presents the financial cost (cash expenditure) of the EBMC programme implemented in the Coastal and Western regions of Kenya by the African Medical and Research Foundation (AMREF) between April 1998 and February 2002. Getting a bednet and insecticide to an employee was estimated to cost the provider US$15.8. This could be reduced by US$0.5 if the remaining stocks were liquidated and by an additional US$1.3 if the salvage of capital items is considered. The venture of distributing bednets to employees through the programme proved lucrative to organized community groups (OCGs), for they made between 24 and 29% gross profit from the nets they sold. Consequently, OCGs in nine of the 13 companies involved had retained enough funds from which they could buy and sell bednets without further donor financial support, and this portrays some elements of a sustainable supply system.

Common Property and Uncertainty: Compensating Coalitions by Mexico's Pastoral "Ejidatarios"

The election of Carlos Salinas de Gortari in 1988 initiated a process of privatization in Mexico's financial and industrial sectors. Banks, state-controlled during most of the 1980s, were reprivatized by reducing the controlling interest of the central government and encouraging recapitalization by the private sector. State-owned industries such as airlines and mines were sold to private investors in an effort to improve efficiency and reduce demands on the public treasury. Also, an increased inflow of foreign investment capital, to be stimulated by legal changes allowing increased foreign private ownership, is now viewed by the Salinas de Gortari administration as a necessary condition for Mexico's future economic growth and stability. In January of 1992, Article 27 of the Mexican Constitution was amended to facilitate the modernization of Mexican agriculture. Two economic conditions help explain this action. First, Mexico is a net importer of agricultural commodities. In some years beans and corn, staples in the Mexican diet, must be imported to meet the demands of a burgeoning population. Second, 50% of the agricultural land in Mexico is controlled by organized community groups: comunidades and ejidos. Ejidos, groups that hold property in common, control approximately 40% of the agricultural land. On average, these lands are 30%50% less productive than comparable private farms and represent, according to some Mexican analysts, an opportunity for increased productivity through privatization.1 The ejido is an important component in Mexico's culture and historical heritage. Its revolutionary past, deeply rooted in the Mexican Revolution of 1910-15, should give pause to the reformer who argues for privatizing these common property land holdings. Questions should