Government dependence of Chinese and Vietnamese community organizations and fiscal politics of immigrant services

Few studies have examined the impact of government support and policies on immigrant services within ethnic enclaves. This paper seeks to address this gap and examines the structure and challenges of ethnic community based organizations (CBOs) that serve low income immigrant populations and the impact of government support and policies on these CBOs. The study utilized case study and ethnographic methodologies and examined 2 Chinese and 2 Vietnamese CBOs in the San Francisco Bay Area. The findings show that ethnic CBOs critically depend on government fiscal support for survival. In exchange for fiscal support, ethnic CBOs represent public assistance and legitimacy interests for government in immigrant communities. However, culturally proficient and community leadership resources of ethnic CBOs can serve as bargaining chips to secure government funding, reduce compliance to government demands, and advance immigrant community interests. Nevertheless, in times of government fiscal crisis, ethnic CBOs and immigrant services tend to be most vulnerable to budget cuts due to lack of political voice. In sum, government-community collaboration through ethnic CBOs has a central role to play in facilitating and strengthening health and human services for rapidly growing, culturally diverse immigrant populations. These collaborative efforts in immigrant services are vital to cultivating healthy immigrant human capital and multicultural communities across the United States.     

The global financial crisis: experiences of and implications for community-based organizations providing health and social services in South Africa

The global financial crisis that began in 2008 with the collapse of the US real estate bubble is considered the worst economic turmoil since the Great Depression in the 1930s. While the crisis has negatively impacted the global economy and the flow of aid to Sub-Saharan African countries, little is known about the implications of the crisis for community-based organizations (CBOs) providing health-related services in marginalized communities. We conducted qualitative interviews with managers of 14 CBOs providing health and social services to marginalized communities in South Africa about their experiences of the crisis. CBOs reported experiencing a marked decrease in funding received from both international and local donors as a result of the global financial crisis. At the same time, they experienced difficulties in securing new funding. Organizations addressed the funding problems by conducting organizational restructuring and implementing austerity measures that led to the retrenchment of staff, reduction in benefits and incentives for staff and volunteers, reduction in the number of communities served and rationing of services provided to these communities. These measures had negative psychological impacts on paid staff and volunteers and contributed to absenteeism and attrition among volunteers, and some of the organizations eventually closed down. Our findings show that the global financial crisis has far-reaching implications for health, social and developmental services delivery and ravaging impacts on the economy of marginalized communities. Policy-makers should explore mechanisms for protecting CBOs from the effects of economic shocks to guarantee the provision of critical services to marginalized communities.     

Strategies for Community/School Collaborations to Prevent Youth Substance Abuse

Within communities across the United States, collaborations have developed between community-based organizations (CBOs) and schools to plan and implement unified approaches to prevent youth substance abuse. This article describes challenges and workable strategies reported by a diverse group of 11 community-based organizations (CBOs) for developing and maintaining collaborative relationships with schools. Strategies recommended by CBOs for effective CBO/school collaborations are described within four categories: (1) establishing the collaboration; (2) maintaining cooperation with schools during program implementation; (3) addressing cultural issues; and (4) institutionalizing the collaborative programs. The need to tailor community prevention efforts to the specific context of each community is emphasized.     

A national,geographic database of CDC-funded HIV prevention services: development challenges and potential applications

Background  

From 2000–2002, the Centers for Disease Control and Prevention (CDC) funded a study that was designed to improve the information available to program planners about the geographic distribution of CDC-funded HIV prevention services provided by community-based organizations (CBOs). Program managers at CDC recognized the potential of a geographic information system (GIS) to organize and analyze information about HIV prevention services and they made GIS a critical component of the study design. The primary objective of this study was to construct a national, geographically-referenced database of HIV prevention services provided by CDC-funded CBOs. We designed a survey instrument to collect information about the geographic service areas where CBOs provided HIV prevention services, then collected data from CBOs that received CDC funding for these services during fiscal year 2000. We developed a GIS database to link questionnaire responses with GIS map layers in a manner that would incorporate overlapping geographies, risk populations and prevention services. We collected geographic service area data in two formats: 1) geopolitical boundaries and 2) geographic distance.     

云南省社会组织参与艾滋病综合防治示范区HIV筛查检测现状分析

目的 了解云南省第三轮全国艾滋病综合防治示范区社会组织提供人类免疫缺陷病毒（human immunodeficiency virus,HIV）筛查检测服务的现状,为社会组织提供HIV筛查检测服务提供建议。方法 采用网络问卷调查收集信息,利用SPSS 19.0进行数据汇总和分析。结果 云南省第三轮全国艾滋病综合防治示范区有50个社会组织参与示范区艾滋病防治工作,100.0%（50/50）的社会组织均提供HIV动员检测服务,64.0%（32/50）的社会组织提供HIV筛查检测服务,血HIV快速检测服务占81.3%（26/32）,唾液检测服务占53.1%（17/32）。100.0%（32/32）的社会组织接受过HIV快速检测技术培训。40.0%（20/50）的社会组织可直接提供HIV快速检测服务。卫生行政部门、疾病预防控制中心以及医院对其开展HIV筛查检测服务的态度差异有统计学意义（χ2=15.309,P=0.004）。结论 社会组织在提供HIV筛查检测和发现HIV感染者有重要作用,云南省第三轮全国艾滋病综合防治示范区应充分发挥社会组织提供HIV筛查检测服务的优势,结合外展干预服务提供HIV筛查检测服务,扩大HIV检测覆盖面。     

Practitioner perspectives on tackling health inequalities: Findings from an evaluation of healthy living centres in Scotland

Little is known about how health practitioners tasked with tackling health inequalities account for their own programmes and actions. This paper attempts to address this gap by drawing on data collected in the course of an evaluation of the Healthy Living Centre (HLC) programme, which was designed to address the wider determinants of health, in particular social exclusion and socioeconomic disadvantage, through targeting services at the most deprived local communities. Six Scottish HLC case studies explored in depth how HLC practitioners conceptualised ‘health inequalities’ and applied the construct to legitimate their public health and health improvement work. Practitioners drew on multiple explanations of health inequalities, sought to apply holistic approaches to service provision, and developed activities that took account of classed practices intended to overcome class-related disempowerment and stigma. They discussed the challenges of positioning services to appeal to and reach target groups and the difficulties in assessing the impact of their work on reducing health inequalities. Responses to tackling inequalities were variable across time and between HLCs, resulting from uneven learning about target groups and their changing needs, an evolving policy agenda and consideration given to the longer-term sustainability of HLC sites. Although practitioners' work to address health inequalities was limited by the programme's focus on working with disadvantaged groups, findings illustrate how classed practices are linked to the challenges of attracting and successfully engaging with such groups. Practitioner accounts highlighted the importance of gaining acceptance to overcome barriers to engagement with disadvantaged communities, the time required to achieve a satisfactory level of engagement, the proximity of service providers to clients and the adaptability of services necessary to address evolving needs.     

Creating a successful school-based mobile dental program

BACKGROUND: Dental disease is one of the leading causes of school absenteeism for children. This article describes the creation and evolution of the St. David's Dental Program, a mobile school-based dental program for children. METHODS: The dental program is a collaboration of community partners in Central Texas that provides free dental care to low-income children in schools without relying on reimbursements or government funding. RESULTS: Since 1998, the program has provided 132,791 screenings for oral health treatment needs and 38,634 encounters for sealants or treatment. In 2005, the program provided $2.1 million worth of services at a cost of $1.2 million (not including donated services). Factors important to the program's success included sustained funding for general operating costs; well-compensated clinicians to deliver care and experienced human service workers to manage program operations; the devotion of resources to maximize consent form return rates; and the development of strong relationships with school district and individual school staff. CONCLUSIONS: By removing cost, time, transportation, and bureaucratic barriers, the program was able to reach more children than fixed-site clinics. The program was a merging of private and public health dentistries. This model can be useful to other communities in light of the unmet need for dental care and tighter federal, state, and local government budgets.     

Creative partnerships for community health improvement: a qualitative evaluation of the Healthy Carolinians community micro-grant project

This qualitative study evaluated a recent innovative strategy used to involve community-based organizations (CBOs) in implementing health-related projects through locally administered microgrants. The purpose of this study was to identify key elements that enabled the success of the CBO projects, barriers and challenges to project success, and ways to effectively engage CBOs as partners in local health initiatives. In addition, this study sought to identify aspects of this approach that can be replicated. Study findings revealed that microfinancing CBOs aided in building partnerships, developing local leadership and expertise, and providing resources that enabled progress toward CBO missions and goals. These positive outcomes far out-weighed barriers and challenges faced by CBOs. Furthermore, the results of this study revealed ideas and information that provide useful guidelines for establishing and administering microgrant projects through local organizations that encourage community groups to design and implement community based health initiatives.     

Herausforderungen der HIV-Pr?vention f��r Migranten

Background

Approximately 30% of new HIV infections in Germany occur among immigrants. HIV prevention thus needs to be better tailored to immigrant communities.

Methods

A survey of the 118 members of the national association of AIDS service organizations (Deutsche AIDS-Hilfe e.V.) was conducted to assess their experiences in providing HIV prevention services to immigrants. The survey is part of a participatory research project (PaKoMi). The analysis focuses on the challenges described by the AIDS service organization (ASO).

Results

A total of 90 ASO participated in the survey (return rate 76%). The great majority (89%) provide HIV prevention services to immigrants. More than half (53%) state a need for further action to improve prevention services to immigrants in their locality. Only a small minority (10%) are satisfied with the level of communal cooperation among local actors on this issue. Major challenges in providing HIV prevention services to immigrants include: intercultural challenges in dealing with cultural differences and taboos, lack of resources, limited access of ASOs to immigrant communities, language barriers, stigmatization processes, and practical and conceptual challenges resulting from the complex needs and multilayered problems of those immigrant groups who are most at risk for HIV/AIDS.

Conclusions

To better manage the challenges described by the ASOs, the participation of immigrant communities in HIV prevention and the cooperation of health and social service providers with community-based immigrant organizations should be improved. Given the social structural factors and legal issues which contribute to the specific vulnerability and increased HIV risks of immigrants, the concept of ??structural prevention?? seems appropriate which conceptualizes HIV prevention as health promotion in the broader social context.     

Community benefit: what it is and isn't

"Community benefit" is the measurable contribtution made by Catholic and other tax-exempt organizations to support the health needs of disadvantaged persons and to improve the overall health and well-being of local communities. Community benefit activities include outreach to low-income and other vulnerable persons; charity care for people unable to afford services; health education and illness prevention; special health care initiatives for at-risk school children; free or low-cost clinics; and efforts to improve and revitalize communities. These activities are often provided in collaboration with community members and other community organizations to improve local health and quality of life for everyone. Since 1989, the Catholic health ministry has utilized a systematic approach to plan, monitor, report, and evaluate the community benefit activities and services it provides to its communities. This approach, first described in CHA's Social Accountability Budget, was updated in the recent Community Benefit Reporting: Guidelines and Standard Definitions for the Community Benefit Inventory for Social Accountability. By using credible and consistent information, health care organizations can improve their strategic response to demands for information that demonstrates their worth.     

The role of community-based organizations in household ability to pay for health care in Kilifi District, Kenya

There is growing concern that health policies and programmes may be contributing to disparities in health and wealth between and within households in low-income settings. However, there is disagreement concerning which combination of health and non-health sector interventions might best protect the poor. Potentially promising interventions include those that build on the social resources that have been found to be particularly critical for the poor in preventing and coping with illness costs. In this paper we present data on the role of one form of social resource--community-based organizations (CBOs)--in household ability to pay for health care on the Kenyan coast. Data were gathered from a rural and an urban setting using individual interviews (n = 24), focus group discussions (n = 18 in each setting) and cross-sectional surveys (n = 294 rural and n = 576 urban households). We describe the complex hierarchy of CBOs operating at the strategic, intermediate and local level in both settings, and comment on the potential of working through these organizations to reach and protect the poor. We highlight the challenges around several interventions that are of particular international interest at present: community-based health insurance schemes; micro-finance initiatives; and the removal of primary care user fees. We argue the importance of identifying and building upon organizations with a strong trust base in efforts to assist households to meet treatment costs, and emphasize the necessity of reducing the costs of services themselves for the poorest households.     

Exploring the capacity of community-based organisations to absorb health system patient referrals for unmet social needs

This study examines the perspectives, resources, role and services provided by community-based organisations (CBOs) in response to the integration of health and social services to address individual unmet social needs, as well as the impact on organisational carrying capacity related to the ability to receive referrals from health system partners. Mixed methods combining qualitative interviews with 24 organisations and Social Network Analysis with 75 organisations were completed in 2018 in two communities (Denton, TX and Sarasota, FL) with robust examples of health and social systems alignment. Findings suggest that while community organisations are embedded in robust cross-sector networks, the potential increase in referrals from clinical settings is not something they are fully aware of, or prepared for, as evidenced by inadequate funding models, misalignment between capacity and capability, and a lack of coordination on screening and referral activities. Misalignment between clinical and CBO understanding of demand, needs and capacity present a potential risk in building strategies that integrate health and social services to address unmet social need. Failing to build a strong cross-sector screening and referral infrastructure that considers CBO capacity from the start could undermine the goal of improving population health through the integration of clinical and social care.     

Community-Based Organizational Capacity Building as a Strategy to Reduce Racial Health Disparities

One of the biggest challenges facing racial health disparities research is identifying how and where to implement effective, sustainable interventions. Community-based organizations (CBOs) and community-academic partnerships are frequently utilized as vehicles to conduct community health promotion interventions without attending to the viability and sustainability of CBOs or capacity inequities among partners. Utilizing organizational empowerment theory, this paper describes an intervention designed to increase the capacity of CBOs and community-academic partnerships to implement strategies to improve community health. The Capacity Building project illustrates how capacity building interventions can help to identify community health needs, promote community empowerment, and reduce health disparities.     

Sampling for evaluation. Issues and strategies for community-based HIV prevention programs

Sampling methods are an important issue in the evaluation of community-based HIV prevention initiatives because it is through responsible sampling procedures that a valid model of the population is produced and reliable estimates of behavior change determined. This article provides an overview on sampling with particular focus on the needs of community-based organizations (CBOs). As these organizations continue to improve their capacity for sampling and program evaluation activities, comparisons across CBOs can become more rigorous, resulting in valuable information collectively regarding the effectiveness of particular HIV prevention initiatives. The author reviews several probability and non-probability sampling designs; discusses bias, cost, and feasibility factors in design selection; and presents six guidelines designed to encourage community organizations to consider these important sampling issues as they plan their program evaluations.     

The role of community-based organizations in adolescent sexual health promotion

Many scholars and practitioners have advocated for a more ecological approach to sexual health promotion for adolescents, such as one that includes involvement from schools, parents, and community organizations. Although extensive research has been conducted with schools and parents, little is known about the roles community-based organizations (CBOs) may play in the education and promotion of sexual health to young people. This study aimed to (a) identify the types of sexual health and sexuality-related questions asked by youth and programming/services, resources, and referrals currently being provided by CBOs; (b) explore the approaches used by CBOs when developing and implementing sexual health promotion programs; and (c) compare these findings with those from a similar study on school teachers, counselors, and nurses within the same state. Data collected from 169 people working in CBOs indicate that a wide variety of topics were covered by CBOs through programming and services, resources, and/or referral protocols. Topics covered varied in frequency. Overall, participants indicated a relatively comprehensive and accessible approach to providing sexuality information to youth. The results of this study suggest that CBOs should be included in the range of sources to be used for comprehensive sexual health promotion. If such organizations are supported with information, training, and resources, they could play a valuable role in the promotion of sexual health for adolescents.     

Faith-based orphan care: Addressing child-oriented goals and child rights in HIV/AIDS-affected communities

Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) has had a profound effect on children and families in sub-Saharan Africa, increasing the need for effective support. Because the large number of children affected by AIDS (CABA) often exceeds the capacity of local families to care for them, state agencies, non-governmental organizations (NGOs) and a wide variety of community-based organizations (CBOs) have become essential partners in caring for HIV/AIDS affected children. Faith-based organizations (FBOs) are a primary source of care for many children, yet relatively little is known about FBOs’ specific approaches and services. National governments are also relying increasingly on FBOs to help them meet the Millennium Development Goals (MDGs) and fulfill their responsibilities under the Convention on the Rights of the Child (CRC). This article looks at two FBOs in South Africa providing care to HIV-affected families and children and explores the extent to which each addresses the objectives of the MDGs and CRC. Both organizations provide important services with regard to the MDGs and Article 6 of the CRC, which relates to life, survival and development. However, the extent to which the two organizations respected Article 3 of the CRC, which relates to prioritizing the nuclear family and preserving the identity of the child, differed.     

Community Based Organizations Addressing South Asian American Health

Addressing the health needs of all Americans is central to the public health agenda in the US. Although some progress has been made in documenting health disparities among South Asians living in the US, more attention is needed to fully understand how communities are addressing the health needs of this community. Community Based Organizations (CBOs) play a vital role in strengthening and empowering communities through outreach and health education. Through research conducted via a web survey and key informant interviews, this study provides a context for understanding how CBOs in the US have begun to address the health of South Asian Americans. Additionally, recommendations are identified that may help improve the health outcomes of this population.     

Staffing in AIDS service organizations: the volunteer contribution

This article reports results from a survey of AIDS service organizations (ASOs) that provide medical and social services to people with AIDS in the Oakland, California, area. The survey was designed to assess organizational and staffing characteristics of ASOs. Forty two of sixty-seven (62.7% response rate) ASOs responded, providing detailed data on their staffing patterns. ASOs that provided social services reported 48.5 percent of their total full-time equivalents (FTEs) as volunteers while medical organizations reported only 9.5 percent of their total FTEs as volunteers. Among the social service providers, ASOs that self-identified as private, non-profit community-based organizations (CBOs) reported greater than half (50.8 percent) of their total FTEs as volunteer staff. All CBOs that reported utilizing more than five volunteer FTEs were AIDS-specific providers and had designated a full-time, paid staff position as volunteer coordinator/director.     

Volunteers’ Experiences Delivering a Community-University Chronic Disease Health Awareness Program for South Asian Older Adults

Volunteers and voluntary organizations can connect preventative health care programs to communities and may play an important role in addressing the health needs of older adults. Despite this, tensions may exist in the structures that drive volunteers and voluntary organizations representing immigrant communities to provide unpaid labour to augment and supplement health care services. Furthermore, organizational challenges may exist for community agencies relying on volunteers to sustain a health screening and education program. The intervention program was led by one voluntary agency specifically for South Asian communities in partnership with the university and five local organizations. This paper draws on volunteer surveys (n?=?22) and key informant interviews (n?=?12) to detail volunteer experiences providing this intervention. Volunteers were university students and other community volunteers. A total of 810 adults participated in the intervention within the Greater Toronto Area, Ontario, Canada between October 2014 and June 2016. We found that volunteers often used their experience as a ‘stepping stone’ position to other education or work. They also gained from the knowledge and used it to educate themselves and their family members and friends. This paper provides a critical reflection on the role of volunteers in a preventative and educational healthcare intervention program for older adults from the South Asian community. Tensions exist when relying on volunteer labour for the implementation of preventative community health care programming and must be explored to ensure program sustainability as well as equity within the health care system.     

The value of collaboration in eliminating barriers to preventive care and screening among underserved populations

Collaboration among a community's institutions and its residents can help increase the use of appropriate screening, preventive, and primary care services. To improve the health of the community, institutions must reach out to their colleagues and other stakeholders. They must not only deal with the structure of the healthcare delivery system but also be responsive to the characteristics of the local population groups they are trying to serve. Over the last several years, a group of 25 community-based partnerships across the country have used a multifaceted model to guide their work in making their communities healthier. Through a wide variety of initiatives tailored to local needs, they have not only improved people's health but also provided a series of benefits to the partnering organizations and the community as a whole.