Building capacity for success: the Tobacco Technical Assistance Consortium

The Master Settlement Agreement with the tobacco industry has infused resources into tobacco control and prevention, which has helped fund tobacco control programs at the national, state, and local levels. Many tobacco control programs face challenges in areas such as strategic planning, fiscal operations, advocacy, and personnel management. To provide technical assistance to these programs, the Robert Wood Johnson Foundation, the American Legacy Foundation, and the American Cancer Society combined resources to fund the Tobacco Technical Assistance Consortium (TTAC). TTAG, housed at the Rollins School of Public Health at Emory University, provides support for tobacco control programs and matches requests for technical assistance with consultants who have the appropriate expertise. TTAC is a valuable addition to tobacco control and prevention resources and is a viable component within a school of public health.     

Web-based technical assistance and training to promote community tobacco control policy change

In 1998 the tobacco industry was released of claims that provided monetary relief for states. A significant expansion of tobacco control activity in many states created a need to develop local capacity. Technical assistance and training for new and experienced staff became a significant challenge for tobacco control leadership. In Colorado, this challenge was addressed in part through the development of a technical assistance and training Web site designed for local tobacco control staff and coalition members. Researchers, technical Web site development specialists, state health agency, and state tobacco control coalition staff collaborated to develop, promote, and test the efficacy of this Web site. The work group embodied a range of skills including tobacco control, Web site technical development, marketing, training, and project management. Persistent marketing, updating of Web site content, and institutionalizing it as a principal source of information and training were key to use by community coalition members.     

Tobacco cessation in Vietnam: Exploring the role of village health workers

The purpose of this study was to explore current tobacco use treatment (TUT) practice patterns, and attitudes and beliefs among Village Health Workers (VHWs) about expanding their role to include delivering smoking cessation interventions and the perceived barriers. We conducted a survey of 449 VHWs from 26 communes in Thai Nguyen province, Vietnam. We assessed TUT practice patterns including asking about tobacco use, advising smokers to quit, offering assistance (3As) and attitudes, self-efficacy, and norms related to TUT. Seventy two per cent of VHWs reported asking patients if they use tobacco, 78.6% offered advice to quit, and 41.4% offered cessation assistance to few or more patients in the past month. Self-efficacy was low, with 53.2% agreeing that they did not have the skills to counsel patients about smoking cessation. The most commonly reported barriers to offering TUT were a lack of training and perceived lack of patient interest. Greater awareness of their commune health centre’s smoke-free policy and higher levels of self-efficacy were associated with screening and offering cessation assistance. VHWs support an expanded role in tobacco cessation, but require additional resources and training to increase their self-efficacy and skills to provide effective treatment.     

The role of research in a technical assistance agency: the case of the 'German Agency for Technical Co-operation'

Technical assistance agencies have a sustainable impact on the health systems of the countries they are operating in. As well as policy-makers at the national level, technical assistance agencies see themselves confronted that their interventions should be based on evidence, usually meaning the results of research. This study has the aim to analyse role of research in the implementation of technical assistance. We sent a questionnaire to all health project managers of the 'German Agency for Technical Co-operation' and performed a qualitative case study in one of the health projects. Forty-seven of 80 (58.8%) of the questionnaires were completed and sent back. The managers considered publications of International Organisations (IOs), scientific articles and local research as most important for their work. The case study showed application problems in the daily work. Research use not only depends on the relevance of the data but also on analytical skills, linguistic barriers and technical access to research by the potential users. The role of knowledge and information management has to be clearly defined in an organisation of technical assistance. The specific needs at the different levels have to be analysed so that skills and resources can be allocated adequately.     

Referrals among cancer services organizations serving underserved cancer patients in an urban area

Significant racial, socioeconomic, and geographic disparities exist nationwide in cancer screenings, treatments, and outcomes. Differences in health and social service provision and utilization may contribute to or exacerbate these disparities. We evaluated the composition and structure of a referral network of organizations providing services to underserved cancer patients in an urban area in 2007. We observed a need for increased awareness building among provider organizations, broader geographic coverage among organizations, and increased utilization of tobacco cessation and financial assistance services.     

Smallpox eradication in West and Central Africa

In 1966, a programme to eradicate smallpox and control measles began in West and Central Africa. With WHO and US bilateral technical and financial assistance, the 20 countries mounted a coordinated campaign of mass vaccination, assessment, surveillance, and maintenance activities. The last cases of smallpox occurred in May 1970. The introduction of epidemiologically directed surveillance-containment activities and their rapid success resulted in interruption of smallpox transmission much sooner than anticipated. The area has remained free of smallpox. From 1966 to 1972, over 28 000 000 children 1-6 years of age also received measles vaccination. The campaign established or strengthened structures for preventive health care services in all the countries.     

Public-private partnerships to build human capacity in low income countries: findings from the Pfizer program

Background

The ability of health organizations in developing countries to expand access to quality services depends in large part on organizational and human capacity. Capacity building includes professional development of staff, as well as efforts to create working environments conducive to high levels of performance. The current study evaluated an approach to public-private partnership where corporate volunteers give technical assistance to improve organizational and staff performance. From 2003 to 2005, the Pfizer Global Health Fellows program sent 72 employees to work with organizations in 19 countries. This evaluation was designed to assess program impact.

Methods

The researchers administered a survey to 60 Fellows and 48 Pfizer Supervisors. In addition, the team conducted over 100 interviews with partner organization staff and other key informants during site visits in Uganda, Kenya, Ghana, South Africa and India, the five countries where 60% of Fellows were placed.

Results

Over three-quarters of Fellowships appear to have imparted skills or enhanced operations of NGOs in HIV/AIDS and other health programs. Overall, 79% of Fellows reported meeting all or most technical assistance goals. Partner organization staff reported that the Fellows provided training to clinical and research personnel; strengthened laboratory, pharmacy, financial control, and human resource management systems; and helped expand Partner organization networks. Local staff also reported the Program changed their work habits and attitudes. The evaluation identified problems in defining goals of Fellowships and matching Organizations with Fellows. Capacity building success also appears related to size and sophistication of partner organization.

Conclusion

Public expectations have grown regarding the role corporations should play in improving health systems in developing countries. Corporate philanthropy programs based on "donations" of personnel can help build the organizational and human capacity of frontline agencies delivering health services. More attention is needed to measure and compare outcomes of international volunteering programs, and to identify appropriate strategies for expansion.     

An evaluation of client satisfaction with training programs and technical assistance provided by Florida's Coordinated School Health Program Office

Client or customer satisfaction surveys assess the perceived quality of programs, products, services, and employee performance. Such assessments prove beneficial for evaluation and planning purposes. This survey examined the satisfaction of clients using the programs, services, and technical assistance provided through the Coordinated School Health Program Office (CSHPO) in the Florida Department of Education. Using the 42-item Client Satisfaction Survey, data were collected in summer 1999 from 300 of 574 clients (52.3%) who attended training sessions or sought technical assistance from CSHPO during 1996-1999. More than two-thirds (67.2%) of clients rated the training program as "very good" or "excellent" at increasing their understanding about the concept of a coordinated school health program. Overall, 69.7% of clients rated the training programs they attended as "very good" or "excellent." Resource materials and staff effectiveness rated positively as well. Findings confirmed client satisfaction with CSHPO's training programs, technical assistance, and staff. Information obtained through the client satisfaction survey can be used by CSHPO to assist in future program planning and resource allocations.     

The graduate technical assistance program: an alternative to traditional training for health administration students.

This paper presents a discussion of current modes of field training for graduate students in health services administration and details the educational goals and structural elements of the Graduate Technical Assistance Program (GTAP) at Arizona State University. The program's unique features include an emphasis on provider defined problems and projects, timely response to these problems by students, and the involvement of students, throughout their training, in consultant relationships with providers. The program also places the student in a new set of collaborative relationships with program faculty. The profiles of the 21 organizations requesting technical assistance, the skills required for project completion, and the range of projects are detailed.     

The continuing evolution of the medical staff organization: from MSO to PSO

Regardless of the speed of the evolution from a MSO to a PSO, it is inevitable. During the course of this evolution, hospital management must be certain that individual clinicians and the PSO as a whole perform technical services that are integrated into the hospital's overall effort to achieve its goals. Although nonclinician managers cannot deliver clinical services or independently judge quality, they can obtain the expert advice and technical assistance needed to understand individual and aggregate PSO practice. Doing so allows managers to not only meet their ethical and legal responsibilities but also implement continuous quality improvement in the hospital, an activity of critical importance in the 1990s.     

A Description of the Southern Rural Access Program's Practice Management Strategies

ABSTRACT: Context: Many state, federal, and foundation resources have been invested in improving the recruitment of primary care providers to rural communities. The Southern Rural Access Program of the Robert Wood Johnson Foundation (RWJF) has provided varying levels of support to several southern states to assist with retention of those providers. Purpose: This study describes the strategies that 6 states used to develop and implement practice management technical assistance services for rural health care providers. Methods: Practice managers in each of the 6 states were surveyed regarding how their service was structured, what types of entities were eligible, and the nature of the technical assistance offered. Information regarding what types of entities used the service, characteristics of the practices, and the number of practices served was also collected. Findings: The survey results showed that almost half (46%) of all practices assisted were private stand-alone physician practices, with overall practice assessments being the practice management service rendered most often. Although the type of organizational home for the technical assistance services varied by state, overall states employed an average of 1.67 full-time equivalent practice managers (0.81 full-time equivalent supported by RVF) and received an average of $136 055 per state from the RWJF for the 2–year period beginning April 2002 for practice management support. Conclusions: Overall, the study found that the type of organizational home did not appear to affect the type of technical assistance services offered. However, the type of organizational home did appear to affect what types of providers used the service, with trade associations assisting their members or constituents at least half the time.     

Patterns of service utilisation following the 1989 Newcastle earthquake: findings from Phase 1 of the Quake Impact Study

Abstract: A screening questionnaire was distributed to 5 000 adult members of the community six months after the 1989 Newcastle earthquake, with a response rate of 63 per cent (n = 3 007). The mean age of respondents was 46.7 years and 58 per cent were female. Subjects' earthquake experiences were rated in terms of weighted indices of exposure to threat and disruption. Psychological morbidity was measured using the General Health Questionnaire and the Impact of Event Scale. Subjects were asked to indicate which of a range of general and disaster-related support services they had used in dealing with the stressful effects of the earthquake. It was estimated that 21.3 per cent of the adult population used general and/or disaster-related support services. Users of these services reported greater exposure to threat and/or disruption and had higher levels of psychological distress than nonusers. However, a high level of use of general services and reliance on medical services were related more to psychological morbidity than degree of exposure to earthquake-related events. Overall, the Newcastle community's needs for assistance in the aftermath of the earthquake were effectively absorbed by the existing support services and the resources marshalled to supplement those services. Individuals and organisations mobilised following natural disasters need to be strengthened by enhancing the capacity of support service workers to identify and manage psychological distress in their clients.     

Smokers' preferences for assistance with cessation

An important issue for public health approaches to smoking control is determining smokers' preferences for the different types of services available to assist with smoking cessation. In a population survey in the state of South Australia, smokers were asked to nominate the forms of assistance that they thought would help them to stop: a stop-smoking group; a lecture; a telephone counseling service; a book, a pamphlet, or a quit kit; a television program or a video program conducted through the mail; a program through their doctor; a program through another health professional; or none of these options. Forty-six percent of current smokers stated that they were interested in none of the options. Among the preferences that were expressed for the different forms of assistance, 67% were for services from a medical practitioner or other health professional; 12.4% for a stop-smoking group; 23.1% for a book, a pamphlet, or a quit kit; and 2.9% for mail or telephone services. The strong preferences for indirect methods that an earlier study and recent commentators have identified did not emerge in this survey. Preferences for personalized, as opposed to indirect forms of assistance, were more likely to be expressed by heavy smokers, those with less confidence of success at stopping, those with greater perceived difficulty of stopping, and those who had reported shorter periods of previous abstinence from smoking.     

Defining and assessing evidence for the effectiveness of technical assistance in furthering global health

Abstract In an era when health resources are increasingly constrained, international organisations are transitioning from directly managing health services to providing technical assistance (TA) to in-country owners of public health programmes. We define TA as: 'A dynamic, capacity-building process for designing or improving the quality, effectiveness, and efficiency of specific programmes, research, services, products, or systems'. TA can build sustainable capacities, strengthen health systems and support country ownership. However, our assessment of published evaluations found limited evidence for its effectiveness. We summarise socio-behavioural theories relevant to TA, review published evaluations and describe skills required for TA providers. We explore challenges to providing TA including cost effectiveness, knowledge management and sustaining TA systems. Lastly, we outline recommendations for structuring global TA systems. Considering its important role in global health, more rigorous evaluations of TA efforts should be given high priority.     

State laws on tobacco control--United States, 1998.

PROBLEM/CONDITION: State laws addressing tobacco use, the leading preventable cause of death in the United States, are summarized. Laws address smoke-free indoor air, minors' access to tobacco products, advertising of tobacco products, and excise taxes on tobacco products. REPORTING PERIOD COVERED: Legislation effective through December 31, 1998. DESCRIPTION OF SYSTEM: CDC identified laws addressing tobacco control by using an on-line legal research database. CDC's findings were verified with the National Cancer Institute's State Cancer Legislative Database. RESULTS: Since a previous surveillance summary on state tobacco-control laws published in November 1995 (covering legislation effective through June 30, 1995), several states have enacted new restrictions or strengthened existing legislation that addresses smoke-free indoor air, minors' access to tobacco, tobacco advertising, and tobacco taxes. Five states strengthened their smoke-free indoor air legislation. All states and Washington, D.C., continued to prohibit the sale and distribution of tobacco products to minors; however, 21 states expanded minors' access laws by designating enforcement authorities, adding license suspension or revocation for sale to minors, or requiring signage. Since the 1995 report, eight additional states (a total of 19 states and Washington, D.C.) now ban vending machines from areas accessible to minors. Thirteen states restrict advertising of tobacco products, an increase of four states since the 1995 report. Although the number of states that tax cigarettes and smokeless tobacco did not change, 13 states increased excise taxes on cigarettes, and five states increased excise taxes on smokeless tobacco products. The average state excise tax on cigarettes is 38.9 cents per pack, an increase of 7.4 cents compared with the average tax in the 1995 report. INTERPRETATION: State laws addressing tobacco control vary in relation to restrictiveness, enforcement and penalties, preemptions, and exceptions. ACTIONS TAKEN: The data summarizing state tobacco-control laws are available through CDC's State Tobacco Activities Tracking and Evaluation (STATE) System; the laws are collected and updated every quarter. The STATE System also contains state-specific data on the prevalence of tobacco use, tobacco-related deaths, and the costs of tobacco use. Information from the STATE System is available for use by policy makers at the state and local levels to plan and implement initiatives to prevent and reduce tobacco use. In addition, CDC is using this information to assess the ongoing impact of tobacco-control programs and policies on tobacco use.     

Prevalence and circumstances of opiate overdose among injection drug users in the Russian federation

Using a self-administered questionnaire, we examined the characteristics of opiate overdose in 16 cities of the Russian Federation. As indicated by responses from 763 injection drug users who took part in this study, 59% experienced an overdose, 81% reported seeing others experiencing an overdose, and 15% stated that they had witnessed a fatal overdose. The most common drug that caused opiate overdose was heroin (74%), although we also found that, in smaller towns, home-produced opiates tended to be a major overdose-causing agent. There were a number of factors that increased the likelibood of overdose, such as mixing opiates with alcobol and tranquilizers or having a longer history of opiate use. We also found that injecting drug users were reluctant to seek medical assistance when their peers experienced an overdose because of the perceived ineffectiveness of ambulance services and fear of police prosecution. At the same time, 57% of respondents admitted that they lacked appropriate skills to treat overdose. We discuss the implications of these findings for overdose prevention programs in Russia.     

抓好资源管理 加强职业卫生技术服务能力建设

目的:为基层疾控中心提高职业卫生技术服务水平提供方法参考。方法:龙泉驿区疾控中心通过引进人才、多渠道筹资、获取服务资质等措施加强职业卫生技术服务能力建设。结果:龙泉驿区疾控中心人才队伍壮大,技术水平提高,工作环境和仪器设备条件得到很大改善;服务能力增强、范围扩大。结论:基层疾控中心职业卫生技术服务能力有待进一步加强,以适应工业迅猛发展的需求     

Evaluation of the Aboriginal and Torres Strait Islander Mental Health First Aid Program

Objective : This study reports findings from an uncontrolled evaluation of a course designed to educate participants in how to recognise and respond to mental health problems until professional help is received. Methods : Utilising a mixed methods design, participants in 21 different courses, delivered across two Australian states, were invited to complete pre‐, post‐, and follow‐up surveys and provide qualitative feedback on their training experiences. Results : Participants reported feeling more confident in their capacity to respond appropriately to a person presenting with a mental health need and believed they would be more likely to provide assistance. Satisfaction was attributed to the skills and sensitivities of instructors who had lived experience of mental health concerns in Aboriginal and Torres Strait Islander communities. Conclusion : This course holds promise in improving mental health literacy in relation to Aboriginal and Torres Strait Islander mental health. Implications for public health : Few courses are available that address issues relating to the social and emotional wellbeing of Aboriginal and Torres Strait Islander People. This study illustrates how community engagement with primary health and specialist mental health services might be strengthened.     

The President's Emergency Plan for AIDS Relief: from successes of the emergency response to challenges of sustainable action

The President's Emergency Plan for AIDS Relief (PEPFAR) has made a major contribution to the reduction of the global HIV/AIDS burden. The program initially focused on rapidly scaling up treatment and prevention services in fifteen low-income countries, then transitioned to an approach that emphasizes sustainability, defined as the capacity to maintain program services after financial, managerial, and technical assistance from the United States and other external donors essentially ceases. Today, PEPFAR continues to expand its HIV prevention, treatment, and care activities while also supporting capacity-building initiatives, coordination efforts, and implementation science. The latter is research focused on improving service delivery, maximizing cost-effectiveness, and achieving public health impact. Recent advances in both scientific knowledge and the provision of prevention, treatment, and care services have bred cautious optimism about greatly reducing the spread of HIV. However, success will require a substantial increase in resources, strengthened health systems, renewed commitment to HIV prevention, and well-financed efforts to develop an effective HIV vaccine.     

Defining and assessing evidence for the effectiveness of technical assistance in furthering global health

Abstract

In an era when health resources are increasingly constrained, international organisations are transitioning from directly managing health services to providing technical assistance (TA) to in-country owners of public health programmes. We define TA as: ‘A dynamic, capacity-building process for designing or improving the quality, effectiveness, and efficiency of specific programmes, research, services, products, or systems’. TA can build sustainable capacities, strengthen health systems and support country ownership. However, our assessment of published evaluations found limited evidence for its effectiveness. We summarise socio-behavioural theories relevant to TA, review published evaluations and describe skills required for TA providers. We explore challenges to providing TA including cost effectiveness, knowledge management and sustaining TA systems. Lastly, we outline recommendations for structuring global TA systems. Considering its important role in global health, more rigorous evaluations of TA efforts should be given high priority.