Organising women for Panchayati Raj

The recently passed 73rd Constitution Amendment Act in India focused on political structures and processes of rural India and vulnerable populations. Participation of women in Panchayati Raj Institutions was questioned in terms of the substance and effectiveness of representation. Rural women were particularly vulnerable as a group because of strong traditional values maintained in rural areas, patriarchal families, lack of women's education and access to information, poor exposure to the "outside" world, and lack of power. Local committees insufficiently represented women. Women were rarely heads of Panchayats and needed the lower positions to advance within the system. State acts have been passed to assure women's representation in Andhra Pradesh. The National Perspective Plan of 1988 provided for over 33% of seats for women and minorities as members and chairpersons of Panches and Sarpanches, based on proportional representation in the total population. Greater participation of women in politics was viewed as dependent not just on fulfilling the law but on assuring principles, democratic, and meaningful administration of government. Effort were equally necessary to address attitudinal, social, and structural barricades. Women needed to know where and how to direct their concerns so that solutions were found to the problems women faced. Women members of Panchayats needed to be educated and informed about politics: their rights, the nature of Indian democracy, policies and programs for women and the underprivileged, and voting rights. Women needed financial support for running for office. Women must view themselves as representatives of all people. Women's centers and other organizations can serve as catalysts to mobilize women and help solve political dilemmas. A combination of Constitutional provisions, government policies, social action, and self awareness among rural women will eventually result in Indian women becoming part of the mainstream political power sharing and decision making.     

Organising services for influenza vaccination for older people

OBJECTIVES: To follow up a trial of home-administered influenza vaccination of older people to explore reasons for their immunisation behaviour, including their views on the organisation of services. METHODS: Follow-up of original trial using analysis of records of 1865 older people and semi-structured interviews of 25 older people. RESULTS: A once-off home visit does not appear to result in sustained changes in immunisation behaviour. Older people's behaviour appears to be largely explained by their beliefs about immunisation; the organisation of services may exert only small effects. Older people can be characterised as belonging to one of four groups in their orientation towards influenza vaccination: the 'faithful', who are keen to have vaccination; the 'converts', who have been persuaded of the benefits of vaccination and are likely to self-initiate appointments for vaccination; the 'easy-going', who require prompting for vaccination; and the 'sceptics', who perceive influenza vaccination to be ineffective or to be irrelevant for them because of their perceived inherent resistance to influenza. The last group sees vaccination as a form of interference and may be resistant to home visits to administer the vaccine. CONCLUSIONS: Targets for immunising older people require more debate because of the delicate balance between achieving herd immunity and preserving autonomy and choice for older people.     

Organising a continence advisory service

Modern surgical techniques have greatly improved the treatment of incontinence, but there remains a large number of patients for whom conservative management will be necessary. This paper reports the appointment of a continence adviser 10 years ago, and describes the subsequent development of a District Continence Advisory Service. Experience has shown that this appointment is essential, not only in terms of facilitating the service, but also as a means of ensuring cost efficiency.     

Missed opportunities for immunization

A survey conducted in the outpatient departments of Dayanand Medical College and Hospital in Ludhiana, India, found that 13.4% of children aged 0-23 months and 33.0% of pregnant women were not being given due immunization. Maximum advantage, however, should be taken of every contact between health workers and clients to provide all available and required health interventions. 80% immunization coverage could be achieved if all children who are brought to clinics for whatever purpose were screened and immunized if necessary. Missed opportunities occur because immunization is not available on all days; there is no uniform contraindication policy; doctors schedule as they please, with only one or two vaccines given to children who are eligible for more; there is an unwillingness to combine vaccines; weak excuses prevent the administration of vaccines; due antigens are not given on discharge from hospitals following recovery; pregnancy of less than 16 weeks is supposed to be a contraindication to tetanus toxoid; there is vaccinator reluctance to open multi-dose BCG/measles vaccine vials for a small number of children for fear of wasting the vaccine; and vaccines may be out of stock. The following suggestions may help minimize missed opportunities for immunization: review of the immunization schedule to provide optimal protection at the earliest age, review of the policy on contraindications to avoid false contraindications, ensuring that all women and children receive all vaccines for which they are eligible, issuing immunization cards to all women and children and checking them on all subsequent visits, making vaccines available in all clinics, educating health care personnel on these issues, packing vaccines in smaller quantities to avoid wastage, and exploiting all contacts with the people to provide maximum health care interventions.     

Organising habilitation services: team structures and family participation

This study is part of a project focusing on co-operation between receivers of habilitation services (families) and professionals. The study focuses on the organisation and co-ordination of the services, and compares two structures for their accomplishment. The first is the typical multiprofessional habilitation team (MHT), and the second is the individualised team (ISP). MHT teams are organised within the habilitation agency, while ISP teams span institutional boundaries. An ISP team is formed around the individual child who receives services from the habilitation centre, and includes parents (sometimes the child), professionals from the habilitation centre, and professionals from other service-providing institutions that are actively involved (for instance pre-school teacher, schoolteacher etc.). The team maps child and family needs, organises assessments and services and formulates goals that subsequently are monitored and followed up. A questionnaire (Measures of Processes of Care) was used to assess the experiences of 385 service receivers. The questionnaire focuses on service receivers' experiences of the family-centredness of the service, operationalised in 56 items, along with five items concerning perceptions of level of control over service provision. The experiences of families having individualised teams were compared to those not having these teams. Significant differences were obtained, suggesting the impact of the form of service organisation on the content. Families having ISP teams report both more family-centred service, and a greater level of control over service provision. Results are discussed in terms of organising structures and co-ordination of services, and in terms of family participation.     

Cluster sampling for immunization coverage

The WHO/EPI cluster sampling method for immunization coverage surveys is part of the course for management training in EPI programmes. The application of this method, based on a framework of villages, is impractical in dispersed populations common in many countries in Africa. To make the method work under those circumstances leads to unacceptable bias, which tends to overestimate the real coverage rate. A modified random cluster sampling method for dispersed populations is presented.     

Standards for adult immunization practices

Since the Standards for Adult Immunization Practices were first published in 1990, healthcare researchers and providers have learned important lessons on how to better achieve and maintain high vaccination rates in adults. The success rate of childhood immunization far exceeds the success rate of adult immunization. Thus, information and practices that will produce higher success rates for adult vaccination are crucial, resulting in overall societal cost savings and substantial reductions in hospitalizations and deaths. The Standards, which were developed to encourage the best immunization practices, represent the collective efforts of more than 100 people from more than 60 organizations. The revised Standards are more comprehensive than the 1990 Standards and focus on the accessibility and availability of vaccines, proper assessment of patient vaccination status, opportunities for patient education, correct procedures for administering vaccines, implementation of strategies to improve vaccination rates, and partnerships with the community to reach target patient populations. The revised Standards are recommended for use by all healthcare professionals and all public and private sector organizations that provide immunizations for adults. All who are involved in adult immunization should strive to follow the Standards in order to create the same level of success achieved by childhood vaccination programs and to meet the Healthy People 2010 goals.     

Parental and societal support for adolescent immunization through school based immunization programs

Objectives

Adolescent immunizations such as human papillomavirus vaccine have been implemented through school based immunization programs (SBIPs) in Australia. We assessed community attitudes toward immunization of adolescents though SBIPs.

Methods

A cross-sectional population survey of rural and metropolitan households in South Australia in 2011. Univariate and multiple regression analyses identified predictors of support for a SBIP.

Results

Participation rate was 57.3% with 1926 adults interviewed. Overall, 75.9% regarded school as the best place to offer adolescent immunizations, with 16.4% preferring the family physician. Parents of high school students were most supportive (88.4%) of a SBIP with 87.9% of their adolescents reported as having participated in the program. Adults 18–34 years (79.4%) were more likely to support a SBIP compared to older adults (68.7% of >55 years) [adjusted OR = 2.39, p = 0.002] and men were more supportive (80.3%) than women (71.7%) [adjusted OR = 1.54, p = 0.003]. Reasons for participation in the SBIP included convenience (39.9%), public funding for the service (32.4%), and confidence in immunization recommendations (21.0%).

Conclusions

Public support for the SBIP was very high particularly amongst parents whose adolescent/s had participated in the program.     

Antigen epitope-expressing cytokines for DNA immunization

Strategies to enhance the efficacy of DNA vaccination against malignancy remain to be established. In this study, a plasmid expressing a tumor antigen incorporated into the signal peptide of human IL-2 was tested as a DNA vaccine in a murine model system. Results showed that antigen-specific CTL responses were elicited by intramuscular injection of these plasmids. Importantly, compared with a minigene vector expressing the same epitope, the OVA epitope-incorporated, IL-2 expression plasmid vaccination was more effective in protecting mice from OVA-expressing tumor challenge. The improved efficacy appears to result from enhanced antigen presentation as well as the immunostimulatory activity of IL-2. This approach may provide new perspectives in designing cytokine-adjuvant DNA vaccines for clinical applications.     

A training procedure for immunization.

A booklet on child immunization and a training procedure using a video have been developed in a health authority. The initiative has proven highly acceptable and has resulted in a demonstrable increase in professional knowledge and in vaccine uptake. Further initiatives are described.     

Costs of polio immunization days in China: implications for mass immunization campaign strategies

Ten provinces of China were selected to estimate the cost per immunization of the 1994-95 national immunization days (NIDs) at five levels (e.g. province, prefecture, county, township and village). Personnel costs accounted for the largest overall share of costs (39 per cent), followed by publicity and promotion costs (27 per cent), and logistic costs (15 per cent). Without consideration of vaccine costs, the major part of NID expenses were shouldered at the township level, which paid for 47 per cent of all incremental costs, while county and village level covered 28 per cent and 18 per cent respectively. Estimation of average costs per immunization was 2.86 RMB yuan, or $0.34, including vaccine costs, buildings and equipment amortization and salaries at all levels. The factors affecting average cost of NID included the output volume, socio-economic development and geographic features. Various approaches were recommended: to intensify the productivity of time and staff, to employ alternative inexpensive manpower resources, to make the best use of publicity and social promotion, the expansion of the age groups and utilization of multi-intervention strategies. Good planning at township level was a decisive factor to ensure an effective NID conducted in an efficient manner. The average cost of China's NID was the lowest among all mass immunization campaigns ever documented. Much of the reduced average cost was attributable to economies of scale.