Public health services in Bangladesh with special reference to systems and trends of vital statistics

Health is one of the basic requirements for improvement in the quality of life. Since Bangladesh became independent, a policy for providing essential minimum health care to all has been actively pursued. An overview of Public Health Services in Bangladesh is presented in terms of: (1) a profile of the country, (2) an overview of public health, (3) medical care, and (4) environmental health. Under each of these headings observations are included on recent trends based upon relevant data and information. Finally the authors describe the importance of (1) promotion of health care and planning at the national, divisional, local, and community levels, (2) promotion of medical services at all levels, and (3) effective decentralization of health services to enhance the services of health facilities.     

The pioneers of rural Pakistan: The lady health visitors

Since 1978, when the World Health Organization and the United Nations International Children's Emergency Fund called for urgent action by all governments to provide appropriate health care for the underprivileged, the world community has attempted to implement primary health care strategies. Pakistan, with a population of 118 million people, is one of those countries where the rural population and the underprivileged groups in the katchi‐abadis (squatter settlements) of the urban areas lack appropriate and accessible health services. This article highlights the community experiences of a remarkable group of young Muslim women, the Lady Health Visitors (LHVs) of the Aga Khan Health Services, who deliver primary health care services to disadvantaged women and children in the northern mountainous areas and rural villages of Pakistan. The LHVs are the first contact with the health care system that these underprivileged women experience. The LHVs cure, care, teach, and train traditional birth attendants. In addition, they perform health promotion and document their findings. To provide their maternal and child health services, the LHVs travel by foot through miles of rough terrain to settlements and villages. Prenatal and postnatal care, anemia, diarrhea, and malnutrition are among the major health care problems of these rural women and their children under 5 years of age.     

Social work and health care = clinical social work competence and profile in an area that is hard to survey

From the very beginning professional social work has been involved in health care. However, in our post modern society this area of competence has to be improved, and in order to compete with new health professions, a clear distinction has to be made. This is shown in important points of modern social work: Society perspective (health behaviour and public health circumstances), WHO perspective (health promotion) and psycho-social perspective (health care in social services). Health care under most difficult conditions asks for specialised competence that is to be developed in Germany as "Klinische Sozialarbeit" referring to international clinical social work standards.     

Community health orientation, community-based quality improvement, and health promotion services in hospitals

The objective of the study presented in this article was to examine the relationship between hospital community orientation and the provision of health promotion services. The study used data from the 2000 American Hospital Association survey and the 2000 Area Resource File to examine acute care hospitals throughout the United States. The study was a cross-sectional multiple regression analysis. Hospital community orientation was measured by two independent variables: (1) community health orientation and (2) community-based quality orientation. Health promotion services were represented by two dependent variables: (1) hospital-based health promotion services and (2) collaborative health promotion services. Organizational control variables included bed-size code, not-for-profit ownership, network participation, and joint venture/alliance membership. Environmental control variables included the proportion of population over age 65, the percentage of population below the poverty level, the square root of the proportion of Medicaid inpatient revenue, the presence of state community benefit laws/guidelines, a Herfindahl-Hirschman Index of level of competition, and an index of managed care influence. Results of regression analyses showed that community health and community-based quality orientations were positively and significantly related to both the direct provision of health promotion services by hospitals and the collaborative provision of health promotion services through systems, joint ventures, and networks. The study concludes that a community health orientation and a community-based quality orientation lead to greater provision of health promotion services.     

An international approach to community health care for older adults

Worldwide population ageing, concomitant increases in disability rates, and changes in family health care systems require an examination of current service delivery to optimize use of societal resources in the future. This article examines a community health care approach suggested by research conducted by the World Health Organization Kobe Centre for Health Development (WKC). The WKC approach, which uses a cross-national perspective, envisions a community health care system that integrates health and social services and spans health promotion, primary care, and long-term care. Prototypical approaches for organizing community health care include communal, marketplace, case management, and managed care. The ramifications of these approaches are examined from the perspectives of the older adult, the family, and formal service providers.     

The right to health care--gains and gaps.

The impact on health services of the individual rights and collective responsibility embodied in the U.S. Constitution is examined in the areas of environmental protection, development of health resources, personal health promotion, and social financing of health care costs. Patterns of delivery of health care have shifted from predominantly individualistic ambulatory care to group practice increasingly associated with the prepayment of costs and the establishment of community health centers. Problems remain in the need for more integration of medical and social services in institutions and in the community, more comprehensive community health centers not restricted to the poor, and quality control measures to regulate health maintenance organizations. The role of the law in advances in health care and the achievements of the American Public Health Association are also discussed.     

Personal health practices of urban adults in Alabama: Davis Avenue Community Study

The need to establish baseline data on and monitor the personal health practices and beliefs of adults in a community served by health care facilities is well documented. The purpose of the survey was to determine health care practices, personal health behaviors, and health services use of the adults living in the Davis Avenue Community (DAC), a six-census tract area located in Mobile, AL. The DAC's population is approximately 95 percent black. Using methods developed by the National Center for Health Statistics, 402 adults between the ages of 20 and 69 years were interviewed by telephone by trained personnel to ascertain the health-related characteristics of residents in this health services area. Information collected in this survey provided the staff of the Franklin Memorial Primary Health Center, who provide primary health care in the area, with an empirical base on which to plan and market health promotion and education programs for the health services area.     

New approaches for the elderly show significant results

Capital Health is Canada's largest integrated academic health region, serving a base population of more that 800,000 people in the city of Edmonton and surrounding communities. Capital Health provides a complete range of health services, including transplantation, children's cardiac surgery, innovative community health programs, rehabilitation services, continuing care, palliative care, public health, health promotion and disease prevention. Capital Health's large, integrated health system manages resources well, responds quickly and creatively to challenges and opportunities and blends institutional healthcare with community care and population health. Capital Health is a key partner with the University of Alberta Health Sciences Faculties and provides a rich environment for health research and education.     

Health promotion in South Africa

Health promotion first entered the South African health system in 1990. Today, Health Promotion is a Directorate located within the Social Sector Cluster (SSC) within Primary Health Care (PHC), District and Development operations which falls under the Deputy Director General for Health Service Delivery in the National Department of Health (DoH). The first significant piece of new policy for health promotion in South Africa appeared in the African National Congress (ANC) health policy document, health care services including reproductive health care. At the moment, health promotion service delivery is the responsibility of the national, provincial and local governments with provincial and local governments mainly implementing and the National Health Promotion Directorate offering support. Funding for health promotion activities comes from the Department of Health budget allocation by the National Treasury. One major problem for Health Promotion development is infrastructure. There is significant community participation in South Africa including health promotion policy and strategy document development. Health Promotion research and evaluation is limited. The National Department of Health considers the settings approach to be crucial in driving the progress of health promotion. There are very few trained health promotion specialists either capable or in the position to inform politicians and opinion leaders about the relationship between health and social determinants, and the evidence of effectiveness of health promotion action. Mechanisms for demonstrating evidence of health promotion effectiveness in terms of health, social, economic and political impact are lacking and occupational standards for health promotion education and training are needed.     

Community-based health care in Kibwezi, Kenya: 10 years in retrospect

In response to the interest of the Kenya government in community-based health care, the Kibwezi Rural Health Scheme was developed by the African Medical and Research Foundation (AMREF) in a semi-arid district in eastern Kenya. Based on a community co-operative philosophy and focussing on health promotion and prevention, the scheme includes the following: a health centre with a 15-bed in-patient unit including four maternity beds, out-patient services, and a 15-bed nutrition rehabilitation unit; a cadre of volunteer community health workers, trained by AMREF, who form the backbone of the project; maternal child health/family planning and nutrition services including an applied nutrition programme, a water project; and a mobile health unit. Designed as a replicable model health programme, the intention was that services would be gradually taken over by the Ministry of Health of Kenya. Much has been learned in the development of the project which should be meaningful to others considering similar endeavours. One of the first lessons learned was that the time taken to sensitize the community to community-based health care is critical to the success of the project and may need to be as long as 1-2 years. Another was that gaining the support of the community for the community health workers (CHW) requires a considerable effort on the part of project staff, but seems to be the only viable solution to the remuneration and recognition of the CHW's work. It also became apparent that preventive and promotive health services should be integrated structurally and operationally with curative health services to provide the most benefits for the community served. Finally, although there are some differences of opinion, it is felt that with some refinements, the project could be replicated in other parts of Kenya.     

Inventory of knowledge and skills relating to disease prevention and health promotion

An inventory of the knowledge and skills appropriate for the instruction of medical students in the disciplines of disease prevention and health promotion was developed by a steering committee of medical practitioners and teachers, with the input of over 70 colleagues. The inventory, which is intended as a guide for curriculum planners, defines the fundamentals of subject areas appropriate for the general education of all physicians, including the skills and knowledge related to delivery of personal disease prevention/health promotion services, quantitative methods, health services organization and delivery, and community dimensions of medical practice, as well as attitudes and philosophy.     

Eye health promotion to improve awareness and prevent vision loss among Indigenous Australians

Vision loss in Australian Indigenous communities can be largely prevented if appropriate eye care services are provided and accessed. Our extensive consultations across Australia identify opportunities to improve community and health provider awareness through eye health promotion. An improved awareness of eye care, service availability, and when and how to seek care, will contribute to closing the gap for vision.     

Public health week: marketing the concept of public health.

The Public Health Programs and Services (PHP&S) Branch of the Los Angeles County Department of Health Services began a strategic planning effort in January 1986 to meet new disease trends, curb rising health care costs, consolidate limited resources, and handle shifting demographics. A strategic plan was designed to assess the opportunities and challenges facing the agency over a 5-year horizon. Priority areas were recognized, and seven strategic directives were formulated to guide PHP&S in expanding public health services to a changing community. Health promotion was acknowledged as a critical target of the strategic planning process. Among the most significant results of the health promotion directive was the establishment of an annual Public Health Week in Los Angeles County. Beginning in 1988, 1 week per year was selected to enhance the community's awareness of public health programs and the leadership role PHP&S plays in providing these programs to nearly 9 million residents of Los Angeles County. Events in Public Health Week include a professional lecture series and the honoring of an outstanding public health activist and a media personality who has fostered health promotion. Other free community activities such as mobile clinics, screenings, and health fairs are held throughout the county. With intensive media coverage of Public Health Week, PHP&S has been aggressive in promoting its own services and accomplishments while also educating the community on vital wellness issues. The strategic methodology employed by PHP&S, with its emphasis on long-range proactive planning, is receiving national recognition and could be adopted by similar agencies wishing to enhance their image and develop unique health promotion projects in their communities.     

Perceptions of community leaders and the merger of rural health services

The merger of rural primary care and home health services offers the potential of increasing the administrative efficiency of health care, and thereby enhancing quality of care and increasing access to services, particularly health promotion. In a merger of rural health services in Northeastern Vermont, a survey of key community leaders revealed that improved organization of services, improved health status and greater accessibility of services were benefits expected and to some extent realized as a result of the merger process. The desire to preserve community-based services and having a common philosophy were important factors which served to initiate the merger. The actions of a few key individuals and the support of involved organizations were instrumental in continuing the process.Dr. Smith is an Assistant Professor, Department of Health Services Management and Policy, The University of Michigan School of Public Health.Dr. Zuckerman is an Associate Professor, Department of Health Services Management and Policy, The University of Michigan School of Public Health.This study was supported by a grant from the W.K. Kellogg Foundation (UHG0001L/RAD).     

Educational and health services innovation to improve care for rural Hispanic communities in the US

BACKGROUND: Access to comprehensive and quality health care services is difficult for socioeconomically disadvantaged groups in rural regions. Barriers to health care for rural Latinos include lack of insurance, language barriers and cultural differences. For the Latino immigrant population in rural areas, barriers to access are compounded. HEALTH NEEDS OF RURAL AREAS: THE CASE OF WALHALLA, SC: The town of Walhalla, South Carolina is a rural community located in Oconee County, the northwest corner of the state. Disparities exist between rural and urban residents in several health categories, and these disparities illustrate the need to provide competent, appropriate and affordable healthcare to rural populations. The Hispanic population of Oconee has dramatically increased in the past decade, and the majority of these immigrants have no health insurance and have limited access to health services. DESIGNING A PROGRAM TO FIT THE COMMUNITY--THE "WALHALLA EXPERIENCE": The purpose of the Accessible and Culturally Competent Health Care Project (ACCHCP) is to provide care for underserved populations in Oconee County, South Carolina while providing rural educational opportunities for health services students. Funded by the Health Resources and Services Administration of DHHS, the program is designed to offer culturally appropriate, sensitive, accessible, affordable and compassionate care in a mobile clinic setting. In this interdisciplinary program, nurse practitioners, health educators, bilingual interpreters, medical residents and Clemson University students and professors all played key roles. Women in the community also serve as Promotoras or lay health advisors. The program is unique in using educational initiatives and innovative strategies for bringing health care to this underserved community and offers important information for rural health care initiatives targeting minority groups. This paper reports on the challenges and successes in the development and implementation of the ACCHCP program in Walhalla, South Carolina.     

Community-oriented primary care: a public health model in primary care]

The community-oriented primary care (COPC) model strives to efficiently distribute, organize, and systematize existing health care resources. In addition to promoting healthy lifestyles within the community, the COPC model enables the health care team and the community to cooperate in identifying and prioritizing health issues. Together they develop and implement prevention and treatment plans for those priority areas. With COPC, the health services assume responsibility for the health of a defined population. The health services not only treat diseases but also develop programs for health promotion, protection, and maintenance. Taking this approach, COPC integrates individual and family clinical care with public health, reflecting the spirit of the International Conference on Primary Health Care held in Alma-Ata in 1978. COPC is a systematic process, with flexible principles and methodologies that can be modified to meet the specific challenges of any health care team and community. An analysis of various countries' experiences with COPC shows that applying the model appropriately can improve the general health status of the community and its members.     

A study of the morbidity pattern of referred patients and the effectiveness of the referral system in primary health care centers.

Patient referral system is considered to be an important element in achieving the objectives of the Primary Health Care services. Patients attending the Primary Health Care Center (PHCC) expect basic medical care and appropriate follow-up services. Thus, patients requiring further evaluation and treatment are referred to a secondary health care facility. In this study the morbidity pattern as well as the referral system was evaluated in selected PHCC in the city of Jeddah. A systematic random sample of all the patient referrals from selected PHCC's were analyzed. A total of 1,164 referrals were studied, 59.9 per cent were females and 40.1 per cent were males. The contents of referral letters from PHCC to hospitals as well as feed back from hospitals were analyzed. The majority of referrals were for the age group 25-44 years old 458 (39.3%). The results demonstrated that 5 per cent of patients were routinely referred to the secondary health care centers, and the feedback from these secondary health care facilities was (22.7%). It was also noted that the majority of referral letters lack commonly accepted standards of information about the patient. It was concluded that the follow-up and feed-back system needs to be reinforced. The primary health care providers need to review the patient referral system and implement specific criteria for the optimum utilization of this essential service for the benefit of the community.     

Delivering services to the Bangladeshi community: the views of healthcare professionals in East London

OBJECTIVE: To explore the views of primary care staff about delivering services to the local Bangladeshi community. STUDY DESIGN: Qualitative case study. METHODS: Six focus groups, each with a different healthcare profession: speech and language therapists; child development team; health advocacy team; salaried general practitioners; school nurses; and occupational therapists. RESULTS: The study contributors spoke of the community as homogeneous and different from other communities. Language, religion and a lack of knowledge of the National Health Service were barriers to effective service use. There was only limited acknowledgement of the deprivation of this community and of similarities to other deprived communities. Health education and promotion were thought to be the best solutions to the difficulties identified. CONCLUSIONS: The study contributors' views seemed to derive from anecdotal rather than research-based evidence. There is a clear need for training, not only in equality and diversity, but also in core public health approaches: understanding the links between poverty and poor health; the scope and limitations of health promotion; and the role of community development.     

Barriers to meeting the mental health needs of the Chinese community.

BACKGROUND:This study aimed to identify the barriers encountered by Chinese people with mental health needs in England which hindered their obtaining appropriate help from the National Health Service (NHS). METHODS: Attenders at Chinese community centres in health authority districts with resident Chinese population in excess of 2000 were invited to fill in a 12-item Chinese Health Questionnaire (12-CHQ). Individuals who scored two or above, indicating a high probability of a mental health problem, were invited to undertake a semi-structured interview. RESULTS: A total of 401 completed the 12-CHQ. Eighty-six (21.4 per cent) screened positive and 71 (82.6 per cent) agreed to be interviewed. Although 70 (98.6 per cent) were registered with a general practitioner (GP), there were long delays before they made contact with health professionals, and the GP was the first port of call for help in only 27 (38.6 per cent) interviewees. Fifty-two (74.3 per cent) had encountered difficulties when they sought professional help. The main barriers were language, interviewees' perceptions of symptoms as somatic rather than psychiatric in origin, lack of knowledge about statutory services, and lack of access to bilingual health professionals. Doctors, particularly GPs, were pivotal in the management of their conditions. The majority were prescribed psychiatric medication with only a small number in contact with community psychiatric services. Unemployment and social exclusion were common. Stigma associated with mental illness and limited knowledge in the community were identified as the causes for the widespread discrimination experienced by the interviewees. CONCLUSION: The mental health needs of these Chinese people were not adequately met by statutory services, nor could they rely on family and friends for care and support. Training for health service staff and access to health advocates are essential to maximize the effectiveness of health professional-patient contacts. The promotion of better understanding of mental illness by the Chinese community is important, and greater flexibility within the NHS is required to ensure those professionals with bilingual skills are used to the best effect.     

Reaching the difficult audience: an experiment to provide occupational health services to farmers and ranchers in Colorado, U.S.A

From its inception in the late 1970s, the W.K. Kellogg Foundation funded Workplace Health in Agriculture Program at Colorado State University underwent numerous evolutions as the needs of the agricultural community were identified. Direct health and safety consultation with agribusiness met with limited success due to the cost of providing services over a wide geographic area and a general unwillingness within this group of employers to involve themselves with "OSHA"-type regulations. Therefore, the program changed from promotion of, and providing health and safety consultation upon request, to education of specific target groups within the agricultural community supplemented by consultation services when needs were identified. Target groups for educational services included rural health care providers, vocational-agriculture students and teachers, farm/ranch clubs and groups (with special emphasis on farm wives groups), and rural emergency services. These groups became the promoters of health and safety within the agriculture community, which resulted in a direct, positive impact on requests for, and interest in health and safety services provided by the program.