Universal Healthcare & Community Public Health PDF

UNIT 1A LAB: COMMUNITY HEALTH ❖​ Attract those with a more public or civic purpose in mind, such as community service DEVELOPMENT or advocacy...

UNIT 1A LAB: COMMUNITY HEALTH ❖​ Attract those with a more public or civic purpose in mind, such as community service DEVELOPMENT or advocacy for educational quality ❖​ Forms of association may take on formal DEFINITION OF A COMMUNITY organizational structures and adopt charters ❖​ a group of people living in the same place or for governance purposes. having a particular characteristic in common (Oxford) Community is Diverse ❖​ a feeling of fellowship with others, as a ❖​ An asset for communities wherein, life result of sharing common attitudes, experiences and individual talents provide a interests, and goals. (Merriam Webster) broad range of resources residents can use ❖​ a social group of any size whose members to get things done in their communities reside in a specific locality, share –asset-based community development. government, and often have a common (mapping of resident’s capabilities, skills, cultural and historical heritage. and knowledge to assemble tasks ❖​ a social, religious, occupational, or other effectively). group sharing common characteristics or interests and perceived or perceiving itself Community is Networking as distinct in some respect from the larger ❖​ Interact with family members, friends, society within which it exists business or civic associates, service (dictionary.com) providers, and coworkers. ❖​ These social networks provide emotional NATURE OF COMMUNITY and physical support, as well as access to resources linked to others in our network. Community is Structured (by relationship) ❖​ The popularity of technology-based social ❖​ community reveals a pattern of networking assets, such as Craig’slist, interpersonal relations governed by certain Facebook and Twitter, demonstrates just accepted norms or rules, such as how important such networks are to reciprocity, shared values, inclusiveness or individuals. respect for property. ❖​ valuable collectively as being organize and ❖​ these norms are formally recognized and mobilize assets to accomplish goals in subscribed to in a public manner, creating communities. institutions such as schools, churches, civic organizations and neighborhood Community is Resources associations. ❖​ broader set of “capitals” that make up ❖​ They have statutory authority granted to communities, such as natural or these institutions by the state to govern environmental capital, human capital, built how they respond to the local needs. capital (physical infrastructure), and ❖​ Because of their limitations, citizens rely on economic or fiscal capital (actual financial other institutions or create improvised wealth). forms of social organization to accomplish ❖​ community capital usually refers to the task. economic measure of wealth that provides the tax base upon which local communities Community is Collective rely to provide a stream of funds for capital ❖​ Represented by the organization of activities projects and services. and interaction. ❖​ An opportunities in our communities for individualism to thrive. 1  DEFINITION OF COMMUNITY IN PUBLIC 6. Leverage HEALTH PERSPECTIVE ❖​ leverage centered on the potential ways ❖​ Community was defined similarly but that groups or individuals can bring about experienced differently by people with positive or negative consequences for the diverse backgrounds. These results parallel community as a whole. similar social science findings and confirm the viability of a common definition for 7. Pluralism participatory public health. ❖​ referred to discussions of the maintenance of distinctions between coexisting ethnic DEFINITIONAL ELEMENTS OF COMMUNITY group. 1. Locus PROCESS OF COMMUNITY HEALTH ❖​ located and described, denoting a sense of DEVELOPMENT: INTRODUCTION place, locale, or boundaries. ❖​ A community health needs assessment is a systematic process involving the community 2. Sharing to identify and analyze community health ❖​ referred to the existence of shared needs and assets in order to prioritize these perspectives and common interests that needs, and to plan and act upon significant contributed to a sense of community (i.e. unmet community health needs. This values, norms, passions, activities, sexual process results in a product: a summary identity, tribulations, oppression etc.) report. 3. Joint Action COMMUNITY BENEFIT: ❖​ source of community cohesion and identity. ❖​ Improve access to health care services A conscious intent to generate community ❖​ Enhance the health of the community. through action was not viewed as ❖​ Advance medical or health care knowledge. necessary; rather , joint action was seen as ❖​ Relieve or reduce the burden of government leading naturally to the creation of or other community efforts. community (i.e. socializing, hang our, converse etc.) PROCESS OF COMMUNITY HEALTH DEVELOPMENT: GUIDING PRINCIPLES 4. Diversity ❖​ Those who live in poverty and at the ❖​ a societal view of community and made margins of our society have a moral priority reference to differences in interpersonal for services. interaction. ❖​ Not-for-profit health care has a responsibility to work toward improved 5. Divisiveness health in the communities they serve. ❖​ Divisiveness referred to descriptions of ❖​ Health care facilities should actively involve community fragmentation or a lack of unity, community members, organizations and often expressed as an overemphasis on agencies in their community benefit individualism and self-interest, or as programs. attitudes that hindered unity and ❖​ Health care organizations must demonstrate cooperation. the value of their community service. ❖​ Community benefit programs must be integrated throughout health care organizations. 2  ❖​ Leadership commitment is required for the community at large. It may be successful community benefit programs. helpful to discuss the following questions about resource PROCESS OF COMMUNITY HEALTH availability with the internal assessment team. DEVELOPMENT: HEALTH NEEDS ​ Geographic area ASSESSMENT ​ Priority populations ​ Range of issues Step 1 ​ Revisit resources and time lines ❖​ Plan and prepare for the assessment. ​ Involve members of the community Step 3 from the beginning of the ❖​ Identify data that describes the health and community health needs needs of the community. assessment process. for examples ​ Select indicators of community members and ​ Demographics and organizations can work with to Socioeconomic Status conduct an assessment. ​ Access to Health Care ​ Health Status of Overall Step 2 Population and Priority ❖​ Determine the purpose and scope of the Populations community health needs assessment. ​ Risk Factor Behaviors ​ There are two options for ​ Conditions Related to Top developing a community health 10 Causes of Death needs assessment: a single ​ Child Health organization approach and a ​ Infectious Diseases multiple organization partnership ​ Natural Environment approach. The main differences ​ Social Environment between the two are described in ​ Resources/Assets the table below. ​ Other considerations: ​ Standards and benchmarks ​ Organizational needs and priorities ​ Quality and usability of data indication ​ Before you start a community health needs assessment, get a general idea of the human and financial resources available for the assessment. This can be found both within your organizations and from 3  ❖​ Identify relevant secondary data for ​ Identify and understand indicators causal factors ❖​ Collect community and public ​ Identify major community health input and feedback. health needs ​ What health problems are most troubling to Step 5 community members? ❖​ Define and validate priorities. ​ What are issues of concern ​ Determine who will be involved in to public officials– school the setting of priorities - the team, principals, police and the or key partners will conduct an health department? initial review of data and identify ​ Are any community-based preliminary priorities. Key partners organizations, such as a might include public health officials, community coalition, other service providers and already addressing issues? community leaders. ​ At this stage, it is also ​ Establish criteria for setting important to receive input priorities - examples: Magnitude, about potential community severity, historical trends, strengths, resources, or assets impact, importance of the problem available to respond to the to the community, existing of health needs of the resources, relationship of the community. problem to other community issues, feasibility of change, value of immediate intervention. ​ Validate priorities– confirming that the need identified is the need that should be addressed. ​ Ranking - Participants in the priority-setting process can be asked to rank identified needs with a numerical score based on the criteria established earlier in this step. Step 4 ❖​ Understand and interpret the data. ​ The goal of this step is to determine the major health needs in your community and related issues. At the end of this step, you should be able to provide a summary of your initially identified health needs. ​ Analyze And interpret the data ​ Identify disparities 4  ❖​ Identifying sources for data and expert consultation. ❖​ Developing a time line for the assessment and making sure that time lines are met. ❖​ Informing the board and executive leadership about progress, challenges and findings. ❖​ Developing a plan for setting priorities. ❖​ Maintaining communications with all people and groups interested in the assessment. Step 6 THE ROLE OF MEDICAL TECHNOLOGISTS ❖​ Document and communicate results. IN THE PUBLIC HEALTH ​ should be presented in a manner easily understandable and accessible to your community. A. LABORATORY PUBLIC HEALTH ​ Write the assessment report PERSPECTIVE ​ Develop tables, graphs and maps to display the data THE IMPORTANCE OF LABORATORY IN PUBLIC ​ Disseminate results widely HEALTH: ❖​ serve as important and evolving role in PROCESS OF COMMUNITY HEALTH supporting the broad mission of public DEVELOPMENT: THE PRODUCT health; ❖​ A summary report of the community health ❖​ generate data used to make decisions and needs assessment can include: plans, evaluate programs, and provide local ​ Description of the community testing services (just like clin. Labs that assessed. diagnose, monitor and treat patient) ​ Description of the assessment ❖​ serve as conduits, collecting specimens for process. various state-level screening and disease ​ Description of any information gaps. control programs; ​ With whom the hospital worked. ❖​ Responsible for tracking specimens, ​ Problems/needs identified. ordering tests and reporting results. ​ Description of health facilities and ❖​ often serve as surge capacity for state other resources in the community. public health labs (PHLs), for testing to ​ How needs were prioritized support emergency response. ❖​ Work with local PH professionals work as a team with investigator, inspector and posed PROCESS OF COMMUNITY HEALTH to provide rapid and relevant responses to DEVELOPMENT: THE ROLE OF THE community needs. ASSESSMENT LEADER ❖​ Forming an internal team. DIFFERENTIATION OF PRIVATE AND ❖​ Identifying and working with community GOVERNMENT LABORATORIES IN THE partners. ❖​ Investigating any existing assessments or PHILIPPINES: current assessment processes. ❖​ Government ❖​ Developing a budget of financial and other a.​ National Reference Labs / central resources needed for the assessment. b.​ Referral / peripheral clinical labs (local) 5 ❖​ Private ❖​ Allowing for enhanced local awareness in a.​ Clinical labs (Hospitals and diagnosing clinical or environmental issues non-hospital based) and a more efficient response in times of b.​ Free standing labs crises; c.​ Institutional labs ❖​ Assume the workload associated with many local emergencies. LOCAL PH LABORATORY SERVICES AND PROGRAMS National Reference Laboratory System ❖​ Vary by size of community they served ❖​ Contribute testing services in the statewide (national or local) network (sentinel or confirmatory labs); ❖​ Depends on the relationship with the state ❖​ Small labs collects and process specimen PH departments and laboratories and and forward to NRLs for confirmation. community needs. ❖​ Provide network at the local PHL, provincial ❖​ On-site testing (TB, STIs, and other and regional agencies to maximize screening and prevention programs); resources to serve the community needs. ❖​ Serve other confidential service programs (HIV screening and counselling to avoid National Institute of Health (NIH), UP-Manila stigma); ❖​ Support the national effort to improve the ❖​ Report results directly and rapidly to PH health of Filipinos by enhancing the programs country's capability for health research and ❖​ Within the agency for expedited disease development. control programs (TB, Dengue, HIV/AIDS, ❖​ promote the development of study groups STIs, Shistosomiasis, Rabies, Polio, etc.) and research programs ❖​ establish mechanisms for the dissemination LOCAL PHL THAT SUPPORTS OTHER PH and utilization of research outputs. PROGRAMS IN THE IMPLEMENTATION OF COMMUNITY HEALTH STANDARDS OPPORTUNITIES FOR LAB NETWORKING AT ❖​ lead poisoning, ; LOCAL PHL ❖​ iodine deficiency, ❖​ Communication among PHL and local clin ❖​ communicable disease (HIV, TB, Polio) labs provides opportunity exchange surveillance and testing, information and data related to ongoing PH ❖​ water testing and monitoring, issues and investigation; ❖​ local environmental testing, food safety, and ❖​ Identify unmet community lab service ❖​ inspection programs by providing food needs; microbiology services, including ❖​ Useful to hospitals to communicate with investigations of outbreak of foodborne microbiology heads a number of issues, as diseases. continuing education, training and lab quality improvement programs. PHL ARE FAMILIAR TO LOCAL HEALTH ❖​ Meet regulatory requirements; PROBLEMS: ❖​ Provide training practicing lab professionals, ❖​ Enabling to prioritize laboratory work and to hosting post-doc researches and interns; address the immediate needs of the ❖​ Intermediary in communicating state-level community; PHL relevant policies to local clin labs, ❖​ Have strong ties and proximity to reportable diseases, evaluation of PH community clinicians, public health interventions. (example: community-based professionals, private labs, local media, testing of HIV and STIs, rHIVDA, HIV Proficiency Program) 6  OTHER NEW ROLES ON THE 21ST B. THE MEDICAL TECHNOLOGIST IN CENTURY PH PUBLIC HEALTH PERSPECTIVE ❖​ Provide surge capacity for emergency response (select agent testing); CAREERS OF MT IN PHL ❖​ Turn around time improvement efforts; ❖​ Purpose: ❖​ Equipment and testing capacities were ​ Protect the health of the nation; made available (i.e. GenExpert for TB, PCR, ​ A valuable resource for safeguarding provision of coulters for CD4/CD8 the health of our citizens monitoring of HIV patients provision of lab equipments); QUALIFICATIONS ❖​ Provision of technical trainings allows them ❖​ Clinical laboratory scientists to develop expertise in molecular and other ❖​ Microbiologist types of testing for public health purposes; ❖​ Chemists ❖​ Molecular biologists LOCAL PHL CHALLENGES: ❖​ Researchers ❖​ Some with low resource setting; ❖​ Laboratorians with various levels of ❖​ Expanding expertise and scope testing education from associate degrees to require state-of-the-art lab facilities (i.e. doctorates molecular testing and security requirement of select agents testing. PH LABORATORIANS WORK CLOSELY WITH ❖​ Infrastrusture of lab; ❖​ Biosafety and biosecurity requirements OTHER PH PROFESSIONALS AND PARTNER ❖​ IT (hardware and software) for LIS IN THE CLINICAL LABS IN: ❖​ Data management ❖​ Investigating and controlling infectious ❖​ Regionalization, specialization or shifting, or diseases and outbreaks: sharing of resources (instrumentation) in ❖​ Preventing disease and disability in addressing PH issues; vulnerable populations, including women ❖​ Aging work force and difficulty of and children; recruitment and replacement of qualified ❖​ Monitoring the environments; and scientific leadership. ❖​ Preparing for the responding to local, ❖​ Lack of single national accreditation national emergencies such as pandemic program for both and local PHL influenza, coronavirus, bioterrorism and professionals result in number of issues; natural disasters; 1.​ Complicates efforts by lab directors to implement a single QA or data TEST USUALLY PERFORMS ARE: management programs ❖​ Screening of STIs 2.​ Proficiency programs do not cover ❖​ Screening for inborn errors; products that cover the full scope ❖​ Diagnostic testing for: TB, HIV, Hepatitis B& of testing (particularly hospital labs) C, Influenza, Dengue, Parasites, and other 3.​ Complicates in establishing emerging viruses. productivity and other benchmark ❖​ Reference testing (serotyping and and compare cost and other genotyping) management metrics. ❖​ Epidemiologic surveillance testing: (DNA fingerprinting or microbiology isolates, antimicrobial susceptibility trends, molecular subtyping of influenza A searching for novel viruses) 7  ❖​ Testing for agents of bioterrorism (routine ​ environmental, testing, real-time PCR assays) ​ genetic, ❖​ Testing of chronic diseases and ​ systemic and cultural environmental health ❖​ conducted in a coordinated and integrated way, and the achievement of policy MODERNIZING MEDICAL TECHNOLOGISTS coherence through ​ whole-of-government, AS PART OF PUBLIC HEALTH WORKFORCE ​ whole-of-society and ❖​ Identify and embed practiced-based faculty ​ health-in-all policies approaches. from the community, including those who might not possess graduate or terminal “There are people changing the world by leading degrees, in academic settings. with kindness and empathy. All these to say, our ❖​ Provide leadership programs for degree means a lot if we back it up with some interprofessional faculty teams focusing on humanity.” - Dissertation Coach PH topics. ❖​ Link to existing groups that are working to increase diversity. ❖​ Enhance partnerships of health professional schools or programs and PH agencies to provide increased opportunities to learn through real-world practice. ❖​ Improve applied experiences in PH (faculty, students through social networking). Philippines needs national health policies, strategies and plans informed by the SDG and Health 2020 that are vital to achieving health improvement govern by specialized health professionals. The goal is to identify investment priorities that will have the greatest potential impact on health and well-being. SO HOW DO MY/MLS HELP ACHIEVE THE SDG GOALS? ❖​ Requires political will and investments; ❖​ Policies and strategies must be informed by evidence through; ❖​ Policymakers and scientists work together that require trade-offs; ❖​ Scientists need new skills in doing research in communities connect to policy makers tackling complex issues of different perspectives. ❖​ The implementation of both the SDG and Health 2020 requires a focus on all the determinants of health: ​ political, commercial, social, 8 UNIT 1C LAB: FORMATION OF COMMUNITY HEALTH WORKERS (CHW) IN COMMUNITY HEALTH DEVELOPMENT CHWs ❖​ come from the communities they serve and they have little or no secondary and no tertiary education. ROLES ❖​ Roles: GENERALIST ​ Generalist village health workers have been working in developing country health programmes from before the Alma Ata declaration; some in large national programmes, ​ expected to perform a wide range of functions such as: ​ home visits, environmental sanitation, provision of water supply, first aid and treatment of simple and common ailments, health education, nutrition and surveillance, maternal and CHW GOVERNANCE, OWNERSHIP AND child health and family ACCOUNTABILITY planning activities, ❖​ Community participation communicable disease ❖​ Relationships with formal health services control, community ❖​ Incentives development activities, ❖​ Volunteers versus paid workers referrals, record-keeping, ❖​ Incentives and disincentives and collection of data on vital events Relationship with Formal Health ❖​ Another Role: SPECIALITY CHW ❖​ The attitudes and interactions of health ​ This is often, but not only, true for personnel in the formal health services with programmes run by NGOs, which CHWs have an immediate impact on critical frequently have a programme aspects of CHW programme management, specific focus. such as selection, continuing training and ​ Specialization may also be a supervision. response to the difficulty ❖​ During the training period, teams lived in experienced in finding the optimal villages where they assessed various health mix of CHW functions and tasks and social problems through and the right balance between action-oriented research. breadth and depth of tasks. 9 Incentives and Disincentives ❖​ There is no tidy package of three incentives that will ensure motivated CHWs who will continue to work for years. ❖​ A complex set of factors affects CHW motivation and attrition, and how these factors play out varies considerably from place to place. ❖​ Monetary incentives can increase retention. CHWs are poor people trying to support their families. But monetary incentives often bring a host of problems because the money may not be enough, may not be paid regularly, or may stop altogether. ❖​ Many programmes have used in-kind incentives effectively. CHWs represent an important health resource whose potential in providing and extending a reasonable level of health care to underserved populations must be fully tapped. 10