Community psychiatry and deinstitutionalization in Jamaica

Between 1960 and 1990, the population of Jamaica's single mental hospital was reduced by 58 percent, from more than 3,000 to less than 1,300. Services were reoriented from mental-hospital-based custodial care to rehabilitative, community-based care with no appreciable increase in the mental health budget. Despite several changes in government over the past 30 years, continuity of public policy and fiscal support has allowed ongoing development of the island's community mental health services. The national community mental health service, which had a case-load of about 14,000 patients in 1990, relies on specially trained psychiatric nurse practitioners who provide crisis management, medication management, and supportive psychotheraphy; make home visits; and carry out treatment plans developed by the community psychiatrist. Community acceptance of mentally ill persons has been enhanced by public education programs and media coverage of advances in treatment (AU)

Caribbean Cooperation in health (CCH); Trinidad and Tobago. Meeting of Donors

Comments on the effect of the world economic crisis on the social sector in the Caribbean and the concern about the potential of long term effect on the health and other social sectors. The limited available resources devoted to services and the rising expectations of the population have emphasised the need to rationalize the use of scarce resources while attempting to satisfy basic health needs. Looks at the institutions within the Caribbean which will make for the success of the initiative. Outlines the seven priority areas around which the CCH was organised such as: environmental protection, human resources development, chronic diseases control and accidents prevention, strengthening of health systems, food and nutrition, maternal and child health and population and AIDS. Presents a brief review of the socio-economic situation in Trinidad and Tobago and gives an epidemiological analysis of the country. Discusses the general health status of the country, the birth and mortality rates, special health problems and communicable and non-communicable diseases. Presents an overview of the priority areas mentioned and outlines the policies, strategies, plans and programmes adopted by Trinidad and Tobago. Presents a project profile of each priority area in which the following are outlined: problem description, project objectives, project components, budget, associated institutions and duration(AU)

The use of community health aides as perceived by their supervisors in Jamaica, West Indies (1987/88)

A research project funded by the Commonwealth Caribbean Medical Research Council (CCMRC) began in February 1987, to study aspects of the situation in connection with the 508 community health aides employed in the Government Service of Jamaica. This report deals specifically with the role of supervisors (public health nurses and midwives) in relation to community health aides (CHAs) employed in the government primary health care service, Jamaica. There were 77 supervisors interviewed, and questionnaires were returned from all four administrative health areas in Jamaica. The supervisors reported that they could supervise more CHAs in the community setting than in the clinic setting alone. In-service training was an integral part of CHA programme, and there was regular evaluation of the CHAs, with at least an annual evaluation in keeping with the policy of the agency. Resource persons from other sectors assist in continuing education programmes for the CHAs. The study outlines the main weaknesses and the strengths of the community health aide programme, and highlights the fact that CHA is a valuable member of the health team and does contribute significantly to primary health care (AU)

Learning health management by doing it

The course leading to a diploma in health management which was introduced at the University of the West Indies in 1984 contains a large practical element. This article explains how the students tackled their field assignments and draws attention to the benefits gained and the difficulties encountered (AU)

Training primary health care workers for the Caribbean

In a programme inaugurated in Jamaica, community health aides have been trained to act as primary health workers. They form an important link between health departments and the communities they serve. The idea, which has spread to other Caribbean countries, is helping to solve the problem of manpower to meet health service needs.(AU)

Evaluation of the nutrition component of in-service training for primary health care personnel in Cornwall county

Both the Government of Jamaica through the Ministry of Health, and international agencies have been involved in the design, support, implementation and evaluation of the primary health care programme in the county of Cornwall. The programme involves several approaches to the provision of simple health services through the training of community health aides (CHAs), and the changing of the roles of midwives and other health staff who are involved in bringing primary health care to the neighbourhood level through Type I health centres with referral services, and home-visiting. The programme has as one of its major aims the improvement of formal training of health staff involved in primary health care, and on-going in-service training forms an integral part of this programme. Evaluation of this in-service training programme in relation to nutrition knowledge and its practical application is the purpose of this study. Sixty-four nutrition knowledge questionnaires based on topics covered in the in-service training over a specific period were administered to health staff of Type I health centres (CHAs and DMs) throughout the five parishes in the county of Cornwall. Interviews with 440 mothers of children 0-24 months of age who attended child welfare clinics were conducted immediately after consultation with the midwives. Their recollection of nutrition advice received was compared with those recorded on child health cards to determine the appropriateness of advice given as they related to the age, present feeding regime and nutritional status of the children. Changes in the nutritional status between visits to clinic were also examined as an indicator of nutrition knowledge impact on community nutrition. While nutrition knowledge of both categories of health staff was found to be generally adequate, the results indicated that there were specific areas in which greater emphasis is necessary. A wide gap between nutrition knowledge and its application by the health workers in terms of giving sound advice to clinic attenders is indicated. Enough importance is not attached to record-keeping by health workers (AU)