Community participation for health - an assessment of a community's response [abstract]

OBJECTIVE: To evaluate factors influencing community participation in promoting community health. METHODS: This operational research project was carried out in the urban community of Air Pipe and Chambers Lanes, St.Andrew. Household heads of 50 percent of the 70 families were interviewed about their health needs, values, resources, cultural beliefs and desire to improve their health status. Community participation in ensuing interventions was observed. RESULTS: Poor water supply reported by 63 percent of family heads interviewed; indiscriminate dumping of refuse and its attendant insect, rodent and odour nuisances and low levels of health literacy were the priority problems identified by the community. Community participation in the process, including relevant solutions, was influenced by a willingness among field personnel to meet with residents at their convenience. Cleaning up of the community, an intervention undertaken, had participation of 75 percent of families subsequent to an agreement that the clean-up would exclude a gully which provided Christmas work for them. Fifty percent of the families signed up for a scheme to bring water supply into their homes. This effort failed due to lack of trust, the presence of laggards in paying the required contributions and, primarily, the withdrawal of outside leadership for sustained efforts at community empowerment. CONCLUSION: Organizing this community for participation in health was facilitated by the social influence of the organizers and respect for community values. The need for sustained efforts at attaining empowerment seems relevant and vital. (AU)

Reformas del sector de la salud y participacion social / Health sector reforms and societal involvement

This article begins by briefly reviewing different forms of citizen participation in the health system. The article then suggests the need for mechanisms for society to control each of the tasks that the health system should perform: defining overall policies, financing, insurance, service provision, and evaluating the effectiveness and efficiency of the system. In general, in the countries of Latin America and the Caribbean, health sector policy formulation continues to be carried out in a centralized manner, with limited involvement by individuals and little adaptation to local realities. The reform processes in the Region are progressing in defining or improving the financing responsibility so as to better reconcile the objectives of equity, efficiency, and freedom of choice. Nevertheless, little has been done to develop instruments for citizens to control the functions of financing and insurance. Appropriate instruments are still lacking for citizens to effectively manage service providers. Among the principal obstacles to citizens participation in the health sector in the Region are: inequality in the distribution of income and other forms of power, an embryonic recognition of the rights and the absence of mechanisms for people to truly exercise them, the weakness with which existing control mechanisms recognize social diversity and incorporate the views of minorities or of the most marginalized groups in society, weak civic organizations (AU)

Contraceptive technologies and consumer choices

Whilst a greatly increased range of contraceptive methods is now available, in practice it requires a very strong national delivery system to provide reliable access to contraceptives if users are to have an effective choice of methods. Contraceptive use in the Caribbean varies amongst countries but, with an average for the region of over 40 percent of women of reproductive age using modern contraceptive methods, it is comparatively high. Generally there is wide public awareness and knowledge about contraception and how it may be used safely and effectively. Despite the relatively high contraceptive use in the Caribbean, in practice the full range of contraceptive choice for consumers is not always available. The paper details 4 critical steps that must be taken for the Caribbean consumer to benefit from the full range of contraceptive choices (AU)

An AIDs-related survey of knowledge, attitudes and practices among people in Ocho Rios, St. Ann Jamaica

Acquired immune deficiency syndrome (AIDS), caused by infection with the human immunodeficiency virus (HIV), is now of pandemic proportion and taking a severe toll in human suffering and death. The stigman attached to AIDS, with fear of contagion, moral issues relating to drug use and sexual orientation have greatly affected individuals and communities experiencing HIV/AIDS. For persons with HIV/AIDS community based care may also be a problem because of rejection by family members, discrimination and harassment. A cross-sectional survey was carried out among residents of Ocho Rios, St. Ann, Jamaica, during February of 1998, to determine their level of knowledge of HIV/AIDS; their attitude towards persons with HIV/AIDS; current practices toward HIV/AIDS person known to them, and their level of support for community based care of these persons. A total of 188 questionnaires were completed from a sample size of 276, selected from the 1997 Electoral Register, using the systematic sampling technique.(AU)

An assessment of knowledge attitude and perceptions of solid waste management within a community - its implication for energy recovery

Problems of solid waste disposal have been experienced by many societies worldwide. This has caused growing concern among environmentalists and ecologists as this creates serious threats to the environment. Energy recovery can be seen as a potential alternative to promote sustainability, protect the environment and efficiently utilize wasted resources. To date there is no working model of an energy recovery from solid waste plant in the Caribbean region. In anticipation of renewed interest in environmental protection by governments and in keeping with the concept of Health promotion, this cross-sectional study examined the knowledge, attitude and perception of members of the Hermitage/August Town community with regard to refuse collection, disposal, and alternative methods of refuse disposal. Findings revealed that although 82.6 percent knew collection schedule, knowledge of disposing bulky items was not high since 29 percent was unsure how this should be handled. The attitude and perceptions were quite remarkable. 53 percent thought community involvement was necessary to solve refuse problems, and 98.9 percent expressed willingness to comply with any solid waste management programme that will improve their community. Judging from the number of respondents who were willing to become involved in community programmes, to contribute towards a solution of refuse problem and to practise refuse separation of needed, it appears that the community was frustrated with the situation and they were willing to take control of their health and well being by action.(AU)

Fostering community participation in the control of dengue and the aedes aegypti mosquito in a peri-urban area

During September 1995, the Epidemiology Unit assessed that there was an outbreak of dengue in Jamaica as evidence by steep increase in confirmed dengue cases - consistent with an epidemic. Approximately ten million Jamaican dollars of additional funds had to be earmarked for dengue and Aedes Aegypti prevention and control, as all 13 parishes were affected. Greendale a small middle income peri-urban community just outside of Spanish Town in the parish of St. Catherine was selected randomly for study from a stratified list of communities, to determine whether community participation in the control of dengue and the Aedes Aegypti mosquito could be fostered, within this type of setting. The results showed that 83 percent of the respondents would be willing to participate voluntarily for this type of program. The challenge is how to translated their willingness into positive community action. Active participation of communities in health matters is now seen as the means by which radical health improvement for the majority of people can be accomplished. Health education is seen by most health professionals as the most common solution to community problems, however the ad-hoc manner in which it is conducted in Greendale needs to be addressed. Among the recommendations to ensure long term sustainable programmes is that concept of community participation should be part of the school curriculum within the context of safe environments. (AU)

Community participation as seen by primary health care workers in the parish of St. Catherine, Jamaica

Primary health care workers in the parish of St. Catherine were studied over a six week period (February 2nd to March 18th) to access their knowledge, attitudes and perceptions towards community participation. The categories of workers in the sample were doctors; nurses; community health aides; dental staff; public health inspectors; pharmacist; others, comprising contact investigators, orderlies, nutritionist and laboratory technicians. A questionnaire instrument was administered among 13 health centres in zones 2 and 3 for a total of 80 workers. The majority of workers were female (85 percent), and the significant age distribution was between 20 years and 49 years. While most of the workers said they heard of community participation only 54 percent described their understanding of the concept as clear. There was clearer understanding of the concept among community health aides (CHA's) as compared to nurses. Overall the attitude of the workers towards community participation was high (66 percent). Most workers felt that health workers and communities should share decision-making, but only 54 percent of the workers studied thought that they had the skills needed for community participation. It is evident that there is potential for participation, but primary health care workers need the tools and the necessary skills to be effective in carrying out the bridging role between the health services and the community. There is need for training in community participation in primary health care; better utilization of the expertise of workers who have some training in community participation and more care in the choice of workers so that they work in the areas in which they live (AU)

Ethnographic study of communities in Jamaica, St. Lucia and St. Vincent

Reports on the results of an integrated vector control programme aimed at introducing or strengthening community participation in the control of all vectors of disease in three Caribbean countries. Specifically the study's objectives were to, obtain information on community beliefs relating to the use and possible classification of the word "fever"; febrile illness and their causes and treatments; dengue and its symptoms; transmission of illnesses by mosquitoes, rodents and other pest; methods employed to prevent disease transmission, especially dengue; methods employed in the home to control mosquitoes, rodents and pests. Examines how health status and environmental conditions are perceived by the informant; the links between health and actions undertaken at the household levels as a result of these perceptions; and the role Government and the Community can play in vector control as well as the perceived effectiveness of Government activities. Identifies and investigates topics that might be specific to the study area, such as the distinction between dengue and cholera and dengue and influenza. The countries selected for the ethnographic study were St. Lucia, St. Vincent and Jamaica. (AU)

Aedes aegypti infestation characteristics in several Caribbean countries and implications for integrated community-based control

Periodic larval surveys for Aedes aegypti were conducted in 11 Caribbean countries between 1983 and 1989. On average, there were 24 potential larval habitats per house including 4.9 which held water at the time of examination. Breteau indices for the various islands ranged from 34.7 to 121.6. In descending order of importance, water storage drums, house plants, buckets, used tires and miscellaneous small discarded containers accounted for 84 percent of all foci. Highest rates of infestation were found in tires (38.4 percent) and drums (33.8 percent). For the development of integrated community-based vector control programs, not only should consideration be given to the larval ecology of Ae. aegypti, but also to the sociological significance of the various container habitats and the selection of control strategies most appropriate for their management. (AU)

Community involvement in rehabilitation programme for disabled children: a Guyanese experience

The challenge facing rehabilitation of disabled persons in the 1990s is considered. The potential of a community-based model of rehabilitation as a major response to that challenge is examined in light of a two-year rural outreach programme with 56 disabled children in Guyana. The demanding task of translating the principles of community involvement into practice is discussed.(AU)

Health care financing in Grenada: how to share the responsibility of paying for better services

Presents details of a study of the health services sector and the current and prospective means of financing its operation. Findings show that the public health system accounted for nearly 14.6 percent of the government's recurrent budget or about EC$23.5 million in 1990/91, whilst Grenadian spent EC$3 million on private consultations and medicine. The combined total amounts to EC$265 per capita, which is significantly more than in Dominica and St. Lucia. Details on how the public and private sectors share the responsibility of paying for health services are given. Concludes that public health system is well organized in terms of structure and distribution of physical facilities, but inefficient in the management of personnel and material resources. Recommendations and suggestions as to ways non-tax sources can share the responsibility of paying for better health services are given

Comparative health care financing in St. Lucia, Grenada and Dominica

Presents the findings of a study of health care financing in the English-speaking Caribbean. The initial objective of the study was to explore whether increased support for maternal and child health might be provided through an expansion of social insurance coverage to include health benefits for workers and their dependents and also to find out how countries can adapt the organization, financing and delivery of health services so as to continue to provide primary health care equitably and efficiently, while at the same time providing essential secondary and tertiary level services. Details of the comparative study of the health systems in the three countries in terms of the adequacy of the health care provided at different levels and the real resources with which it is provided. Findings show that the level of health care spending both from public and private sources vary considerably among the islands. Includes statistical data on expenditure on health as well as the findings of a survey of consumers' view on the organization and quality of health care in the islands

The role of women and NNAs in disaster management

To date female participation in disaster management planning committees in the Caribbean has been limited; yet women are a valuable resource for organized action at all levels of the managerial process. Below, some guidelines on how women, nurses and national nurses' associations can take a more active part in managing disasters. (Au)