Challenges and opportunities in addressing social determinants of child health in Cambodia: perspectives and experience of frontline providers in two health districts.

OBJECTIVES: Other forces related to socio-economic and cultural factors, besides biomedical and behavioural fields, also influence health but receive little attention in health research. This study aims to illuminate social determinants of health and to identify challenges and opportunities in addressing social determinants of child health (SDCH) in rural Cambodia. METHODS: This is a qualitative study based on interviews of frontline primary health care providers, health officials, local authorities and community volunteers in two health districts in Cambodia. The data were supplemented by secondary data on different aspects of the districts and Cambodia. RESULTS: Poverty, lack of basic commodities and adverse social conditions remained problems for population health. While access to health services was considered adequate, households and communities had several major risk exposures. Challenges in addressing SDCH were the high prevalence of social and household adverse conditions, and the lack of training of providers, of information about social services, of effective coordination and of trust in public services. Opportunities were present, including social services being existent albeit poor functioning, the traditional practice of social inquiry, existing frontline providers being open to further information and training, existing subnational coordination bodies at district and provincial levels, and use of evidence in planning and resource allocation. CONCLUSION: Addressing SDCH requires broad and coordinated efforts of stakeholders from multiple sectors. Among the prerequisites are to leverage the existing structures and mechanisms, training primary health care providers and providing them with adequate information about local resources and available supports. Improving social care services and infrastructures requires strong coordination, planning and adequate resource allocation.

RéSUMé: OBJECTIFS: D'autres forces liées aux facteurs socio-économiques et culturels, en plus des domaines biomédicaux et comportementaux, influencent également la santé mais reçoivent peu d'attention dans la recherche en santé. Cette étude vise à éclairer les déterminants sociaux de la santé et à identifier les défis et les opportunités pour aborder les déterminants sociaux de la santé infantile (SDCH) dans les régions rurales du Cambodge. MéTHODES: Il s'agit d'une étude qualitative basée sur des entretiens avec des prestataires de soins de santé primaire de première ligne, des responsables de la santé, des autorités locales et des volontaires communautaires dans deux districts de santé au Cambodge. Les données ont été complétées par des données secondaires sur différents aspects des districts et du Cambodge. RéSULTATS: La pauvreté, le manque de produits de base et les conditions sociales défavorables restent des problèmes pour la santé de la population. Bienque l'accès aux services de santé est considéré suffisant, les ménages et les communautés sont exposés à plusieurs risques majeurs. Les défis liés à la lutte contre la SDCH étaient la prévalence élevée de conditions sociales et domestiques défavorables, ainsi que le manque de formation des prestataires, d'informations sur les services sociaux, de coordination efficace et de confiance dans les services publics. Des opportunités étaient présentes, y compris des services sociaux existants bienque fonctionnant mal, la pratique traditionnelle de l'enquête sociale, les prestataires de première ligne existants étant disposés à encore d'informations et de formation, les organes de coordination sous-nationaux existants au niveau des districts et des provinces, et l'utilisation des preuves dans la planification et l'allocation des ressources. CONCLUSION: Aborder la SDCH nécessite des efforts larges et coordonnés des parties prenantes de plusieurs secteurs. Parmi les conditions préalables, il faut tirer parti des structures et mécanismes existants, former les prestataires de soins de santé primaire et leur fournir des informations adéquates sur les ressources locales et soutiens disponibles. L'amélioration des services et des infrastructures de protection sociale nécessite une coordination, une planification et une allocation adéquate des ressources.

Rapid organizational network analysis to assess coordination of services for HIV testing clients: an exploratory study.

Recognizing that HIV testing provides a gateway opportunity to connect with at-risk populations, we explored an approach to collect, analyze and present data on the network of connections between HIV testing organizations and other health and social service agencies operating in Durham County, NC. We surveyed 26 health and social service organizations, including 6 providing HIV testing services, and presented the results including frequency tabulations, network visualizations and metrics, and GIS maps to the participating organizations. Mapping the landscape of organizational relationships was seen as a practical and expedient approach to facilitating cross-sector collaborative efforts to improve community health.

Introducing Technology in Child Welfare Referrals: A Case Study.

Access to social services is important for the safety of children and ultimately for reunification of families involved in the child welfare system. The process of linking families to services however, varies by caseworker and can be cumbersome and time-consuming. The DCFS Needs Portal is an internet-based intervention to improve the timing and quality of social service referrals in Los Angeles County We used a case study approach including in-depth interviews, direct observations and user feedback obtained from the Needs Portal to 1) determine perceived benefits and barriers to adopting the Needs Portal and 2) report how the flow of information between users and developers was used to adapt to user needs. Our analyses revealed four major barriers: 1) caseworker apprehension regarding new technology, 2) variation in communication styles by user type, 3) lack of technological infrastructure and 4) competing workplace demands. Information sharing between developers and users has the potential to better meet the needs of users and ultimately maximize utilization of new technology. Although internet-based interventions are designed to inexpensively and effectively coordinate services, emerging interventions may require in-person assistance and modifications in order to succeed.