[Health Care for Refugees: Challenges and Opportunities in Hamburg]. / Medizinische Versorgung von Flüchtlingen: Chancen und Herausforderungen in Hamburg ­ ein Praxisbericht.

The massive increase in the number of refugees represents a great challenge to German cities. In Hamburg, 40 868 asylum seekers were registered in 2015, of which 22 315 remained in the city. The goal of the health administration is to provide primary medical care in response to specific health risks and needs of refugees while allowing them to be swiftly integrated into the standard health care system. Public authorities, charities and civil society are working hand in hand. In all reception centres in Hamburg, medical consultations with translation services are offered in fully equipped medical container practices. For every 1 000 refugees, a full-time doctor and a medical assistant are available. In addition to contractual staff, employees of contractually integrated hospitals are participating in the provision of medical care. Systematic collection of data on the health condition of the refugees as well as strengthening public health services are key factors in the planning and improvement of services in the future. Healthier living conditions and access to the standard health care system provide an opportunity to facilitate successful integration of refugees into society.

Integrating partner professionals. The Early Explorers project: Peers Early Education Partnership and the health visiting service.

BACKGROUND: A range of voluntary sector organizations are involved in the delivery of services to children, particularly within the Early Year's sector and children's centres. Peers Early Education Partnership (PEEP) Early Explorers project is one example of the way in which explicit partnerships are being forged across statutory and voluntary sectors with the aim of improving outcomes for children and families. This paper reports an exploration of stakeholder views and experiences of two Early Explorer clinics located in areas of high deprivation. METHODS: Semi-structured interviews were conducted with a purposive sample of stakeholders (n= 25) from children's centres, PEEP, the health visiting service and service users. Data were fully transcribed and analysed using a thematic approach. RESULTS: The data suggest that the two key groups of stakeholders providing Early Explorer clinics (i.e. health visitors and PEEP practitioners) had quite different objectives in terms of their early goals for the clinic, but that despite these differences good progress was achieved in terms of working together effectively. All stakeholders including service users referred to the presence of PEEP as having improved the quality of the clinic environment, and participating mothers identified a wide range of benefits from the enhanced service. However, somewhat restricted views about the role of practitioners within the clinics were identified by users, and the findings suggest that although the early goals for the clinic had been exceeded, these may have been limited in terms of true 'partnership' working. CONCLUSIONS: Early Explorer clinics appeared to have enhanced the service provided within traditional child health clinics and to have provided practitioners with access to hard-to-reach families and parents with access to services that are consistent with the broader policy aims of improving parent-infant interaction. However, questions remain as to whether the benefit of 'partnership' working was fully realized.

Prehospital emergency medical services in Lebanon: overview and prospects.

Prehospital emergency medical services in Lebanon are based on volunteer systems with multiple agencies. In this article, a brief history of the development of prehospital care in Lebanon is presented with a description of existing services. Also explored are the different aspects of prehospital care in Lebanon, including funding, public access and dispatch, equipment and supplies, provider training and certification, medical direction, and associated hospital-based emergency care.

Socially disempowered women as the key to addressing change in Malawi: how do they do it?

Malawi women are in the ironic juxtaposition of being socially disempowered while, at the same time, thought to hold the key to shaping an effective community response to the HIV crisis. Based on this juxtaposition, a descriptive, qualitative study was conducted in Malawi and the United States where 26 participants from nongovernmental organizations (NGOs) and community-based organizations (CBOs) discussed the roles of Malawi women. Interviews were audiotaped, transcribed, and analyzed. We identified an improvement in women's economic status as the strongest factor in reducing gender inequities. Through providing stipends for rural Malawi women, one NGO created unintended changes in gender roles.

The Israel Cancer Association's role as a volunteer organization in forecasting, establishing, implementing and upgrading palliative care services in Israel.

The Israel Cancer Association has contributed, as a key player, to the establishment and upgrade of palliative care in Israel. The aim of this article is to describe the involvement and contribution of the ICA, as a volunteer organization, from a clinical, educational, legal, and organizational perspective. Another main goal of this survey is to shed light on the palliative care network in Israel, in each one of these infrastructures.

Is international volunteer surgery for cleft lip and cleft palate a cost-effective and justifiable intervention? A case study from East Asia.

BACKGROUND: Although surgery provided by international volunteers is increasingly common in the developing world, there have been few assessments of the cost-effectiveness of these activities. In this context, this study covered 15 years of experience of one international nongovernmental organization, Smile for Children, in providing cleft lip (CL) and cleft palate (CP) surgical services in Vietnam. METHODS: We analyzed the cost-effectiveness of the program and its contributions to building local capacity. To assess the cost-effectiveness of CL/CP surgery performed during Smile for Children's missions in Vietnam, we analyzed the data from four annual missions, from 2007 to 2010. According to the 2003 World Health Organization Guide to Cost-Effectiveness Analysis, we calculated cost per disability-adjusted life years (DALYs) averted with and without age weighting. For the data from the 2010 mission, we repeated the same calculation but with and without considering opportunity cost for labor. RESULTS: The discounted cost per DALY averted averaged $68, ranging from $52 to $79 depending on the year of the mission. The average discounted cost per DALY averted with age weighting was $56 (range $43-$65). For the calculation that takes into account the volunteers' possible income loss as the labor cost of the mission in 2010, the cost per DALY averted without age weighting increased by 28%, from $76 to $97; and the cost per DALY averted with age weighting increased by 27%, from $63 to $80. Under all of these varying assumptions, the CL/CP program operated by Smile for Children is a cost-effective intervention using international criteria for cost-effectiveness. CONCLUSIONS: The contribution of the international volunteer surgical team to building in-country capacity is notable. It was achieved primarily through training Vietnamese surgeons during the mission trips and through sending these surgeons to Korea for training. Other staff, including anesthesiologists, were also trained; and equipment and supplies were provided.

VCT clinic HIV burden and its link with HIV care clinic at the University of Gondar hospital.

BACKGROUND: Voluntary Counselling and Testing (VCT) is an important component of any HIV/AIDS control and prevention activities. VCT makes people aware of their HIV serostatus and enables early identification of those who need care. It is an important link to HIV care and support. The main aim of this study is to describe the HIV burden at VCT and define the relationship between the VCT Center and the HIV Chronic Care Clinic of the University of Gondar (UoG) Hospital. METHODS: It is a record based descriptive study undertaken by using data collected by health professionals at the VCT center and the HIV chronic care clinic of the UoG Hospital. Patient data collected from 2005/06 to 2008/09 was investigated. Analysis was carried out using the SPSS version 16.0. RESULTS: A total of 19,168 people were tested for HIV and a prevalence of 25.4% was obtained. 4298 HIV positive people were referred to the HIV chronic care clinic but only 27% actually registered at the clinic. Chi-square analyses showed residence, age and time of VCT visit showed significant relations with hospital care attendance. CONCLUSION: The overall HIV prevalence is high. The data obtained at the HIV care clinic regarding patients' clinical conditions at acceptance were incomplete. Improvements are required on the link between VCT and HIV care and documentation of data.

Partnership working in services for children: use of the common assessment framework.

Transformation in the structure and delivery of services for children and young people in the UK Children Act (Department for Education & Skills, 2004. The Children Act. London: HMSO) initiated new alliances between statutory, public and voluntary agencies. Traditional relationships and notions of partnership have been extended, necessitating an innovative approach to dialogue and multiple perspectives. Hudson's assertion that although the "rhetoric on partnering remains strong, the real policy thrust is now about choice and contestability" (2006, Journal of Integrated Care, 14(1), 13-21) exemplifies the dynamic policy context around notions of partnership and the rationale for collaborative advantage. This paper explores the experiences of practitioners working in a relatively new multi-agency context--the common assessment framework (CAF). Envisaged as a standardized approach to the assessment of need and as a tool to facilitate integrated working, the CAF is utilized by practitioners in the UK to improve outcomes for children and young people. We present data from a study that employed an interpretative phenomenological analysis approach and gathered semi-structured interviews with 20 practitioners. Interviews drew upon their experiences of interprofessional working in which diversity, partnership working, and competing aims and objectives emerged as significant themes. The insights that were gained are discussed in terms of their potential impact on service delivery in the UK and their contribution toward responsive practice across dynamic professional boundaries.

Improving effective surgical delivery in humanitarian disasters: lessons from Haiti.

Kathryn Chu and colleagues describe the experiences of Médecins sans Frontières after the 2010 Haiti earthquake, and discuss how to improve delivery of surgery in humanitarian disasters.

Regional patterns and correlates of HIV voluntary counselling and testing among youths in Nigeria.

Prevalence of Voluntary Counselling and Testing (VCT) for HIV among young people in Nigeria is low with implications on the epidemic control. Using the 2003 Nigerian National Demographic and Health Survey, we examined the regional prevalence, pattern and correlates of VCT for HIV among youths aged 15 to 24 in Nigeria. Analysis was based on 3573 (out of 11,050) observations using logistic regression model to estimate the effects of identified predictors of volunteering for HIV testing. Results show that national prevalence of VCT is low (2.6%) with regional variations. Generally, the critical factors associated with VCT uptake are age, sex, education, wealth index and risk perception with North (sex, education, religion, occupation and risk perception) and South (age and education) variance. It is recommended that Nigerian HIV programmers should introduce evidence based youth programmes to increase the uptake of VCT with differing approaches across the regions.

[The role of the ASL of Brescia in the health and safety of immigrant workers]. / Il ruolo dell'ASL di Brescia nella tutela della salute e della sicurezza dei lavoratori immigrati.

According to available studies, migrant workers represent a vulnerable workers' category. For this reason, the Italian law on safety and health at work (art. 11, D.Lgs 81/08) points out the need for Public Administration initiatives devoted to migrant workers' health and safety at work. Local Public Health Department of Brescia for years now had a significant commitment in migrants' health. Thanks to the collaboration of occupational physicians and expert physicians on migration health, it was developed a multidimensional method to assess working risks taking into account also the fragile conditions of migrant workers, considering both personal and social characteristics and professional experience, in order to support companies in the planning of necessary actions to improve health and safety at work. The method was shared by both local industrial association and trade unions and then tested in some manufactures.

[Annual "Door Knock" Fundraising Campaign Jubilee--for the patients and against the disease].

Marking the annual "Door Knock" Fundraising Campaign Jubilee, this article provides an overview of the Israel Cancer Association (ICA) activity for patients and against the disease, that comply with the principles of the World Cancer Declaration (WCD) of the UICC (Union for International Cancer Control). To elucidate, as a voluntary organization, all of ICA's resources are derived exclusively from public contributions--with no funding from the government budget. This independence enables ICA to operate according to strictly professional criteria, while maintaining a global and national point of view and vision. ICA activity will be presented with respect to the international treaty, from monitoring the disease at the national level, to activity to promote research, prevention methods, early detection, enhancing treatment modalities and rehabilitation, and maintaining quality of life for patients and survivors. This presentation will also provide an overview of how ICA's initiative, in close collaboration with the Ministry of Health, and the HMO's, white relying on the volunteer activity of members of the ICA professional committees, and that of many other volunteers, leads Israel to significant accomplishments in each one of the treaty sections. These activities have resulted in concrete achievements at the national level, positioning Israel high on the global scale.

The impact of aid chains: relations of dependence or supportive partnerships for community-led responses to HIV/AIDS?

In the context of increasing global emphasis on partnerships between international, governmental and civil society organisations in the distribution of international aid, this paper examines the ways in which the resulting aid chains promote and undermine community-led responses to HIV/AIDS. The impact of the aid-granting system is examined using an ethnographic case study of an HIV/AIDS prevention programme with Cambodian military families. The case study draws on observations of stakeholder meetings and programme activities, interviews with stakeholders (the donor, NGOs and military community) and textual materials (programme guidelines, policies and reports). Campbell et al.'s interrelated concepts of relational, symbolic and material context are used to frame the analysis. The establishment of a relationship with a more powerful international NGO is shown to be beneficial to the military community and civil society groups. The international NGO uses its significant material and economic leverage to improve the community's relational context (by ensuring the support of the military high command), symbolic context (by strengthening the position of community and civil society partners in relation to government bodies) and material context (through increasing access to health services). However, material and symbolic asymmetries between partners in the aid chain persist, curtailing the community's involvement and leadership. At the material and relational levels, the hierarchical flow of aid encourages accountability to the demands of the donor while excluding grassroots groups from directly accessing funding. At the symbolic level, problem-focused representations of the military further reinforce the community's position as recipients of intervention, which undermines recognition for the community's knowledge, strengths and right to fully participate. Thus while aid chains can be supportive of community-led responses, this analysis highlights how the structures and dynamics of international aid continue to position marginalised communities as recipients, not leaders, of HIV/AIDS programmes, raising particular dilemmas for intermediary international NGOs.

Brave and angry--the creation and development of the International Planned Parenthood Federation (IPPF).

This paper looks back on the developments in thinking from birth control, through voluntary family planning, to a comprehensive approach to sexual and reproductive health and rights (SRHR), and celebrates some of the key players in this evolution. It tells the story of the creation of the International Planned Parenthood Federation (IPPF) in 1952, and scrutinises how important this organisation was then and is now. It gives an idea of the efforts it took to reassemble initiatives around the world into one body, strong enough to foster the cause to the benefit of all. While IPPF was and still is a unique association, it has increased its partnerships and works together with a multitude of organisations active in the field of SRHR. In the current political context joint efforts are still needed to protect the universally recognised human right of people to decide freely and responsibly on the number and spacing of their children, and their access to adequate education and information.