Food Policy Council Self-Assessment Tool: Development, Testing, and Results.

A large number of food policy councils (FPCs) exist in the United States, Canada, and Tribal Nations (N = 278), yet there are no tools designed to measure their members' perceptions of organizational capacity, social capital, and council effectiveness. Without such tools, it is challenging to determine best practices for FPCs and to measure change within and across councils over time. This study describes the development, testing, and findings from the Food Policy Council Self-Assessment Tool (FPC-SAT). The assessment measures council practices and council members' perceptions of the following concepts: leadership, breadth of active membership, council climate, formality of council structure, knowledge sharing, relationships, member empowerment, community context, synergy, and impacts on the food system. All 278 FPCs listed on the Food Policy Network's Online Directory were recruited to complete the FPC-SAT. Internal reliability (Cronbach's α) and inter-rater reliability (AD, rWG(J), ICC [intraclass correlations][1], ICC[2]) were calculated, and exploratory and a confirmatory factor analyses were conducted. Responses from 354 FPC members from 94 councils were used to test the assessment. Cronbach's α ranged from 0.79 to 0.93 for the scales. FPC members reported the lowest mean scores on the breadth of active membership scale (2.49; standard deviation [SD], 0.62), indicating room for improvement, and highest on the leadership scale (3.45; SD, 0.45). The valid FPC-SAT can be used to identify FPC strengths and areas for improvement, measure differences across FPCs, and measure change in FPCs over time.

Pioneering a National Advanced Practice Leadership Council to Enhance Care Delivery in a Large 19-State Health System.

This article describes an innovative approach to enhancing the capacity of advanced practice clinicians (APCs) in a large faith-based health system consisting of multiple markets across the United States. With the challenges in health care today, promotion of advanced practice is vital to increasing quality and access to care while maintaining cost-effectiveness. The development of a national Advanced Practice Leadership Council led by the Vice President of Advanced Practice at Catholic Health Initiatives has been a progressive approach in mitigating the challenges facing APCs in today's health care arena. The success of the Council has led to its inclusion on the health system's national clinical governance structure. The authors discuss development of the Council along with specific information regarding various committee work, including APC state regulations, delineation of privileges, quality measures, and total compensation.

Civil society participation in the health system: the case of Brazil's Health Councils.

BACKGROUND: Brazil created Health Councils to bring together civil society groups, heath professionals, and government officials in the discussion of health policies and health system resource allocation. However, several studies have concluded that Health Councils are not very influential on healthcare policy. This study probes this issue further by providing a descriptive account of some of the challenges civil society face within Brazil's Health Councils. METHODS: Forty semi-structured interviews with Health Council Members at the municipal, state and national levels were conducted in June and July of 2013 and May of 2014. The geographical location of the interviewees covered all five regions of Brazil (North, Northeast, Midwest, Southeast, South) for a total of 5 different municipal Health Councils, 8 different state Health Councils, and the national Health Council in Brasilia. Interview data was analyzed using a thematic approach. RESULTS: Health Councils are limited by a lack of legal authority, which limits their ability to hold the government accountable for its health service performance, and thus hinders their ability to fulfill their mandate. Equally important, their membership guidelines create a limited level of inclusivity that seems to benefit only well-organized civil society groups. There is a reported lack of support and recognition from the relevant government that negatively affects the degree to which Health Council deliberations are implemented. Other deficiencies include an insufficient amount of resources for Health Council operations, and a lack of training for Health Council members. Lastly, strong individual interests among Health Council members tend to influence how members participate in Health Council discussions. CONCLUSIONS: Brazil's Health Councils fall short in providing an effective forum through which civil society can actively participate in health policy and resource allocation decision-making processes. Restrictive membership guidelines, a lack of autonomy from the government, vulnerability to government manipulation, a lack of support and recognition from the government and insufficient training and operational budgets have made Health Council largely a forum for consultation. Our conclusions highlight, that among other issues, Health Councils need to have the legal authority to act independently to promote government accountability, membership guidelines need to be revised in order include members of marginalized groups, and better training of civil society representatives is required to help them make more informed decisions.

Leveraging shared governance councils to advance evidence-based practice: the EBP Council journey.

This column shares the best evidence-based strategies and innovative ideas on how to facilitate the implementing of EBP principles and processes by clinicians as well as nursing and interprofessional students. Guidelines for submission are available at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1741-6787.

[The local mental health council, a concrete tool for networking]. / Le conseil local de santé mentale, outil concret du travail en réseau.

Mental health needs are expressed well beyond the doors of the psychiatric hospital. The health and social sectors are also confronted with situations of psychological suffering. The local mental health council offers solutions to professionals faced with this issue. The creation of the local mental health council and the collaborative way of working which it promotes give rise to projects aimed at improving mental health care.

Financing of health systems to achieve the health Millennium Development Goals in low-income countries.

Concern that underfunded and weak health systems are impeding the achievement of the health Millennium Development Goals in low-income countries led to the creation of a High Level Taskforce on Innovative International Financing for Health Systems in September, 2008. This report summarises the key challenges faced by the Taskforce and its Working Groups. Working Group 1 examined the constraints to scaling up and costs. Challenges included: difficulty in generalisation because of scarce and context-specific health-systems knowledge; no consensus for optimum service-delivery approaches, leading to wide cost differences; no consensus for health benefits; difficulty in quantification of likely efficiency gains; and challenges in quantification of the financing gap owing to uncertainties about financial commitments for health. Working Group 2 reviewed the different innovative mechanisms for raising and channelling funds. Challenges included: variable definitions of innovative finance; small evidence base for many innovative finance mechanisms; insufficient experience in harmonisation of global health initiatives; and inadequate experience in use of international investments to improve maternal, newborn, and child health. The various mechanisms reviewed and finally recommended all had different characteristics, some focusing on specific problems and some on raising resources generally. Contentious issues included the potential role of the private sector, the rights-based approach to health, and the move to results-based aid. The challenges and disagreements that arose during the work of the Taskforce draw attention to the many issues facing decision makers in low-income countries. International donors and recipient governments should work together to improve the evidence base for strengthening health systems, increase long-term commitments, and improve accountability through transparent and inclusive national approaches.

Councils as empowering contexts: mobilizing the front line to foster systems change in the response to intimate partner violence.

Collaborative approaches to change are common, and though evidence for their effectiveness is equivocal, there is growing support that councils facilitate desired changes in the systems response to intimate partner violence. Questions remain regarding the specific mechanisms by which this change is facilitated, and recent work has focused on examining the intermediate processes through which councils may produce more distal change. One such mechanism relates to the potential of councils to be empowering contexts for their membership, often comprised of front-line providers and responders. The present study examines what factors are positively related to perceived individual empowerment as an outcome for members, and importantly, considers not only perceived council context, but also the perceived organizational contexts in which each council member is employed. Study findings suggest that both contexts-council and organizational-are important when considering the degree to which members are empowered. Specifically, member participation, council leadership, and supportive council and organizational climates are significantly positively related to the degree to which councils function as empowering contexts. However, the effect of belonging to a council with a supportive climate, characterized in particular by shared power in decision-making, is stronger when members are from high organizational support settings versus low support settings.

Testing changes: the next step in accelerating excellence.

Saskatchewan's Health Quality Council (HQC) was launched in 2003 with a mandate not only to measure and report on healthcare but also work with a range of partners to improve the province's health system. In late 2007, HQC's board decided it was time for Saskatchewan to reinvent its healthcare system, using the highest-performing systems in the world as its model. And in 2008, HQC launched Accelerating Excellence, a multi-level program to rethink, redesign and renew healthcare.

Associations between Food Policy Councils and Policies That Support Healthy Food Access: A National Survey of Community Policy Supports.

Food policy councils (FPCs) are one form of community coalition that aims to address challenges to local food systems and enhance availability, accessibility, and affordability of healthy foods for local residents. We used data from the 2014 National Survey of Community-Based Policy and Environmental Supports for Healthy Eating and Active Living, a nationally representative survey of US municipalities (n = 2029), to examine the prevalence of FPCs and cross-sectional associations between FPCs and four types of supports for healthy food access (approaches to help food stores, practices to support farmers markets, transportation-related supports, and community planning documents). Overall, 7.7% of municipalities reported having a local or regional FPC. FPCs were more commonly reported among larger municipalities with ≥50,000 people (29.2%, 95% Confidence Interval (CI): 21.6, 36.8) and western region municipalities (13.2%, 95% CI: 9.6, 16.8). After multivariable adjustment, municipalities with FPCs had significantly higher odds of having all four types of supports, compared to those without FPCs (adjusted odds ratio (aOR) range: 2.4-3.4). Among municipalities with FPCs (n = 156), 41% reported having a local government employee or elected official as a member, and 46% had a designated health or public health representative. Although FPCs were uncommon, municipalities that reported having a local or regional FPC were more likely to report having supports for healthy food access for their residents.

The role and functions of community health councils in New Zealand's health system: a document analysis.

BACKGROUND: Community/consumer health councils (CHCs) are a relatively new phenomenon in New Zealand. CHCs are usually established within district health boards (DHBs) to help address gaps in community engagement in the health sector. Little is known about the establishment, structure, roles and functioning of these councils. AIM: To undertake a literature review, including grey literature, related to the structure, roles and functioning of CHCs in New Zealand. METHOD: A document analysis of the New Zealand-focused website materials and newspaper articles related to CHCs was conducted. Data were analysed thematically using a qualitative content analysis approach. RESULTS: The search identified 251 relevant web sources and 118 newspaper articles. The main role of the CHCs appeared to be to advise and make recommendations to their respective DHBs (and DHB governance and management structures) about health service planning, delivery and policy. All CHCs discussed in the identified sources comprised different demographic backgrounds and expertise. Although the CHCs were mainly engaged in information sharing and consultation, their influence on DHB decision-making could not be determined from the sources. CONCLUSION: This is the first study of CHCs throughout New Zealand investigating their roles, structure and type of engagement. As the concept is evolving and more CHCs are being established, this information may be useful for future CHCs. With increasing longevity of CHCs in New Zealand, future studies could usefully investigate CHCs' potential to represent the health interests of their local communities, and their influence on DHB decision-making.

Permanent education as an inalienable responsibility of health councils: the current scenario in the Unified Health System.

OBJECTIVE: To verify whether health councils in Brazil carry out permanent education activities for municipal, state and federal district councilors. METHOD: This was a cross-sectional study with secondary data collection in the Health Council Monitoring System (Sistema de Acompanhamento dos Conselhos de Saúde - Siacs) from May to August 2017. The Siacs is publicly accessible and available on the internet. It provides data from thousands of health councils throughout Brazil. Analysis and interpretation of the data were based on the literature and the enacted legislation, particularly Resolution 453/2012 and the National Policy of Permanent Education for Social Control in the Unified Health System (Política Nacional de Educação Permanente para o Controle Social no Sistema Único de Saúde). RESULTS: Despite the fact that Resolution 453/2012 establishes the deliberation, elaboration, support and promotion of permanent education for social control as functions of the councils (in accordance with the guidelines of the National Policy of Permanent Education), approximately 40% of councils do not carry out permanent education. CONCLUSIONS: It is necessary to strengthen the role of health councils in the elaboration of educational initiatives across the national territory. This includes the allocation of financial resources to increase access to and participation in these initiatives, which would strengthen social control in the Unified Health System. This study emphasizes that the discussion of permanent education is not given sufficient attention in the agendas and routines of health councils. This compromises the effectiveness of councils' monitoring and deliberation of public health policy.

[Establishment of Networks of National Reference Centres and associated Consiliary Laboratories in Germany]. / Etablierung von Referenznetzwerken aus Nationalen Referenzzentren mit assoziierten Konsiliarlaboratorien in Deutschland.

The German Federal Ministry of Health has funded National Reference Centres (NRC) for laboratory-based surveillance of selected infection pathogens and infections disease syndromes. This selection is based on the epidemiologic relevance of the pathogens, specific diagnostic requirements, antimicrobial resistance and need for public health measures. Currently there are 18 NRC, nominated for a duration of 3 years. Toward the end of a nomination period, each NRC is evaluated by an expert committee, based on the catalogue of core tasks. In order to expand the spectrum of competencies 47 consiliary laboratories on additional pathogens of special epidemiologic importance have been named. Their main function is to provide information and consultation on special diagnostic issues. In order to further improve the effectiveness and cooperation of the system Networks have been created. The aim of the Networks is to facilitate exchange of diagnostic methods and prevention concepts and to improve the geographic coverage of the services.