Strengthening user participation through health sector reform in Colombia: a study of institutional change and social representation.
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The challenge of achieving community participation as a component of health sector reform is especially great in low- and middle-income countries where there is limited experience of community participation in social policy making. This paper concentrates on the social representations of different actors at different levels of the health care system in Colombia that may hinder or enable effective implementation of the participatory policy. The study took place in Cali, Colombia and focused on two institutional mechanisms created by the state to channel citizen participation into the health sector, i.e. user associations and customer service offices. This is a case study with multiple sources of evidence using a combination of quantitative and qualitative social science methods. The analysis of respondents' representations revealed a range of practical concerns and considerable degree of scepticism among public and private sector institutions, consumer groups and individual citizens about user participation. Although participation in Colombia has been introduced on political, managerial and ethical grounds, this study has found that health care users do not yet have a meaningful seat around the table of decision-making bodies. (+info)
Mobilizing women for minority health and social justice in california.
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Women's Health Leadership is building the leadership capacity of diverse community leaders in California committed to promoting health and social justice in their communities. This program provides opportunities for cross-cultural exchanges of ideas, resources, and expertise. Graduates continue to receive technical support and to engage in peer learning via an alumnae network. The network is dedicated to advancing social justice issues and to addressing health disparities. It is also a way to mobilize trained grassroots leaders to provide expertise to influence policy decisions, to provide technical support and resources to local communities, and to foster new partnerships across the state. (+info)
The blue ribbon panel on depowered and advanced airbags - status report on airbag performance.
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In February 2000, a group of highway safety organizations sent a letter to the Secretary of the U.S. Department of Transportation expressing concern about a possible return to the 30-mph rigid barrier test using unbelted dummies previously required by Federal Motor Vehicle Safety Standard (FMVSS) 208. The letter asked the National Highway Traffic Safety Administration (NHTSA) to expedite data collection of the real-world crash experience of airbag-equipped vehicles certified to the 30-mph sled test using unbelted dummies because of suggestions that depowered airbags may not provide the same level of protection, particularly to larger, unbelted occupants. For the same reason, the letter also recommended that the auto industry commit funding for additional data collection and to establish a panel of experts to evaluate the data. In response, the Alliance of Automobile Manufacturers (Alliance) committed to funding a 3-year program to be managed by an independent third party. A panel of experts consisting of representatives from thehighway safety research community, the National Transportation Safety Board, academia, medical institutions, and the insurance industry was established as the Blue Ribbon Panel (BRP) for Evaluation of Depowered and Advanced Airbags and met for the first time in February 2001. The BRP also includes representatives from NHTSA and the automobile industry who participate as observers. The BRP held its first public meeting in April 2003 to provide an update of its activities and to summarize the real-world evidence on the performance of depowered airbags. This AAAM session will provide a brief summary of the public meeting. (+info)
Performance of advanced air bags based on data William Lehman Injury Research Center and new NASS PSUs.
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The Ryder Trauma Center is a Level I trauma center that treats only the most severely injured occupants of vehicle crashes as well as other severe cases of trauma. The center investigates these crashes through funding provided by the Alliance of Automobile Manufacturers and the U.S. Department of Transportation-sponsored Crash Injury Research and Engineering Network (CIREN) program. MAIS 3+ nonfatal and fatal injuries comprise approximately 2 percent of the total NASS/CDS cases. Among the Ryder trauma center cases, 50 percent are MAIS 3+ and 25 percent are fatal. If the MAIS 3+ fatal and nonfatal injuries were considered as "failures" and the remaining 98 percent with MAIS 2 or less as successes, this could be equated to the 75 percent failure rate (MAIS 3+ and fatal) in the trauma center cases for analysis purposes. The total database of frontal cases with no rollover consists of 147 drivers with first-generation airbags and 58 cases with second-generation airbags. (+info)
Health co-operatives: review of international experiences.
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There is renewed interest in the revival of health co-operative as a "third option" for meeting health care needs of populations in developing countries in the context of health sector reforms. This article reviews some international experiences with health co-operatives. We briefly assess the history of health co-operatives in industrialized countries where they originated and review past experience from China and the states of Kerala and Gujarat in India to explore the viability of health co-operatives for the provision of health care. In industrialized countries, co-operatives came into existence as autonomous entities with voluntary participation, aiming to contribute to the welfare of their members. In recent years, however, co-operatives are being envisaged as a mechanism to overcome economic barriers in access to health care, despite lack of evidence of their cost-effectiveness and sustainability. In China, health co-operatives achieved universal coverage of basic health services but became dysfunctional when state support was withdrawn. In Gujarat/India, co-operatives have been useful to provide primary health care services and not as a mechanism to run hospitals and provide medical care for the general population. In Kerala/India, health co-operatives could not successfully compete with expanding state health services and private services unless they were managed like private enterprises. In terms of managerial effectiveness and sustainability co-operatives can not be "prescribed" to compensate for the deteriorating access to health services following market-oriented health sector reforms in developing countries. (+info)
Consumers as tutors - legitimate teachers?
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BACKGROUND: The aim of this study was to research the feasibility of training mental health consumers as tutors for 4th year medical students in psychiatry. METHODS: A partnership between a consumer network and an academic unit in Psychological Medicine was formed to jointly develop a training package for consumer tutors and a curriculum in interviewing skills for medical students. Student attitudes to mental health consumers were measured pre and post the program. All tutorial evaluation data was analysed using univariate statistics. Both tutors and students evaluated the teaching program using a 4 point rating scale. The mean scores for teaching and content for both students and tutors were compared using an independent samples t-test. RESULTS: Consumer tutors were successfully trained and accredited as tutors and able to sustain delivery of tutorials over a 4 year period. The study found that whilst the medical students started with positive attitudes towards consumers prior to the program, there was a general trend towards improved attitude across all measures. Other outcomes for tutors and students (both positive and negative) are described. CONCLUSIONS: Consumer tutors along with professional tutors have a place in the education of medical students, are an untapped resource and deliver largely positive outcomes for students and themselves. Further possible developments are described. (+info)
"Asia is now the priority target for the world anti-tobacco movement": attempts by the tobacco industry to undermine the Asian anti-smoking movement.
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STUDY OBJECTIVE: To identify and examine the strategies utilised by multinational tobacco companies to undermine and discredit key anti-tobacco activists and organisations in the Asian region. METHOD: A series of case studies drawing upon material gathered through systematic reviews of internal tobacco industry documents. DATE SOURCES: Tobacco industry documents made public as part of the settlement of the Minnesota Tobacco Trial and the Master Settlement Agreement. RESULTS: The industry sought to identify, monitor, and isolate key individuals and organisations. The way industry went about fulfilling this mandate in the Asian region is discussed. Industry targetted individuals and agencies along with the region's primary anti-smoking coalition. CONCLUSIONS: Attack by multinational tobacco companies is a virtual quid pro quo for any individual or agency seriously challenging industry practices and policies. Understanding their tactics allows anticipatory strategies to be developed to minimise the effectiveness of these attacks. (+info)
Advocacy for mental health: roles for consumer and family organizations and governments.
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The World Health Organization urges countries to become more active in advocacy efforts to put mental health on governments' agendas. Health policy makers, planners and managers, advocacy groups, consumer and family organizations, through their different roles and actions, can move the mental health agenda forward. This paper outlines the importance of the advocacy movement, describes some of the roles and functions of the different groups and identifies some specific actions that can be adopted by Ministries of Health. The mental health advocacy movement has developed over the last 30 years as a means of combating stigma and prejudice against people with mental disorders and improving services. Consumer and family organizations and related NGOs have been able to influence governments on mental health policies and laws and educating the public on social integration of people with mental disorders. Governments can promote the development of a strong mental health advocacy sector without compromising this sector's independence. For instance, they can publish and distribute a directory of mental health advocacy groups, include them in their mental health activities and help fledgling groups become more established. There are also some advocacy functions that government officials can, and indeed, should perform themselves. Officials in the ministry of health can persuade officials in other branches of government to make mental health more of a priority, support advocacy activities with both general health workers and mental health workers and carry out public information campaigns about mental disorders and how to maintain good mental health. In conclusion, the World Health Organization believes mental health advocacy is one of the pillars to improve mental health care and the human rights of people with mental disorders. It is hoped that the recommendations in this article will help government officials and activists to strengthen national advocacy movements. (+info)