加拿大基层医疗改革及启示

加拿大经过了长期的探索与实践,已经形成了比较完整的医疗卫生体系,基本解决了居民的医疗卫生问题。作为一个具有全民医疗保险的国家,其基层医疗运行的顺畅与否,直接影响到整个卫生体系的运作,因此加拿大医疗体系从开始建立至现在,一直致力于基层医疗的改革。文章结合文献资料以及实地考察从组织形式的改革、付费机制的改革以及整合社区资源三个方面介绍了加拿大基层医疗体系的改革,其中整合社区资源经验尤其值得我们在今后的社区卫生服务改革中借鉴。

加拿大卫生改革现状、发展趋势及其对我国的启示

全民医疗保健制度是加拿大卫生体系乃至社会政策的核心,经济起伏下的筹资增减深刻影响到加拿大近二十年卫生发展历程,以公平、公正为基本价值观,构建低成本高效益卫生服务体系,为全民及时提供高质量卫生服务是加拿大卫生改革发展的基本趋势。本文介绍了上世纪后十年和本世纪初十年两阶段的加拿大卫生改革的背景、现状、特征、主题、内容、影响、经验和教训,并从公平、效率和长期性三方面阐述了对我国卫生改革发展的启示。

Long-term care for aged ethnic minority people in Yunnan,China:Understanding the situation

Chinese governmental sectors have been investing lots of money in setting up new institutions for long-term care(LTC)in rural China to respond to the predicted increasing and urgent needs of the growing number of aging people.However,very few have identified that many ethnic minority groups have been enjoying their traditional home-based LTC systems,which are cost-effective and have been working really well for generations.This article reports on a study on LTC needs and provisions for the Dai,one of the ethnic minority groups in rural areas of southwest China,in Yunnan(Province).A randomized sample was drawn from 12 villages in Ruili,a county 752 km from Kunming,the capital city of Yunnan.Totally,187 elderly persons were interviewed intensively.Activities of daily living were measured as the core indicator for understanding LTC.The research revealed that there is a significant disparity between the needs of the villagers and provisions from the different levels of government.There is an urgent need to reexamine the allocation of public resources for the aged.Traditional culture and practices of caring for the elderly,and practices in LTC of different ethnic groups,must be carefully considered.

Performing arts as a social technology for community health promotion in northern Ghana

Objective:We present first-phase results of a performing arts public health intervention,‘Singing and Dancing for Health,’aiming to promote healthier behaviors in Ghana’s impoverished Northern Region.We hypothesize that live music and dance drama provide a powerful technology to overcome barriers such as illiteracy,lack of adequate media access,inadequate health resources,and entrenched sociocultural attitudes.Our research objective is to evaluate this claim.Methods:In this first phase,we evaluated the effectiveness of arts interventions in improv-ing knowledge and behaviors associated with reduced incidence of malaria and cholera,focusing on basic information and simple practices,such as proper hand washing.Working with the Youth Home Cultural Group,we codeveloped two‘dance dramas’delivering health messages through di-alog,lyrics,and drama,using music and dance to attract spectators,focus attention,infuse emotion,and socialize impact.We also designed knowledge,attitude,and behavior surveys as measurement instruments.Using purposive sampling,we selected three contrasting test villages in the vicinity,contrasting in size and demographics.With cooperation of chiefs,elders,elected officials,and Gha-na Health Service officers,we conducted a baseline survey in each village.Next,we performed the interventions,and subsequently conducted follow-up surveys.Using a more qualitative approach,we also tracked a select subgroup,conducted focus group studies,and collected testimonials.Sur-veys were coded and data were analyzed by Epi Info.Results:Both quantitative and qualitative methods indicated that those who attended the dance drama performances were likelier than those who did not attend to list the causal,preven-tive,and transmission factors of malaria and cholera.Also,the same attendees were likelier than nonattendees to list some activities they do to prevent malaria,cholera,and other sanitation-related diseases,proving that dance dramas were highly effective both in raising awareness and in trans-forming behaviors.Conclusions:As a result of this study,we suggest that where improvements in community health depend primarily on behavioral change,music and associated performing arts-dancing,singing,and drama-presented by a professional troupe offer a powerful social technology for bringing them about.This article is a status report on the results of the project so far.Future re-search will indicate whether local community-based groups are able to provide equal or better outcomes at lower cost,without outside support,thus providing the capacity for sustainable,local-ized health promotion.

‘Feeling of despair’ as the leading cluster theme of conceptual descriptive analyses in participatory assessment: Russia Oxfam GB case study

This article provides a case study on participatory assessment based on experience gained from an EU-Oxfam GB project entitled“Empowering Municipalities to Effectively Address Poverty”conducted in five small towns in Russia.Participatory assessment through focus group discussions(FGDs)was the main approach used in the implementation of the project.A participatory assessment was performed through 25 FGDs in five remote areas in central Russia.More than 200 participants representing people living in poverty,such as single mothers,people with disabilities,families with many children,families with disabled children,and pensioners,voluntarily participated in the meetings.Most of the participants were women(75%)aged between 25 and 70 years.We consider that the participants’representation is relevant in accordance with the official poverty studies.Through identification of patterns of recurrent ideas and opinions,a qualitative method helps us understand social phenomena from the views of and on the basis of the opinions of the participants.The FGDs’narratives underwent pattern analysis,resulting in the framing of the cluster themes and narrative conceptualization.Cluster analysis of the FGDs’narratives led to the framing of 10 cluster themes of importance,followed by conceptual descriptions and related narratives.The conceptual description of the leading theme,feeling of despair(theme 1),was described by respondents’expressions/narratives,such as“Nobody needs us and there is no future for us and our children in this town,”the narrative idea that crosscuts the subsequent themes.The following nine themes are of equal importance,are interlinked,and for the major part constitute the leading theme,feeling of despair(theme 1):state social and family support(theme 2);health care(theme 3);who are those living in poverty?(theme 4);housing(theme 5);living costs(theme 6);employment(theme 7);children’s well-being and future(theme 8);environment and recreation(theme 9);and legal rights(theme 10).Equal importance of these themes is justified by the analysis of patterns and recurrence of the FGDs’narrative ideas.The assigned numbers from 2 to 10 are given to simplify the references to the corresponding cluster throughout the analysis and do not reflect the ranks of the clusters.The leading theme(theme 1)touches on the psychological status of the FGDs’participants,while the remaining nine themes(themes 2-10)relate to the state system of social services,including health care.For example,per the conceptual descriptions,the state social and family support(theme 2)is described by the following narrative:“Those who have a family network get their support,for those without family help,state support is crucial but is very little and not everybody can get it.Nobody wants to help or provide decent services-people in local government get fed up with you,you get sent from one place to another.”The frustration(“Nobody wants to help or provide decent services;the government gets fed up with you,you get sent from one place to another.”)caused by poor services(“State support is crucial but is very little and not everybody can get it.”) crosscuts the theme’s conceptual description. In this article, feeling of despair refers to a psychosocial condition caused by people living in poverty and their dissatisfaction with state services. Details of the remaining themes are given. The purpose of this article is to draw the attention of practitioners and policy makers to the participatory results rather than their focusing on the qualitative methodological details. We argue that a participatory understanding of community needs, through cluster theme analysis and conceptual descriptions, can help local municipalities develop more targeted community programs on poverty and vulnerability reduction.

Unregulated health care workers in the care of aging populations:Similarities and differences between Brazil and Canada

Introduction:The world’s population is rapidly aging.Unregulated health care workers(UH-CWs)are emerging as a potentially important workforce in the care of older adults.Objective:A review was conducted to identify the activities of UHCWs with respect to con-tributions and limitations.Methods:A systematic integrative literature review was conducted using online databases(LILACS,PubMed,EMBASE,CINAHL,and grey literature).The inclusion criteria were as fol-lows:(i)description of UHCW activities related to older adults;and(ii)description of UHCW activities performed in Brazil or Canada.Results:Eleven papers were included in this review.In both countries,UHCW activities included health promotion,mental health care,and rehabilitation.In Brazil,UHCWs performed integrated care,while in Canada UHCWs performed personal care and housekeeping.Conclusion:These results highlight the potential and limits of UHCWs who provide care for the aging population.Such information is important to health and social policy making and household decision making.

Factors associated with the utilization of institutional and home birth services among women in Ethiopia: A scoping review

Objective:To examine the factors associated with the use of institutional delivery and home birth services among women in Ethiopia.Methods:Fifteen peer-reviewed,primary research articles published between 2011 and 2015 were selected for this scoping review.The articles included case-control,cross-sectional,and retro-spective follow-up studies conducted in Ethiopia.Results:Findings were categorized with use of content and factorial analysis.The data in this scoping review revealed a significant inequality in skilled care use among Ethiopian women with differences in economic status,education,residence,autonomy in decision making,parity,and antenatal care attendance.Conclusion:Sociodemographic,accessibility,and obstetric factors are key determinants of skilled care utilization.Strategies and policy changes to address maternal health service use should aim to improve economic status,facilitate higher education,increase access to care,promote the empowerment of women,and enhance antenatal care initiatives.Additional research should be conducted to evaluate the influence of the media and culture on skilled care utilization,since few studies have examined these factors.

Healthy China 2030: “Without national health, there will be no comprehensive well-being”

On August 19-20,2016,the China National Health and Wellness Conference was held in Beijing.Both President Xi Jinping and Premier Li Keqiang attended the meeting and delivered important speeches with key messages.Their contributions are summarized here[1]。

Editorial

Global health has changed a lot in the last two decades,starting with obscure efforts to work on problems affecting the poor,marginalized,and disadvantaged around the world by a relatively few dedicated souls and progressing to a burgeoning enterprise complete with many billions of dollars and many engaged people and organizations all over the world,including a growing number in poor countries.Furthermore,there is today a corporate-like atmosphere complete with private-public partnerships,bureaucratic multilateral organizations,engagement of academia,management consultants,including non-government organisations(N s),a growing civil society participation,and widespread recognition of global health’s importance from most all corners.