Exploring perceptions of community health policy in Kenya and identifying implications for policy change

BACKGROUND:

Global interest and investment in close-to-community health services is increasing. Kenya is currently revising its community health strategy (CHS) alongside political devolution, which will result in revisioning of responsibility for local services. This article aims to explore drivers of policy change from key informant perspectives and to study perceptions of current community health services from community and sub-county levels, including perceptions of what is and what is not working well. It highlights implications for managing policy change.

METHODS:

We conducted 40 in-depth interviews and 10 focus group discussions with a range of participants to capture plural perspectives, including those who will influence or be influenced by CHS policy change in Kenya (policymakers, sub-county health management teams, facility managers, community health extension worker (CHEW), community health workers (CHWs), clients and community members) in two purposively selected counties: Nairobi and Kitui. Qualitative data were digitally recorded, transcribed, translated and coded before ...

Enhancing Connectedness Through Peer Training for Community-Dwelling Older People: A Person Centred Approach

Social interaction and connectedness is important to the mental health and wellbeing of older people. The aim of this research study was to facilitate and increase opportunities for social connectedness for older people living in regional areas through the use of technology training. Weekly technology training sessions were conducted at a Seniors Citizen's Club with a peer trainer (an experienced, retired computer teacher) and sessions were attended not only by the six study participants, but also by other club members, with up to 15 club members participating in sessions. Data analysis involved all documents generated by the project, including the individual interviews, researcher observations of training sessions, reports from the peer trainer and weekly diaries maintained by participants. Findings demonstrated that computer training at the Senior Citizens Club helped participants build group cohesion and to form tiered connections with partners, family, and friends with whom they no longer live ...

Circles of Support and personalization: Exploring the economic case

Circles of Support aim to enable people with learning disabilities (and others) to live full lives as part of their communities. As part of a wider study of the economic case for community capacity building conducted from 2012 to 2014, we conducted a mixed methods study of five Circles in North West England. Members of these Circles were supporting adults with moderate to profound learning disabilities and provided accounts of success in enabling the core member to live more independent lives with improved social care outcomes within cost envelopes that appeared to be less than more traditional types of support. The Circles also reported success in harnessing community resources to promote social inclusion and improve well-being. This very small-scale study can only offer tentative evidence but does appear to justify more rigorous research into the potential of Circles to secure cost-effective means of providing support to people with learning disabilities ...

Diversity Conceptual Model for aged care: Person-centred and difference-oriented and connective with a focus on benefit, disadvantage and equity

AIM:

This project aimed to develop a Diversity Conceptual Model to support the aged care sector to identify diversity characteristics and associated benefits and disadvantages in order to consider greater equity in policy and practice.

METHODS:

A multi-method approach was used to develop the Diversity Conceptual Model using a literature review, organisation-wide consultation using a questionnaire, focus groups and interviews with key stakeholders.

RESULTS:

A Diversity Conceptual Model was developed as a visual 'tool', made up of numerous components, with a focus on diversity characteristics that may be creating benefits and disadvantages for a consumer to participate in their health care. Continuous quality improvements and equity are presented as essential overarching components of the Model.

CONCLUSION:

The Diversity Conceptual Model has many potential applications for aged care. The author proposes that its wider adoption would increase confidence, skills and knowledge, enabling the aged care sector to influence greater equity in ...

Derivation and validation of the Personal Support Algorithm: an evidence-based framework to inform allocation of personal support services in home and community care

Personal support services enable many individuals to stay in their homes, but there are no standard ways to classify need for functional support in home and community care settings. The goal of this proyect was to develop and evidence-based clinical tool to inform service planning while allowing for flexibility in care coordinator judgment in response to patient and family circumstances. 

The effect of community health worker–led education on women’s health and treatment– seeking: A cluster randomised trial and nested process evaluation in Gujarat, India

A community-based health insurance scheme operated by the Self-Employed Women´s Association in Gujarat, India reported that the leading reasons for inpatient hospitalisation claims by its members were diarrhoea, fever and hysterectomy- the latter at the average age of 37. This claims pattern raised concern regarding potentially unnecessary hospitalisation amongst low-income women. 

Ghana's community-based primary health care: Why women and children are ‘disadvantaged’ by its implementation

Policy analysis on why women and children in low- and middle- income settings are still disadvantaged by access to appropiate care despite Primary Health Care (PHC) programmes implementation is limited. Drawing on the street- level bureaucracy theory, this article explored how and why frontline providers (FLP) actions on their own and in interaction with health system factors shape Ghana´s community-based PHC implementation to the disadvantage of women and children accessing and using health services. 

Assessing the feasibility of community health insurance in Uganda: A mixed-methods exploratory analysis

Community health insurance (CHI) aims to provide financial protection and facilitate health care access among poor rural populations. Given common operational challenges that hamper the full development of the scheme, there is need to undertake systematic feasibility studies. These are scarce in the literature and usually they do not provide a comprehensive analysis of the local context. The present research intends to adopt a mixed-methods approach to assess ex-ante the feasibility of CHI. 

Primary healthcare policy implementation in the Eastern Mediterranean region: Experiences of six countries

Primary healthcare (PHC) is essential for equitable access and cost-effective healthcare. This makes PHC a key factor in the global strategy for universal health coverage (UHC). Implementing PHC requires an understanding of the health system under prevailing circumstances, but for most countries, no data are available. This paper describes and analyse the health systems of Bahrain, Egypt, Lebanon, Qatar, Sudan and the United Arab Emirates, in relation to PHC

Primary healthcare policy implementation in the Eastern Mediterranean region: Experiences of six countries.

Primary healthcare (PHC) is essential for equitable access and cost-effective healthcare. This makes PHC a key factor in the global strategy for universal health coverage (UHC). Implementing PHC requires an understanding of the health system under prevailing circumstances, but for most countries, no data are available.
This paper describes and analyses the health systems of Bahrain, Egypt, Lebanon, Qatar, Sudan and the United Arab Emirates, in relation to PHC.

Evaluating a Community-Placed and Clinically Integrated Community Health Worker Program

Community health worker (CHW) programs can act as bridges between patients and health care teams, but the complexity and variability of program components and outcomes make them difficult to evaluate. This evaluation used a realist approach to identify underlying mechanisms and contextual factors associated with successful implementation of a community-placed CHW program affiliated with a primary care practice in the Midwest United States. The analysis identified mechanisms by which stakeholders built trust, self-efficacy, and empowerment to improve patient-centered outcomes and experiences.

IFIC Scotland Integrated Care Matters: Build Back Better Webinar Series

The new report from the International Foundation for Integrated Care (IFIC), Realising the true value of integrated care describes the steps we must take to create a radically different future beyond Covid-19. The report is a powerful call to reset our compass to a new reality based on solidarity and collaboration for population health. IFIC Scotland and partners will explore this new future in series 5 of their Integrated Care Matters webinars.

Guest panelists, members of IFICs international Special Interest Groups, will share their experiences and insights and challenge us to design a better future that improves lives and opportunities for all. Each webinar will be accompanied by a topic resource with links to further information.

All who register will receive links to the recordings and topic resources.

A Community Resource Navigator Model: Utilizing Student Volunteers to Integrate Health and Social Care in a Community Health Center Setting

While unmet social needs are major drivers of health outcomes, most health systems are not fully integrated with the social care sector to address them. 

This case study describes the development and implementation of a model utilizing student volunteer community resource navigators to help patients connect with community-based organizations. The authors then detail initial implementation outcomes and practical considerations for future work.

Integrated care in action – primary care. Understanding how integrated care systems are redesigning primary care services

This case study shows how integrated care systems are redesigning primary care services.