scholarly journals Responding to health inequities: Indigenous health system innovations

2016 ◽  
Vol 1 ◽  
Author(s):  
J. G. Lavoie ◽  
D. Kornelsen ◽  
L. Wylie ◽  
J. Mignone ◽  
J. Dwyer ◽  
...  
Keyword(s):  
Health System ◽  
Indigenous Health ◽  
Indigenous Communities ◽  
Health Inequities ◽  
Healthcare Services ◽  
International Perspective ◽  
Full Potential ◽  
Community Members ◽  
Culturally Informed ◽  
The Usa

Over the past decades, Indigenous communities around the world have become more vocal and mobilized to address the health inequities they experience. Many Indigenous communities we work with in Canada, Australia, Latin America, the USA, New Zealand and to a lesser extent Scandinavia have developed their own culturally-informed services, focusing on the needs of their own community members. This paper discusses Indigenous healthcare innovations from an international perspective, and showcases Indigenous health system innovations that emerged in Canada (the First Nation Health Authority) and Colombia (Anas Wayúu). These case studies serve as examples of Indigenous-led innovations that might serve as models to other communities. The analysis we present suggests that when opportunities arise, Indigenous communities can and will mobilize to develop Indigenous-led primary healthcare services that are well managed and effective at addressing health inequities. Sustainable funding and supportive policy frameworks that are harmonized across international, national and local levels are required for these organizations to achieve their full potential. In conclusion, this paper demonstrates the value of supporting Indigenous health system innovations.

Transforming a global order in New Zealand to reduce health inequities in service provision

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
E Rawson
Keyword(s):  
Public Health ◽  
New Zealand ◽  
Indigenous Knowledge ◽  
Best Practice ◽  
Indigenous Health ◽  
Indigenous Communities ◽  
Health Inequities ◽  
Medical Emergency ◽  
Major Work ◽  
Health Initiatives

Abstract St John has been providing service in New Zealand for nearly 140 years since its arrival. It has now close to 4000 staff and nearly 20000 Members and over 8500 volunteers. In New Zealand the major work of St John is its Ambulance service providing front line first responders to crash, medical emergency and other life-threatening situations. St John New Zealand also provides a number of 'Community Health' initiatives focused on strengthening communities and prevention. In recent years St John has recognised that they have not engaged well with Indigenous communities and that their organisation in New Zealand must become skilled and relevant in addressing the needs of the Indigenous people of New Zealand, as they suffer the greater burden of disease and illness than any other population in the country. St John NZ Community and Health Services are embarking on a process of transformation through re-orienting its culture and practice by adopting Public Health approaches and an equity lens over all its programmes. They also have committed to understanding and using Indigenous knowledge to support this re-orientation to most effectively engage and implement programmes that will reduce Indigenous health inequities. This presentation will describe the process by which they will be implementing their strategy for change and highlight best practice for working with Indigenous communities. Key messages Indigenous Knowledge is key to addressing Indigenous Health inequities. Mainstream Public Health can learn from Indigenous Public Health approaches.

scholarly journals Artificial intelligence (AI) and global health: how can AI contribute to health in resource-poor settings?

2018 ◽  
Vol 3 (4) ◽  
pp. e000798 ◽  
Author(s):  
Brian Wahl ◽  
Aline Cossy-Gantner ◽  
Stefan Germann ◽  
Nina R Schwalbe
Keyword(s):  
Artificial Intelligence ◽  
Patient Safety ◽  
Global Health ◽  
Health Outcomes ◽  
Health System ◽  
Healthcare Services ◽  
Full Potential ◽  
High Profile ◽  
Resource Poor ◽  
Improve Health

The field of artificial intelligence (AI) has evolved considerably in the last 60 years. While there are now many AI applications that have been deployed in high-income country contexts, use in resource-poor settings remains relatively nascent. With a few notable exceptions, there are limited examples of AI being used in such settings. However, there are signs that this is changing. Several high-profile meetings have been convened in recent years to discuss the development and deployment of AI applications to reduce poverty and deliver a broad range of critical public services. We provide a general overview of AI and how it can be used to improve health outcomes in resource-poor settings. We also describe some of the current ethical debates around patient safety and privacy. Despite current challenges, AI holds tremendous promise for transforming the provision of healthcare services in resource-poor settings. Many health system hurdles in such settings could be overcome with the use of AI and other complementary emerging technologies. Further research and investments in the development of AI tools tailored to resource-poor settings will accelerate realising of the full potential of AI for improving global health.

scholarly journals Improving immunization practices in United States hospitals and health systems

2017 ◽  
Vol 22 (3) ◽  
pp. 199-211
Author(s):  
Wesley D. Kufel ◽  
Dennis M. Williams ◽  
David Jay Weber
Keyword(s):  
Health System ◽  
Health Systems ◽  
Healthcare Services ◽  
Healthcare Personnel ◽  
Fee For Service ◽  
Content Type ◽  
Vaccination Rates ◽  
Immunization Rates ◽  
The Usa ◽  
Mandatory Vaccination

Purpose Payment for healthcare services in the USA has shifted from fee for service to compensation based on value and quality. The indicators used for payments are a variety of clinical measures, including administration of vaccines to patients. The purpose of this paper is to describe the implementation of programs in health systems to improve vaccination rates and patient outcomes. Design/methodology/approach A search of the literature was conducted to find examples of vaccine programs in US health systems, and also to identify policies to improve immunization rates. Findings Successful programs for improving vaccination rates require advocacy and support of leadership, a systematic and multidisciplinary approach, and an evaluation of local resources and capacity. Numerous examples exist of medical, nursing, and pharmacy led programs that improve vaccination rates. The department in charge has relied on the support of other groups to ensure the success. Social implications Mandatory vaccination of healthcare personnel (HCP) in the health system has been a growing trend in the USA. Although there has been some resistance to mandatory vaccinations for HCP, the standards and requirements have resulted in improved rates in health systems, which ultimately improve efficiency and protects patients. Originality/value This review describes considerations for implementing a successful vaccination program in a health system and provides examples of specific strategies. An overview of mandatory vaccinations for HCP is also described.

scholarly journals Addressing rural and Indigenous health inequities in Canada through socially accountable health partnerships

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e048053
Author(s):  
Ray Markham ◽  
Megan Hunt ◽  
Robert Woollard ◽  
Nelly Oelke ◽  
David Snadden ◽  
...  
Keyword(s):  
British Columbia ◽  
Health System ◽  
First Nations ◽  
Appreciative Inquiry ◽  
Indigenous Communities ◽  
Health Inequities ◽  
Social Accountability ◽  
Indigenous Populations ◽  
Deliberative Dialogue ◽  
Services Delivery

BackgroundThere are few examples of the practical application of the concepts of social accountability, as defined by the World Bank and WHO, to health system change. This paper describes a robust approach led by First Nations Health Authority and the Rural Coordination Centre of British Columbia. This was achieved using partnerships in British Columbia, Canada, where the health system features inequities in service and outcomes for rural and Indigenous populations. Social accountability is achieved when all stakeholders come together simultaneously as partners and agree on a path forward. This approach has enabled socially accountable healthcare, effecting change in the healthcare system by addressing the needs of the population.InnovationOur innovative approach uses social accountability engagement to counteract persistent health inequities. This involves an adaptation of the Boelen Health Partnership model (policymakers, health administrators, health professionals, academics and community members) extended by addition of linked sectors (eg, industry and not-for-profits) to the ‘Partnership Pentagram Plus’. We used appreciative inquiry and deliberative dialogue focused on the rural scale and integrating Indigenous ways of knowing along with western scientific traditions (‘two-eyed seeing’). Using this approach, partners are brought together to identify common interests and direction as a learning community. Equitable engagement and provision of space as ‘peers’ and ‘partners’ were key to this process. Groups with varying perspectives came together to create solutions, building on existing strengths and new collaborative approaches to address specific issues in the community and health services delivery. A resulting provincial table reflecting the Pentagram Plus model has fostered policies and practices over the last 3 years that have resulted in meaningful collaborations for health service change.ConclusionThis paper presents the application of the ‘Partnership Pentagram Plus’ approach and uses appreciative inquiry and deliberative dialogue to bring about practical and positive change to rural and Indigenous communities.

scholarly journals Pilinahā: An Indigenous Framework for Health

2019 ◽  
Vol 3 (Supplement_2) ◽  
pp. 32-38 ◽  
Author(s):  
Sharon Kaʻiulani Odom ◽  
Puni Jackson ◽  
David Derauf ◽  
Megan Kiyomi Inada ◽  
Andrew H Aoki
Keyword(s):  
Health Care ◽  
Health System ◽  
Indigenous Communities ◽  
Well Being ◽  
Indigenous Community ◽  
Community Members ◽  
Urban Neighborhood ◽  
Key Concepts ◽  
Growing Body

ABSTRACT This article speaks to the abundance and wisdom of indigenous community members in Kalihi, an urban neighborhood in Honolulu, Hawaii. Its findings result from community members sharing their stories of health, health care, and healing. These stories evolved into a distinct framework for health—Pilinahā or the Four Connections Framework. Pilinahā addresses 4 vital connections that people typically seek to feel whole and healthy in their lives: connections to place, community, past and future, and one's better self. This article describes the origins, intent, key concepts, and implementation of this framework. By doing so, the authors hope to add to the growing body of work on community and indigenous well-being, further the dialogue with other indigenous communities, and collectively foster a more meaningful and effective health system for all.

scholarly journals Community engagement approaches for Indigenous health research: recommendations based on an integrative review

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e039736
Author(s):  
Chu Yang Lin ◽  
Adalberto Loyola-Sanchez ◽  
Elaine Boyling ◽  
Cheryl Barnabe
Keyword(s):  
Community Engagement ◽  
Health Research ◽  
Indigenous Health ◽  
Indigenous Communities ◽  
Indigenous Community ◽  
Integrative Review ◽  
Community Settings ◽  
Comprehensive List ◽  
The Usa ◽  
Research Recommendations

ObjectiveCommunity engagement practices in Indigenous health research are promoted as a means of decolonising research, but there is no comprehensive synthesis of approaches in the literature. Our aim was to assemble and qualitatively synthesise a comprehensive list of actionable recommendations to enhance community engagement practices with Indigenous peoples in Canada, the USA, Australia and New Zealand.DesignIntegrative review of the literature in medical (Medline, Cumulative Index to Nursing and Allied Health Literature and Embase) and Google and WHO databases (search cut-off date 21 July 2020).Article selectionStudies that contained details regarding Indigenous community engagement frameworks, principles or practices in the field of health were included, with exclusion of non-English publications. Two reviewers independently screened the articles in duplicate and reviewed full-text articles.AnalysisRecommendations for community engagement approaches were extracted and thematically synthesised through content analysis.ResultsA total of 63 studies were included in the review, with 1345 individual recommendations extracted. These were synthesised into a list of 37 recommendations for community engagement approaches in Indigenous health research, categorised by stage of research. In addition, activities applicable to all phases of research were identified: partnership and trust building and active reflection.ConclusionsWe provide a comprehensive list of recommendations for Indigenous community engagement approaches in health research. A limitation of this review is that it may not address all aspects applicable to specific Indigenous community settings and contexts. We encourage anyone who does research with Indigenous communities to reflect on their practices, encouraging changes in research processes that are strengths based.

scholarly journals Community-based interventions for detection and management of diabetes and hypertension in underserved communities: a mixed-methods evaluation in Brazil, India, South Africa and the USA

2020 ◽  
Vol 5 (6) ◽  
pp. e001959
Author(s):  
Luisa S Flor ◽  
Shelley Wilson ◽  
Paurvi Bhatt ◽  
Miranda Bryant ◽  
Aaron Burnett ◽  
...  
Keyword(s):  
South Africa ◽  
Blood Pressure ◽  
Mixed Methods ◽  
Health System ◽  
Diabetes Management ◽  
Full Potential ◽  
Community Based ◽  
Underserved Communities ◽  
Treatment Targets ◽  
The Usa

IntroductionAs non-communicable disease (NCD) burden rises worldwide, community-based programmes are a promising strategy to bridge gaps in NCD care. The HealthRise programme sought to improve hypertension and diabetes management for underserved communities in nine sites across Brazil, India, South Africa and the USA between 2016 and 2018. This study presents findings from the programme’s endline evaluation.MethodsThe evaluation utilises a mixed-methods quasi-experimental design. Process indicators assess programme implementation; quantitative data examine patients’ biometric measures and qualitative data characterise programme successes and challenges. Programme impact was assessed using the percentage of patients meeting blood pressure and A1c treatment targets and tracking changes in these measures over time.ResultsAlmost 60 000 screenings, most of them in India, resulted in 1464 new hypertension and 295 new diabetes cases across sites. In Brazil, patients exhibited statistically significant reductions in blood pressure and A1c. In Shimla, India, and in South Africa, country with the shortest implementation period, there were no differences between patients served by facilities in HealthRise areas relative to comparison areas. Among participating patients with diabetes in Hennepin and Ramsey counties and hypertension patients in Hennepin County, the percentage of HealthRise patients meeting treatment targets at endline was significantly higher relative to comparison group patients. Qualitative analysis identified linking different providers, services, communities and information systems as positive HealthRise attributes. Gaps in health system capacities and sociodemographic factors, including poverty, low levels of health education and limited access to nutritious food, are remaining challenges.ConclusionsFindings from Brazil and the USA indicate that the HealthRise model has the potential to improve patient outcomes. Short implementation periods and strong emphasis on screening may have contributed to the lack of detectable differences in other sites. Community-based care cannot deliver its full potential if sociodemographic and health system barriers are not addressed in tandem.

scholarly journals The effects of integrative healthcare on Peruvian Indigenous groups

SURG Journal ◽  
2014 ◽  
Vol 7 (2) ◽  
pp. 5-12
Author(s):  
Rebecca Wolff
Keyword(s):  
Traditional Medicine ◽  
Healthcare System ◽  
Indigenous Health ◽  
Medical Knowledge ◽  
Indigenous Communities ◽  
Healthcare Services ◽  
Indigenous Groups ◽  
Integrative Healthcare ◽  
Integral Role ◽  
Biomedical System

Indigenous communities are vulnerable to a variety of health risks due to political marginalization, socioeconomic challenges and geographic isolation. Most developed and developing nations rely mainly on biomedical healthcare services, which do not adequately incorporate the use of traditional medicinal knowledge. Peru is home to over 50 Indigenous groups, many of which practice holistic and traditional approaches to healthcare. Peruvian healers and medicinal plants play an integral role in such traditional medicinal systems. Integrative healthcare, which incorporates Indigenous medicine into the biomedical healthcare system, is a potential solution to improving healthcare services for an entire nation. However, integrative healthcare fails to address the lack of accessibility and affordability of the Peruvian healthcare system for marginalized populations. Traditional medicine reflects a multi-dimensional, spiritual and individualized approach to healthcare that is in conflict with the scientific and esoteric nature of the biomedical system. Incorporating traditional medicine into the biomedical system could threaten the existence of traditional medicinal knowledge and decrease the need for dissemination of traditional knowledge and culture. In a Peruvian context, integrative healthcare would have a detrimental impact on the maintenance and dissemination of Indigenous Peruvian medical knowledge. Keywords: Peru; Indigenous; health; policy; traditional, complementary and alternative medicine (TCAM)

Artificial Intelligence Based System

2021 ◽  
Vol 34 (2) ◽  
pp. 80-90
Author(s):  
Anupam Sharma ◽  
Jasleen Kaur
Keyword(s):  
Artificial Intelligence ◽  
Patient Safety ◽  
Global Health ◽  
Health Outcomes ◽  
Health System ◽  
Healthcare Services ◽  
Full Potential ◽  
Menstrual Hygiene ◽  
High Profile ◽  
Resource Poor

The field of artificial intelligence (AI) has evolved considerably in the last 60 years. While there are now many AI applications that have been deployed in high-income country contexts, use of AI in resource-poor settings remains relatively nascent. With a few notable exceptions, there are limited examples of AI being used in such settings. However, there are signs that this is changing. Several high-profile meetings have been convened in recent years to discuss the development and deployment of AI applications to reduce poverty and deliver a broad range of critical public services. The authors provide a general overview of AI and how it can be used to improve global health outcomes in resource-poor settings. They also describe some of the current ethical debates around patient safety and privacy. The research paper specifically highlights the challenges related to women menstrual hygiene and suggests AI technology for improving the menstrual hygiene and healthcare services in resource-poor settings for women. Many health system hurdles in such settings could be overcome with the use of AI and other complementary emerging technologies. Further research and investments in the development of AI tools tailored to resource-poor settings will accelerate the realization of the full potential of AI for improving global health in resource-poor contexts.

scholarly journals “Everything is provided free, but they are still hesitant to access healthcare services”: Why does the Indigenous community in Attapadi, Kerala continue to experience poor access to healthcare?

2020 ◽  
Author(s):  
Mathew Sunil George ◽  
Rachel Davey ◽  
Itismita Mohanty ◽  
Penney Upton
Keyword(s):  
Health System ◽  
Indigenous Communities ◽  
Healthcare Services ◽  
Access To Healthcare ◽  
Indigenous Community ◽  
Local Health ◽  
Financial Protection ◽  
Healthcare Facilities ◽  
Meaningful Involvement ◽  
Poor Access

Abstract Background Inequity in access to healthcare services is a constant concern. While advances in healthcare have progressed in the last several decades, thereby significantly improving the prevention and treatment of disease, these benefits have not been shared equally. Excluded communities such as Indigenous communities typically face a lack of access to healthcare services that others do not. This study seeks to understand why the indigenous community in Attapadi continues to experience poor access to healthcare in spite of both financial protection and adequate coverage of health services Methods Ethnographic fieldwork was carried out among the various stakeholders living in Attapadi . A total of 52 in-depth interviews and 5 focus group discussions were conducted amongst the indigenous community, the healthcare providers and key informants. The data was coded utilising a reflexive and inductive approach leading to the development of the key categories and themes Results The health system provided a comprehensive financial protection package in addition to a host of healthcare facilities for the indigenous community to avail services. In spite of this, the community resisted the attempts of the health system to improve their access. The failure to provide culturally respectful care, the discrimination of the community at healthcare facilities, the centralisation of the delivery of services as well as the lack of power among the indigenous community to negotiate with the health system for services that were less disruptive to their lives were barriers to improving healthcare access. Power differentials between the community and the health system stakeholders also ensured that meaningful involvement of the community in the local health system did not occur. Conclusion Improving access to health care for indigenous communities would require UHC interventions to be culturally safe, locally relevant and promote active involvement of the community at all stages of the intervention. Structural power imbalances that affect access to resources and prevent meaningful involvement of indigenous communities also need to be addressed.

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