scholarly journals Community-based psychiatry services in Sri Lanka: A new model in the making

2021 ◽  
Author(s):  
Mahesh Rajasuriya
Keyword(s):  
Sri Lanka ◽  
Care Delivery ◽  
Rapid Development ◽  
Community Services ◽  
The State ◽  
Small Island ◽  
Service Development ◽  
State Health ◽  
Community Based ◽  
Health Authorities

Sri Lanka is a lower middle-income small island nation in the Indian Ocean with a multi-ethnic population of 22 million. The healthcare system of the country is well-established and fairly advanced, the delivery of which is free to the consumer. The health indicators of the country are impressive compared to regional figures. Psychiatric care in Sri Lanka saw a rapid development over the last four decades as the care model transformed from an asylum-based one, established during the British colonial times, to a district-wise hospital-based care delivery model. Gradually, the teams that provided inpatient and outpatient services at the hospitals started to also provide community-based care. The newly added community based services include outreach clinics, residential intermediate rehabilitation centres, home based care, community resource/support centres and telephone help lines. There is no or little separate funding for community-based care services. The teams that deliver community services are funded, mostly indirectly, by the state health authorities. This is so as these community teams are essentially the same psychiatry teams that are based at the hospitals, which are funded and run by the state health authorities. This lack of separation of the community and hospital teams without separate and dedicated funding is an impediment to service development, which needs to be addressed. Paradoxically, it conforms an advantage by making care delivery from the hospital to the community continuous, as it is the same team that provides both hospital- and community-based care. In addition to the essential mental health care provision in the community with this basic infrastructure, each community service has improvised and adapted utilization of other resources available to them, formally as well as informally, to compensate their financial and human resource limitations. These other resources are the community officials and the community services of the non-health sectors of the government, mainly of the civil administration. Though sustainability maybe questionable when services involve informal resources from the non-health sectors, it has so far proven useful and effective, in a resource-poor environment, as it brings the community and various sectors together to facilitate services to support their own community.

scholarly journals Difficulties in Accessing Cancer Care in a Small Island State: A Community-Based Pilot Study of Cancer Survivors in Saint Lucia

2021 ◽  
Vol 18 (9) ◽  
pp. 4770
Author(s):  
Aviane Auguste ◽  
Glenn Jones ◽  
Dorothy Phillip ◽  
James St. Catherine ◽  
Elizabeth Dos Santos ◽  
...  
Keyword(s):  
Health Services ◽  
Cancer Survivors ◽  
Cancer Care ◽  
Care Delivery ◽  
Research Capacity ◽  
Small Island ◽  
Future Research ◽  
Snowball Sampling ◽  
Community Based ◽  
Saint Lucia

Developing robust systems for cancer care delivery is essential to reduce the high cancer mortality in small island developing states (SIDS). Indigenous data are scarce, but community-based cancer research can inform care in SIDS where formal research capacity is lacking, and we describe the experiences of cancer survivors in Saint Lucia in accessing health services. Purposive and snowball sampling was used to constitute a sample of survivors for interviews. Subjects were interviewed with a questionnaire regarding socio-demographics, clinical characteristics, health services accessed (physicians, tests, treatment), and personal appraisal of experience. We recruited 50 survivors (13 men, 37 women). Only 52% of first presentations were with general practitioners. The mean turnaround for biopsy results in Saint Lucia was three times longer than overseas (p = 0.0013). Approximately half of survivors commenced treatment more than one month following diagnosis (median of 32 days, IQR 19–86 days), and 56% of survivors traveled out-of-country for treatment. Most survivors (60%) paid for care with family/friends support, followed by savings and medical insurance (38% each). In conclusion, cancer survivors in Saint Lucia are faced with complex circumstances, including access-to-care and health consequences. This study can guide future research, and possibly guide practice improvements in the near term.

State-Minority Contestations in Post-colonial Sri Lanka

2019 ◽  
Vol 9 (4) ◽  
pp. 157-165
Author(s):  
Mansoor Mohamed Fazil
Keyword(s):  
Qualitative Research ◽  
Sri Lanka ◽  
Research Method ◽  
The State ◽  
Social Forces ◽  
Social Force ◽  
State Structure ◽  
Post Colonial ◽  
State And Society ◽  
The Military

Abstract This research focuses on the issue of state-minority contestations involving transforming and reconstituting each other in post-independent Sri Lanka. This study uses a qualitative research method that involves critical categories of analysis. Migdal’s theory of state-in-society was applied because it provides an effective conceptual framework to analyse and explain the data. The results indicate that the unitary state structure and discriminatory policies contributed to the formation of a minority militant social force (the Liberation Tigers of Tamil Eelam – The LTTE) which fought with the state to form a separate state. The several factors that backed to the defeat of the LTTE in 2009 by the military of the state. This defeat has appreciably weakened the Tamil minority. This study also reveals that contestations between different social forces within society, within the state, and between the state and society in Sri Lanka still prevail, hampering the promulgation of inclusive policies. This study concludes that inclusive policies are imperative to end state minority contestations in Sri Lanka.

About some of the factors for public administration effectiveness

2020 ◽  
Vol 22 (1) ◽  
pp. 26-32
Author(s):  
ALIKHAN М. BAIMENOV ◽  
Keyword(s):  
Public Administration ◽  
Corporate Culture ◽  
Work Experience ◽  
Information Technologies ◽  
Selection Process ◽  
Rapid Development ◽  
The State ◽  
Information Flows ◽  
Factors Affecting ◽  
State Apparatus

The article emphasizes that modern governments, working in unique socio-economic, historical and cultural conditions, must take into account global trends, as well as the growth of citizens’ expectations associated with the rapid development of information technologies and other factors. In such circumstances, special attention is paid to the effectiveness of public administration. The article discusses some of the significant factors impacting the effectiveness of public administration, such as the professionalization of the state apparatus, the legibility of the institutional framework, the optimization of information flows and corporate culture. In accordance with this, on the basis of work experience in the public administration system and analysis of civil service reforms in the countries of the region, the main challenges and possible solutions are shown. In the professionalization of the state apparatus, the importance of the merit principles in the selection and promotion stages of personnel through the empowerment of human resource (HR) management services, the integrity of tools and approaches at all stages of selection process, and the responsibility of the selection board are noted. The author focuses on the need to ensure a balance of powers, responsibility and resources, delimitation of powers between political and administrative civil servants, optimization of information flows. Particular importance is paid to corporate culture, which is one of the main factors affecting the efficiency of the state apparatus. It is noted that central values of corporate culture and leadership in state bodies of the countries of our region, along with generally accepted in the modern leadership theory, should be respect for the dignity, work and time of employees.

scholarly journals Modelling the impact of delaying vaccination against SARS-CoV-2 assuming unlimited vaccine supply

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Marcos Amaku ◽  
Dimas Tadeu Covas ◽  
Francisco Antonio Bezerra Coutinho ◽  
Raymundo Soares Azevedo ◽  
Eduardo Massad
Keyword(s):  
Mathematical Model ◽  
Vaccination Campaign ◽  
Vaccination Rate ◽  
Sao Paulo ◽  
The State ◽  
São Paulo ◽  
Health Authorities ◽  
The World ◽  
The Moment ◽  
The Impact

Abstract Background At the moment we have more than 177 million cases and 3.8 million deaths (as of June 2021) around the world and vaccination represents the only hope to control the pandemic. Imperfections in planning vaccine acquisition and difficulties in implementing distribution among the population, however, have hampered the control of the virus so far. Methods We propose a new mathematical model to estimate the impact of vaccination delay against the 2019 coronavirus disease (COVID-19) on the number of cases and deaths due to the disease in Brazil. We apply the model to Brazil as a whole and to the State of Sao Paulo, the most affected by COVID-19 in Brazil. We simulated the model for the populations of the State of Sao Paulo and Brazil as a whole, varying the scenarios related to vaccine efficacy and compliance from the populations. Results The model projects that, in the absence of vaccination, almost 170 thousand deaths and more than 350 thousand deaths will occur by the end of 2021 for Sao Paulo and Brazil, respectively. If in contrast, Sao Paulo and Brazil had enough vaccine supply and so started a vaccination campaign in January with the maximum vaccination rate, compliance and efficacy, they could have averted more than 112 thousand deaths and 127 thousand deaths, respectively. In addition, for each month of delay the number of deaths increases monotonically in a logarithmic fashion, for both the State of Sao Paulo and Brazil as a whole. Conclusions Our model shows that the current delay in the vaccination schedules that is observed in many countries has serious consequences in terms of mortality by the disease and should serve as an alert to health authorities to speed the process up such that the highest number of people to be immunized is reached in the shortest period of time.

scholarly journals Factors Associated with COVID-19 Vaccine Hesitancy

Vaccines ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 300
Author(s):  
Patricia Soares ◽  
João Victor Rocha ◽  
Marta Moniz ◽  
Ana Gama ◽  
Pedro Almeida Laires ◽  
...  
Keyword(s):  
Health Status ◽  
Vaccine Hesitancy ◽  
Multinomial Regression ◽  
Community Based ◽  
Safety And Efficacy ◽  
Perceived Safety ◽  
Factors Associated ◽  
Health Authorities ◽  
Flu Vaccine ◽  
Release Of Information

It is critical to develop tailored strategies to increase acceptability of the COVID-19 vaccine and decrease hesitancy. Hence, this study aims to assess and identify factors associated with COVID-19 vaccine hesitancy in Portugal. We used data from a community-based survey, “COVID-19 Barometer: Social Opinion”, which includes data regarding intention to take COVID-19 vaccines, health status, and risk perception in Portugal from September 2020 to January 2021. We used multinomial regression to identify factors associated with intention to delay or refuse to take COVID-19 vaccines. COVID-19 vaccine hesitancy in Portugal was high: 56% would wait and 9% refuse. Several factors were associated with both refusal and delay: being younger, loss of income during the pandemic, no intention of taking the flu vaccine, low confidence in the COVID-19 vaccine and the health service response during the pandemic, worse perception of government measures, perception of the information provided as inconsistent and contradictory, and answering the questionnaire before the release of information regarding the safety and efficacy of COVID-19 vaccines. It is crucial to build confidence in the COVID-19 vaccine as its perceived safety and efficacy were strongly associated with intention to take the vaccine. Governments and health authorities should improve communication and increase trust.

scholarly journals Weathering the storm: A qualitative study of social prescribing in urban and rural Scotland during the COVID-19 pandemic

2021 ◽  
Vol 9 ◽  
pp. 205031212110291
Author(s):  
Alison Fixsen ◽  
Simon Barrett ◽  
Michal Shimonovich
Keyword(s):  
Urban Areas ◽  
Third Sector ◽  
Community Services ◽  
Clinical Approach ◽  
Community Based ◽  
Online Delivery ◽  
Social Distancing ◽  
Social Prescribing ◽  
And Shifts

Objectives: The non-clinical approach known as social prescribing aims to tackle multi-morbidity, reduce general practitioner (GP) workload and promote wellbeing by directing patients to community services. Usual in-person modes of delivery of social prescribing have been virtually impossible under social distancing rules. This study qualitatively examined and compared the responses of three social prescribing schemes in Scotland to the COVID-19 pandemic. Methods: We interviewed a theoretical sample of 23 stakeholders in urban and rural social prescribing schemes at the start of COVID-19 pandemic. Follow-up interviews with a representative sample were conducted around 10 months later. Interviewees included social prescribing coordinators (SPCs) GPs, managers, researchers and representatives of third sector organizations. Interview transcripts were analysed in stages and an inductive approach to coding was supported by NVivo. Results: Findings revealed a complex social prescribing landscape in Scotland with schemes funded, structured and delivering services in diverse ways. Across all schemes, working effectively during the pandemic and shifting to online delivery had been challenging and demanding; however, their priorities in response to the pandemic had differed. With GP time and services stretched to limits, GP practice-attached ‘Link Workers’ had taken on counselling and advocacy roles, sometimes for serious mental health cases. Community-based SPCs had mostly assumed a health education role, and those on the Western Isles of Scotland a digital support role. In both rural or urban areas, combatting loneliness and isolation – especially given social distancing – remained a pivotal aspect of the SPC role. Conclusion: This study highlights significant challenges and shifts in focus in social prescribing in response to the pandemic. The use of multiple digital technologies has assumed a central role in social prescribing, and this situation seems likely to remain. With statutory and non-statutory services stretched to their limits, there is a danger of SPCs assuming new tasks without adequate training or support.

Measuring the Efficacy of a Pilot Public Health Intervention for Engaging Communities of Puerto Rico to Rapidly Write Hurricane Protection Plans

2020 ◽  
pp. 1-10
Author(s):  
Mark E. Keim ◽  
Laura A. Runnels ◽  
Alexander P. Lovallo ◽  
Margarita Pagan Medina ◽  
Eduardo Roman Rosa ◽  
...  
Keyword(s):  
Public Health ◽  
Puerto Rico ◽  
User Satisfaction ◽  
National Guard ◽  
Rapid Development ◽  
Public Health Intervention ◽  
Health Intervention ◽  
Project Work ◽  
Community Members ◽  
Community Based

Abstract Objective: The efficacy is measured for a public health intervention related to community-based planning for population protection measures (PPMs; ie, shelter-in-place and evacuation). Design: This is a mixed (qualitative and quantitative) prospective study of intervention efficacy, measured in terms of usability related to effectiveness, efficiency, satisfaction, and degree of community engagement. Setting: Two municipalities in the Commonwealth of Puerto Rico are included. Participants: Community members consisting of individuals; traditional leaders; federal, territorial, and municipal emergency managers; municipal mayors; National Guard; territorial departments of education, health, housing, public works, and transportation; health care; police; Emergency Medical Services; faith-based organizations; nongovernmental organizations (NGOs); and the private sector. Intervention: The intervention included four community convenings: one for risk communication; two for plan-writing; and one tabletop exercise (TTX). This study analyzed data collected from the project work plan; participant rosters; participant surveys; workshop outputs; and focus group interviews. Main Outcome Measures: Efficacy was measured in terms of ISO 9241-11, an international standard for usability that includes effectiveness, efficiency, user satisfaction, and “freedom from risk” among users. Degree of engagement was considered an indicator of “freedom from risk,” measurable through workshop attendance. Results: Two separate communities drafted and exercised ~60-page-long population protection plans, each within 14.5 hours. Plan-writing workshops completed 100% of plan objectives and activities. Efficiency rates were nearly the same in both communities. Interviews and surveys indicated high degrees of community satisfaction. Engagement was consistent among community members and variable among governmental officials. Conclusions: Frontline communities have successfully demonstrated the ability to understand the environmental health hazards in their own community; rapidly write consensus-based plans for PPMs; participate in an objective-based TTX; and perform these activities in a bi-lingual setting. This intervention appears to be efficacious for public use in the rapid development of community-based PPMs.

Are Communities Willing to Transition Into Learning Health Care Communities? A Community-Based Participatory Evaluation of Stakeholders’ Receptivity

2021 ◽  
pp. 104973232199864
Author(s):  
Nabil Natafgi ◽  
Olayinka Ladeji ◽  
Yoon Duk Hong ◽  
Jacqueline Caldwell ◽  
C. Daniel Mullins
Keyword(s):  
Health Care ◽  
Health Care Delivery ◽  
Health Care Professionals ◽  
Care Delivery ◽  
Lessons Learned ◽  
Community Members ◽  
Community Based ◽  
Care Community ◽  
Care Experience ◽  
National Initiative

This article aims to determine receptivity for advancing the Learning Healthcare System (LHS) model to a novel evidence-based health care delivery framework—Learning Health Care Community (LHCC)—in Baltimore, as a model for a national initiative. Using community-based participatory, qualitative approach, we conducted 16 in-depth interviews and 15 focus groups with 94 participants. Two independent coders thematically analyzed the transcripts. Participants included community members (38%), health care professionals (29%), patients (26%), and other stakeholders (7%). The majority considered LHCC to be a viable model for improving the health care experience, outlining certain parameters for success such as the inclusion of home visits, presentation of research evidence, and incorporation of social determinants and patients’ input. Lessons learned and challenges discussed by participants can help health systems and communities explore the LHCC aspiration to align health care delivery with an engaged, empowered, and informed community.

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