Strengthening primary health care: building the capacity of rural communities to access health funding

A Qualitative Evaluation of Rural Community Coalitions

A multiple case study design was used to evaluate coalitions for community health improvement and promotion in Oklahoma. Data collection in three communities took place in two-day site visits; interviews were conducted with 42 persons. A coalition development model was used to analyze structure, activities and outcomes: mobilization, development of organizational structure, activities, member satisfaction, accomplishments, and maintenance. Each community mobilized a multi-sectoral Steering Committee with a simple organizational structure but had limited success in implementing its plans. The process was truncated in the third community. Member satisfaction was mixed. In particular, they expressed desire for more assistance in leveraging resources to enact their priorities. Because organizational structure and activities were consistent with project design, we attributed the limited success to program design choices. In particular, the organizational structure did not promote community leadership or member engagement.

Evaluating health services research capacity building programs: implications for health services and human resource development

Evaluation of research capacity building programs presents challenges, including defining "research capacity building" and measuring it. The present study evaluates infrastructure capacity-building strategies and barriers and facilitators of two federally funded health-related research capacity building programs within the United States. We developed a conceptual framework and abstracted 223 data elements from existing project files. We administered questionnaires to 17 principal investigators and conducted 2-h interviews of 15 principal investigators. Finally, we conducted one-and-a-half-day site visits with five projects. We aggregated data and analysis results across the two programs. Impacts and strategies were also analyzed as to whether host institutions had little or no existing research infrastructure ("seed projects") or had well-developed research infrastructure ("fertilizer projects"). Projects were associated with increases in publication and presentation rates by Principal Investigators and staff, increases in research funding, changes in organizational research culture, and positive impacts on the community. Project characteristics and activities associated with each of these outcomes were identified. It was also noted that the correlations between these outcomes were small and non-significant.

Community participation in rural health: a scoping review

BACKGROUND

Major health inequities between urban and rural populations have resulted in rural health as a reform priority across a number of countries. However, while there is some commonality between rural areas, there is increasing recognition that a one size fits all approach to rural health is ineffective as it fails to align healthcare with local population need. Community participation is proposed as a strategy to engage communities in developing locally responsive healthcare. Current policy in several countries reflects a desire for meaningful, high level community participation, similar to Arnstein's definition of citizen power. There is a significant gap in understanding how higher level community participation is best enacted in the rural context. The aim of our study was to identify examples, in the international literature, of higher level community participation in rural healthcare.

METHODS

A scoping review was designed to map the existing evidence base on higher level community participation in rural healthcare planning, design, management and evaluation. Key search terms were developed and mapped. Selected databases and internet search engines were used that identified 99 relevant studies.

RESULTS

We identified six articles that most closely demonstrated higher level community participation; Arnstein's notion of citizen power. While the identified studies reflected key elements for effective higher level participation, little detail was provided about how groups were established and how the community was represented. The need for strong partnerships was reiterated, with some studies identifying the impact of relational interactions and social ties. In all studies, outcomes from community participation were not rigorously measured.

CONCLUSIONS

In an environment characterised by increasing interest in community participation in healthcare, greater understanding of the purpose, process and outcomes is a priority for research, policy and practice.

Applying a basic development needs approach for sustainable and integrated community development in less-developed areas: report of ongoing Iranian experience

INTRODUCTION

Despite considerable achievements in the provision of basic developmental facilities in terms of drinking water, access to primary healthcare services, high-quality and nutritious food, social services, and proper housing facilities, there are many rural and slum communities in Iran where these essential needs remain unfulfilled. Lack of equity is prominent, as large differences exist in underprivileged provinces. New policies developed in the past two decades have resulted in substantial achievements in meeting population needs and reducing the socio-economic gap; nevertheless, poverty levels, unemployment due to a large increase in the birth rate in the early 1980s, and lack of community participation are matters yet to be addressed. To overcome these deficiencies, a basic development needs approach was adopted to promote the concept of community self-help and self-reliance through intersectoral collaboration, creating an environment where people could take an active part in the development process, with the Iranian government providing the necessary support to achieve the desired level of development.

DESCRIPTION OF THE PROJECT

Following firm commitment from the Iranian government and technical support from the World Health Organization Regional Office, basic development needs was assigned a high priority in health and health-related sectors, reflected in the third National Masterplan (2001-2005). A comprehensive intersectoral plan was designed, and pilot projects were commenced in three villages. Each village elected a representative, and committee clusters were formed to run and monitor projects identified by a process of local needs assessment and priority assignment. In each region, a variety of needs were elicited from these assessments, which were actively supported by local authorities.

LESSON LEARNED

A basic development needs approach was found to be a reliable discipline to improve community participation, needs-led resource allocation and intersectoral co-operation in community development, particularly in underprivileged areas. Iran's initial experience of basic development needs has gained widespread public support but will require periodical evaluation as it is introduced into other rural and urban regions across the country.