Health Services in China

In the face of the adverse condition of overpopulation, limited resources and technological backwardness shared by the developing nations, at least one country, the People's Republic of China, is attempting to devise a health system which rejects Western standards of medical care and its inherent biases and is geared rather to meet the needs of the local population. This system relies on extensive and often intensive use of traditional practitioners, health teams and medical auxiliaries in an attempt to make health and medical care available to most of China's 80% rural population. By focusing on training and deployment of medical and health personnel, the Chinese are seeking to avoid the burden of large investments in curative medicine accessible only to wealthy urban elites which plagues many other developing countries

The challenge of complexity in evaluating health policies and programs: the case of women's participatory groups to improve antenatal outcomes.

BACKGROUND: During the last years, randomized designs have been promoted as the cornerstone of evidence-based policymaking. Also in the field of community participation, Random Control Trials (RCTs) have been the dominant design, used for instance to examine the contribution of community participation to health improvement. We aim at clarifying why RCTs and related (quasi-) experimental designs may not be the most appropriate approach to evaluate such complex programmes. RESULTS: We argue that the current methodological debate could be more fruitful if it would start from the position that the choice of designs should fit the nature of the program and research questions rather than be driven by methodological preferences. We present how realist evaluation, a theory-driven approach to research and evaluation, is a relevant methodology that could be used to assess whether and how community participation works. Using the realist evaluation approach to examine the relationship between participation and action of women groups and antenatal outcomes would enable evaluators to examine in detail the underlying mechanisms which influence actual practices and outcomes, as well as the context conditions required to make it work. CONCLUSIONS: Realist research in fact allows opening the black boxes of "community" and "participation" in order to examine the role they play in ensuring cost-effective, sustainable interventions. This approach yields important information for policy makers and programme managers considering how such programs could be implemented in their own setting

Leading change beyond your classroom – Capacity building in SoTL and leadership by SaMnet

The issue: The introduction of quality standards can place delegates to the ACSME conference in the forefront of reflection on, and changes to, teaching in their school, faculty, and university. How do you make the transition from being someone who experiments and implements strategies to teach more effectively into someone who leads colleagues in doing so? Furthermore, what support can you gain in that process, both support from within your institution, as you work to help others to satisfy externally imposed standards, as well as outside your university? Approach: Development of the capability of academic staff in science and mathematics to lead change is a chief aim of the ALTC/OLT project developing the Science and Mathematics network of Australian university educators – SaMnet. We have engaged more than 100 university staff (‘SaMnet Scholars’) across 19 institutions in teams of four to pursue action-learning projects. SaMnet are supporting these teams with guidance in the scholarship of teaching and learning and in providing insight into leading organisational change. SaMnet also provides mentoring and contact with other academics who share an interest in the area of a particular project, e.g., standards, inquiry learning, or new ICTs. The effort is meant to change an individual innovation in teaching into a formally recorded experiment. A well documented experiment can not only be published; it can provide data sufficient to convince colleagues, heads of school, deans, and others that the innovation addresses their key performance indicators, such as those that result from national quality standards. This approach builds on an uneven foundation: (1) the growth in SoTL in universities; (2) a history of initiatives to improve teaching in science and mathematics that is recognised has having left little widespread impact; and (3) literature on the nature of change in organisations, in general, and on change in universities, in particular. The first set of SaMnet’s action-learning projects is approaching a mid-point, and the projects have another year to run. The ACSME conference provides an opportune moment to reflect and gain additional perspectives on the strategies being pursued. Progress: Work in progress - initial. Key questions: 1. How might insights into organisational change be relevant to your efforts in your university, particularly in relation to coming standards? 2. What do you feel that you could learn from SaMnet Scholars at this session about tailoring your efforts to gain support from your head of school and dean? 3. What are we missing? What could a national network of science and mathematics academics do for you that we might not have thought of? 4. What aspects of leading change would you like to learn about – steps and transitions in change processes (Kotter and Bridges), aspects of a new idea that spur adoption (Rogers), or surface issues and underlying issues that need to be addressed (Wilber)

Evaluation of a group based cognitive behavioural therapy programme for menstrual pain management in young women with intellectual disabilities: protocol for a mixed methods controlled clinical trial

BACKGROUND: Menstrual pain which is severe enough to impact on daily activities is very common amongst menstruating females. Research suggests that menstrual pain which impacts on daily functioning may be even more prevalent amongst those with intellectual disabilities. Despite this, little research attention has focused on pain management programmes for those with intellectual disabilities. The aims of this pilot study were to develop and evaluate a theory-based cognitive behavioural therapy (CBT) programme for menstrual pain management in young women with intellectual disabilities. METHODS/DESIGN: The study utilised a mixed methods controlled clinical trial to evaluate elements from a CBT programme called Feeling Better (McGuire & McManus, 2010). The Feeling Better programme is a modular, manualised intervention designed for people with an intellectual disability and their carers. The programme was delivered to 36 young women aged 12 – 30 years who have a Mild - Moderate Intellectual Disability, split between two conditions. The treatment group received the Feeling Better intervention and the control group received treatment as usual. To evaluate the effectiveness of the programme, measures were taken of key pain variables including impact, knowledge, self-efficacy and coping. Process evaluation was conducted to examine which elements of the programme were most successful in promoting change. DISCUSSION: Participants in the intervention group were expected to report the use of a greater number of coping strategies and have greater knowledge of pain management strategies following participation in the intervention and at three month follow-up, when compared to control group participants. A significant advantage of the study was the use of mixed methods and inclusion of process evaluation to determine which elements of a cognitive behavioural therapy programme work best for individuals with intellectual disabilities. TRIAL REGISTRATION: Current Controlled Trials ISRCTN7556775

Disorganized Attachment in Infancy: A Review of the Phenomenon and Its Implications for Clinicians and Policy-Makers

Disorganized/Disoriented (D) attachment has seen widespread interest from policy makers, practitioners, and clinicians in recent years. However, some of this interest seems to have been based on some false assumptions that (1) attachment measures can be used as definitive assessments of the individual in forensic/child protection settings and that disorganized attachment (2) reliably indicates child maltreatment, (3) is a strong predictor of pathology, and (4) represents a fixed or static trait of the child, impervious to development or help. This paper summarizes the evidence showing that these four assumptions are false and misleading. The paper reviews what is known about disorganized infant attachment and clarifies the implications of the classification for clinical and welfare practice with children. In particular, the difference between disorganized attachment and attachment disorder is examined, and a strong case is made for the value of attachment theory for supportive work with families and for the development and evaluation of evidence-based caregiving interventions

A framework linking community empowerment and health equity: it is a matter of CHOICE.

This paper presents a framework to explore the relationship between health equity and community empowerment. It traces the progression of the concept of participation to the present term of empowerment and the links among empowerment, equity, and health outcomes. It argues that the relationship can best be described by using the acronym CHOICE (Capacity-building, Human rights, Organizational sustainability, Institutional accountability, Contribution, and Enabling environment). Based on the concept of development as freedom put forward by Nobel Laureate Amartya Sen, the paper describes how each factor illustrates the relationship between equity and empowerment in positive health outcomes, giving appropriate examples. In conclusion, it is suggested that these factors might form the basis of a tool to assess the relationship between equity and empowerment and its impact on health outcomes

Health sector reforms in Kenya: an examination of district level planning.

The paper examines health sector reforms in Kenya at the district level based on the Government of Kenya's Health Policy Framework of 1994. The authors present the context of and historical perspective to health sector reforms in Kenya and discuss the major reform policies including decentralization to the district level. The authors then review intended policy outcomes, investigating assumptions on which the implementation and effectiveness of the reform agenda at the local level are based. The authors argue that emphasis on outcomes rather than process has not supported sustainable reforms or achieved the government's goal of improving health and ensuring equity for the citizens of the country