Year : 2007 | Volume
: 20 | Issue : 2 | Page : 103-
American Medical Association, Chicago, IL, USA
|How to cite this article:|
Gadon M. Co-Editor's Notes.Educ Health 2007;20:103-103
|How to cite this URL:|
Gadon M. Co-Editor's Notes. Educ Health [serial online] 2007 [cited 2020 Aug 3 ];20:103-103
Available from: http://www.educationforhealth.net/text.asp?2007/20/2/103/106524
This issue of Education for Health is dedicated to the theme of the global fragmentation of health services and strategies to address this. The programs described in these manuscripts are examples of multidisciplinary partnerships between stakeholders in planning, delivering and utilizing health services. Two of the programs are in Africa, two in Belgium, two in Canada, two in Australia and two in the United States. The remaining programs are located in Spain and the Philippines. The initial call for papers sought examples of programs in the field that integrated medicine and public health in the delivery of health services and improvement of health. Many of the articles utilized the framework of "Towards Unity for Health" (TUFH) (Boelen, this issue), while others used that of Community-Oriented Primary Care (Kark, 2002). Regardless of the model utilized, the unifying goal of all of these projects was to improve healthcare access, service delivery and health through an integrated planning and delivery process that includes input from individual health practitioners, public policymakers and the community members.
In an effort to expand the potential audience for the important topics covered in this special issue of Education for Health, all abstracts have been presented in three languages, Spanish and French in addition to the usual English. In this regard, we would like to especially thank: Jaime Gofin, Charles Boelen, Fernando Mora and Denise Donovan. Finally, three of the special issue papers are presented in the authors' native language of French.
Overall, those readers unfamiliar with the concept of TUFH or the process of integrating the realms of medicine and public health programmatically may find this issue somewhat of a challenge to digest. As I read all of the final papers, I was struck by the lack of standardized methodology of evaluation. The intent of creating this issue was in part to increase awareness of the model and stimulate the development of a comprehensive method of evaluation that will allow for some elements of replication. I would suggest all readers first read the guest editorial by Charles Boelen entitled "Towards Unity for Health: The Quest for Evidence". Here Boelen describes the genesis of and rationale for the TUFH concept, and provides a set of questions useful in structuring an analytic read of the material. Several commentaries from authors with expertise in this area are provided to enhance understanding of the TUFH concept as well.
The programs described in this issue differ in goals, settings, stakeholders, methods of evaluating impact and state of development. The "Maisons Medicales" manuscript by Drielsma and Morel is a well-established model in which clinical outcomes as well as improvements in service delivery have been documented. This program has a well-established health information system, a component which received little discussion in the majority of the other manuscripts - an essential but often little discussed component of any integrated system. The UPHOLD model of Orabaton et al. is also mature and was successful in improving the use of health services as well as improving institutional quality assessment and community service organization capacity for service delivery. The study of the Canadian model of improving health service access for Francophone minorities is a clear demonstration of increased public health and clinical service delivery for a marginalized population, through an increase in workforce capacity and network creation. The circumstances that allowed for this workforce increase were a strong partnership between a physician organization, physician training institutions, policymakers and the communities affected by the physician shortage. As a result, Schofield and Gauthier point out that there was a strong and sustainable infrastructure in place which should facilitate retention of the physicians once trained.
Several of the other articles focus on integration from the perspective of the academic world. Peek describes a program in which the community is instrumental in improving breast cancer screening rates in an inner city population, through a partnership between the community, physicians and medical school. Robinson et al. describe a north-south collaboration between medical schools and community NGOs for purposes of both public health research and programming.
Finally, Segura et al. describe a model of partnership from both the perspective of its success and the challenges to its sustainability. This program highlights one of the elemental - and one might even say inevitable - features of any partnership; conflict between stakeholders. Partnerships in health may ultimately lead to improvements in services and health outcomes, but they do require nurturing, ongoing sustenance, commitment to the partnership and adequate resources to survive in the long-term.
We hope you will find this issue enjoyable as well as intellectually stimulating, and that you will provide us your thoughts on these articles through involvement in the interactive discussions in which you can participate online.
Margaret Gadon, MD, MPH
KARK S.L. & CASSEL, J. (2002). The Pholela Health Centre: a progress report 1952. American Journal of Public Health, 92(11) 1743-1747.