bluuebunny/crossref_metadata_2025 huggingface dataset:
Physician autonomy and the pharmaceutical industry
Authors: Wijeratne Tissa , Low Essie , Neil Christopher
Published: April 2019

The physician–industry relationship is a topic that generates keen interest among physicians globally. This chapter reviews the potential risks and benefits of such relationships in patient care. Physicians must adhere to strict professional standards and strong ethical principles, with the prime interest of offering the best possible care for the patient while using the resources available through pharmaceutical industry partnerships. One must never cross the boundaries in this complex interaction; physicians should continue to be the best advocates for patients, and not the pharmaceutical industry. Other aspects of relationships between the pharmaceutical industry and doctors’, trainees’, and residents’ perspectives in the industry, essential drug policy solutions in Sri Lanka, and several key points from the Australian Medical Association’s position statement on medical practitioner’s relationships with industries, are also discussed.
Perspectives on advocacy of medical doctors
Authors: Wasay Mohammad
Published: April 2019

The healthcare system has changed substantially in recent decades. Governments and business organizations have become important stakeholders in the healthcare system. The role of the doctor has also been modified over the period of the past 40–50 years. Patients are seen and taken care by a team of healthcare experts in a multidisciplinary healthcare model. Managed care is a newer health model which is run by business experts. The doctor’s role in this model is very limited. The social healthcare model is most popular in European countries. It is largely supported by taxes and managed by government organizations. This chapter discusses the emerging and future role of doctors as leaders of healthcare systems, in patient support groups, and as advocates for patients. Medical doctors have to learn and adapt to these roles by training and skills development.
Advocacy and the perspective of (neurology) nursing
Authors: Zwinkels Hanneke
Published: April 2019

The advocacy role of neurology nurses—similar as to other involved healthcare professionals—is to support the patient and the caregiver through active involvement in analysing needs during the disease process and thereby improve a present condition of state. Advocacy is an activity to act in the best interest of the patient, in accordance with their wishes. In caretaking for patients’ well-being, the neurology nurse has to keep patients properly informed and carry out treatment and care plans with competence and diligence, while maintaining patients’ confidentiality. Neurology nurses in this way can contribute their expertise and influence as they work with communities or patient populations to improve health. With a case study of a neuro-oncology patient, it is made clear how neurology nurses will be able to determine and understand needs, speak on behalf of others when required, and support the mobilization of resources to effect change, and in this way, improve quality of care. Within multidisciplinary care the neurology nurse can have the role of a patient’s care navigator. When acknowledged as a case manager, the neurology nurse is able to deploy advocacy for the patients she takes care of.
Advocacy for neurology in migrants
Authors: Alaoui Faris Mustapha El
Published: April 2019

Over the years, a large number of migrants have settled in Europe from Africa and the Middle East. This population is prone to several health problems and is more vulnerable to communicable diseases, maternal and child health problems, mental disorders, and cardiovascular diseases. The burden of neurological diseases is thus increased among migrants; in fact, epilepsy, stroke, neurogenetic diseases, or cognitive disorders in older migrants have high prevalence. However, the weight of each disease is different depending on demography, epidemiology, genetics, or degree of poverty in the migrants’ country of origin. A comprehensive health policy must consider the special health needs of women, children, recent and second-generation migrants, but also enable undocumented migrants and asylum seekers. The rights of migrants to healthcare access to must be legally guaranteed in all host countries.
Advocacy in the international arena
Authors: Shakir Raad
Published: April 2019

For neurology, the crucial issue is the recognition of the magnitude and seriousness of nervous system disorders by the public, a subject that is well covered elsewhere in this book. Perhaps as important is the awareness of health authorities on the needs of the public to provision of neurological care. Without full governmental and healthcare authorities’ support, neurological disorders shall remain undersupported and underfunded. This chapter explores the issue of how to achieve this goal internationally. This should be accomplished in the face of other major competing interests not only in medicine, but also in the whole social care system.
Two decades of patient advocacy in multiple sclerosis: The success story of the European Multiple Sclerosis Platform
Authors: Thalheim Christoph
Published: April 2019

While some national patient self-help and advocacy groups in the field of multiple sclerosis (MS) are looking back on 50 or more years of history, the European Multiple Sclerosis Platform—today the voice of more than 700,000 people with MS gathered in 40 member organizations in 36 European countries—was only created in 1989. During the past 16 years of its active work, advocacy on health and social care policies has gained momentum, with the very first report by the European Parliament on the effects of discriminatory treatment towards persons with MS in 2003. This chapter describes hands-on experiences and gives examples of the value of cooperation between national and European levels in advocacy work for the benefit of people with MS for the past two decades.
Neuromuscular disorders and advocacy
Authors: Jones Elaine C. , England John D.
Published: April 2019

Neuromuscular disorders are a wide encompassing group of diseases that affect the nerves, muscles, and neuromuscular junctions but they can also affect cranial nerves, autonomic systems, and cause fatigue and even cognitive deficiencies. Patients with neuromuscular disorders can have a wide range of symptoms that create barriers to daily functioning. It is important that they not only to have access to good diagnostic and therapeutic care, but also management of the sequelae of the disease including disability access, educational support, nutritional support, and others. This is where advocacy becomes vital. Advocacy has a broad definition and includes access to care, but also requires working with governmental bodies to ensure laws and legislation prevent discrimination. This chapter will look at the advocacy needs of neuromuscular patients and will offer resources to help. Case study examples will demonstrate empirical observations of how advocacy efforts can be employed to help.
Advocating for orphan diseases in neurology
Authors: Zimprich Fritz
Published: April 2019

Patients with rare diseases face several common problems caused by the rarity of their diseases. Among many other issues, these include the often long-delayed diagnosis, the limited knowledge and dissemination of knowledge on the diseases, the lack of specific therapies, and the inadequacies of healthcare systems to deal with rare, complex disorders. In recent years patient advocacy organization have emerged for many different rare diseases as a consequence of these unmet needs. They have started to address these issues by many different advocacy actions such as education, political advocacy, and measures to facilitate research and drug development. Successful examples have shown that such efforts can bring real advances for some rare diseases.
Advocacy for patients with headache
Authors: Steiner Timothy J. , Olesen Jes
Published: April 2019

Despite irrefutable evidence of the high prevalence, burden, and cost of headache disorders, advocacy for headache—for more headache research and better headache care—has been largely in vain so far. Headache receives little respect and few resources. There are scientific, public health, and financial arguments for change, which are evidence-based and sound. They make compelling messages, which nonetheless have not yet reached the consciousness of health policymakers. Headache disorders are the least funded of all neurological disorders, while accounting for more disability than all other neurological disorders combined. This is a remediable failure. The worldwide programme of activities of the Global Campaign against Headache, and its collaboration with the Global Burden of Disease studies, are generating an unstoppable flow of evidence to support change. The World Health Organization has acknowledged the global public health importance of headache, and committed to advocacy on its behalf at macro level. A momentum is building. The arguments for change are, for now, unanswerable, but they have to be put to those who can make change happen, and repeated again and again. If they work with these organizations, the many national and supranational professional and lay groups will find previously closed doors are, at last, slowly opening.
Mali
Authors: Minthe Mamadou Bengaly , Sow Assyatou Bobo
Published: April 2019

In Mali, there are no specific official programmes for the medical care of dementia. However, there is a law (decree 95-368/P-RM du 13 octobre 1995) that stipulates the free nature of medical consultations, with the elderly benefiting from a 50% reduction in costs of medical care. The challenge in the future would be the legislation for free treatment of psychiatric illnesses in general and of dementia in particular. The therapeutic approach to dementia care in Mali is multidimensional and includes spiritual, traditional (medicinal plants), and social therapy, which is the most important in the management of dementia. Daily recitation and teaching of the holy book (Quran) is part of prevention and treatment of dementia in current Sufi Islam. The cosmovision of Dogon (worldview of a culture or civilization, especially its relationship with the animated or environment) has its own method for the prevention and treatment of dementia. This chapter describes the sociological aspects, preventative measures, and traditional therapy (Dogon ethnopharmacology) of dementia.
Indonesia
Authors: Ismail Raden Irawati , Basuki Bastaman , Setiawan Martina Wiwie , Mursjid Fidiansjah
Published: April 2019

A comprehensive dementia service delivery is not well established in Indonesia, even though geriatric teams have been in place since 1997. Psycho-geriatric services are mainly provided by departments of psychiatry, as well as the geriatric division of internal medicine or neurology departments. Screening is routinely performed using the Mini-Mental State Examination and the Abbreviated Mental Test. In the near future, the division of geriatric psychiatry in psychiatry departments will have comprehensive services for dementia, from initial assessment to cognitive and functional rehabilitation. This will comprise screening, home visits, day care, home care, educational seminars, and specific programmes tailored to the needs of the person with dementia. Pre-dementia detection and any activities promoting active ageing should be prioritized in Indonesia.
Pakistan
Authors: Khan Muhammad Nasar Sayeed , Afridi Muhammad Iqbal , Javed Afzel
Published: April 2019

Pakistan is one of the largest and most populated nations of South Asia and ranked sixth among the most crowded countries in the world, with a population exceeding 196 million. Because of a lack of research and the cultural setting, it is exceptionally hard to obtain an exact number of individuals suffering from dementia. However, the extrapolated prevalence of people with dementia in Pakistan is around 200,000. Compared to developed countries, only 4.2% of the Pakistani population are aged above 65 years, possibly due to an average life expectancy of 66 years for both genders . Although no specific data on elderly people with dementia in Pakistan are available, it is estimated that 8–10% of the general population aged above 65 years suffer from chronic memory loss. According to the latest 2014 World Health Organization data, Alzheimer’s disease/dementia-related deaths in Pakistan reached a total of 1776 or 0.16% of total deaths. Pakistan currently has the largest generation of young people ever recorded in its history, who will be at risk for dementia and Alzheimer’s disease by 2050, at which time, life expectancy would be expected to continue rising. Thus, the economic burden of treating patients with Alzheimer’s disease and other types of dementia will increase considerably.
United Arab Emirates
Authors: Ahmed Amir IA , Alsuwaidi Salwa , Ali Abdullah Al
Published: April 2019

In the United Arab Emirates (UAE), members of the extended family play a key role in caring for people with dementia. Culture has a strong influence on family caregivers’ motivation, and Emirati people believe strongly that it is their (religious) duty to provide care for their parents and other family members, including those with dementia. This setup contributes positively to keeping elderly people living at home. However, maintaining health and independence in old age will become increasingly challenging in the future, with the increasing ageing population in the UAE, which is expected to reach up to 11% by 2032. Currently, the UAE has no National Dementia Care Strategy, and epidemiological data on dementia in the country are scarce. However, Dubai is known to have a more or less comprehensive system of care for geriatric patients, including dementia care facilities. These dementia care facilities are available free of charge to Emirati citizens.
Australia
Authors: Zeimer Henry
Published: April 2019

Dementia is a major public health issue in Australia, with profound consequences for the healthcare system and society in general, with nearly 1.5% of the population living with dementia. It has wide-ranging effects on the healthcare system and society in general, and its prevalence is expected to increase significantly with the ageing of the population. Through the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme, the Australian government funds services for diagnosis and assessment, as well as subsidizing medications for the treatment of Alzheimer’s disease. The government also funds community support groups and services to assist in the care, and improve the quality of life, of people with dementia. The Australian Health Ministers announced in August 2012 that dementia is a National Health Priority Area, the ninth medical condition to receive this important status.
Germany
Authors: Thyrian Jochen René
Published: April 2019

In recent years, there have been considerable efforts and many comprehensive developments in Germany to address the challenge that demographic change poses on dementia care on both regional and federal levels. Consequently, dementia care has changed considerably in the last decades. These changes have been published by the Alliance for People with Dementia and will be available on databases in the near future. However, Germany has only just begun to integrate important stakeholders and players into this concerted process. The efficacy and efficiency of this action plan have not been evaluated or assessed systematically, and its impact on dementia care is not yet clear. This needs to be investigated in prospective long-term studies. A national plan is to be established in 2018 as the successor of the existing action plan. As such, it is not expected to differ much from the existing action plan and should also be comparable to current plans or strategies in place worldwide.
Greece
Authors: Zygouris Stelios , Tsolaki Magda
Published: April 2019

In Greece, there is an ongoing effort for the creation of a national dementia plan. In 2014, a national dementia observatory was established after appropriate legislation was implemented. National and local Alzheimer’s associations have developed an ongoing collaboration with the health ministry and other regulatory authorities in order to draft a national dementia plan and promote the necessary changes that will lead to improved services for dementia patients and caregivers. This chapter provides an outlook on dementia care in Greece. It outlines the diagnostic process and issues related to disclosure of the diagnosis and various aspects of competence assessment, including mental, functional, financial, driving, and personality competences, as well as issues related to advance directives and end-of-life decisions. Management and treatment of dementia in Greece is also outlined. An overview of available pharmacological treatments is presented.
Ireland
Authors: Dolan Catherine , Lawlor Brian
Published: April 2019

This chapter examines the prevalence and pathways to the diagnosis of dementia, as well as dementia care infrastructure, in the Republic of Ireland. The economic burden of dementia in Ireland is explored, including both formal and informal costs. Dementia care in the community, residential, and acute hospital settings is described. Associated policy, legislation, standards, and guidelines relevant to dementia care in Ireland are addressed. Current funding structures are examined. The contributions of dementia-specific educational efforts and relevant research in Ireland are highlighted. Challenges encountered in moving from a more traditional medical model of dementia care to a psycho-social, person-centred care model in Ireland, including inequitable funding allocation, are outlined.
The Netherlands
Authors: Rikkert Marcel Olde
Published: April 2019

In the Netherlands, there is currently an ongoing transition whereby a relevant part of long-term institutionalized care for dementia patients is being shifted to care at home. Legislation was changed in 2015 to achieve this goal. However, primary and nursing home care still needs to be redesigned to meet the needs of dementia patients and society. Improving network care holds great promise for this transition, as current dementia care in the Netherlands still falls short in terms of fragmentation of care, ad hoc collaboration, lack of feedback on quality and efficiency of care to healthcare professionals involved, and inadequate implementation of established multidisciplinary guidelines.
Northern Ireland
Authors: Cunningham Emma Louise , Todd Stephen , Barton Conor , Passmore Peter
Published: April 2019

The Northern Ireland (NI) Dementia Strategy was launched in November 2011, with similar strategic issues and priorities to those identified in the English, Welsh, and Scottish documents. There are a number of aspects of dementia care in NI of which the province can be proud, several of which are outlined. One of the major achievements has been the successful production of the Mental Capacity Act, which awaits implementation and publication of a code of practice for clinicians. Other challenges include the coordination of care for people with dementia across the healthcare spectrum and the anticipation and incorporation into practice of evolving diagnostic and therapeutic interventions.
Portugal
Authors: Gonçalves-Pereira Manuel , Leuschner António
Published: April 2019

Dementia care in Portugal presents a mixed balance of strengths and important problems and challenges. This chapter begins by highlighting the scarcity of health service data on dementia, within a rapidly changing and complex array of health and social care systems. Public, private, and third-sector services are not integrated enough to fully meet the needs of people with dementia and their families. Despite examples of good standards in dementia care, some complex challenges still need tackling. Portugal does not have a National Dementia Plan, although formal efforts are being made and a general strategy has been proposed. The chapter briefly discusses leading issues, while highlighting that any selection of goals and the feasibility of achieving them are constrained by a shortage of resources. Taking the need to improve timely diagnosis and integrated formal services as an example, the exact role of primary care is one of the primary topics for discussion. In short, there are three aspects which Portugal does well in terms of dementia care: (1) every person with dementia has access to emergency services and, in principle, to primary care services within the public National Health Service; (2) there are examples of high-quality standards in clinical dementia care, mainly in urban centres, and an increasing interest from the social sector, non-governmental organizations, and private institutions in community or institutional social care; and (3) there is increasing interest in dementia-related service research, as well as in psycho-geriatric training. For the future, first, primary care should be more involved in early diagnosis of dementia and its appropriate disclosure, as well as in other areas, e.g. treatment monitoring in collaboration with specialized care, counselling and support, and monitoring caregivers’ health. Second, the complex bio-psycho-social needs in dementia should be better met through improvement of: timely access to community formal services or specialized accommodation when necessary; ‘dementia-friendly’ communities and health/social units (e.g. general hospitals, given the multimorbidity in people with dementia); management of behavioural and psychological symptoms of dementia (with more emphasis on non-pharmacological approaches, and less on antipsychotics); informal caregivers’ support, ensuring minimum standards of information, counselling, psycho-education, and other family interventions; and legal procedures, access to new technologies, and decent end-of-life care. Finally, gaps should be bridged between health and social care, fostering care coordination and case management in every phase of dementia (with standardization of dementia care processes, e.g. definition of the roles of professionals).
Romania
Authors: Mihai Adriana , Ilinoiu Geanina , Trandafir Silvia
Published: April 2019

In Romania, dementia care has gradually improved in the last decade. Accessibility of psychiatric services and availability of psychiatric and/or psychotherapeutic treatment have been significantly enhanced by new legislations and regulations. Public and private sectors of home care for the elderly have also been developed. Despite these changes, the management of dementia remains challenging because of delay in diagnosis and/or inappropriate treatment. Dementia care in the future in Romania should adopt a professional approach by improving education and training, as well as changing attitudes, not only among doctors (general practitioners, psychiatrists, neurologists, etc.), but also among all those involved in care (nurses, social assistants, relatives, etc.) and the general population. Reducing stigma and discrimination will contribute to early diagnosis and appropriate treatment. Collaborative efforts from a medico-social and community perspective, with the support of government authorities, could provide a source of new funding, which should be distributed according to the needs of each county in Romania.
Russia
Authors: Neznanov Nikolay , Zalutskaya Natalia
Published: April 2019

Dementia is an important medical and social problem in the Russian Federation. Since 1999, Russia has begun to develop its geriatric services into an integrated system of care for the elderly, in whom cognitive impairment has been recognized as an important problem. Currently, each region of Russia has a basic geriatric centre which includes an age psychiatry department that provides organizational and methodological guidance for medical, social, and health institutions involved in care provision for the elderly population. However, there are a significant number of financial, medical, social, and community problems that create barriers to achieving optimal quality of care. Therefore, to address these problems, the ‘Strategy of action for senior citizens in the Russian Federation until 2025’ was launched by the government of the Russian Federation, which aims to identify new areas of state and public policy relating to senior citizens and their families, as well as social institutions interacting with this population group, including people with cognitive impairment.
Scotland
Authors: McNulty Seamus V , Jackson Graham A
Published: April 2019

Scotland is a small nation which has a devolved legislature, while still remaining part of the United Kingdom (UK). As the health service has become increasingly divergent from that of the remainder of the UK, more innovative approaches to dementia care have been allowed to develop. The Scottish Dementia Strategy, now in its third iteration, is unique in that it adopts a human rights-based method of dementia care, an approach that has subsequently been followed by other European countries. The Strategy is in continual evolution, with the third Strategy focusing more on care at the end stages of dementia, especially for those in nursing homes or long-term hospital care. Other novel approaches, such as the Dementia Champions programme, have shown benefits in the quality of care for patients with dementia in acute general hospitals, although less so for those in social care settings. Scotland was also a pioneer in enacting incapacity legislation, although this is now under review as shortcomings in the current procedures are becoming unmasked.
Serbia
Authors: Djukic-Dejanovic Slavica , Djokic Gorica
Published: April 2019

Serbia is among the demographically older countries in the world, with 18% of the population aged above 65 years. One in two persons older than 65 years lives with an old spouse. The Serbian National Strategy on ageing identified poverty as a widespread companion of ageing, with a rising poverty index. In 2007, the first non-governmental organization, called ‘Alchajmer’, was established in Sremska Kamenica to support people with Alzheimer’s disease and their caregivers. In 2008, the first Centre for Memory Disorders and Dementia was established as part of the Neurology Clinic at the Clinical Centre of Serbia in Belgrade. A National Guide for Alzheimer’s disease was published in 2013. The Serbian health insurance scheme covers care costs for people with severe dementia through its support programme called Advanced Home Help, which includes provision of geriatric housekeepers from the palliative care programme, as well as modest financial support in accordance with the state’s financial capabilities. There are over 160,000 people with dementia in Serbia, comprising approximately 13% of the Serbian population aged above 65 years, of whom only 4% are prescribed appropriate pharmacological treatment.
Switzerland
Authors: Riese Florian
Published: April 2019

It is estimated that 110,000 people in Switzerland are affected by dementia. Access to professional dementia care is good. The Swiss mandatory health insurance extensively covers medical inpatient and outpatient treatment and the cost of medicines, as well as nursing care. Due to the decentralized organization of the Swiss political and healthcare systems, variation exists in dementia services across the country and there are no nationwide integrated care pathways and no disease registry. Despite the availability of 36 memory clinics, the majority of dementia cases are diagnosed and treated outside specialized services. In 2013, a National Dementia Strategy was initiated to promote the expansion, improvement, and standardization of services. Dementia research in Switzerland is particularly strong in neurobiology, while clinical and health services research is only recently receiving more attention. There are three aspects of its dementia care of which Switzerland is particularly proud: (1) the healthcare system offers access to high-quality acute and long-term dementia care covered by mandatory health insurance, (2) dementia is widely accepted as a public health priority in the ageing Swiss society, and (3) Switzerland initiated a National Dementia Strategy in 2014 that is currently in its implementation phase. In terms of improvement, dementia care pathways could improve the coordination of care between sectors and reduce regional variation in care. Family members and informal caregivers need to be recognized more and supported in their work, and planning of care could be facilitated by creating epidemiological databases on dementia.
Mexico
Authors: Ruiz Federico Ramos , Osuna Amador Ernesto Macias
Published: April 2019

The world population is ageing at an accelerated pace. It is estimated there are 900 million people aged 60 years or above worldwide, and with the rise in life expectancy comes an increased prevalence of chronic diseases such as dementia. In September 2015, Alzheimer’s Disease International reported a total of 46.8 million people with dementia worldwide, which is expected to increase to 74.7 million and 135.1 million by 2030 and 2050, respectively. Dementia also has a tremendous worldwide economic impact on health systems. In 2015, the total cost of dementia care was 818 billion dollars, representing an increase of 35.4% from 2010.
Chile
Authors: Slachevsky Andrea , Gajardo Jean
Published: April 2019

Currently, it is estimated there are about 180,000 people living with dementia in Chile, and this number is projected to triple by 2020. Dementia has increasingly become an important condition for society, health, and social policy. Dementia care falls mostly under the family responsibility, with limited involvement from the health sector which is usually in terms of diagnosis in secondary healthcare. Chile has no National Dementia Strategy. However, civil society and academic efforts over the last few years have helped to create a favourable setting that has paved the way for several milestones in dementia care in the country: a national awareness campaign, enhanced research, increased public funding for day care centres, and the development of a National Dementia Plan with a multisectoral approach to address the complex needs of people with dementia and their caregivers.
Health teaching and behavioural change
Authors: Lankester Ted
Published: April 2019

This chapter discusses health information and raising health awareness. It explains how these feed into behavioural change, both in individuals and in communities, as a key to improving health. It describes ways in which behavioural change can be brought about, starting with transformation in our own attitudes. It outlines materials, equipment, and preparations needed to teach and to improve heath at community level. It describes methods of raising health awareness, such as group discussions, personal teaching at the point of need, flashcards, flipcharts, flannel boards, stories and songs, roleplay, drama, puppets, live examples, still images (slides and digital photographs), moving images (video, DVD, and films), CD-ROMs and the Internet, radio, and TV. It finishes with a section on how to measure the impact of health teaching.
Initial tasks
Authors: Lankester Ted
Published: April 2019

This chapter explores how the community and the health programme can work together in selecting and training appropriate health team members at different levels of expertise. It identifies situations that require caution and understanding, and describes the project cycle. It outlines how to set up a project base, house staff, and identify security needs. It describes options for transport, how transport may be perceived by the local community, and includes questions that should be asked when considering buying a vehicle. It describes methods for ordering supplies, equipment vital to the project, and medicines that should be considered. Finally, it gives a range of ideas on how to fund a project, both from internal and external sources, and provides examples of each.
Learning with the community
Authors: Lankester Ted
Published: April 2019

This chapter describes basic principles of the Participatory Appraisal (PA), including techniques such as focus groups, semi-structured interviews, and mapping. It describes how to triangulate and analyse this information. It goes into detail about types of community surveys, why they should be done, and who can best do them. It gives practical suggestions on preparing survey materials, training the survey team, carrying out the survey, and the use of technology in data collection. It discusses the concept of community diagnosis and how to tally and tabulate results in order to present findings to a variety of audiences.
The community health worker (CHW)
Authors: Lankester Ted
Published: April 2019

This chapter explores current thinking about community health workers (CHWs), their roles, functions, and how they are selected. It gives details on CHW training, including course duration, training locations, curriculum, trainers, supervision, and personal development aspects. It describes the CHW’s health kit, its use, and record keeping. It describes the importance and variety of support systems, including how to work most effectively with the community. The chapter explores how CHWs are increasingly seen by governments as part of the national health system, in addition to their ongoing role in civil society organizations. In this context it compares the advantages and disadvantages of payment. The chapter outlines the increase in the CHW’s role, which, while still including maternal and child health, now includes new priorities, e.g. disability, mental health, and non-communicable diseases (NCDs).
Monitoring and evaluating the health programme
Authors: Lankester Ted
Published: April 2019

This chapter explores the meaning, purpose, and benefits of monitoring and evaluation (M&E) and explains their specific meanings. It discusses who should carry them out, pitfalls to avoid, and practical steps in choosing the most effective and practical indicators. It outlines the advantages and methods in which both so called ‘hard’ and ‘soft’ indicators can be used to paint the most accurate picture. It gives a sample M and E chart, and outlines how to use it. The chapter then describes how to analyse the results and the steps needed to be taken by the programme and others stakeholders in response to the findings.
Managing personnel and finance
Authors: Lankester Ted
Published: April 2019

This chapter describes how to manage personnel, outlining the differences between management and leadership and the most appropriate styles of leadership in community-based healthcare (CBHC). It lists ways of encouraging the health team and also attitudes and practices that discourage them. It highlights the importance of understanding personal and financial pressures on team members. It outlines the process of selecting and inducting new team members, how to carry out appraisals, resolve conflict, manage change, and delegate responsibilities. It outlines basic financial management, including how to keep accounts, prepare budgets, estimate cash flow, and develop a reserves policy. It gives a detailed checklist to help monitor how well finances are being managed. Finally, it looks in some detail at governance issues, emphasizing that the best programmes can fail through poor governance or inaccurate accounting.
Using medicines correctly
Authors: Lankester Ted
Published: April 2019

This chapter talks about the dangers of misusing medicines, including fake supplies, expiry dates, incorrect storage, the extent and dangers of overuse, and incorrect prescribing of medicines and polypharmacy. It covers the expectations of local communities of injections and antibiotics that are unnecessary. It explains a rational drugs policy and Essential Drugs List for both adults and children, as compiled by the World Health Organization. It discusses poor access to life-saving medicines, as well as the differences between health care and medical care. It describes how to train the health team and the community about the appropriate use of medicines.
Setting up and improving a community health clinic
Authors: Lankester Ted
Published: April 2019

This chapter explores how to set up and develop community health clinics which not only treat illness but become a focus for health promotion and community involvement. It encourages programmes to use or strengthen existing primary health centres or health posts and to work in collaboration with the government. It discusses types of clinic, who might use the clinic, and clinic capacity and location. It works through practical aspects such as when the clinic should start, centre design, setting up clinic stations, and keeping and transferring records. It describes systems of payment, affordability, and the welcome and affirmation of those attending. It describes referral systems and preparing for serious illness and accidents. It mentions the value of mobile clinics as an integral part of a community-based system.
Preventing and treating childhood malnutrition
Authors: Lankester Ted
Published: April 2019

This chapter explains why adequate nutrition in childhood is essential for good health. It explores different aspects of poor nutrition, including severe acute malnutrition, micronutrient deficiency, and the increasing problem of childhood obesity. It describes the wide variety of causes of malnutrition and how to tackle them. The chapter describes ways of measuring children’s nutrition status, including mid-upper arm circumference (MUAC) and weight. It lists the six rules of good nutrition and gives strong emphasis and advice on breastfeeding. It describes special feeding programmes in emergency situations, encouraging micro-enterprise, setting up home kitchen gardens, and mass deworming. It also describes ways to evaluate nutrition programmes.
Dealing with childhood illnesses
Authors: Lankester Ted
Published: April 2019

This chapter discusses diseases that commonly kill children. It covers, causes, priorities, and community-based and clinic programmes, including immunization and the Integrated Management of Childhood Illness (IMCI). It emphasizes ways in which diarrhoea, pneumonia, and malaria can be managed at community and family level. It highlights the dangers and types of diarrhoea, its causes, and treatment. It includes a detailed section on dehydration and oral rehydration therapy (ORT and ORS), appropriate rehydrating foods, and how these can be embedded into use by families. It describes acute respiratory infection (ARI), its causes, prevention, diagnosis, and treatment. Importantly, it describes how community health workers (CHWs) and community members can assess ARI severity and how it can be best treated, including the careful use of community-based and home-based antibiotics in remoter areas. Finally, the chapter addresses malaria diagnosis and treatment, particularly how a community can set up a step-by-step control programme.
Setting up a maternal and newborn health programme
Authors: Lankester Ted
Published: April 2019

This chapter discusses causes of death and disability from preventable causes in both mothers and newborns. It outlines what can be done to maximize the health of pregnant women, mothers, and newborns through preparing the community, encouraging birth plans, and setting up antenatal, neonatal, and postnatal care. It describes the ongoing value of traditional birth attendants (TBAs) and midwives in remote areas when carefully trained, while emphasizing the need for facility-based delivery when available and the need to ensure that patients are treated with dignity and understanding. As in other chapters, it summarizes ways to keep records and evaluate the programme.
Setting up a family planning and reproductive health programme
Authors: Goodhart Clare , Lankester Ted , Thomas Claire
Published: April 2019

This chapter explains the importance of family planning and child spacing from a variety of perspectives. It outlines the difficulty of access to family planning for large numbers of people, and the barriers that exist for its widespread uptake. It describes in some detail the range of contraceptives and their different uses. It describes ways in which supplies can be sold, distributed, and managed at community level. It describes the roles of the family planning provider and community health worker (CHW) and emphasizes the importance of reliable and accessible supplies. The chapter also gives information on sexually transmitted infections (STIs), their causes and types, and how they can best be controlled and treated.
A community development approach to HIV care, prevention, and control
Authors: Campbell Ian D , Campbell Alison Rader , Chela Clement
Published: April 2019

This chapter describes community approaches to HIV in the context of the increasing availability of antiretroviral therapy (ART). It outlines ways to appraise local concerns and strengths using a social model known as SALT. It describes the steps that need to be taken in setting up community-based HIV prevention, control, and treatment using the combined strengths of communities, local clinics, and hospitals. It emphasizes the value of the community response and the use of trained community volunteers and counsellors. It explains the role of ART and how this can be used most effectively in the community context. The chapter describes co-infection with TB and other situations of special risk. Throughout the chapter there is an emphasis on the value of collaboration, using the strengths of the community and the overall leadership of the government and its guidelines on treatment and logistics, but without losing the special value of community response and ownership
Non-communicable and chronic diseases
Authors: Grills Nathan
Published: April 2019

This chapter on non-communicable diseases (NCDs) explains how they are now the leading cause of death worldwide, and how their prevention, control, and treatment need to be built into our community health programme. It gives information about physical activity, alcohol moderation, tobacco cessation, and healthy eating, and for each topic uses WHO guidelines as the basis for the advice. The chapter suggests how to raise awareness in the community and ways to integrate the community response with existing services and government health programmes. It details five components for an effective NCD response at the community level—screening, promoting healthy behaviours, advocacy, disease-specific treatments, and interventions. It finishes with ways to monitor and evaluate the programme.
Disability and community-based rehabilitation
Authors: Grills Nathan , Varghese Jubin
Published: April 2019

This chapter explains the causes, types, and importance of disability, and ways in which needs of those with disability can be met through community-based rehabilitation (CBR). It explains how any CBR programme should be based on the principles in the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD). It introduces the World Health Organization (WHO) CBR framework that shows the essential components of a programme. The chapter describes ways to identify people with disability in the community, how to assess their needs, and the importance of linking with community stakeholders and local CBR workers. The chapter goes into detail about the six steps of implementing a CBR programme: screening and assessment, maximizing function, setting up support groups, advocacy, mainstream inclusion, and programme monitoring and evaluation.
Helping communities to manage disaster risk
Authors: Hafvenstein Joel , Stone Jonathan
Published: April 2019

This chapter describes how to manage disaster risk and how community-level action is essential when organizing any emergency response action. It outlines the types of hazards that communities face, how they can be reduced and how we can increase the effectiveness and resilience of community health programmes (CHPs) to meet those hazards. It explains how we can train a disaster response team (DRT) and use them and community health workers (CHWs) both to deliver and to help to implement disaster safety messages. It describes in some detail both the types of disaster and ways in which the community can respond and work with others, including government and external providers.
A general framework for assessing fitness for work
Authors: Hobson John , Smedley Julia
Published: April 2019

The opening chapter of Fitness for Work provides an introduction to the book and sets out a framework for assessing fitness for work. It considers the relationship between work and health including the prevalence of disability and its impact on employment. The role of occupational health services, the various professions working in the field, and how they function are described. Guidance is provided on consent, confidentiality, occupational health reports, and communicating with the employer and other health professionals. The occupational health assessment itself is considered with detailed sections on the consultation, functional assessment, objective tests, and assessing the workplace. Factors affecting work performance are considered as well as matching the individual to the job, rehabilitation, making accommodation and adjustments, and return to work. The chapter concludes by considering recent trends and developments with particular regard to the most recent government initiatives, specifically Improving Lives: the Future of Work, Health and Disability.
Women’s health and other gender issues at work
Authors: Blackburn Blandina , Bose Patrick
Published: April 2019

This chapter describes occupational health perspectives on women’s health at work. It looks at known physical and anticipated psychological symptoms of gynaecological and obstetric disorders and gender dysphoria manifested in a range of symptoms that have an impact on work health and performance. It advises on possible adjustments and applicable legal requirements where relevant. Pregnancy and menopause are separate headings as they are common in the workplace, as more women are working, and working for longer. The adjustments to help the employee with such issues at work are in order to acknowledge and normalize these issues, while maintaining good health and performance at work. New additions include infertility and gender dysphoria, and their management in the workplace. Risk assessments in different work scenarios are crucial in order to advise on adjustments. This chapter is written for qualified, trained occupational health personnel, but can be used by other clinicians and interested parties.
Sickness absence
Authors: Preece Richard
Published: April 2019

Sickness absence is a significant cost to business and an important issue for workers, managers, and occupational health services. Most workers suffer health problems at some time during their career, and face decisions on fitness in relation to their work. Many different factors influence sickness absence although illness is usually accepted as the reason for an episode of sickness absence. It is important to manage the non-biological elements of the biopsychosocial model as many of these may be modifiable, including the behaviours associated with health. Emerging evidence suggests absence can be predicted in some cases although it may be difficult to prevent this. Being in ‘good’ employment is protective of health and keeping people in work is therefore important.
Ill health retirement
Authors: Poole Jon , Evans Glyn
Published: April 2019

This chapter gives advice to doctors who provide reports for pension schemes about the merits of a patient’s application for ill health retirement. This is a challenging area of practice in which the structure and wording of the report is important if difficulties are to be reduced. An overview of pension provision in the UK is included as well as advice contained in determinations by the Pensions Ombudsman. Rates of ill health retirement for national schemes are shown against which doctors should audit their practice. In general, a retiree’s perceived health status tends to improve after retirement, although the improvement will attenuate over time. Heavy manual workers are more likely to retire on the grounds of ill health than non-manual workers, which has been attributed to their poorer health and less favourable working conditions.