Community Based Rural Health Care in India

SUMMARY

India is a large country, geographically as well as popula-tionwise. The majority of its population lives in rural areas, i.e., villages. Again, most of the villages are in remote areas. The State has been making sincere efforts to make the basic social services accessible to all in the rural area. Health being one of the vital services, it has been a challenging task before the State to extend it to the remote rural areas, many of which are not yet connected by motorable roads. As a result of various experiments carried out over the last five decades, the State has developed a fairly well-designed primary health care service, and it is in operation in rural areas. However, there appears to be a striking gap between the delivery of health services in rural areas and utilization of the services by the people. Attempts have been made in this article to apprise the readers of the health service system in India, and it discusses the issue of health service delivery at the village level. The discussion is based on a small study carried out in a rural area in the State of West Bengal (India) where students of social work of the University to which the author belongs are placed for field work. Following the inputs received through supervision of the students' work, the study was initiated and conducted.

This article based on the study seeks to focus on peoples' perception of the health services as provided by the State in rural areas, which in turn gets reflected in the extent to which they utilize the services. Social workers being an integral part of the health set up, their role bears special significance. Discussion, therefore, centres on scope for social work intervention at the community level as well as in institutional level of the health service delivery system to make the services meaningful and effective in rural areas. In fact, it has to take the leadership role in reforming the service delivery system when required.     

Tobacco Control and Smoking Cessation Efforts in an Inner-City African American Community

This paper describes the conceptual framework that guided the development and implementation of a large-scale, community-based health initiative to lower the prevalence of smoking in an urban African American community. This project developed culturally-sensitive approaches to reducing smoking in the community and to promoting tobacco control efforts developed and implemented by community members. A randomized clinical-trial methodology was used to test the efficacy of the culturally-sensitivey community-developed smoking cessation interventions in lowering smoking rates as compared with a self-help approach. Two theoretical models guided the intervention strategies: a macro-level model applicable to the community as a whole, and a psychological process model applicable to individuals. The community model was based on community systems theory and incorporated the Readiness for Change Model which was applied in both the individual and organizational models. In addition, culturally-sensitive data collection methods were developed to improve the reliability and validity of project data, especially in determining the smoking prevalence rates and smoking behaviors of hard-to-reach, inner-city African Americans. Since the health of individuals is related to the health of their communities, smoking cessation and tobacco control activities that are integrated into the framework of the community (Le., churches, city-council, housing developments, community organizations), and incorporate culturally-relevant and specific interventions can be effective methods for achieving behavioral and societal change.     

Planning Other Families: Negotiating Population and Identity Politics in the Peruvian Amazon

This article examines the ways in which globally driven population policies are experienced by rural, indigenous women in Amazonian communities on the periphery of formal, political power. As with other global development processes, population programs are actively resisted, accepted, and modified by the women who are their intended "targets." Through a nuanced exploration of the interface of indigenous identity with the discourse of empowerment and reproductive rights, this article traces the impact of internationally funded population and development programs on local identity politics in the Peruvian Amazon.     

Tracking Transformations in Health Movement Organisations: Alzheimer's Disease Organisations and their Changing ‘Cause Regimes’

In this paper, we aim to contribute to the elaboration of a framework for the systematic periodisation of health social movement organisations (HSMOs). Drawing on historical and contemporaneous data on two organisations that identify as Alzheimer's disease movement organisations (the Alzheimer's Society in Britain and the Alzheimer Society of Ireland), we consider transformations in these organisations' ‘cause regimes’. By cause regime, we refer to who and what an HSMO is fighting for, as articulated in its public self-identifications; to the broader framing of the cause and to how organisations' public self-identifications of their cause can govern or regulate their operation, including their interactions with and representations of those on whose behalf they advocate. We show that the transformation of HSMOs' cause regime can give rise to a series of organisational tensions and challenges, including the alignment of the public identification of its cause with the patient identities it promotes, or its day-to-day ‘patient identity work’.     

Intergenerational Issues in Long Term Planning

No abstract available for this article.     

Experiences of Post‐Qualifying Study in Social Work

This article is based on a research project to explore the experiences of past and current candidates for post‐qualifying awards in social work in England. Also included in the study are the Leads of the post‐qualifying consortia in England. The study used questionnaire survey and nominal group techniques to gather data, which were coded and categorised into themes. The main findings relate to the perceived purposes of post‐qualifying study, motivations for undertaking post‐qualifying study, the factors that sustain and hinder study, the advice that those who have or who are experiencing post‐qualifying study would give to those about to start and future plans and hopes in this area.

Post‐qualifying study is generally valued, especially in relation to the opportunities it provides for professional development. The support of a mentor who has direct experience of the candidate's programme is highly prized, as are clear and consistent guidance from the programme and meaningful study time and workload relief from employers. There are also frustrations for some candidates who do not feel that their post‐qualifying study has stretched them beyond qualifying standards or who experience the teaching as divorced from the realities of daily practice. The appetite for a wider choice of post‐qualifying modules suggests that providers of post‐qualifying study will need to collaborate within and across regions in order to achieve a critical mass of candidates for more specialist or focused learning. The study suggests a need for further research to understand the impact of post‐qualifying study on candidates' social work practice.

The article concludes with two checklists of questions, one for individual candidates and another for agencies and programmes. These questions arise from the findings in the research.     

Community work and community care: Links in practice and in education

This article emphasises the individualising nature of much current community care provision and then discusses opportunities which may have been presented by the emphasis on user-empowerment within the community care changes. Drawing on personal experience and written from a perspective that we need a community care provision infused with the practices and values of community work, the article considers how community work needs to change and how community care workers need to change. The implications for social work educators are brought out throughout the article.     

‘Meeting Face to Face Creates New Insights’: Recruiting Persons with User Experiences as Students in an Educational Programme in Social Work

Even though empowerment and involvement of users have, for a long time, been important goals for educational programmes in social work, these programmes have only to a very little extent availed themselves of the resources that people with user experiences have to offer. This article will present a course that is part of the bachelor programmes in social work and social education at Lillehammer University College in Norway. Persons with user experiences were recruited and took part in a course on equal terms with the bachelor students. Four lecturers from the college, including the author as the project leader, carried out the planning and implementation of the course. The article gives an account of the experiences gained from the course as expressed by the students.     

Do Family Meetings Improve Measurable Outcomes for Patients,Carers, or Health Systems? A Systematic Review

Abstract

Family meetings are a common intervention in acute and subacute inpatient care settings. The aim of this systematic review was to investigate the quantitative research exploring the impact of inpatient family meetings on patient, carer, or service outcomes. A search of electronic databases (Medline, Cinahl, Embase, PubMed, and Psychinfo) was conducted from the earliest available time until July 2012. Inclusion and exclusion criteria were applied, and quality assessment of included articles was conducted. Eight studies were included in the final selection. Results indicate that there is some low-to-moderate quality evidence that inpatient family meetings reduce psychological distress of family carers and assist in meeting their information and support needs. There is weak evidence that inpatient family meetings may help to reduce readmission rates and facilitate entry to continuing care programs.     

Accredited Mental Health Social Work in Australia: A Reality Check

Abstract

Accredited mental health social workers (AMHSWs) have a great deal to offer the clients they see in their private practices, many of whom have complex needs. However, they are constrained by the inflated expectations Government has about evidence-based psychological interventions. The restrictions placed on the professional private practice of AMHSWs by Federal Government Medicare funding of a narrow set of psychological interventions ultimately limits the services received by clients. In this article, the findings of a survey of AMHSWs are presented, highlighting the tensions between individualised responses promoted by Medicare payments, and those premised on principles of social justice and social inclusion.