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Health Extension: Community-Based Healthcare and the Future of Cooperative Extension explores innovation in extension health programs, engaged scholarship promoting research-based information in communities, and the evaluation and documentation of community programs and their impacts. This volume provides land-grant and university-based colleagues up-to-date information on using the Cooperative Extension System (CES) for community engagement in healthcare while also familiarizing those outside CES and the academy with a roadmap for improvement. The contributions of a diverse array of scholars challenge the status quo in extension programs by characterizing the introspection, understanding, creativity, partnerships, and leadership that will be required to improve lives and communities in the twenty-first century. This perspective underscores the role of CES as foundational to the future of Health Extension and offers an alternative to approaches that utilize the CES as a model without the accompanying advantages of history, community embeddedness, and sustainability.
As a low-income country, Ethiopia has made impressive progress in improving health outcomes. This report examines how Ethiopia s Health Extension Program (HEP) has contributed to the country s move toward Univeral Health Coverage (UHC), and to shed light on how other countries may learn from Ethiopia s experiences of HEP when designing their own path to UHC. HEP is one of the government s UHC strategies introduced in a context of limited resources and low coverage of essential health services. The key aspects of the program include the capacity building and mobilization of more than 30, 000 Health Extension Workers (HEWs) targeting more than 12 million model families, and the mobilization of health development army ? to support the community-based health system. Using the HEP-UHC conceptual model and data from Demographic and Health Surveys, the study examines how the HEP has contributed to the country s move toward UHC. During the period that the HEP has been implemented, the country has experienced significant improvements in many dimensions: in terms of socioeconomic, psychological, behavioral, and biological dimensions of the beneficiaries; and in terms of the coverage of health care services. The study finds an accelerated rate of improvements among the rural, less-educated, and the poor population, which is leading to an overall reduction in equity gaps and improvements in the equity indicators including the concentration indices - that suggest a more equitable distribution of resources and health outcomes. The HEP in Ethiopia has demonstrated that an institutionalized community approach is effective in helping a country make progress toward UHC. The elements of success in the HEP include the emphasis on community mobilization which identifies community priorities, engages and empowers community members, and supports their ability to solve local problems. The other aspect of HEP is the emphasis on institutionalization of the activities, which addresses the sustainability of community programs through high level of political commitment, and effective coordination of national policies and leveraging of support from partners. These findings may offer useful lessons for other low income countries facing similar challenges in developing and implementing a sustainable UHC strategy.
Foundations for Community Health Workers Foundations for Community Health Workers is a training resource for client- and community-centered public health practitioners, with an emphasis on promoting health equality. Based on City College of San Francisco's CHW Certificate Program, it begins with an overview of the historic and political context informing the practice of community health workers. The second section of the book addresses core competencies for working with individual clients, such as behavior change counseling and case management, and practitioner development topics such as ethics, stress management, and conflict resolution. The book's final section covers skills for practice at the group and community levels, such as conducting health outreach and facilitating community organizing and advocacy. Praise for Foundations for Community Health Workers "This book is the first of its kind: a manual of core competencies and curricula for training community health workers. Covering topics from health inequalities to patient-centered counseling, this book is a tremendous resource for both scholars of and practitioners in the field of community-based medicine. It also marks a great step forward in any setting, rich or poor, in which it is imperative to reduce health disparities and promote genuine health and well-being." Paul E. Farmer, MD., PhD, Maude and Lillian Presley Professor of Social Medicine in the Department of Global Health and Social Medicine at Harvard Medical School; founding director, Partners In Health. "This book is based on the contributions of experienced CHWs and advocates of the field. I am confident that it will serve as an inspiration for many CHW training programs." Yvonne Lacey, CHW, former coordinator, Black Infant Health Program, City of Berkeley Health Department; former chair, CHW Special Interest Group for the APHA. "This book masterfully integrates the knowledge, skills, and abilities required of a CHW through storytelling and real life case examples. This simple and elegant approach brings to life the intricacies of the work and espouses the spirit of the role that is so critical to eliminating disparities a true model educational approach to emulate." Gayle Tang, MSN, RN., director, National Linguistic and Cultural Programs, National Diversity, Kaiser Permanente "Finally, we have a competency-based textbook for community health worker education well informed by seasoned CHWs themselves as well as expert contributors." Donald E. Proulx, CHW National Education Collaborative, University of Arizona
Ethiopia’s model for delivering basic services appears to be succeeding and to confirm that services improve when service providers are more accountable to citizens. As discussed in the World Development Report 2004, accountability for delivering basic services can take an indirect, long route, in which citizens influence service providers through government, or a more direct, short route between service providers and citizens. When the long, indirect route of accountability is ineffective, service delivery can suffer, especially among poor or marginalized citizens who find it challenging to express their views to policymakers. In Ethiopia, the indirect route of accountability works well precisely because of decentralization. Service providers are strictly accountable to local governments for producing results, but in turn, the local authorities are held accountable by the regional and federal governments. A degree of local competition for power and influence helps to induce local authorities and service provides to remain open to feedback from citizens and take responsibility for results. The direct route of accountability has been reinforced by measures to strengthen financial transparency and accountability (educating citizens on local budgets and publicly providing information on budgets and service delivery goals), social accountability (improving citizens’ opportunities to provide feedback directly to local administrators and service providers), and impartial procedures to redress grievances. Woreda-level (district) spending has been a very effective strategy for Ethiopia to attain its Millennium Development Goals (MDGs). Woreda health and education goes to pay for health extension workers (HEWs) and teachers. This study finds evidence that woreda-level spending in health and education is effective. Owing to the intervention of HEWs, the use of health services has increased, especially among the poorest quintiles. Finally, the effect of woreda-level spending on agricultural extension workers is associated with higher yields for major crops. Spending on agricultural extension workers increases the probability that farmers, regardless of the size of their plots, will use improved farming techniques. Education, health, and agriculture account for 97 percent of woreda spending. This is complemented by support for capacity building and citizen voice. Clearly, spending efficiency is improved through better capacity, more transparency, and greater accountability to citizens.
Providing an in-depth look at the lives of women and girls in approximately 150 countries, this multivolume reference set offers readers transnational and postcolonial analysis of the many issues that are critical to the success of women and girls. For millennia, women around the world have shouldered the responsibility of caring for their families. But in recent decades, women have emerged as a major part of the global workforce, balancing careers and family life. How did this change happen? And how are societies in developing countries responding and adapting to women's newer roles in society? This four-volume encyclopedia examines the lives of women around the world, with coverage that includes the education of girls and teens; the key roles women play in their families, careers, religions, and cultures; how issues for women intersect with colonialism, transnationalism, feminism, and established norms of power and control. Organized geographically, each volume presents detailed entries about the lives of women in particular countries. Additionally, each volume offers sidebars that spotlight topics related to women and girls in specific regions or focus on individual women's lives and contributions. Primary source documents include sections of countries' constitutions that are relevant to women and girls, United Nations resolutions and national resolutions regarding women and girls, and religious statements and proclamations about women and girls. The organization of the set enables readers to take an in-depth look at individual countries as well as to make comparisons across countries.
Revitalizing Health for All examines thirteen cases of efforts to implement CPHC reforms from around the globe including Australia, Brazil, Democratic Republic of Congo, Iran, South Africa, and more.
In 2001, Ethiopian Television aired a documentary about a small, rural village called Awra Amba, where women ploughed, men worked in the kitchen, and so-called harmful traditional practices did not exist. The documentary radically challenged prevailing images of Ethiopia as a gender-conservative and aid-dependent place, and Awra Amba became a symbol of gender equality and sustainable development in Ethiopia and beyond. Village Gone Viral uses the example of Awra Amba to consider the widespread circulation and use of modeling practices in an increasingly transnational and digital policy world. With a particular focus on traveling models—policy models that become "viral" through various vectors, ranging from NGOs and multilateral organizations to the Internet—Marit Tolo Østebø critically examines the hidden dimensions of models and model making. While a policy model may be presented as a "best practice," one that can be scaled up and successfully applied to other places, the local impacts of the model paradigm are far more ambivalent—potentially increasing social inequalities, reinforcing social stratification, and concealing injustice. With this book, Østebø ultimately calls for a reflexive critical anthropology of the production, circulation, and use of models as instruments for social change.
Biomedical Entanglements is an ethnographic study of the Giri people of Papua New Guinea, focusing on the indigenous population’s interaction with modern medicine. In her fieldwork, Franziska A. Herbst follows the Giri people as they circulate within and around ethnographic sites that include a rural health center and an urban hospital. The study bridges medical anthropology and global health, exploring how the ‘biomedical’ is imbued with social meaning and how biomedicine affects Giri ways of life.