Keywords: community, public health, partnership, paradign shift, Alabama citizens, southern rural access program, autauga health initiative
The Community Resource Development (CRD) unit of the Alabama Cooperative Extension System (ACES) publishes Action once each quarter. The goal of the CRD unit is to help people solve community problems, take advantage of opportunities, and build on their assets. To accomplish this, the CRD unit provides educational and technical assistance in economic development, leadership development, strategic planning, environmental education, community health, and public policy education. We also link community groups to internal and external resources.
Improving the Health of Alabama Citizens is the focus of this Winter 2001 issue of Action. Particular attention is given to community and partnership approaches to improving health. Dr. Kathleen Tajeu, Extension community health specialist and CRD faculty member, is the primary coordinator of this issue. Other contributors are Mary Scisney (Alabama Department of Public Health), Lucy Sowell (Southern Rural Access Program), and Tom Miller (Alabama Department of Public Health).
The next issue of Action, Spring 2001, will continue the focus
on CRD's involvement in Alabama community health programs. Attention will
be given to programs concerning breast cancer and children's health insurance.
For more information on these topics or suggestions for additional topics,
contact the editor at (334) 844-3517, or FAX (334) 844-9022, or e-mail
jchesnut@acesag.auburn.edu.
J.
Thomas Chesnutt
Editor
Extension Tourism Specialist
In response to changes in the health care environment, the role of the health department as that of direct clinic service provider is evolving and changing as more services are being provided outside the health department setting. While clinic services continue, many of our health department staffs are now freed up to "move outside the walls of the health department and into the community." This is consistent with a national reemergence of an emphasis on the provision of the essential public health functions of assessment, policy development, and assurance. Assessment is the systematic collection of data. Better known as a needs assessment, it gives us some idea of what public health needs are in the state. Policy development takes this data and uses science rather than politics to develop strategies for meeting the identified needs. The purpose of quality assurance is to assure that those persons who need services are cared for, as well as to assure a competent public health and personal care workforce. To facilitate this transition, or new paradigm shift in thinking, Alabama Department of Public Health's Bureau of Family Health Services (BFHS) revised its mission and goals using a set of ten practices linked to the core public health functions. Under the leadership of the director, Thomas Miller, M.D., M.P.H., the Bureau has set forth a new vision to improve and advance health at the local level.
Recent efforts to enhance the efficiency of Alabama's Maternal and Child Health (MCH) programs include the investing of approximately $900,000 of state MCH funds for county health departments to engage in 17 innovative community-based initiatives that demonstrate effective strategies related to improving the health of the MCH population. These endeavors highlight the importance of local solutions to local problems, as well as the contributions that county health departments can make in achieving MCH goals.
One program that has demonstrated exemplary efforts in reflecting the principles of community-based collaboration is the Franklin County Coalition for the Hispanic Community. The project's purpose is to overcome barriers for the growing MCH Hispanic population residing in Franklin County, Alabama. The project staff has established strong partnerships with the Hispanic community, demonstrated visionary leadership, operated from an asset-based perspective, and has remained very participant-focused. Twenty-one Franklin County residents serve as the board of directors, also known as the Hispanic Coalition. Four subcommittees have been formed since the inception of the project: education, law enforcement, resources, and services. The project coordinator works as a full-time staff member to the coalition and has spearheaded ongoing needs assessment of the Hispanic community and the identification of resources to meet the identified needs. Services offered by the project include interpreters, health screening to Hispanic school children and adolescents, and the provision of culturally appropriate education programs and materials for the Hispanic Franklin County community. For further information on this project, contact Ms. Martha Sibley, office manager at (256) 332-2700.
The Franklin County Coalition for the Hispanic Community is just one
example of a project resulting from the Alabama Department of Public Health's
BFHS paradigm shift. Projects such as these will help give shape and definition
to the future of MCH services linking local county health department staff
and other key partners. Such active community-based collaborations are
anticipated to maximize resources, develop sustainable outcomes, and create
greater community ownership and commitment. The long-term impact of these
changes will be improved protection and promotion of the health and safety
of women, infants, children, youth, and their families in Alabama.
Mary
L. Scisney, MSN, CPNP
Director
Community
Development Branch
Alabama
Department of Public Health
Improving access to health care in rural areas entails several strategies. Increasing the numbers and distribution of health care professionals in rural areas can occur in the short run by successfully recruiting and retaining currently available professionals. A longer term strategy entails improving access to educational opportunities for students in rural areas, who will make a commitment to return to rural areas upon graduation from a health professions education program.
Improving access to emergency medical services is important in most rural communities. It is critical to retain health care facilities locally that are appropriate to the needs of the rural communities and simultaneously establish linkages to more specialized care that may be located outside rural communities. Citizens in rural communities can organize to improve their health outcomes via health promotion efforts and play a role in making decisions about local health care system development. Another critical component of ensuring availability of appropriate services is securing resources to finance the development and maintenance of health care facilities. The SRAP has five core components that are supportive of these strategies: Recruitment and Retention, Rural Leaders Pipeline, Rural Health Networks, Community Development, and Revolving Loan Fund.
The recruitment and retention component is a collaborative effort between the Alabama Department of Public Health's Office of Primary Care and Rural Health and the Southwest Area Health Education Center. This program will conduct community focus groups in eight southwestern counties. Focus group participants will include representatives from health care and the community and will discuss perceived needs and ideas for developing community-based strategies for recruiting and retaining health care professionals. This project will be linked with Alabama's SRAP community development effort. The Office of Primary Care and Rural Health will also implement a Web-based medical placement program.
The Rural Leaders Pipeline component consists of two programs. The Tuskegee Area Health Education Center's Health College Connection Program will provide a multiweek summer enrichment program for recent rural minority high school graduates accepted into college and enrolled college students interested in medical or health careers. Program participants will be able to spend time with a variety of preceptors, visit schools of health professions, and engage in a variety of other activities designed to encourage their health careers aspirations. A reconfigured Minority Rural Health Pipeline Program, through the University of Alabama, will focus on recent rural minority high school graduates currently enrolled in college and offer them year-round activities supportive of their interests in health professions. Both of these Rural Leaders Pipeline programs will seek to establish linkages with the University of Alabama at Birmingham's Minority Medical Education Program, which supports undergraduates in their efforts to secure admission to medical school.
The Rural Health Networks component focuses on the Integrated Community Network for Quality Health Care Project. This project will focus on the development and implementation of a health care system that will integrate and coordinate all of the health care resources for Perry County. Foundation resources will support a network coordinator and consultants to complete a community-driven strategic plan and help guide planned implementation efforts. Key local partners in this effort are Judson College, Perry County Commission, businesses, and the community in general. The county commission will provide matching funds of $30,000.
Alabama's Community Development component entails three endeavors. One endeavor will enable the Escambia County Health Department to hire a part-time community development coordinator to facilitate the work of the Escambia County Health Care Coalition. The Alabama Cooperative Extension System's Community Resource Development unit will coordinate the other two endeavors. Rural Health Works assists communities in conducting health care economic impact analysis. This analysis helps communities understand the contributions to the local economy of a sustained local health care infrastructure and can assist communities who decide to engage in related community-based strategic planning. The Healthy Communities Capacity Building Technical Assistance Team Project will hire a technical assistance team coordinator. The coordinator will facilitate the development of a statewide clearinghouse of resource persons and materials and develop a process of linking those resources to communities at different stages of collaborative community planning related to health care issues. This effort will be undertaken in cooperation with a steering committee that will facilitate linkages with the Recruitment and Retention component, the Rural Health Networks component, and the Escambia County Health Care Coalition.
The Alabama Rural Health Access Program will also determine the scope
of need and develop strategies for a revolving loan fund that will provide
rural Alabama counties in need with working capital for the establishment
of new primary health care facilities and other health care infrastructure
improvement projects. For further information on the Alabama Southern Rural
Access Program, contact Ms. Lucy Sowell at (334) 947-6288.
Lucy
Sowell
Administrative
Assistant
Southern
Rural Access Program
Initially, the focus was on traditional health concerns, focusing on a medical model with attention to entities such as health care providers and institutions. Through a series of early brainstorming sessions, the group soon embraced a broader sense of what constitutes a healthy community, encompassing a wide range of quality-of-life issues.
After much research, the decision was made to conduct a series of dialogues throughout the county, utilizing guidelines and technical assistance from the Healthy Communities agenda. According to the Coalition for Healthier Cities and Communities, this agenda is designed to engage citizens and organizations across the country in dialogue leading to action and policy for healthy communities. The dialogues were conceptualized as miniature town meetings.
From June 1999 to April 2000, a group of approximately 350 people, diverse in age, gender, race, and socioeconomic status, took part in 30 dialogues. Each dialogue had a facilitator who led the participants through the following seven questions.
A wealth of information was obtained from the dialogues. Analysis consisted of clustering the responses into kindred groupings defined by the steering group. Six patterns of a healthy community emerged. Framed like the national Healthy Communities report, "A Message to America from America's Communities," these six patterns offer a model for the following: leadership, civic mindedness, family basics, long-range planning and vision, diversity, and communication.
The monograph, which summarizes the findings, is currently in draft form and nearing completion. It is structured around the six patterns, defining each and listing ideas for action, thereby providing examples of activities that could further develop the community's potential in these areas.
The report will be shared with those
who participated in the dialogues, as well as with a broader audience in
the community. In addition, policymakers at both the municipal and county
levels will be apprised of the results. It is hoped that this information
will further stimulate thinking and planning around the community's quality
of life with the possibility of new public and private policies and programs.
In addition, it can be used to reaffirm existing activities by adding credibility
and reinforcement. If you would like to discuss the process or acquire
further information, contact either Ms. Valerie Conner at the Autauga County
Extension Office (334) 361-7273 or Dr. Tom Miller at the Alabama Department
of Public Health (334) 206-5200.
Tom
Miller, M.D., M.P.H.
Director,
Bureau of Family
Health
Services
Alabama
Department of Public Health
| Winter 2001 | Editor, J. Thomas Chesnutt |
