PRESENTATION: COMMUNITY HEALTH
NURSING /
THE WAY FORWARD PRESENTED BY
CHENNA (COMMUNITY HEALTH NURSES NATIONAL ASSOCIATION)
The way forward as we see it in
Community Health Nursing is usually informed by what has happened in the
past. I will, therefore give a brief backdrop as a stepping stone to point
the way forward.
BACKDROP INFORMATION
Between the 1950’s-1960’s health conditions were
very poor.
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Maternal and infant mortality were high.
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Communicable diseases, especially among children were rampant.
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Environmental conditions were very poor.
Commissions of Enquiry led to some improvement in
health conditions. Hospitals and a limited amount of health centers were
built. Soon however, hospitals were overcrowded, there was malnutrition and
generally social conditions did not improve as was expected. Maternal and
infant mortality declined somewhat, communicable diseases were under control
but lifestyle diseases came to the fore. Added to this a large chunk of the
national budget as spent on treating illnesses.
National funds can be better utilized if people
are taught to value health and practice healthy lifestyles.
The way forward should therefore focus on keeping
communities healthy, that is encouraging health promotion activities and
preventing diseases. Efforts should be concentrated on all areas throughout
Trinidad and Tobago. More so in rural communities that do not have ready
access to secondary and tertiary care.
THE WAY FORWARD
1.
Total removal of the two
tiered system. The provision of health care will be
hampered when two “masters” are to be served. There should be a concerted
move to have all employees under the Regional Health Authorities. However,
terms and conditions of employment and proper remuneration should be similar
for all workers within a specific category. This will remove the apparent
fear of staff moving over t the regional health Authorities.
2.
A dynamic Director of
Community Nursing is needed – for the effective
functioning of the community.
3.
Strengthening the Community
Health Service – using the team approach – since we
know that health is an all encompassing concept, each community should be
serviced simultaneously by nursing staff including Home nursing teams, medical
staff and auxiliary staff, such as the Social Worker, Social Welfare Officer,
Public Health Inspector, Nutritionist, Environmental Health Workers for
example Insect Vector Control personnel.
4.
Breaking down the walls
that separate different Ministries. There should be
more collaboration between Ministries to ensure that there are no barriers to
services that contribute to health for example education, agriculture, water
and sewage authority, social welfare, housing, etc. for example research ahs
shown that the more educated people make better life choices and have less
children.
5.
Health education ot focus
specifically on maternal and child health issues; an
effective family planning system in place would help to ease the overcrowding
in hospitals and would prevent many social ills.
6.
Continue the immunization
drive to ensure 100% coverage.
7.
Involve the communities in
identifying their problem and possible solutions.
When individuals and groups are part of the decision making / planning
process, they are more receptive to buying into the programme and seeing it to
its fulfillment.
8.
Address the perceived or
real inequity in the distribution of health services in the urban and rural
areas. Maybe an incentive can be provided for
persons to work in these areas.
9.
Assist the underprivileged
persons to improve their socio-economic conditions.
Initially there should be a system to provide assistance while, simultaneously
preparing them (individuals) to earn a livelihood.
10.
An effective referral system must
be instituted so that follow up, and health education could continue.
11.
There should be broad policy guidelines to ensure that health and
health-related issues are addressed.
12.
Training and retraining of
staff should be mandatory. There should be adequate
staffing to provide the services.
13.
Adequate and timely
recording and reporting so that a surveillance system can be set up.
14.
Health services can be
re-oriented and re-focused toward health promotion.
For example in each community there should be screening centers for females
and more so for males. It is a well-established fact that women usually seek
health care but men are more reluctant to do so. If it is available in their
community they are more likely to access this service. It is well known that
if diagnoses are made early the prognosis is usually better.
15.
Setting up programmes at
work places – going and offering the service. For
example Banks (Breast Self Examinations), Police Stations and Fire Stations
(various blood tests).
16.
Work time should be
staggered to accommodate the working public – this
should be done in a structured manner.
17.
Creating partnerships
– training of people in the community to assist
those who are at home and unable to get out.
18.
Technical staff in the
various health centres should be part of the decision making
(for example remodeling / building of new facilities) and any
other activities that their involvement would be needed (for example)
community groups with projects.
19.
Upward mobility
20.
All existing vacant positions and
those that are surely going to be created should be filled and personnel
properly remunerated.
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