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The purpose of this research is to identify quick, effective and affordable architectural design solutions to improve the health of patients, visitors and staff, in an underfunded community healthcare center (CHC) in Baltimore.

Both qualitative (individual and Focus group interviews) and quantitative methods (space syntax analysis and questionnaire survey) are used to assess the healing environment. The questionnaires cover interior and exterior environment related questions.

The questionnaire identifies three issues related to wayfinding, interior design, and access to natural light. The findings demonstrate that the waiting area, exam room and laboratory need to be upgraded. Incorporation of some other interior components including, wall art, plants, music, signage are also suggested by the respondents.

Very few studies in the USA have been done to understand the effects of architectural design to create a healing environment on the community scale.

In 2010 the Patient Protection and Affordable Care Act boosted the expansion of community health centers (CHCs) with $11 billion in mandatory funding from 2011 to 2015. This study used data from the Medical Expenditure Panel Survey (MEPS) and the North Carolina Behavioral Risk Factor Surveillance System (BRFSS) to assess the cost savings associated with the use of community health centers compared to other primary care providers. After controlling for various demographic, socioeconomic characteristics and health conditions, we found savings at an average of $3,437 in total expenditures and $1,211 in ambulatory care expenditures. These results suggest that continuing investment in health centers are important during times of budget cuts in order to improve access to care and to generate cost savings to the healthcare system.

This paper addresses some key management issues relating to developing mobile support for community healthcare (CHC) provision, such as support structures, service management and organization.

The paper presents three generic examples that draw out the heterogeneous nature of CHC support and the issues and challenges involved. The research is mostly qualitative, based on interviews with key health and social care professionals in the south of England, supported by desk‐based activity. The initial phase of the pilot involved six healthcare professionals, who were interviewed for approximately an hour and a half each using a semi‐structured questionnaire.

It is clear that many CHC professionals, for the generic case examples, cannot do their community activity without some mobile technology support, such as a mobile telephone. More sophisticated support offers much potential to improve patient/client care in the community as well as efficiency benefits.

The investigation is ongoing with the next stage involving other regions and a wider set of interviews and focus groups.

Practical considerations, such as availability and appropriateness of equipment, security, confidentiality and accountability issues access procedures and usage protocols need to be addressed before the full benefits can be achieved.

Identification of ten main issues and challenges facing mobile service provision and management.

This chapter seeks to quantify the effects of geographic access to community health centers on the likelihood of an individual having a regular source of health care.

Utilizing survey and center location data, the analysis employs bivariate cross-tabulation with chi-square and multinominal logistic regression to quantify the relationship between variables.

While individuals living in close spatial proximity to community health centers were more likely to identify a community health center as a regular source of care as compared with those without proximal access, the effect of community health center access on the identification of any source of regular health care was generally insignificant or negative, except for populations with a chronic medical condition.

While these findings support current literature suggesting that spatial proximity to care is insufficient to transform at-risk populations into regular primary care users, it is important to note that it is possible that individuals prefer to access primary care services outside of their immediate neighborhoods, potentially mediating the observed effect of proximity to care on the likelihood of having a regular source of care. Also, because this analysis is based on cross-sectional survey data, it is impossible to make a causal argument about the relationship between variables. Only the observed association can be asserted and used to inform future studies.

Existing research supports a positive association between community health center utilization and measures of health for social groups traditionally facing barriers to care, but few studies isolate the effect of center availability and health, particularly when considering those living in the catchment area but are not regular users. Due to the complexity and prevalence of barriers to health care for vulnerable and at-risk populations, these findings suggest that improving geographic access to primary health care does not guarantee positive outcomes for target groups. The magnitude of social disadvantage on vulnerable and at-risk populations can have a devastating effect on health care outcomes that is not easily overcome by social programs.

In an increasing trend, clients are being moved from tertiary and secondary care to primary care. This “downloading”, accompanied by the increasingly complex needs of clients, has forced providers and policy makers to acknowledge the importance of primary care. In exploring options for the reorganization of primary care, the characteristics of community health centres are often promoted as the model with the best potential. This article outlines a descriptive overview of community health centres (CHCs) across Canada.

This paper seeks to identify strategies that promote the development and sustainability of a successful comprehensive community health center located in a rural Mid‐western state.

The authors used a qualitative case study methodology, using a purposive sample of 15 employees and board members of a rural community health center. Semi‐structured interviews were conducted, transcribed, and analyzed for common themes and sub‐themes that would describe the strategies used to develop and sustain the successful center.

Leading with Consideration was identified as the dominant theme in the interviews, field notes and archival data. Four sub‐themes: Living the Mission, Fostering Individual Growth, Building a Community, and Encouraging Innovation, emerged from the narratives. Leadership was the most important theme that emerged from the data, resulting in a workforce culture that upholds the mission of the center, leadership that seeks to inspire the growth of both employees and clients. As a result, there is a sense of community and innovative health care endeavours that have created a sustainable holistic health care model.

The themes that emerged from the narratives of the participants may not be transferable to other community health centers. The case selected for this study was located in a rural, primarily Caucasian setting, so the findings may not be transferable to urban or more racially diverse settings.

Transformational leadership may be an important concept for safety net clinics to promote a positive work environment that continually addresses the important mission of the organization, promotes retention of staff, and promotes staff to provide quality, continuity of care to clients to promote their health. Within current safety net organizations, the findings from this research may affirm leaders' servant leadership styles and how they positively impact their organization. Healthy work environments guided by transformational leaders promote retention of quality health care professionals, who in turn, provide quality care in medically underserved communities.

This study is one of the first qualitative studies to describe concepts that support the development of a successful, sustainable community health center.

The purpose of this study is to examine different types of primary healthcare utilization and its influencing factors among the elderly in Indonesia.

Data were obtained from the 5th Indonesian Family Life Survey, a longitudinal database of demography and health information using multistage stratified sampling of households. Older adults aged at least 60 years were sampled; proxy respondents and incomplete data were excluded from the study.

Most of the elderly preferred to visit nurse/midwives practitioner (NP), followed by the community health centers (CHC). Those who lived outside of the Java region were more likely to visit NP; moreover, those without formal education and lived in the rural area were more likely to use CHC. Education level, region and chronic conditions were significant predicting factors for almost all types of primary healthcare use.

Indonesia is moving towards an aged society in the coming decades. However, there are significant barriers to access almost all types of primary health care by the elderly in Indonesia. This shows the possibility of health care inequality for the elderly population. This study provides evidence of the various types of primary healthcare use by the elderly and its influencing factors. It hopes policymakers can use the data to develop an effective strategy to enhance the quality of primary healthcare services provides to the elderly population.

Indonesian nurses fulfill vital functions in the health system and are often the only human resource for health not only in remote and poor rural areas but also in urban areas. Nurses, as a part of primary care providers, require an adequately trained to contribute to the better primary care system.

Many low- and middle-income countries (LMICs) are struggling to reduce maternal mortality rates, despite increased efforts by the United Nations through the implementation of their Millennium Development Goals program. Industrialized nations, such as Canada, have a collaborative role to play in raising the global maternal health standards. The purpose of this paper is to propose policy approaches for Canadians and other Organization of Economic Cooperation and Development (OECD) nations who wish to assist in reducing maternal mortality rates.

Ten Canadian health experts with experience in global maternal health were interviewed. Using qualitative analytical methods, the authors coded and themed their responses and paired them with peer-reviewed literature in this area to establish a model for improving global maternal health and survival rates.

Findings from this study indicated that maternal health may be improved by establishing a collaborative approach between interdisciplinary teams of health professionals (e.g. midwives, family physicians, OB/GYNs and nurses), literacy teachers, agriculturalists and community development professionals (e.g. humanitarians with diverse linguistic and cultural backgrounds). From this, a conceptual approach was devised for elevating the standard of maternal health. This approach includes specifications by which maternal health may be improved, such as gender justice, women’s literacy, freedom from violence against women, food and water security and healthcare accessibility. This model is based on community health center (CHC) models that integrate upstream changes with downstream services may be utilized by Canada and other OECD nations in efforts to enhance maternal health at home and abroad.

Maternal mortality may be reduced by the adoption of a CHC model, an approach well suited for all nations regardless of economic status. Establishing such a model in LMICs would ideally establish long-term relationships between countries, such as Canada and the LMICs, where teams from supporting nations would collaborate with local Ministries of Health, non-government organizations as well as traditional birth attendants and healthcare professionals to reduce maternal mortality.

All OECD Nations ought to donate 0.7 percent of their GDP toward international community development. These funds should break the tradition of “tied aid”, thereby removing profit motives, and genuinely contribute to the wellbeing of people in LMICs, particularly women, children and others who are vulnerable. The power of partnerships between people whose aims are genuinely focused on caring is truly transformative.

Canada is not a driver of global maternal mortality reduction work but has a responsibility to work in partnership with countries or regions in a humble and supportive role. Applying a comprehensive and interdisciplinary approach to reducing maternal mortality in the Global South includes adopting a CHC model: a community development approach to address social determinants of health and integrating various systems of evidence-informed healthcare with a commitment to social justice. Interdisciplinary teams would include literacy professionals, researchers, midwives, nurses, family physicians, OB/GYNs and community development professionals who specialize in anti-poverty work, mediation/dialogue and education campaigns that emphasize the value of all people regardless of their gender, ethnicity, religion and income. Diasporic Canadians are invaluable members of these teams due to their linguistic and cultural knowledge as well as their enthusiasm for working with their countries of origin. Establishment of long-term partnerships of 5–10 years between a Canadian team and a region or nation in the Global South that is dedicated to reducing maternal mortality and improving women’s health are valuable. Canada’s midwifery education programs are rated as world leaders so connecting midwives from Canada with those of the Global South will facilitate essential transfer of knowledge such as using birth plans and other evidence-based practices. Skilled attendants at the birth place will save women’s lives; in most cases, trained midwives are the most appropriate attendants. Video link to a primer about this paper by Dr Farah Shroff: https://maa.med.ubc.ca/videos-and-media/.

There are virtually no retrievable articles that document why OECD nations ought to work with nations in the LMICs to improve maternal health. This paper outlines the reasons why it is important and explains how to do it well.

The Chinese population is rapidly ageing before they are rich. The purpose of this paper is to describe healthcare seeking behaviour and the critical factors associated with healthcare seeking behaviour.

Using a purposive sampling method, the authors recruited 44 adults aged 60 years or older from three provinces, representing the developed (Shanghai), undeveloped (Ningxia) regions and the regions in between (Hubei). From July to September 2008, using a semi-structured guide, the authors interviewed participants in focus group discussions.

The healthcare needs for chronic and catastrophic diseases were high; however, the healthcare demands were low and healthcare utilizations were even lower owing to the limited accessibility to healthcare services, particularly, in underdeveloped rural areas. “Too expensive to see a doctor” was a prime complaint, explaining substantial discrepancies between healthcare needs, demands and use. Care seeking behaviour varied depending on insurance availability, perceived performance, particularly hospital services, and prescription medications. Participants consistently rated increasing healthcare accessibility as a high priority, including offering financial aid, and improving service convenience. Improving social security fairness was the first on the elderly’s wish list.

Healthcare demand and use were lower than needs, and were influenced by multiple factors, primarily, service affordability and efficiency, perceived performance and hospital service quality.

Community health clinics serving the poor and underserved are geographically expanding due to changes in U.S. health care policy. This paper describes the experience of a collaborative alliance of health care providers in a large metropolitan area who develop a conceptual and mathematical decision model to guide decisions on expanding its network of community health clinics.

Community stakeholders participated in a collaborative process that defined constructs they deemed important in guiding decisions on the location of community health clinics. This collaboration also defined key variables within each construct. Scores for variables within each construct were then totaled and weighted into a community-specific optimal space planning equation. This analysis relied entirely on secondary data available from published sources.

The model built from this collaboration revolved around the constructs of demand, sustainability, and competition. It used publicly available data defining variables within each construct to arrive at an optimal location that maximized demand and sustainability and minimized competition.

This is a model that safety net clinic planners and community stakeholders can use to analyze demographic and utilization data to optimize capacity expansion to serve uninsured and Medicaid populations.

Communities can use this innovative model to develop a locally relevant clinic location-planning framework.