Building capacity for rural health : the role of boundary crosser and the impact of their behaviours on community readiness partnerships

The concept of partnership has entered policy rhetoric and is urged as good practice in a variety of domains including health. Rural communities tend to have fewer resources available for the provision of services such as health than their metropolitan counterparts, and so could be expected to benefit from partnerships with external agencies. Indicators of coalition maturity for working in partnership with external agents in order to build stronger communities are distilled from the group development and partnership research literature and considered in the light of the experiences of the University Department of Rural Health in community engagement. The chapter draws on experiences of two rural community coalitions working to plan and negotiate health service provision. The coalitions were analysed against the indicators. A key indicator of maturity and readiness for working in partnership with external agents is related to the behaviour of ‘boundary crossers’. Boundary crossers are defined as people who move freely between two or more domains and who understand the values, cultures and language, and have the trust, of both. Domains can be within a community or be the community and an external sector. Community health professionals, especially those in senior positions, often act as boundary crossers between the community and broader domains such as regional/state health services or policy, although other community members can fill the role. Other key indicators of coalition maturity for working in partnership with external agents include local leadership that empowers the community, a willingness of community coalitions to take risks and mould opportunities to meet their vision, and a culture of critical reflection and evaluation of past actions.

This chapter analyses the impact of boundary crossing behaviour on community readiness and partnerships with external agents that are intended to build rural community capacity to plan and negotiate health service provision. It is argued that the characteristics and modus operandi of boundary crossers who are members of rural community coalitions affect the level of maturity of the coalitions and community readiness to work with external agents. An understanding of the characteristics and modus operandi of boundary crossers provides valuable insights for external agents in designing their approach to partnerships that build rural community capacity for health.

Using project evaluation to build capacity for integrated health care at local levels

Capacity-building evaluation featuring multidisciplinary cross-agency workshops fostered continuous quality improvement, while focusing on skills required and systemic barriers to health care integration between GPs and a regional hospital.

What's needed to increase research capacity in rural primary health care

The aim of this study is to identify ways to build research capacity within primary health. A consultation was undertaken in late 2004 using a combination of a one-page survey and a guided meeting format, in a primary health setting in rural NSW. Most (81.3%) of the 134 individuals consulted were part of an Area Health Service, with 12.7% from non-government settings. Most (80.6%) were clinicians, with a third (31.5%) nurses, 8.3% in medicine, and the remainder from a range of allied health professions. Eleven organisations were represented. The main  outcome measures were identification of support needs, processes to enhance research engagement, and barriers and enablers to clinicians’ research  involvement. The results showed that popular delivery modes for research training and support were courses and “one-to- one” advice. Writing topics were generally more popular than others. Common barriers were time and technology issues. A key enabler was a discipline-specific focus. This is one of few rural Australian  consultations on research needs in primary health conducted with a diverse  range of clinicians at the clinician level. It will direct future research capacity  building efforts towards maximising face-to-face discipline specific options and  minimising technology use.

Narratives and landscapes : their capacity to serve indigenous knowledge interests

The thesis is a culmination of my research which drew on tyangi wedi tjan Rak Mak Mak Marranunggu and Marrithiel knowledge systems. These awa mirr spiritual knowledge systems have guided our Pilu for millennium and have powerful spiritual affiliation to the land and our continued presences. The understandings of the spiritual connectedness and our practices of relatedness have drawn on Pulitj, our deep awa mirr spiritual philosophy that nourishes us on our country. This philosophy gave us our voice and our presence to act in our own ways of knowing and being on the landscapes created by the Western bureaucratic systems of higher education in Australia to bring forth our Tyikim knowledge systems to serve our own educational interests. From this spiritual ‘Puliyana kunun’ philosophical position the thesis examines colonising constructions of Tyikim peoples, Tyikim knowledge systems in education, Tyikim research and access to higher education for Tyikim students. From the research, it is argued that the paradigm, within which the enclave-derived approach to Indigenous higher education is located, is compatible with the normalising imperialistic ideology of higher education. The analysis of the Mirrwana/Wurrkama participatory action research project, central to the research, supported an argument for the Mirrwana/Wurrkama model of Indigenous higher education. Further analysis identified five key pedagogical principles embedded within this new model as metaphorically equivalent to wilan~bu of the pelangu. The thesis identifies the elements of the spirituality of the narrative exposed in the research-in-action through the “Marri kubin mi thit wa!”. This is a new paradigm for Tyikim participation in higher education within which the Mirrwana/Wurrkama model is located. Finally, the thesis identifies the scope for Tyikim knowledge use in the construction of contemporary ‘bureaucratic and institutionalised’ higher education ngun nimbil thit thit teaching and learning experiences of Tyikim for the advancement of Tyikim interests. Here the tyangi yigin tjan spiritual concepts of narrative and landscape are drawn upon both awa mirr metaphorically and in marri kubin mi thit wa Tyikim pedagogical practice.

Creating (in) capacity : teachers in globalized education policies

The relationship between education and globalization stands largely unexamined from teachers’ perspectives. By focusing on the teachers, as axiomatic to educational and pedagogical change, teachers feature in education policy and through their plight, the paper explores and challenges ideas that displacing teachers from input into educational reforms facilitates progressive implementation of new education. Demonstrating teachers' displacement from the policy making process becomes evident through the use of computer assisted qualitative research examining and drawing inference from textual evidence. Using text analysis focuses on teachers' work and how it is shaped and represented. On a policy continuum beginning from the policy makers and leading towards the policy takers, the way that teachers are represented in education policy demonstrates their limited capacity to influence policy making. By examining how teachers and their work are thus defined in macro policies, the intension is to raise concerns about the uncontested way that globalization driven educational reforms have entered the discourse of educational policy and the implications for educators. Educational policy advocates teachers’ critical role yet blurs teachers' participative capacity and leads towards the conclusion that policy obscures teachers’ agency in order to ensure that teachers are objects of policy rather than integral to policy making.

The meaning of capacity building in Indonesia

Capacity building has been prominent in development projects of various kinds for the last decade. Capacity is, in this context, an amorphous term broadly defined as the ability of people, organizations, and communities to handle all the aspects of existence that relate to them (Vincent-Lancrin, 2006). Capacity building generally refers to efforts to develop this ability among particular groups, resulting in enhanced potential to manage their own needs (Potter and Brough, 2004). Capacity building and the associated process of capacity development have been considered central in improving governance, civil society institutions, and local administrations in developing countries (Brinkerhoff, 2000). The World Bank, with its emphasis on strengthening governance, has made capacity building a focus of its programs and leads the development of relevant models and evaluative measures (Wilhelm and Kushnarova, 2004; Straussman, 2007).

Despite its importance in development circles and a quantity of scholarly consideration, the effects of capacity building initiatives are difficult to document and evaluate, and the concept has generated criticism as well as support. Though many aspects of capacity building have been elucidated, one issue that remains less thoroughly studied is the concept’s meaning to target populations. This paper considers the meaning and nature of capacity building in Indonesia, including local perceptions of the concept. This, it is hoped, will offer insight into the whole question of capacity in that nation and that this discussion will inform future development efforts.

Rural primary health care workers and research : what is their present capacity?

Aims & rationale/Objectives : The main objectives of this project were to:
- conduct an audit of research skills and experience of primary health care staff in nine south western Victorian not-for-profit agencies
- identify capacity for research in five pre-identified areas
- investigate unpublished research endeavours/innovative projects taking place in the linked community organisations.
Methods : A 9-item survey was developed and will be distributed to all primary health care staff at the nine agencies via the internal email system of each organisation. The survey was developed after consultation with several agency directors, to obtain an organisational perspective on research capacity issues. Staff were also invited to take part in informal focus groups exploring key themes.
Principal findings : This study is in progress, and is expected to be completed at the end of March, 2007. Expected findings are the identification of primary health care staff's capacity for research, and discussion of relevant organisational assistance which would develop their research skills or enable continued participation in research.
Discussion : Phase 2 of the Australian PHC Research, Evaluation and Development Strategy aims to support the development and expansion of the primary health care research workforce. Findings from the current study will support this goal by assisting rural primary health care workers to identify the training and support they need to undertake quality research. The data could also be used to: a) assist the consortium to identify common research interests; b) to inform the consortium regarding the potential for collective research efforts; and c) to support funding submissions from the consortium or from individual agencies.
Implications : These findings will help to inform improved strategic planning in relation to building research capacity. The data could also be used by participating agencies to support applications for research grant funding.
Presentation type : Poster
Session theme : Building research capacity