The role of district nurses in public health: a discussion

The government has challenged community nurses, through recent policy changes, to become more involved in improving the health of local populations. However, very little has been written about the role of district nurses within this agenda. This article explores these opportunities and discusses some of the challenges facing district nurses if they are to embrace this new agenda. A model is examined which details four approaches to public health in which district nurses could contribute: individual advice-giving, personal support, environmental control and community development. District nurses have many valuable skills and attributes that could be utilized within all four approaches; it is important that they use these skills in collaboration with others. There will be implications for the future education and leadership of district nurses.

Partnerships, community participation and intersectoral collaboration in South Africa

Five community partnerships (CP) were initiated in South Africa as demonstration projects aimed at the re-orientation of health professionals' education (HPE) to be more community responsive and interprofessional. A cluster evaluation of these partnerships has demonstrated that, in addition to motivating all stakeholders to forge closer working relationships, it is necessary for partnerships to pay close attention to a variety of structural and operational dimensions, the lack of which could prove to be major constraints to effective partnership functioning. This study critically reviews the challenges to collaborative working as experienced by the South African cluster. Within the context of the post-apartheid restructuring and development, the discussion highlights the insights that partnerships offer to clarify the extent to which potential barriers could affect the stakeholder groups. The paper identifies potential impediments, and makes explicit how they impact on partnership fostering. Evidence is also presented for their early detection and possible solutions are identified. The lessons learnt from these South African cases are that wide representation, commitment and a sense of ownership, sound leadership skills, regular and effective communication, reliable member expertise and capabilities and attention to power issues are crucial elements in the partnership equation. The paper concludes with an invitation to health administrators and partnership executives to devote attention to the array of interacting components that, collectively, could impinge on the effectiveness of the multifaceted nature of interprofessional joint working arrangements.