Role of Community Partnerships in Addressing Health Problems in Developing Countries and the U.S.

The four manuscripts in this section of the Community Partnerships issue offer a diversity of approaches to community-based participatory research (CBPR) in developing countries and one disadvantaged immigrant population in the U.S. They employ a mix of perspectives that include original research (Nyamathi et al., Tharenos & Santorino), policy and practice (Rutta et al.), and lessons learned (Kobetz et al). Two of the articles inform us about CBPR in East Africa and range from a narrow focus on the documentation of physical activity in Ugandan villages by children using donated digital cameras (Therenos & Santorino) to the description of a broad, complex partnership between clinical service, industry and government policy-makers in creating a new, safer and more accessible pharmaceutical service for Tanzania (Rutta E et al). The other two articles present CBPR in India and Miami, Florida, U.S., to document health needs and perceptions among HIV-positive mothers and of a Haitian community-academic research partnership to reduce excess cancer burden among Haitian women, respectively.

Rutta et al's description of the creation of an entirely new class of pharmaceutical workers and services in underserved communities in Tanzania is remarkable and offers lessons for North America and Western Europe. This innovative service combines basic pharmaceutical dispensing with basic primary care and prevention services. The program was launched not only as a public-private partnership, but with a heavy investment in changing consumer attitudes toward these expanded roles of the drug dispensers. The CBPR principle of local community capacity-building is exemplified by Tharenos and Santorino who engaged village youth and youth leaders in the planning, implementation, interpretation, and dissemination phases of the investigation. Youth photographers acquired the skills to document physical activity. The results include a visually spectacular collection of photographs that capture the cultural nuances of survival, socialization, and ceremony as a way of life in one Southwest Ugandan village. The trusting relationship among the research partners is evident and preservation of the mutual trust sustained the required patience for challenging aspects of the endeavor, e.g., teaching photography to the youth using a wide variety of donated cameras, limited resources for purchasing batteries. The Ugandan study's theme might seem surprising for a country overwhelmed by the needs of patients with HIV/AIDS, tuberculosis and malarial infections. Yet it reminds us that chronic diseases are growing as major causes of mortality in developing countries as lifestyles increasingly resemble those of the West.

Sustainability of research benefit is a growing demand by communities that contribute their scarce resources to research partnerships. All of the studies in this issue use a cultural translation approach to the development and implementation of their interventions and demonstrate how CBPR processes of co-learning and social action can promote sustainability of health research benefit. Dissemination is a key element of sustainability; however, CBPR expands the scope of dissemination beyond the traditional domain of peer-reviewed journals. For instance, an instructive take home message from the Tharenos and Santorino article is the authors' careful attention to dissemination of findings in the form of a "Community Policy Briefing." The approximately 2-page brief can be widely circulated in its current format and is relevant to the core activities of a broad audience, e.g., community members, clinicians, researchers, community health planners, public health professionals, educators, lawmakers. Thus, knowledge in such usable formats can cast a wide net of influence with which to address persistent health disparities.

Two of the manuscripts record the experience of marginalized groups whose perspectives and voices are intended to inform policy, services, and research. One describes the outcome of focus groups with HIV-infected women in India which point to such barriers to needed care as discrimination by family, community and the health system and the loneliness perpetuated by gender roles of women in India who are devoted to the care for ill husbands and children while there is no one to care for them (Nyamathi, A et al). The other explores factors leading to Haitian women who live in South Florida (in "Little...