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Year : 2007  |  Volume : 20  |  Issue : 2  |  Page : 79

Community-Action Councils: A Pathway to Embrace Towards Unity for Health (TUFH)

American University of the Caribbean School of Medicine, St. Maarten, Netherlands, Antilles

Date of Submission14-Jul-2007
Date of Web Publication29-Aug-2007

Correspondence Address:
B Salafsky
#1 University Drive at Jordan Rd., Cupecoy

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Source of Support: None, Conflict of Interest: None

PMID: 18058696

How to cite this article:
Salafsky B. Community-Action Councils: A Pathway to Embrace Towards Unity for Health (TUFH). Educ Health 2007;20:79

How to cite this URL:
Salafsky B. Community-Action Councils: A Pathway to Embrace Towards Unity for Health (TUFH). Educ Health [serial online] 2007 [cited 2022 Jan 20];20:79. Available from:

Having assisted with the implementation of the TUFH concept, I have more recently found myself in a situation where the principal ideas of TUFH have proven most valuable.

The primary element that drives the success of TUFH is the bringing together of multiple stakeholders to solve problems in health. In my experience, the first steps down this road involve a medical school or other health care institution. This is because these entities are often relatively neutral in the politics of health care and, in most cases, are respected as educational bodies upon which all stakeholders depend.

In order for a health care institution to successfully bring together a wide array of stakeholders, it must first recognize its social responsibility to the community. In declaring willingness to assume this responsibility and to do so with stakeholders, who, in fact, share in this responsibility, the institution takes the first steps towards the initiation of TUFH.

I have generally found that having committed to social responsibility, the medical school is usually welcomed as a meeting point for multiple stakeholders who can initially come together to discuss issues of common interest. Later, stakeholders form a council or body consisting of all the participants, including the medical school. Formal bylaws, officers of the council and a mission statement can then be created. The identity of the council - both within the community and externally - can lead in turn to identification of health-related problems facing the community which the council, with various roles being played by the different stakeholders, can begin to address.

So, for example, several years ago, at the University of Illinois, College of Medicine-Rockford, we created a community council, the Rockford Regional Health Council. It comprised all the major stakeholders, including such stakeholders as the local hospitals, health department, the medical society, public education, community health organizations, and the medical school. Eventually, a formal entity was created with officers, bylaws and a mission statement. Funds from the various stakeholders allowed the council to hire an executive director. In the past seven years the Rockford Regional Health Council has successfully gained external grant support from various sources and has addressed a broad number of community health-related issues. These include: Assessment of Community Needs and Adopting a Strategic Plan, Access to Primary Care, Coalition on Childhood Immunizations, School-linked Health Centers, an Asthma Consortium, Pandemic Influenza Preparedness, Diabetes Coalition, etc. It is truly TUFH in action.

Now, however, I find myself in quite a different environment. I am in a Third World country, a small island in the Caribbean. Here resources are thin. There are inadequate numbers of providers, and there is a fair amount of politicalization among the stakeholders. We have, in the beginning, put out a ‘white paper’ to all potential stakeholders stating the social responsibility of the medical school, particularly in terms of island health and public education. A number of stakeholders were then identified and invited to a ‘Dean’s Council’ in order to discuss the feasibility of coming together in a TUFH partnership to begin to address issues in health care and public education. Somewhat surprisingly, at least to me, was the virtually uniform ‘buy-in’ by all stakeholders to proceed with the formation of a council and the identification of projects which they would review and prioritize collectively. These initial meetings generated considerable enthusiasm and future planning is now underway.

There has also been a curious spin-off. A number of other agencies and entities, both governmental and non-governmental, have approached us and expressed an interest in joining this process. In order to better ensure success, we have also committed one faculty position to this endeavor and intend to hire an individual with expertise in health systems research. Lastly, there is one other important element in this equation. Given the paucity of manpower, the need to inculcate concepts of social responsibility and TUFH in our medical students, we are in the process of re-structuring our curriculum so that students will be required to become involved in community research/service projects done under the leadership of Health System Research faculty and one or more community stakeholders.

Only time will tell how successful we will be. I believe we have certainly raised awareness of the problems in this community. We have begun the process of having the various stakeholders communicating with each other and have clearly introduced the concept of TUFH. I believe this scenario has broad applicability to communities facing and addressing health care problems. Our model could be most useful where resources, personnel and available time are spread thinly. The solving of local problems health care, through demonstration projects which embrace TUFH will, in time, evolve to address problems at regional or national levels. Thus, people’s health needs will be met on an ever-broadening scale.


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