I have just returned from the 2nd International Conference of the
International Society for Third Sector Research (ISTR). ISTR deals with
the research on the non-profit, volunteer, and community sectors. One are
of growing interest is the role of non-governmental and non-private
health services. One panel was on NGO delivery of health services. Papers
ranged from Israel, where the NGO/NPO sector supplies much of the health
care under contract formulae with the government, AIDS/HIV services in
Argentina.

Two messages which came through loud and clear were: (a) services
providers where were neither transparent (to their clients) nor
accountable downward (to their community) were not well received by their
communities, and (b) we are moving to a world where the consumers will be
more knowledgable (individually in the family practice office, or in
groups as AIDS, MS, or clef-lip support groups). This later point forces
one to ask what does it mean to be a knowledgable service provider
(individual or agency) in the face of a knowledable client -or client
community.

As information and communication technologies favour the questioning
/searching user seeking out information provider sites there are three
learning (learning organization) issues to be addressed:

1.  What should general health education contain to help the population
    be wise in its pursuit of relevant health information?

2.  How should health care professionals (and others in social and human
    services) be educated and trained to deal with knowledgable clients
    and knowledgable client groups?

3.  How should health care organizations (and social/human services) be
    structured to operate in this environment? If they are not gatekeepers
    for information, just what is their role and to whom are the
    accountable (funders, clients)?

Clearly, information access sites (run by whom?) are central to the
emerging scenario. What should be funded as a social good (service) and
what should be sold in the market as a private consumable?

Lastly, there are strong implications for the research agenda here. If
client groups organize they may well influence the research agenda (the MS
groups have done this). If there is wide discussion between 'clients'
there will be horizontal diffusion of information and lessons learned.
What is the role of the research community if people can lean much of what
they need from each other?

The future is clearly one of a multidisciplinary (environmental?) health
perspective in which 'expert' teams have to come to terms with
knowledgable communities and individuals. It will not be enough to have
resorted to multidisciplinary teams and 'consultation' when the basis is
there for knowledgable collaboration.

The three issues listed above are a starting point for discussions in this
area.

Sam Lanfranco, <[log in to unmask]>