DCSTSDeputy Chief of Staff for Training & Schools
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1 explains how the DCSTs as stewards [23] and integrators[32] of the implementation framework should follow a health systems thinking pathway that includes positive feedback [10,30] and champions.
Involvement of CEOs, DCSTs, heads of obstetrics and gynaecology and midwifery at training institutions, and clinical managers is essential for this.
In the case of Enduring Freedom (Afghanistan) and Iraqi Freedom, the DCSTs give US Central Command the logistics information to assist them in their decisionmaking.
Another great tool used in Operation Iraqi Freedom is the DLA contingency support team (DCST).
The stroke subjects had significantly impaired performance on dichotic competing sentence testing (DCST).
However, these improvements have also been documented in other provinces with lower levels of WBOT coverage, and furthermore could have been affected by other interventions such as the DCSTs. Given the interest in and expectations of greater investment in WBOTs, assessing their impact on and contribution to PHC outputs and health outcomes is becoming increasingly important.
"One Marine Corps flag officer recently commented that his perception of DLA's competencies had changed since he had been working with the DCSTs," said Petruccelli.
There are several reasons why the re-engineering of PHC has been disappointing, including the fact that hardly any extra resources were committed to the initiative, apart from budgeting for the DCSTs. Two of the most important reasons relate to the essential place of the district hospital within the DHS, especially in underserved rural areas.
The Reserve role in DCSTs reflected what Navy Supply Corps Reserve RDML Fenton Priest, Director of Reserve Readiness, called "a niche of J-9: to help prepare the DLA work force to go forward in a hostile environment."
DCSTs were the drivers of implementation and overall clinical governance, and their leadership role in neonatal care is discussed in the DCST article in this supplement.
The District Clinical Specialist Team (DCST), each managed by a Head of Clinical Unit (HOCU), is one of the strategies within the three streams of primary healthcare (PHC) re-engineering that is being implemented to strengthen health systems.