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Biomedical subjects

O Gish

Publications and source records attributed to O Gish.

At least 19 recordsLinked to original sources
PubMed1992

Malaria eradication and the selective approach to health care: some lessons from Ethiopia.

Analysis of the failure of the World Health Organization's global malaria campaign has contributed to the formulation of the primary health care concept as the basic international strategy for health improvement. The Primary Health Care Conference held in Alma-Ata in 1978 was to have ended the period of vertical disease control programs, such as the one against malaria, stressing instead the integration of these programs into horizontal community-based health systems. Malaria control programs, however, have not been integrated well--or in some cases at all--into primary health care networks. An analysis of the Ethiopian experience, as part of the worldwide malaria eradication program, illustrates the political and economic forces that have worked against the move from vertical to integrated malaria control activities, and from vertical to integrated health programs more generally.

Delivery of Health Care↗
PubMed1990

Some links between successful implementation of primary health care interventions and the overall utilization of health services.

All societies have need of a sick care system into which the general population has easy access. Such a system is required for the coherent organization of any health care service which is to be effective. Virtually all people want curative care when ill, but generally are less interested in preventive activities. It follows that a sick care service should be as widely available as it is hoped will be a preventive one. An effective sick service provides the basis of sufficiently regular contact with the bulk of the population so as to allow for the successful fulfillment of preventive health care goals. A shift is required from conventional input planning methods--more doctors, more health centers, etc.--to output planning; that is, actual utilization by the population of the services offered. The concern here is with the overall contact rate between the health service and the entire (relevant) population and not just the rate for any one particular health care program. Planning for additional inputs should be based on the expected outputs (contacts) which are expected to flow from those inputs. An average, well distributed annual utilization level of three to four contacts per capita should provide an adequate basis for fulfillment of preventive (and curative) goals in the health sector.

Developing Countries↗
PubMed1984

Values in health care.

The first part of the paper is concerned with the health care values of various groups; namely, those which are resource oriented, disease oriented, political decision-makers, organized sellers and purchasers of health care and patients. These groups are further divided according to selected political/ideological and socio-economic characteristics, essentially along capitalist and socialist lines. Some of the ways in which the values held by these groups are determined, formulated and, by implication at least, changed and the political, economic and other bases for some of their practical applications are identified. The second part of the paper focuses upon values in public health education and related practice. It is argued that to become more useful to the 'health of the public' the new public health worker will have to become more activist, assuming an adversarial stance toward the market economy in capitalist countries and oppressive governmental structures everywhere. A wider integration of knowledge concerning the effects of health of all types of economic, social and political practices is required; this, in turn, would contribute to the emergence of alternative forms of public health analysis and practice. The recognition of wider forms of public health leadership should follow, coupled with organizational changes directed at the greater participation of popular groupings in all types of public health activities.

Capitalism↗
PubMed1982

Economic dependency, health services, and health: the case of Lesotho.

This article is concerned with two factors affecting the health status of the people of Lesotho: (1) the nation's function as a reserve labor economy (that is, the primary source of income for about half the country's male labor force is employment in South Africa); and (2) the health care system (its size, composition, accessibility, and efficiency). Although such apparently diverse factors usually are analyzed independently, they might be combined to provide a more complete understanding of the determinants of health and disease. The paper reaches the conclusion that any substantive solutions to the problems of Lesotho will be found primarily in the wider southern Africa setting, and not within the context of small, dependent national states. At the same time, these small, dependent national states must make development decisions considering existing geopolitical realities. Foresightful decision making on these issues could both contribute immediately to the health of the people of Lesotho, and also increase in longer-term possibilities for a better life for all the people of southern Africa.

Agriculture↗
PubMed1981

Health and family planning services in Bangladesh: a study in inequality.

The development of health and family planning services in Bangladesh is examined in the context of the country's political economy. Inequities of power, influence, opportunity, and the ownership and distribution of assets and income are seen to lie at the root of the "Bangladesh crisis." In this, the country is not unlike many others in the Third World, only more so. The internal and external pressures which have contributed to a coercive attitude toward the problem of too rapid population growth are discussed. The allocation of Bangladeshi health service resources is examined in terms of expenditure, manpower, and facilities; they are found to be both inequitably distributed and inefficiently applied. Some alternatives to present patterns of development are touched upon. It is concluded that despite the country's poverty, most people do not have to go without basic primary health care (including family planning), which can be afforded even by countries as economically impoverished as Bangladesh.

Bangladesh↗
PubMed1978

Alternative forms of transport and their use in the health services of developing countries.

During the past few years greater interest has been shown in ways in which the coverage of health services in developing countries might be increased. Frequently, it has been advocated that greater use be made of mobile health services, often using relatively sophisticated transport systems, including aircraft. The present article examines the uses to which mobility in health services has been put and the merits of different forms of transport, within the resource constraints and health "needs" of Third World countries. Our main conclusions are that for the majority of health service movement appropriate intermediate technology transport should be used (i.e. bicycle, animals, or motorcycles). The use of mechanical transport within health services with the highest benefit per unit cost is likely to be that employed in the regular supportive (not policing) visits to permanently staffed fixed basic care facilities by more highly skilled and scarce health personnel. Those clinics located closer to the regional base can usually be reached more cheaply by land transport, while those at a distance might justify the use of a light aircraft. Where aircraft are used in this supportive role, it is important they are integrated into the ongoing health services and tightly scheduled to lessen the risk of their diversion to less cost-effective activities.

Aircraft↗
PubMed1977

Mobile health services: a study in cost-effectiveness.

The techniques of cost-effectiveness are employed to simplify resource allocation decisions concerned with the use of land and air transport systems in the health services of a developing country. Outcome classifications are produced for patients seen by mobile and fixed primary care units. The mobile services examined were far more costly (8 to 14 times greater) per likely-effective-patient-contact than comparable care delivered from permanently staffed fixed clinics. This was particularly so for the air-delivered service. The disparity in cost-effectiveness was due mainly to the small proportion of patients seen by the mobile services who could be treated effectively in contrast to a far larger proportion at fixed clinics. This was a consequence of the periodic availability of care from the mobile services as against the continuing provision of care at fixed clinics. The main justification for the use of mechanical transport in connection with primary health care is regular supportive (not policing) visits by skilled health workers to rural clinics. Land vehicles are cheaper than aircraft for visiting the more accessible facilities; for the more distant clinics, the cost of journeys by land vehicle are similar to those by aircraft.

Aircraft↗
PubMed1977

Inequality in the distribution and differential utilization of health services: a Botswana case study.

The uneven provision of health care in a developing country, Botswana, is examined. Curative out-patient attendance and in-patient hospitalization rates were found to vary markedly for groups of the population living at different distances from health facilities. Those people living 10 miles or less from clinics and hospitals had far higher utilization rates than those living at further distances. If the disparity in service provision described is to be altered then the planning and development of health services should concentrate upon the provision of basic health care and adapt to the manpower and economic constraints within which such systems operate.

Botswana↗