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PubMed1997

The earnings experience of rural-urban migrants in Korea.

"Migration models in the Harris-Todaro tradition imply that urban informal sector earnings are less than rural sector earnings. Examining the situation for [South] Korea, we find that both urban formal and informal sector earnings exceed earnings opportunities in rural areas, making rural-urban migration the best decision for the individual and for the Korean economy in terms of maximizing output.... The implication for policy makers is that government efforts may be better directed toward mitigating the externalities caused by over-crowding, rather than attempting to influence population movements."

Asia↗
PubMed1999

Lay people's perceptions of sexually transmitted infections in Uganda.

In order to understand lay people's perceptions of sexually transmitted infections (STIs) focus group discussions and semi-structured interviews were held with community members and patients with STIs in Mbarara and Kampala, Uganda. Symptoms of common STIs and the modes of transmission methods were known. STIs were perceived as naturalistic diseases caused by a tiny insect called akakoko or akawutka, although female infertility, one of the common complications of STIs, was perceived as a supernatural ailment. There was no stigma towards people with AIDS, although stigma towards people with other STIs was high. There were also strong negative attitudes towards the use of condoms. More than 60% of the patients interviewed had received treatment from the informal sector which included self-treatment and traditional healers. To reduce the incidence and complications of STIs, there may be a need to collaborate with the informal sector, to further evaluate the beliefs and practices identified in this study and to target them for health education.

Adolescent↗
PubMed1996

Sources of income among homeless adults with major mental disorders or substance use disorders.

OBJECTIVE: The study documented sources and amounts of income among homeless adults with major mental or substance use disorders. It examined whether income varied by diagnostic group and whether those who received case management would be more likely to have income. METHODS: A total of 564 homeless adults from a countywide probability sample completed structured interviews. Based on DSM-III-R criteria, respondents were divided into four groups--those with current major mental disorders, substance use disorders, dual disorders, and no disorders. Income from entitlement benefits, formalsector employment, informal-sector employment, and other sources was documented by group. Logistic regression analysis was used to examine relationships between income sources, case management, and diagnostic groups. RESULTS: Although informal-sector income was the most common income source, it provided the fewest median dollars per month ($42). Entitlement benefits provided the most monthly income ($340) and was the second most common source. Respondents with major mental disorders, substance use disorders, or dual disorders were no less likely than those with no disorders to report income from entitlement benefits or formal-sector employment. Among those with major mental disorders, substance use disorders, or dual disorders, respondents who had recent case management were four to nine times more likely to report entitlement income. CONCLUSIONS: The results support other research and anecdotal findings on the importance of case management in obtaining entitlement income among homeless adults with major mental or substance use disorders.

Adolescent↗
PubMedDate not supplied

Occupational health in Central America.

The 12.4 million economically active population (EAP) of the seven Central American countries includes a large informal sector. Social security covers only 14-60%. No surveillance of occupational safety and health (OSH) hazards or accidents exists. Extrapolating the incidence of occupational accidents among insured Costa Rican workers to the Central American EAP yields two million accidents yearly, still a gross underestimate. Occupational diseases are underreported, misdiagnosed, and not recognized as such. A number of regional OSH programs aim at modernization of the labor administrations and address the formal sector, in particular textile maquila, in connection with free trade agreements. The weak role of the ministries of health is expected to strengthen under the Pan American Health Organization OSH program. Employers largely influence new policies. Workers' influence on OSH policies has been weak, with only about 10% unionization rate and scarce resources and OSH knowledge. Informal workers, however, are getting organized. OSH research is underdeveloped and not linked to policy making. Construction, agriculture, and general un/underemployment are considered priorities for intervention. The informal sector needs to be included in national and regional OSH policies. Regional collaboration and international development support are of strategic importance to achieve sustainable improvement in OSH.

Accidents, Occupational↗
PubMed2004

Therapy of falciparum malaria in sub-saharan Africa: from molecule to policy.

The burden of falciparum malaria remains as great as ever, and, as has probably always been the case, it is carried mainly by tropical Africa. Of the various means available for the control of malaria, the use of effective drugs remains the most important and is likely to remain so for a considerable time to come. Unfortunately, the extensive development of resistance by the parasite threatens the utility of most of the affordable classes of drug: the development of novel antimalarials has never been more urgently needed. Any attempt to understand the vast complexities of falciparum malaria in Africa requires an ability to think "from molecule to policy." In consequence, the review ambitiously tries to examine the current pharmacopeia, the process by which new drugs are developed and the ways in which drugs are actually used, in both the formal and informal health sectors. The informal sector is particularly important in Africa, where around half of all antimalarial treatments are bought from informal outlets and taken at home without supervision by health care professionals: the potential impact of adherence on clinical outcome is discussed. Given that the full costs are carried by the patient in a large proportion of cases, the importance of drug affordability is explored. The review also discusses the splicing of new drugs into national policy. The various parameters that feed into deliberations on changes in drug policy are discussed.

Adolescent↗
PubMed2002

Effectiveness of community health financing in meeting the cost of illness.

How to finance and provide health care for the more than 1.3 billion rural poor and informal sector workers in low- and middle-income countries is one of the greatest challenges facing the international development community. This article presents the main findings from an extensive survey of the literature of community financing arrangements, and selected experiences from the Asia and Africa regions. Most community financing schemes have evolved in the context of severe economic constraints, political instability, and lack of good governance. Micro-level household data analysis indicates that community financing improves access by rural and informal sector workers to needed heath care and provides them with some financial protection against the cost of illness. Macro-level cross-country analysis gives empirical support to the hypothesis that risk-sharing in health financing matters in terms of its impact on both the level and distribution of health, financial fairness and responsiveness indicators. The background research done for this article points to five key policies available to governments to improve the effectiveness and sustainability of existing community financing schemes. This includes: (a) increased and well-targeted subsidies to pay for the premiums of low-income populations; (b) insurance to protect against expenditure fluctuations and re-insurance to enlarge the effective size of small risk pools; (c) effective prevention and case management techniques to limit expenditure fluctuations; (d) technical support to strengthen the management capacity of local schemes; and (e) establishment and strengthening of links with the formal financing and provider networks.

Community Health Services↗
PubMed2004

Violence and HIV/AIDS prevention among female out-of-school youths in southwestern Nigeria: lessons learnt from interventions targeted at hawkers and apprentices.

Between 1997 and 2003, four studies on hawkers and apprentices in motor parks and work shops in south west, Nigeria were carried out to evaluate the effectiveness of interventions aimed at preventing HIV infection and gender based violence (GBV). The studies were in 3 phases namely baseline survey, intervention and end line survey. Interventions consisting of:--development and distribution of education materials and training programmes for the police, judiciary, instructors, drivers, traders and apprentices/hawkers, including micro-credit facilities were implemented in some of the studies. The major lessons learnt were that: Young girls working in the informal sector of the Nigerian economy face dual risks of HIV infection and GBV and yet they are seldom targets of intervention; Many had been victims of GBV and did not seek redress either because they accept it is their lot, are afraid of being stigmatized or are put off the prolonged legal system; Perpetrators tend to deny their involvement in violence; Despite the challenges involved, interventions implemented among female apprentices and hawkers, especially those that involve multiple stakeholders, made a difference in protecting this group from dual risks of GBV and HIV/AIDS infection. We recommend more intervention programmes for this population, and regulation of activities in the informal sector of the Nigerian economy.

Adolescent↗
PubMed2005

Overview of culturally-based mental health care in Vancouver.

This article is a description of how cross-cultural services in mental health have evolved in Vancouver. With 49% of Vancouver's total population described as a 'visible minority' by Statistics Canada, it has been essential for the city, in its efforts to provide health care that is accessible, available and acceptable to all, to develop health care that acknowledges racial and cultural diversities. Vancouver's Cross Cultural Mental Health Services had their beginnings over 25 years ago. The services encompass both formal and informal sectors of the healthcare system, are provided at primary, secondary and tertiary levels of healthcare delivery and are available through hospital- and community-based services. With recent regionalization of British Columbia's health services, the cross-cultural mental health service has experienced increased coordination under the administration of the Vancouver Coastal Health Authority (one of six British Columbia health regions). The initial elements of a cross-cultural mental health service consisted of the Vancouver Association for the Survivors of Torture, the Cross-Cultural Clinic at Vancouver General Hospital, and the Multicultural Liaison Workers Program of the Vancouver Community Mental Health Service. Collaboration and partnerships between the formal and informal sectors support each other, bridge gaps in services and provide a milieu for growth and development.

British Columbia↗
PubMed1999

NGOs in community health insurance schemes: examples from Guatemala and the Philippines.

In poor rural communities, access to basic health care is often severely limited by inadequate supply as well as financial barriers to seeking care. National policies may introduce social health insurance, but these are likely to begin with the salaried public and private sector workers while the informal sector population may be the last to be covered. Community initiatives to generate health care financing require a complex development process. This paper covers attempts to develop such schemes in rural populations in Guatemala and the Philippines through non-government organizations and notes the major factors which have contributed to unequal progress in the two schemes. The scheme of the Association por Salud de Barillas (ASSABA) in Guatemala was not sufficiently established as an administrative body at the conceptual stage and there was no clear national policy on health care financing. By the time the necessary action was taken, local conflicts hindered progress. In the Philippines, the ORT Health Plus Scheme (OHPS) was implemented during the period of legislation of a national health insurance act. The appraisal after three years of operation shows that OPHS has made health care affordable and accessible to the target population, composed mainly of low and often unstable income families in rural areas. The major success factors are probably the administrative structure provided by a cooperative and controls in the delivery system and in expenditures, through the salaried primary health care team, referral process and the capitation agreement for hospital-based services. The proliferation of such schemes could benefit from national guidelines, a formal accreditation process and an umbrella organization to provide assistance in design, training and information services, involving government, non-government and academic institutions as an integral part of the development process.

Accreditation↗
PubMed1997

Use of ineffective or unsafe medications among members of a Medicare HMO compared to individuals in a Medicare fee-for-service program.

Adverse drug reactions and inappropriate prescribing practices are an important cause of hospitalization, morbidity, and mortality in the elderly. This study compares prescribing practices within a Medicare risk contract health maintenance organization (HMO) in 1993 and 1994 with prescribing practices for two nationally representative samples of elderly individuals predominantly receiving medical care within the Medicare fee-for-service sector. Information on prescriptions in the fee-for-service sector came from the 1987 National Medical Expenditures Survey (NMES) and the 1992 Medicare Current Beneficiary Survey (MCBS). A total of 20 drugs were studied; these drugs were deemed inappropriate for the elderly because their risk of causing adverse events exceeded their health benefits, according to a consensus panel of experts in geriatrics and pharmacology. One or more of the 20 potentially inappropriate drugs was prescribed to 11.53% of the Medicare HMO members in 1994. These medications were prescribed significantly less often to HMO members in 1994 than to individuals in the fee-for-service sector, based on information from both the 1987 NMES and the 1992 MCBS. Utilization of unsafe or ineffective medications actually decreased with increasing age in the HMO sample, with lowest rates in individuals over the age of 85. However, no relationship between age and medication use was seen in the NMES study, except for individuals over the age of 90 years. The study data support the conclusion that ineffective or unsafe medications were prescribed less often in the Medicare HMO than in national comparison groups. In fact, for the very old, who are most at risk, the use of these medications was much lower in the Medicare HMO than in the Medicare fee-for-service sector. Nevertheless, in 1994, approximately one of every nine members of this Medicare HMO received at least one such medication. Continued efforts and innovative strategies to further reduce the use of unsafe and ineffective drugs among elderly Medicare HMO members are needed.

Aged↗
PubMed2004

Security issues arising in establishing a regional health information infrastructure.

A regional health information infrastructure is being developed in an internally self-governing country which is a dependent territory of the British Crown, is not part of the United Kingdom but is a member of the British Commonwealth. This country of about 70000 inhabitants (and significant numbers of visitors) within the British Isles shares many functions with the United Kingdom-from the perspective of this paper the key shared functions relate to the infrastructure of the departments of social security, social services, central registry, all health care services and national insurance systems. Although it remains independent in various other respects, for the most part it endeavours to achieve an harmonious legislative relationship with the UK, and with the EU. One primary goal of the information infrastructure development project is to provide links between community, primary and secondary healthcare services and thereby to ensure integrity of information as it refers to each individual receiving care services. A second goal has been to integrate this environment with various other government functions including the issuing and checking of NHS ID numbers and of national insurance ID numbers, the payment of social welfare benefits, and perhaps with other functions where access to a common list of names and addresses is a significant factor. This paper outlines some of the issues that have arisen in endeavouring to meet the often conflicting wishes and needs of different groups as regards a health information infrastructure within a general public sector information service.

Computer Security↗
PubMed2004

Gender differences in health care-seeking behavior for sexually transmitted diseases: a population-based study in Nairobi, Kenya.

BACKGROUND: Health care-seeking behavior for sexually transmitted diseases (STDs) is important in STD/HIV control. GOAL: The goal of this study was to describe the proportion seeking care, patient delay, and choice of provider among men and women with STD-related complaints in Nairobi, Kenya. STUDY DESIGN: A population-based questionnaire was administered in 7 randomly selected clusters (small geographic areas covering approximately 150 households each). RESULTS: Of the 291 respondents reporting complaints, 20% of men versus 35% of women did not seek care, mainly because symptoms were not considered severe, symptoms had disappeared, or as a result of lack of money. Of those who sought care, women waited longer than men (41 vs. 16 days). Most men and women went to the private sector (72% and 57%, respectively), whereas the informal sector was rarely visited (13% and 16%, respectively). Relatively more women visited the government sector (28% vs. 15%). Because women were mostly monogamous, they did not relate their complaints to sexual intercourse, which hampered prompt care-seeking. CONCLUSION: Women should be convinced to seek care promptly, eg, through health education in communities.

Adolescent↗
PubMed1989

The 1990 World Population and Housing Census Programme.

A population census is the primary source of demographic information for every country. In planning for the 1990 round of censuses, the international community has adopted a number of recommendations for changes for countries and regions to consider in planning for and carrying out their census. In particular, alternatives for the measurement of economic activity have been proposed in order to obtain a more realistic indication of employment and unemployment in countries where the agriculture and informal sectors are important. New recommendations have also been made for the measurement of stocks and flows of international migrants. In each of the major regions, recommendations have been adapted to local concerns. Preparations are being made for technical cooperation in the 190 census round, and a calendar of the census dates in all countries is shown to be nearly complete.

Agriculture↗
PubMed1999

The impact of economic sanctions on health and human rights in Haiti, 1991-1994.

OBJECTIVES: This report examines the impact of an economic embargo from 1991 to 1994 on health, well-being, and human rights in Haiti. METHODS: Data from surveillance systems for nutrition, reportable diseases, and hospital diagnoses were combined with survey data and interviews with affected women, governmental representatives, diplomats, and staff of nongovernmental organizations. RESULTS: Changes included declining income, rising unemployment, poorer nutrition, declining infant mortality, rising mortality among 1- to 4-year-olds, decreased attention to children's well-being and education, and family breakdown. Survival strategies among poor Haitians included changed dietary habits, informal-sector economic activity, moving in with relatives, selling domestic goods, increased informal unions among couples, decreased school attendance, and indentured servitude among children. CONCLUSIONS: The implementation of economic sanctions in Haiti resulted in extensive violations of rights; the impact was greatest on the most disadvantaged Haitians. Many Haitian and international supporters of democracy were unaware of the extensive negative impact that sanctions could have. The impact continues now, 5 years after sanctions ended. Modified policies reduced some of the burden of sanctions, and international assistance prevented what otherwise might have become a humanitarian disaster during sanctions.

Child Health Services↗
PubMed2006

Traditional risk-sharing arrangements and informal social insurance in Eritrea.

In Eritrea neither the state nor the market is effective in providing health insurance to low-income people (in rural and informal job sector). Schemes intended for the informal sector are confronted with low and irregular incomes of target populations and consequently negligible potential for profit making. Because of this there, are no formal health insurance systems in Eritrea that cover people in the traditional (or informal) sector of the economy. In the absence of formal safety nets traditional Eritrean societies use their local social capital to alleviate unexpected social costs. In Eritrea traditional risk-sharing arrangements are made within extended families and mutual aid community associations. This study reveals that in a situation where the state no longer provides free public health services any more and access to private insurance is denied, the extension of the voluntary mutual aid community associations to Mahber-based health insurance schemes at the local level is a viable way for providing modern health services.

Cross-Sectional Studies↗
PubMed2005

Is there a gender difference on the association between informal work and common mental disorders?

Economic activity in Brazilian women has been increasing in recent years, particularly in the form of under- and self-employment, which allows more flexibility in the work schedule and facilitates part-time work, a crucial issue for women reconciling family duties and the need for a remunerated occupation. This paper investigates the gender difference in the association between employment status and common mental disorders (CMD). A cross-sectional survey of a random sample of private households included 683 adults aged 15 years and over living in Olinda, Brazil. The self-reporting questionnaire (SRQ-20) was used to estimate the prevalence of CMD. The association between unemployment and CMD for men (OR=1.77, 95% CI 0.8-3.9) was in the same direction as that found for women (OR=2.66, 95% CI 1.1-6.3), but not significant. In contrast to this, while women working in the informal sector were more likely to be a case of CMD than formal workers (OR=3.02, 95% CI 1.3-7.2), no difference was found for informally working men (OR=1.08, 95% CI 0.5-2.4). The estimated OR for female informal workers was out of the 95% confidence intervals of the corresponding OR estimated for males, and the test for interaction was statistically significant (p=0.04). From a policy perspective, the value of encouraging people to take informal work depends both on how quickly individuals can be moved out of unemployment into informal work compared to other destinations, and how well individuals fare once in informal work. The results of the present study suggest that working outside the protection of employment legislation and with limited opportunity for skill use may be a risk for women's mental health.

Adolescent↗
PubMed2001

Hysterectomy prevalence and adjusted cervical and uterine cancer rates in England and Wales.

OBJECTIVE: To present recent trends in cervical and uterine cancer adjusted for true population at risk, using accurate estimates of the prevalence of hysterectomy where the cervix has been removed or not. To describe trends and projections of hysterectomy incidence and prevalence with and without cervix removal. DESIGN: Collation of available NHS and private sector information. SETTING: England and Wales. SAMPLE: NHS operations from Hospital Inpatient Enquiry, Hospital Episode Statistics and Hospital Activity Analysis for England and Wales. Private sector data from surveys with up to 97% coverage. METHODS AND MAIN OUTCOME: Measures NHS data by 5-year age group, year and operation type were collated for 1961-1995. non-NHS operations for 1981, 1986, and 1992/3 were back-projected. Hysterectomy incidence rates, 1961-95, were back-projected to estimate prevalence rates by accumulation. True populations at risk of disease and hysterectomy were calculated by applying one minus the relevant hysterectomy prevalence rates to the population by age group and year. RESULTS: When based on the true population at risk, the age standardised cervical cancer incidence rate in 1992 was 14.4 per 100,000, compared with 12.6 when based on the all women population estimate. Incidence rates for earlier years were also affected, but there was no important effect on the rate of change over time. Absolute changes for uterine cancer are greater because the true population at risk is proportionally smaller particularly at the older ages, but there are again no major effects on the rate of change. By 1995 2.3 million women in England and Wales were without a uterus, with a peak prevalence of 21.3% in the age group 55-59. Projections based on 1995 incidence rates show hysterectomy prevalence for the screened age groups, 25-64, will now fall. Subtotal hysterectomy is 3.5% of operations and increasing. CONCLUSIONS: True populations at risk must be used to assess the impact of screening if further reductions in cervix cancer incidence rates are not to be masked. It is essential to monitor hysterectomy by type, as subtotal hysterectomy is becoming more common. Hysterectomy incidence may have peaked. Hysterectomy prevalence in England and Wales may not be as high as would be estimated from some regional studies.

Adolescent↗