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PubMed1995

The impact of alternative cost recovery schemes on access and equity in Niger.

The authors examine accessibility and the sustainability of quality health care in a rural setting under two alternative cost recovery methods, a fee-for-service method and a type of social financing (risk-sharing) strategy based on an annual tax+fee-for-service. Both methods were accompanied by similar interventions aimed at improving the quality of primary health services. Based on pilot tests of cost recovery in the non-hospital sector in Niger, the article presents results from baseline and final survey data, as well as from facility utilization, cost, and revenue data collected in two test districts and a control district. Cost recovery accompanied by quality improvements increases equity and access to health care and the type of cost recovery method used can make a difference. In Niger, higher access for women, children, and the poor resulted from the tax+fee method, than from the pure fee-for-service method. Moreover, revenue generation per capita under the tax+fee method was two times higher than under the fee-for-service method, suggesting that the prospects of sustainability were better under the social financing strategy. However, sustainability under cost recovery and improved quality depends as much on policy measures aimed at cost containment, particularly for drugs, as on specific cost recovery methods.

Cost Sharing↗
PubMed2000

Massive outbreak of poliomyelitis caused by type-3 wild poliovirus in Angola in 1999.

The largest outbreak of poliomyelitis ever recorded in Africa (1093 cases) occurred from 1 March to 28 May 1999 in Luanda, Angola, and in surrounding areas. The outbreak was caused primarily by a type-3 wild poliovirus, although type-1 wild poliovirus was circulating in the outbreak area at the same time. Infected individuals ranged in age from 2 months to 22 years; 788 individuals (72%) were younger than 3 years. Of the 590 individuals whose vaccination status was known, 23% had received no vaccine and 54% had received fewer than three doses of oral poliovirus vaccine (OPV). The major factors that contributed to this outbreak were as follows: massive displacement of unvaccinated persons to urban settings; low routine OPV coverage; inaccessible populations during the previous three national immunization days (NIDs); and inadequate sanitation. This outbreak indicates the urgent need to improve accessibility to all children during NIDs and the dramatic impact that war can have by displacing persons and impeding access to routine immunizations. The period immediately after an outbreak provides an enhanced opportunity to eradicate poliomyelitis. If continuous access in all districts for acute flaccid paralysis surveillance and supplemental immunizations cannot be assured, the current war in Angola may threaten global poliomyelitis eradication.

Acute Disease↗
PubMedDate not supplied

The availability and accessibility of the contraceptive implant from family planning agencies in the United States, 1991-1992.

During the first year and a half after the hormonal contraceptive implant became available in February 1991, an estimated 81,100 women obtained this method from family planning agencies in the United States. Nevertheless, according to a recent survey of family planning providers, implant availability through the family planning clinic system is still far from universal. By September 30, 1992, only 40% of all family planning agencies were offering implant services to their clients: That proportion ranged from 30% of health department family planning providers to 80% of Planned Parenthood affiliates. Some of the key reasons cited by agencies that do not yet provide implants include the special clinician training required to learn insertion and removal procedures, and the cost of the method. Furthermore, full accessibility of this method to low-income women attending family planning clinics has been limited primarily to those who receive Medicaid, which has paid for more than 60% of all hormonal implants inserted by family planning agencies.

Contraceptive Agents, Female↗
PubMed2000

Inequality of child mortality among ethnic groups in sub-Saharan Africa.

Accounts by journalists of wars in several countries of sub-Saharan Africa in the 1990s have raised concern that ethnic cleavages and overlapping religious and racial affiliations may widen the inequalities in health and survival among ethnic groups throughout the region, particularly among children. Paradoxically, there has been no systematic examination of ethnic inequality in child survival chances across countries in the region. This paper uses survey data collected in the 1990s in 11 countries (Central African Republic, Côte d'Ivoire, Ghana, Kenya, Mali, Namibia, Niger, Rwanda, Senegal, Uganda, and Zambia) to examine whether ethnic inequality in child mortality has been present and spreading in sub-Saharan Africa since the 1980s. The focus was on one or two groups in each country which may have experienced distinct child health and survival chances, compared to the rest of the national population, as a result of their geographical location. The factors examined to explain potential child survival inequalities among ethnic groups included residence in the largest city, household economic conditions, educational attainment and nutritional status of the mothers, use of modern maternal and child health services including immunization, and patterns of fertility and migration. The results show remarkable consistency. In all 11 countries there were significant differentials between ethnic groups in the odds of dying during infancy or before the age of 5 years. Multivariate analysis shows that ethnic child mortality differences are closely linked with economic inequality in many countries, and perhaps with differential use of child health services in countries of the Sahel region. Strong and consistent results in this study support placing the notion of ethnicity at the forefront of theories and analyses of child mortality in Africa which incorporate social, and not purely epidemiological, considerations. Moreover, the typical advantage of relatively small, clearly defined ethnic groups, as compared to the majority in the national population, according to fundamental indicators of wellbeing--child survival, education, housing, and so forth--suggests that many countries in sub-Saharan Africa, despite their widespread poverty, are as marked by social inequality as are countries in other regions in the world.

Africa South of the Sahara↗
PubMedDate not supplied

Comparing the Peru service availability module and situation analysis.

This report reviews the experience of the World Fertility Surveys and the Demographic and Health Surveys (DHS) in collecting community-level data on family planning. It assesses the validity of the community data for Peru that were collected via a service availability module, much like that which is used for the DHS, through a comparison with data from the Situation Analysis. The analysis indicates that the knowledgeable informant, the main source of information about family planning in each community for the service availability module, may not be an accurate source of data. Information about the availability of family planning services is more reliable when it is obtained by means of visits to service sites. However, given cost considerations, sampling problems, and analysis issues, routine linkage of Situation Analyses to household surveys such as the DHS is not recommended at this time.

Contraception Behavior↗
PubMed1996

Use of health services by urban youth: a school-based survey to assess differences by grade level, gender, and risk behavior.

PURPOSE: The purpose of this study was: (a) to describe reported access to health care among urban youth, and (b) to compare intention to seek care and risk behaviors for youth who did and did not seek care. METHODS: A cross-sectional survey measuring knowledge, attitudes, self-efficacy, and behavioral intentions related to sexuality and use of and access to health care was administered to 3,677 urban middle and high school students in health education classes. RESULTS: A total of 13% of students reported no established health care, whereas 25% reported no care within the past 6 months. A physical examination was the most common reason for seeking care. Younger teenagers, males, and those not under care were less aware of teen clinics, thought it more difficult to access care, and had less intention to seek care within the next year (P < .001). Older students had greater knowledge and self-efficacy concerning sexual matters, were less positive about abstinence, and higher life and sex risk scores (P < .001). Females reported greater self-efficacy regarding sexual matters, were more positive about abstinence, and had lower life risk scores (P < .001). Adolescents receiving care had higher knowledge and self-efficacy scores, were more positive about condoms, had greater intention to seek care, but had higher life and sex risk scores. CONCLUSIONS: Awareness and use of health care remain low for a sizable number of at risk urban youth, especially younger and male teenagers. The school is a setting in which adolescents not under care can be reached for provision of information about health care.

Adolescent↗
PubMedDate not supplied

Review on development and community implementation of oral rehydration therapy.

The review of the current status and implementation of Oral Rehydration Therapy at the community level have been presented in this communication with special emphasis on its development, ORS access rate, ORS use rate and home available fluids. The global ORS supply has gone up an increased eleven folds since 1981. Similarly the ORS access rate has also increase from 46% to 68% in 1991. However, the global ORS use rate was low (21%). The major constraints during ORT implementation which have been reported by several scientists are also discussed.

Asia↗