Equity in health and economic globalisation

This article proposes that equity in health is inseparable from social equity in its broadest sense. An equitable system allows the lowest income sectors to have access to an acceptable level of basic goods and services. Equity in health thus entails decreasing the differences in access to, and use of all health services. Globalization, on the other hand, means the process by which economic power is expanding and increasingly concentrated in the hands of corporations that are progressively entering national economies worldwide through the international free-market ideology. Explored in this article were some ways in which globalization leads to inequities.     

Why is basic service access worse in slums? A synthesis of obstacles

Many residents of urban areas face joint obstacles to basic service access, but these barriers are more prevalent and severe in slum settlements. Analyses of obstacles have typically been conducted in a piecemeal rather than synthetic framework and have focused on access to single services rather than the range of services needed to support household welfare. By contrast, this study uses data from fieldwork in four slum settlements situated in Hyderabad, India to develop a typology synthesising the obstacles – economic, spatial, social, institutional, and political – to the full range of service access desired by residents. Economic differences explain little of the access deficit within this population. While social and institutional obstacles are more likely to explain slum formation and residence over the long term, variation in spatial and political factors present the most acute short-term access barriers. The article concludes by suggesting the most promising means for slum residents and supporting stakeholders to overcome multi-faceted obstacles.     

Health service utilization among widows living with HIV/AIDS: an interview survey in Manipur, India

Widows living with HIV/AIDS (WLHA) are a vulnerable and often overlooked group. The North Eastern Indian state of Manipur, which has one of the highest concentrations of HIV/AIDS cases in India, is not an exception. This paper aims to describe the pattern of and factors contributing to the use of health services by WLHA in Manipur. Structured face-to-face interviews were conducted among 510 respondents. Only 49% of the respondents were aware of available health facilities. The place of residence (67.8%) and appointment at a convenient time (70.8%) were the main factors affecting the use of health services. To improve access to health services, it is imperative that the services of trained health providers are made easily available. Policy makers and organizations working on HIV/AIDs should work together to remove the barriers to the use of health services, making them user friendly for vulnerable groups such as WLHA.     

The percentage of HIV treatment and prevention services in Kenya provided by faith-based health providers

ABSTRACT

Although the percentage of health services provided by the faith-based sector in sub-Saharan Africa is often cited along a range from 30% to 70%, depending on the country, such citations tend to be anecdotal and without reference to actual analysis of health service data. This article reports on a secondary analysis of health service data in Kenya to determine the percentage of HIV services provided by faith-based health providers. It then discusses the contributions of faith-based providers in light of these data, identifying opportunities and challenges involved in efforts to ensure that the resources of the faith-based sector are maximised.     

Financing primary health care: An NGO perspective

How is primary health care (PHC) to be funded in a climate of economic recession? The authors survey the financial implications of the Alma Ata Declaration of 1978 and the Bamako Initiative of 1987. They draw on a survey of over 100 Oxfam-funded health projects to assess four methods of PHC funding and their impact on the poorest users: charges for treatment, revolving drugs funds, personal insurance schemes, and income-generating projects.     

Community rehabilitation workers as catalysts for disability: inclusive youth development through service learning

This paper explores access to health and education for disabled youth in sites with and without community rehabilitation workers (CRWs). A cross-sectional survey using a structured questionnaire was undertaken in nine sites in South Africa, and a snowball sample of 523 disabled youths of both sexes, aged between 18 and 35 years, was selected. The survey found that a significantly larger proportion of disabled youth living in sites with CRWs were seen by health care workers at home, and that there was a large difference in educational access between sites with and without CRWs. CRWs are well positioned to promote equal citizenship for disabled youth through service learning with occupational therapy final year students to improve access to health and education, so that barriers to their participation in economic development are removed.     

Matching services with local preferences: managing primary education services in a rural district of India

India's poorest households have particularly little access to education. Urgent reforms are therefore needed to improve the universal availability of quality basic services and universal access to those services. At least 32 million children in India are estimated to not be enrolled and attending school. These children must be brought into schools in order to meet the goal of Universal Elementary Education (UEE). Widespread support exists for the decentralization of public services due to the equity and efficiency benefits associated with it. In particular, decentralization is seen to facilitate the matching of services with local preferences, increasing the chances of meeting policy goals. This approach is explored in the context of research conducted in a village of Raichur district, where poor households' preferences with regard to school timing are analyzed. Sections consider the equity and efficiency merits of decentralization, the agenda for improving education service delivery in India, users' relationship to the education system in Raichur district, how preferences are revealed, whose preferences are important in the conflict between local and policy perspectives, preference heterogeneity in the village context, and whether aspects of education services can be selectively decentralized.     

Qualitative methods for assessing conditional cash-transfer programmes: the case of Panama

Governments in Latin America and elsewhere have implemented conditional cash-transfer programmes to improve standards of living in populations defined as vulnerable and excluded from the benefits of development, in order to improve access to education and health services, and to improve human capital. Qualitative research conducted among three indigenous groups in Panama provides lessons for assessing these programmes on the basis of the perceptions and culturally informed beliefs and practices of potential beneficiaries. This article shows that required co-responsibilities should be matched with high-quality services that are consistently available and socially, culturally, and linguistically appropriate.     

A training approach for community maternal health volunteers that builds sustainable capacity

This article examines a training approach for community health volunteers which increased access to maternal health services in rural communities in Zambia. The effectiveness of the training approach was evaluated in an operations research component. Skilled birth attendance rates increased by 63% from baseline over a two-year period in the intervention districts, out-performing increases recorded in control sites at statistically significant levels. As a low-cost, high-impact intervention which shows good sustainability potential, the approach is suitable for national level scale-up and for adaptation for use in other countries in support of maternal and new-born health goals.     

Health for All by the Year 2000: What about the nomads?

Health for All by the Year 2000 (HFA/2000) was a goal embraced in 1978 by all countries, especially the developing countries. Therefore to that end, many countries have since established policies and plans to make healthcare accessible to all of their citizens. Such access has come to be regarded as a right, and the last 30 years have seen major growth in national systems of healthcare provision. However, while remarkable advances have been made in both health status and the healthcare sector in general, nomadic people still lag the furthest behind in every field of progress. They continue to be neglected and left out of the development mainstream, including access to health services. Some countries have large nomadic populations, such as Somalia, with more than 60% of its population nomads. All nomads share characteristics which include an unstable life pattern, an interest in livestock, suspicion of outsiders, strong cultural beliefs, and faith in their traditional medicine. Nomads' self-reliance and independence, their sense of identity and community organization, and the predictability of their movements between water-points favor the development of health services. In the interests of equity and social justice, and if HFA/2000 is to become a reality, nomadic people must have equal rights to better healthcare.     

Increasing access to rural maternal health services in Zambia through demand-side interventions

This paper examines a demand-side intervention that significantly increased access to maternal health services in rural Zambia in a context where skilled birth attendance rates had been stagnant for over two decades. Aspects of the intervention design that were crucial to the programme's success were the participatory and adult learning-centred approach used to mobilise intervention communities, the use of a community volunteer model, and the design's sensitivity and responsiveness to underlying social factors and problems. The demand-side intervention is already being scaled up in six districts, and is highly suitable for national level scale-up.     

Performance-based partnership Agreements for the reconstruction of the health system in Afghanistan

The reconstruction of the health system in Afghanistan is in its early stages, and donors have proposed Performance-based Partnership Agreements (PPAs) through which to subcontract the delivery of health services to private organisations, both for-profit and not-for-profit. Beyond ideological debates, this article sets out to explain the model underlying the PPA initiative and sheds light on empirical data concerning the assumed benefits of such an approach. The article studies privatisation and the contracting-out of health services, though there is as yet no information that can demonstrate the superiority of private over public service provision. Similarly, the merits of subcontracting have not been fully proven and such arrangements raise several ethical issues. Where PPAs are to be attempted, it is important to remain cautious and to ensure that operations are organised in such a way as to permit proper comparison. The paper concludes with recommendations to organisations involved in or considering the advantages of PPAs.     

Using key informant monitoring in safe motherhood programming in Nepal

This article discusses the methodology and application of the Key Informant Monitoring (KIM) tool as used by the Nepal Safer Motherhood Project (NSMP). NSMP aims to achieve a sustained increase in the uptake of midwifery and essential obstetric care services by addressing, among other things, constraints on access to such services. Data collected by community-based Key Informant Researchers (KIRs) are synthesised and used by NSMP and key project partners for monitoring and planning purposes. NSMP has used KIM findings to modify its main interventions at the local level. International and Nepali NGOs have adopted KIM in their safe motherhood and other development programmes. Village Development Committees, with support from NGOs and NSMP, have responded to issues raised by KIM by running maternal health awareness-raising campaigns, working with traditional healers, improving the quality of care, and facilitating local emergency transport and funding schemes. KIRs have proved effective as sources of information and as change agents, spreading safe motherhood messages to promote behaviour change.     

The South African telecommunications environment: a brief assessment of regulatory change

Abstract

Communications play a critical role in transforming society. Governments as the custodians of communications therefore have a serious obligation to ensure that all the people of their country have access to basic telecommunications services. Access to basic communication services is a right because communications is an enabler of social interaction across time and geographic space, a creator of economic development and prosperity for even the most dispersed populations. In South Africa, under apartheid, vast populations of people were excluded from this basic right of having access to communications, resulting in a serious backlog of basic communication services. One of the major objectives of the Afican National Congress (ANC) government when it came to power in 1994 was to ensure that communications were made available to all people even those in the most remote areas of South Africa. These objectives were constrained by a number of factors such as: telecommunications policy that favoured a monopolistic telecommunications environment. To re-engineer the South African telecommunications landscape, telecommunications policy has since 1994 evolved in a revolutionary way.     

Meaning or Measurement? Researching the Social Contexts of Health and Settlement among Newly-arrived Refugee Youth in Melbourne, Australia

What are the most appropriate methodological approaches forresearching the psychosocial determinants of health and wellbeingamong young people from refugee backgrounds over the resettlementperiod? What kinds of research models can involve young peoplein meaningful reflections on their lives and futures while simultaneouslyyielding valid data to inform services and policy? This paperreports on the methods developed for a longitudinal study ofhealth and wellbeing among young people from refugee backgroundsin Melbourne, Australia. The study involves 100 newly-arrivedyoung people 12 to 18 years of age, and employs a combinationof qualitative and quantitative methods implemented as a seriesof activities carried out by participants in personalized settlementjournals. This paper highlights the need to think outside thebox of traditional qualitative and/or quantitative approachesfor social research into refugee youth health and illustrateshow integrated approaches can produce information that is meaningfulto policy makers, service providers and to the young peoplethemselves.     

Access and coverage: which farmers do plant clinics reach in Uganda?

This article reports on a study that assessed farmers’ access to, and coverage of, five plant clinics operating from market places in two districts of Uganda. Despite the noticeable geographic and thematic coverage of the services, placing plant clinics at markets did not automatically ensure equitable access and high farmer attendance. Clinic users were predominantly middle-aged male farmers and overall attendance was relatively low. Uganda has taken plant clinics to scale in recent years due to their potential to strengthen the country’s responsiveness to pests and diseases. Optimising farmer reach and ensuring equity in access requires reviewing clinic placement, timing, and mobilisation strategies.     

加快中国对东盟服务出口的途径探讨——论服务业对外直接投资

随着中国东盟合作进程的加快，中国与东盟于2007年1月14日正式签署了《服务贸易协议》，该协议于2007年7月1日正式生效，宣告了双方服务贸易市场的开放，意味着中国东盟服务贸易进入了一个新的发展阶段，因此，研究如何推进中国东盟服务贸易发展成为一个新的热门话题。进入21世纪以来，国际直接投资向服务产业的转移已成为新的发展趋势，通过对外直接投资以商业存在实现的服务贸易已成为主要的服务贸易方式，本文从投资角度对如何推进中国东盟服务贸易进行初步探讨。     

中国—东盟服务贸易发展的现状及战略选择

在服务贸易的发展基础、产业结构、发展阶段和发展速度方面,中国与东盟国家存在较大的差异,双方的服务贸易存在较强的互补性,为双边服务贸易的发展壮大奠定了基础。为了进一步提高中国与东盟服务贸易的发展水平,双方需要立足比较优势,整合区内资源,促进服务贸易政策的调整与完善,并进一步提升服务业的开放水平。     

中国—东盟服务贸易发展与广西的战略选择

本文简要概括中国—东盟服务贸易"黄金十年"取得的成效,分析目前中国—东盟服务贸易发展存在的问题,从优化服务贸易结构、扩大服务业对外开放等5个方面论述构建中国—东盟服务贸易发展"钻石十年"的策略,并提出中国—东盟服务贸易发展"钻石十年"广西的战略选择。     

Decentralising urban health activities in developing countries

While there is considerable documented experience of decentralising health services in rural areas of developing countries, the decentralisation of health services in the urban context is rarely analysed. Urban development literature usually fails to address health issues, while the literature on the decentralisation of health services tends to ignore the urban sector. This article addresses the relationship between a Ministry of Health and a City Council, and identifies key issues to consider in the decentralisation of urban health activities: roles and responsibilities; legislation; coordination and communication; and resource constraints. The case-study from Maseru, Lesotho, highlights aspects of planning which need to be considered by national and local governments which are trying to strengthen urban health activities by decentralisation.