WaSH as a maternal health issue: three perspectives from rural Uganda

Inadequate water, sanitation, and hygiene (WaSH) knowledge and practices affect maternal and newborn morbidity and mortality. This article describes postpartum knowledge, resources, and practices in three rural Ugandan hospitals. A lack of WaSH resources was problematic for both staff and newly-birthed mothers who demonstrated a lack of knowledge about the appropriate use of WaSH resources and the links between WaSH and health protection. These results suggest that in addition to increasing the availability of medical interventions, basic preventative public health practices should be reflected in policy and practice integrated across the spaces inhabited by pregnant women to achieve improved maternal and newborn outcomes.     

中国公共卫生财政资源分配公平性研究——基于社会剥夺的视角

"社会剥夺"是社会心理学的重要概念体系,本研究旨在基于社会剥夺的视角,对中国公共卫生财政分配的公平性及其公平性缺口进行定量评估.研究发现中国大部分西部和中部地区比多数东部地区具有较高的社会剥夺水平;较高社会剥夺水平的地区,其居民健康需求也较高;中国公共卫生财政资源地区间分布的公平性较差且部分地区公平性缺口较大;但公平性有逐年变好的趋势,这主要归功于政府对人均投入均等化的关注而并非对居民健康需求差异的关注.建议在新一轮医改中,政府应对公共卫生服务的"均等化"准确定位;应逐步建立以需求为导向的平等可及的转移支付机制,重点关注农业人口比重较大的地区,优先支持公平性缺口较大的地区;尽早开发科学有效的财政资源分配工具等.     

Reforming the World Health Organization: what influence do the BRICS wield?

The World Health Organization (WHO) is currently undergoing fundamental reform that is intended to impact its programmes and priority setting and its financial and governing structures. Within the reform debates, new relations of powers are emerging among traditional donors and emerging economies such as the ‘BRICS’: Brazil, Russia, India, China and South Africa. These five emerging economies have formally committed ‘to strengthen and legitimise the WHO as the coordinating authority in global health’ through the principle of multilateralism. In this paper, the results of a qualitative study – based on 21 key informant interviews – that seeks to better understand BRICS’ engagement in this organisation and the extent to which their action enables these countries to influence the reform process were presented. The results show that individual BRICS countries found natural pairings with each other on both particular elements of the reform, notably governance and WHO financing, and specific health issues. While numerous examples of individual BRICS countries seeking to raise the profile of specific health issues were found, some evidence of a coordinated effort to influence reform as a bloc was also found. Although this was largely limited to rhetorical announcements of support in formal Declarations and Communiqués, it nevertheless articulates a vision of the WHO as an organisation with a broad mandate delivered with sufficient, predictable funding.     

Access to infrastructure and human well-being: evidence from rural Nepal

This article documents the level of access to infrastructure and assesses its perceived impacts on human well-being in rural Nepal. The study found a more varied level of well-being in less remote communities and determined that the perceived impacts of access to infrastructure on human well-being is higher in more remote areas. Notably, access to roads received the highest priority among respondents, followed by drinking water and irrigation. The methodology and findings of this study have practical implications for rural development in hills and mountains where human settlements are highly dispersed and access is key to human well-being.     

Understanding accessibility to healthcare for elderly people in Bangladesh

Healthcare facilities for the rising number of elderly people living in rural and semi-urban areas in Bangladesh are insufficient. This article assesses the accessibility to healthcare for elderly people living in rural and semi-urban areas. Data collection was carried out using surveys, focus group discussions, and key informant interviews, and both quantitative and qualitative tools were used in analysis. Upazila hospitals, which are geographically easily accessible for elderly people in rural and semi-urban areas, have a dearth of specialist doctors to treat their chronic diseases and lack sophisticated diagnostic facilities. It is recommended that a course on gerontology be introduced in the medical curriculum to increase the number of available geriatricians, and resources allocated for sophisticated diagnostic facilities in upazila hospitals.     

Explaining Policy Stability and Change in Swiss Health Care Reforms

The article investigates recent health reforms and reform attempts in Switzerland. A substantial reform, the revision of the health insurance law in 1994, is followed by a long period of refused reform proposals and incremental change. In order to explain policy change and policy stability in health policies, we apply veto‐player theory to partisan and parliamentary debates on reform proposals of the health insurance from the end of the 1980s until today. Shifts in ideological positions of parties, especially with regard to the objective of solidarity, allowed for a new win‐set in the 1990s that was at the base of the law revision. Since then, the win‐set is empty as parties did not change their preferences. New and substantial reforms will only be possible, it is concluded, if the pivot player, the Christian‐democratic party, changes its ideological positions to a significant extent.     

Reducing Adolescents’ Perceived Barriers to Treatment and Increasing Help-seeking Intentions: Effects of Classroom Presentations by General Practitioners

The Building Bridges to General Practice (BBGP) program is an outreach initiative. It aims to reduce young peoples’ perceived knowledge- and belief-based barriers to engaging in treatment and to increase their behavioral intentions to consult a general medical practitioner (GP) for physical and psychological problems. By increasing intentions, the BBGP program aims to increase actual consultations with a GP for both types of problem. A quasi-experimental nested design was used to evaluate the effect of the intervention in three Australian high schools. A Treatment group (n = 173, M = 16 years) and Comparison group (n = 118, M = 15 years) completed questionnaires of perceived barriers, intentions and self-reported consultations with a GP. Questionnaires were completed 1 week before the intervention, 5 then 10 weeks post-intervention. The Treatment group, but not the Comparison group, showed reductions in perceived barriers over time, increased intentions to consult a GP for psychological problems and a significant correlation between intentions and subsequent GP consultations. Results support the utility of the intervention for improving adolescents’ beliefs, intentions and behavior related to consulting a GP for physical and psychological problems.

Shaping participation: an international NGO implementing a government participation policy

This article reports on a case study of how one NGO utilised a government participation policy to establish ostensibly participatory spaces in the Cambodian health sector. The ethnographic field study revealed how the NGO exerted influence in establishing and facilitating participative committees by controlling membership, resources, and meeting agendas. This resulted in limited citizen participation, with committees used to educate, lobby, and mobilise community leaders to work towards the NGO’s priorities rather than community identified needs. This case contributes to our understanding of insisted spaces and the role of third parties implementing government participation policies.     

The historical contribution of faith-based health providers in the Ecuadorian health system: an overview of the evidence

ABSTRACT

Faith-based health providers (FBHPs) have historically shaped the national health system in Ecuador, yet there is little robust evidence of this role, or their current contribution to the national health system. This article situates FBHPs in the Ecuadorian health system, using secondary analyses of national health surveys to consider changes in contribution from 1998 to 2014, and synthesising this with secondary literature. The research confirms the important role that FBHPs have historically played in Ecuador, but also shows that their current role needs to be better understood if universalisation of health service coverage is to be achieved.