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Welfare Reform on the Web (December 2008): Healthcare - overseas

An activity-based cost analysis of the Honduras Community-Based Integrated Child Care (AIN-C) programme

J.L. Fiedler, C.A. Villalobos and A.C. De Mattos

Health Policy and Planning, vol.23, 2008, p. 408-427

The Community-Based Integrated Child Care (AIN-C) programme is a preventative health and nutrition programme run by the Honduras Ministry of Health that relies primarily on volunteers to help mothers monitor and maintain the adequate growth of young children under two, and to treat and refer children under five who are ill. It is a model for other countries interested in providing a community-based package of priority child care services. This study was undertaken to provide the first comprehensive estimates of the cost of the AIN-C programme, with the goal of providing a planning tool for Honduras. Once phased-in, the programme's long-term annual recurrent cost (US$6.43) and incremental budget requirement (US$3.90) per participating child represent modest expenditures to provide monthly weighing and counselling services for children under two and limited curative care services for children under five. The AIN-C programme model has the potential to increase service coverage at a cost per visit of 11% of a similar Ministry of Health facility-based service.

Are donor allocations for humanitarian health assistance based on needs assessment data?

J. von Schreeb and others

Global Public Health, vol. 3, 2008, p. 440-447

Donors agreed at an international meeting in 2003 that humanitarian aid should be allocated on the basis of a needs assessment. This research studied applications to the Swedish International Development Cooperation Agency for funding for healthcare projects to see if they contained needs assessment data. In 2003, a total of 258 million SEK were allocated to 38 healthcare projects. Two thirds of these applications lacked any estimates of need. Interviews with agency staff revealed that needs assessment data had a limited role in funding decisions, whereas the implementation capacity of the applicant was of great importance.

Does an expansion in private sector contraceptive supply increase inequality in modern contraceptive use?

S. Agha and M. Do

Healthcare Policy and Planning, vol. 23, 2008, p. 465-475

Analysis of data from demographic and health surveys in Morocco, Indonesia, Kenya, Ghana and Bangladesh found no support for the hypothesis that an increase in private sector contraceptive supply leads to higher inequality in the modern contraceptive prevalence rate. Continued public sector supply of contraceptives to the poorest women protects against increased inequality in modern contraceptive use. The study highlights the role of the public sector in building contraceptive markets for the private sector to exploit.

Health security as a public health concept: a critical analysis

W. Aldis

Health Policy and Planning, vol. 23, 2008, p. 369-375

Although the concept of health security is becoming accepted in public health literature and practice, there is no agreement on its scope and content. Incompatible understanding of the concept between developed and developing countries, coupled with fears of hidden national security agendas, are leading to a breakdown of mechanisms for global cooperation. Some developing countries are beginning to doubt that internationally shared health surveillance data are used in their best interests.

(For commentary see Health Policy and Planning, vol. 23, 2008, p. 376-378)

The 'healthcare state' in transition: national and international contexts of changing professional governance

E. Kuhlmann and V. Burau

European Societies, vol.10, 2008, p. 619-633

This article demonstrates the continuing importance of the national-level regulation of healthcare within the EU. Nation states often act as filters or sieves for adapting challenges originating from Europe. The paper challenges claims about European convergence and highlights the continuing significance of national regulatory frameworks. The critique of convergence is not total, however, as the authors also observe on-going hybridisation of health systems. New health policies and the drivers for change are broadly similar in all European health systems. Managerialism, markets and consumer choice are the preferred strategies of health policymakers across the EU.

Incentives and choice in health care

F.A. Sloan and H. Kasper (editors)

London: MIT Press, 2008

A vast body of empirical evidence has accumulated demonstrating that incentives affect health care choices made by both consumers and suppliers of health care services. Decisions in health care are affected by many types of incentives, such as the rate of return pharmaceutical manufacturers expect on their investments in research and development, or disincentives, such as increases in copayments patients must make when they visit physicians or are admitted to hospitals. In this volume, leading scholars in health economics review these new and important results and describe their own recent research assessing the role of incentives in health care markets and decisions people make that affect their personal health. The contexts include demand decisions - choices made by individuals about health care services they consume and the health insurance policies they purchase - and supply decisions made by medical students, practicing physicians, hospitals, and pharmaceutical manufacturers.

Modelling prenatal healthcare utilization in Tajikistan using a two-stage approach: implications for policy and research

N.N. Habibov and L. Fan

Health Policy and Planning, vol. 23, 2008, p. 443-451

Since the transition to a market economy, prenatal healthcare utilisation in Tajikistan has deteriorated both in terms of probability of use and frequency of use. An improvement in utilisation is essential for reducing child and maternal mortality. Findings suggest that higher educational attainment increases use of prenatal care. Conversely poverty, limited knowledge of matters related to sex, low quality of healthcare services, lack of public infrastructure and travel difficulties all reduce the use of prenatal healthcare. Progress towards broader improvements in these areas will have a positive impact on prenatal healthcare use.

Public production of anti-retroviral medicines in Brazil, 1990-2007

M. Flynn

Development and Change, vol. 39, 2008, p. 513-536

This article examines Brazil's experience with the public production of anti-retroviral drugs and highlights the vital role of the state in guaranteeing access to life saving medicines and fulfilling human rights commitments. It argues that three factors led to the government becoming a direct producer of anti-retroviral drugs:

  1. a pre-existing infrastructure of public laboratories that had served the public health system since the 1960s
  2. strong civil society pressures, including public health activists both inside and outside government
  3. a pharmaceutical sector characterised by high prices and controlled by transnational drug companies.

Toward a grounded theory of why some immunization programmes in sub-Saharan Africa are more successful than others: a descriptive and exploratory assessment in six countries

J.F. Naimoli and others

Healthcare Policy and Planning, vol. 23, 2008, p. 379-389

This study set out to explore why some immunisation programmes in sub-Saharan Africa are more successful than others. The findings suggest that there are different paths to success, and that not only what countries do, but how they execute their programmes, seem to make a difference to coverage outcomes. Solutions to overcoming the challenge of sustained immunisation coverage do not reside exclusively within immunisation programmes; strengthening health systems can potentially enhance more direct efforts by programmes to improve their performance.

Universal public health insurance and private coverage: externalities in health care consumption

S. Glied

Canadian Public Policy, vol. 34, 2008, p. 345-357

Private sources (out-of-pocket payments and private insurance) constitute an increasingly large share of total health care expenditures in most developed countries with predominantly public health insurance systems, including Canada. This article explores arguments that such a mix is undesirable in the case of health care. The analysis is based on the assumption that private purchases of healthcare should be limited if such purchases make non-purchasers worse off. Results suggest that private purchase does not have a direct impact on the health on non-purchasers, but does have significant fiscal implications for the public insurance system and may reduce social welfare if people value the degree of equality in itself.

Women's social position and health-seeking behaviours: is the health care system accessible and responsive in Pakistan?

B.T. Shaikh, D. Haran and J. Hatcher

Health Care for Women International, vol. 29, 2008, p. 945-959

More than two-thirds of Pakistan's population live in remote and rural areas with minimal access to good quality health services. Data were collected via a household survey to gain insight into women's health-seeking behaviours and to explore the various determinants of health service utilisation. Results showed that more than one third of women did not know the cause of their illness, due to low levels of education and lack of exposure to the world outside the home. Women used the Aga Khan Health Services, Pakistan rather than government facilities because of the greater availability of female staff and a perception that the quality of treatment was better. Consulting faith healers and going to shrines rather than getting medical advice was found to be culturally acceptable. In order to combat lack of knowledge of the causes of illness, mass health promotion and education campaigns are needed. To encourage greater use of the government healthcare system, the recruitment of more female staff is vital. Community health workers could also be used to combat unsafe health behaviours such as reliance on visiting shrines.

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