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Availability of essential health services in post-conflict Liberia
To assess the availability of essential health services in northern Liberia in 2008, five years after the end of the civil war.
We carried out a population-based household survey in rural Nimba county and a health facility survey in clinics and hospitals nearest to study villages. We evaluated access to facilities that provide index essential services: artemisinin combination therapy for malaria, integrated management of childhood illness, human immunodeficiency virus (HIV) counselling and testing, basic emergency obstetric care and treatment of mental illness.
Data were obtained from 1405 individuals (98% response rate) selected with a three-stage population-representative sampling method, and from 43 of Nimba county's 49 health facilities selected because of proximity to the study villages. Respondents travelled an average of 136 minutes to reach a health facility. All respondents could access malaria treatment at the nearest facility and 55.9% could access HIV testing. Only 26.8%, 14.5%, and 12.1% could access emergency obstetric care, integrated management of child illness and mental health services, respectively.
Although there has been progress in providing basic services, rural Liberians still have limited access to life-saving health care. The reasons for the disparities in the services available to the population are technical and political. More frequently available services (HIV testing, malaria treatment) were less complex to implement and represented diseases favoured by bilateral and multilateral health sector donors. Systematic investments in the health system are required to ensure that health services respond to current and future health priorities.
Journal Article
Divided : the perils of our growing inequality
\"The issue of inequality has irrefutably returned to the fore, riding on the anger against Wall Street following the 2008 financial crisis and the concentration of economic and political power in the hands of the super-rich. The Occupy movement made the plight of the 99 percent an indelible part of the public consciousness, and concerns about inequality were a decisive factor in the 2012 presidential elections. How bad is it? According to Pulitzer Prize-winning journalist David Cay Johnston, most Americans, in inflation-adjusted terms, are now back to the average income of 1966. Shockingly, from 2009 to 2011, the top 1 percent got 121 percent of the income gains while the bottom 99 percent saw their income fall. Yet in this most unequal of developed nations, every aspect of inequality remains hotly contested and poorly understood. Divided collects the writings of leading scholars, activists, and journalists to provide an illuminating, multifaceted look at inequality in America, exploring its devastating implications in areas as diverse as education, justice, health care, social mobility, and political representation. Provocative and eminently readable, here is an essential resource for anyone who cares about the future of America--and compelling evidence that inequality can be ignored only at the nation's peril. \"-- Provided by publisher.
Book
Inequalities in utilization of maternal and child health services in Ethiopia: the role of primary health care
Background
Health systems aim to narrow inequality in access to health care across socioeconomic groups and area of residency. However, in low-income countries, studies are lacking that systematically monitor and evaluate health programs with regard to their effect on specific inequalities. We aimed to measure changes in inequality in access to maternal and child health (MCH) interventions and the effect of Primary Health Care (PHC) facilities expansion on the inequality in access to care in Ethiopia.
Methods
The Demographic and Health Survey datasets from Ethiopia (2005 and 2011) were used. We calculated changes in utilization of MCH interventions and child morbidity. Concentration and horizontal inequity indices were estimated. Decomposition analysis was used to calculate the contribution of each determinant to the concentration index.
Results
Between 2005 and 2011, improvements in aggregate coverage have been observed for MCH interventions in Ethiopia. Wealth-related inequality has remained persistently high in all surveys. Socioeconomic factors were the main predictors of differences in maternal and child health services utilization and child health outcome. Utilization of primary care facilities for selected maternal and child health interventions have shown marked pro-poor improvement over the period 2005–2011.
Conclusions
Our findings suggest that expansion of PHC facilities in Ethiopia might have an important role in narrowing the urban-rural and rich-poor gaps in health service utilization for selected MCH interventions.
Journal Article
Hidden systems : water, electricity, the internet, and the secrets behind the systems we use every day
\"What was the first message sent over the internet? How much water does a single person use every day? How was the electric light invented? For every utility people use each day, there's a hidden history below the surface - a story of intrigue, drama, humor, and inequity. This graphic novel provides a guided tour through the science of the past - and how the decisions people made while inventing and constructing early technology still affect the way people use it today. Full of art, maps, and diagrams, Hidden Systems is a thoughtful, humorous exploration of the history of science, and what needs to be done now to change the future.\"-- Provided by publisher.
Book
Transformative Innovations in Reproductive, Maternal, Newborn, and Child Health over the Next 20 Years
As part of the \"Grand Convergence: Aligning Technologies and Realities in Global Health\" Collection, Cyril Engmann and colleagues discuss promising innovations that have the potential to move the RMNCH agenda forward.
Journal Article
Use of human rights to meet the unmet need for family planning
In this report, we describe how human rights can help to shape laws, policies, programmes, and projects in relation to contraceptive information and services. Applying a human rights perspective and recognising the International Conference on Population and Development and Millennium Development Goal commitments to universal access to reproductive health including family planning, we support measurement of unmet need for family planning that encompasses more groups than has been the case until recently. We outline how human rights can be used to identify, reduce, and eliminate barriers to accessing contraception; the ways in which human rights can enhance laws and policies; and governments' legal obligations in relation to contraceptive information and services. We underline the crucial importance of accountability of states and identify some of the priorities for making family planning available that are mandated by human rights.
Journal Article
Availability of drugs and medical supplies for emergency obstetric care: experience of health facility managers in a rural District of Tanzania
Background
Provision of quality emergency obstetric care relies upon the presence of skilled health attendants working in an environment where drugs and medical supplies are available when needed and in adequate quantity and of assured quality. This study aimed to describe the experience of rural health facility managers in ensuring the timely availability of drugs and medical supplies for emergency obstetric care (EmOC).
Methods
In-depth interviews were conducted with a total of 17 health facility managers: 14 from dispensaries and three from health centers. Two members of the Council Health Management Team and one member of the Council Health Service Board were also interviewed. A survey of health facilities was conducted to supplement the data. All the materials were analysed using a qualitative thematic analysis approach.
Results
Participants reported on the unreliability of obtaining drugs and medical supplies for EmOC; this was supported by the absence of essential items observed during the facility survey. The unreliability of obtaining drugs and medical supplies was reported to result in the provision of untimely and suboptimal EmOC services. An insufficient budget for drugs from central government, lack of accountability within the supply system and a bureaucratic process of accessing the locally mobilized drug fund were reported to contribute to the current situation.
Conclusion
The unreliability of obtaining drugs and medical supplies compromises the timely provision of quality EmOC. Multiple approaches should be used to address challenges within the health system that prevent access to essential drugs and supplies for maternal health. There should be a special focus on improving the governance of the drug delivery system so that it promotes the accountability of key players, transparency in the handling of information and drug funds, and the participation of key stakeholders in decision making over the allocation of locally collected drug funds.
Journal Article
The Efficacy of an Integrated Risk Reduction Intervention for HIV-Positive Women With Child Sexual Abuse Histories
Child sexual abuse (CSA) is associated with HIV risk behaviors [Bensley, L., Van Eenwyk, J., and Simmons, K. W., 2003.] and more prevalent among women living with HIV than in the general population [Koenig, L. J., and Clark, H., 2004]. This randomized Phase~I clinical trial tested the impact of a culturally congruent psychoeducational intervention designed to reduce sexual risks and increase HIV medication adherence for HIV-positive women with CSA histories. An ethnically diverse sample of 147 women were randomized to two conditions: an 11-session Enhanced Sexual Health Intervention (ESHI) or an attention control. Results based on \"intent to treat'' analyses of pre-post changes are reported here. Additional analyses explored whether the observed effects might depend on \"intervention dose,'' i.e., number of sessions attended. Women in the ESHI condition reported greater sexual risk reduction than women in the control condition. Although there were no differences between women in the ESHI and control groups on medication adherence, women in the ESHI condition who attended 8 or more sessions reported greater medication adherence at posttest than control women. The findings provide initial support for this culturally and gender-congruent psychoeducational intervention for HIV-positive women with CSA, and highlight the importance of addressing the effects of CSA on sexual risk reduction and medication adherence in preventive interventions for women.
Journal Article