VAUGHAN,, PATRICK;WALT,, GILL;BENNETT-JONES,, NICOLA
doi: 10.1093/heapol/1.1.3pmid: N/A
Article PDF first page preview Close This content is only available as a PDF. © 1986 Oxford University Press
doi: 10.1093/heapol/1.1.5pmid: N/A
Abstract Traditionally, cities have benefited from a disproportionate share of the resources available for health care and, as a result, most developments in primary health care have been in rural areas. Recently, however, attention has been called to the inequities that exist within cities and to the rapid growth of the urban poor. This paper reviews the topic of primary health care and the urban poor in developing countries. The disease patterns of the urban poor reflect the problems of underdevelopment and industrialization. The few studies that focus upon the health problems of the urban poor demonstrate a prevalence of infectious diseases and malnutrition which is comparable to and often greater than that observed in rural populations. At the same time, however, the urban poor suffer the typical spectrum of chronic and social diseases. The magnitude of the health problems of the urban poor rarely emerges in city health statistics. This is either because the ‘unofficial’ squatters and shanty town or slum inhabitants do not appear in the statistics or because their conditions are obscured by the enormous difference that exists between their status and that of the urban elite. At the community level there is now evidence of relevant, constructive and hopeful approaches to helping the urban poor through primary health care. Although there are few analytical or evaluative examinations of such initiatives, it is possible to identify emerging trends such as the development of neighbourhood health programmes, the use of community health workers and attempts to link hospital services with community health action. It remains to be seen whether the health departments in any cities can bring about the co-ordination and support needed for the improvement of environmental and socio-economic conditions which are fundamental for improving health. Also, international agencies need to focus more attention upon the particular plight of the urban poor. This content is only available as a PDF. © 1986 Oxford University Press
BARROS, FERNANDO, C;VAUGHAN, J, PATRICK;VICTORA, CESAR, G
doi: 10.1093/heapol/1.1.19pmid: 10283013
Abstract Caesarean sections in Brazil rose from 15 per cent of all births in 1970 to over 30 per cent in 1980. A new policy was introduced by the largest medical care provider (INAMPS) which made the reimbursement fee payable to doctors the same for both vaginal and caesarean section deliveries. However the caesarean rate has continued to rise. This study analysed the antenatal care and deliveries of over 7000 births which occurred during 1982 in the city of Pelotas in southern Brazil. The organization of health care is discussed in relation to the findings on the utilization of the different antenatal and delivery services available. Utilization is then related to the gestational risk and socio-economic status of the mothers. There were marked differentials between the low and high risk mothers and between those from high and low income families. Doctors clearly concentrated their efforts on the low risk and high income mothers, with 50 per cent of private patients having an operative delivery compared to 13 per cent of uninsured mothers. There was a large demand for tubal ligations to be carried out at the same time as the caesareans. The non-medical and financial reasons for these high rates are discussed and the high extra cost that is being incurred by patients and the insurance schemes is emphasized. This content is only available as a PDF. © 1986 Oxford University Press
doi: 10.1093/heapol/1.1.30pmid: N/A
Abstract A nurse practitioner programme was established in Jamaica in the 1970s when it became clear that the demand for health centres which provided curative as well as preventive care could not be met by medically-trained personnel alone. Nurse practitioners (NPs) were to assume specific medical responsibilities beyond those normally assumed by nurses. It was recognized that for the scheme to work efficiently the medical and nursing professions would have to co-operate and that doctors would have to accept the expanded role of the NPs. The initial plan also emphasized the need for legislation controlling the training and practice of nurse practitioners. However, the matter of legislation was not dealt with when the programme was implemented. In the implementation of the programme great care was taken to consult with doctors and gain their acceptance of the programme. It was not appreciated, however, how important acceptance of the programme by pharmacists would be. When trained NPs began to practise, pharmacists refused to accept their prescriptions unless they were countersigned by a doctor, since the legal right of NPs to prescribe had not been established. This decision by pharmacists threatened the operation of the whole programme. The problems were discussed and eventually practice protocols directing the practice of NPs were prepared and accepted by all professional groups involved. Standing orders which define the relationship of NPs to other health workers were also prepared with a view to moving on to legislation as soon as possible. This content is only available as a PDF. © 1986 Oxford University Press
doi: 10.1093/heapol/1.1.37pmid: 10312155
Abstract The World Health Organization's ‘Global Strategy’ is an ambitious vision, but to achieve its goals it must first be implemented. Implementation will require careful and detailed planning. This paper evaluates the possibilities of transforming the Global Strategy from a laudable policy initiative into an actual ‘Plan for Health’, from the point of view of a health economist. This economic evaluation assesses the probable costs of implementing various activities of the Strategy, and the likelihood that developing countries will be able to afford these costs, either on their own, or with the assistance of the developed countries. A final section considers the current global situation and presents trends over the last two decades. The numbers of countries that have already achieved the goals of the Strategy, that can be expected to achieve the goals of the Strategy by the year 2000, and that are unlikely to achieve these goals (on the basis of current trends) are shown. The WHO ‘success indicator’ based on numbers of countries is compared to a more epidemiological one based on deciles of the world's population. It is argued that, even several years after the initiation of the Global Strategy, insufficient information exists on the next logical step of transforming the Policy into a Plan. Unless adequate attention is paid to this vital step, implementation of the Strategy will inevitably be ad hoc and patchy. Further research on the costs of the activities proposed by the Global Strategy, and the probable effects on health of those activities, is desperately needed. This content is only available as a PDF. © 1986 Oxford University Press
doi: 10.1093/heapol/1.1.48pmid: N/A
Abstract Health indicators and factors affecting health status were surveyed in 4 areas of Mashonaland, Zimbabwe, in order to compare the health status of different occupational groups, in particular farm labourers, mineworkers and peri-urban workers. The surveys included nutritional anthropometry of the under 5s, data on demographic patterns and interviews to assess factors such as income, diet, environmental conditions and access to health services. It was found that the health status of children was poorest in the commercial farm areas. Poor health status was associated with other unfavourable factors including overcrowding, poor housing, poor access to water supplies and insanitary conditions. Income per household, relative to a poverty datum line computed for each area, was very much lower in the commercial farm areas than in the urban and mine areas. Farm labourers, who are shown by this study to be disadvantaged in many ways when compared to other occupational groups, are also in the most unfavourable position as regards trying to change the situation in which they find themselves, having neither a strong union nor representation on local councils. Legislation regulating both environmental and working conditions provides less protection to farm labourers than it does to the other labouring groups considered. It is concluded that the poor health status of disadvantaged groups in Zimbabwe will not be substantially improved while the national wealth remains in private hands. Policies to address ill health at its source will only be possible when there is public control of the national wealth. This content is only available as a PDF. © 1986 Oxford University Press
doi: 10.1093/heapol/1.1.58pmid: 10283014
Abstract National health policies of many countries stress priority for primary health care (PHC). This emphasis has arisen as a reaction to large expenditures on hospitals and sophisticated technology in major cities of developing countries, while vast rural populations have been virtually ignored. The paradox developed from colonial and neo-colonial emulation of European and North American medical models. In 1978, an international conference of WHO/UNICEF at Alma-Ata, USSR defined the meaning of PHC, along with several principles of organization and equity under which it should be provided. To reach rural people with PHC, thousands of community health workers have been prepared and stationed in villages. Their training, however, is very brief and, with weak supervision, their performance has been disappointing. To achieve the WHO goal of ‘Health for All’ through PHC requires greatly expanded education of public health leaders, who can supervise and inspire community personnel. This content is only available as a PDF. © 1986 Oxford University Press
NOSSEIR, NASEK, K;McCARTHY,, JAMES;GILLESPIE, DUFF, G;SHAH,, FARIDA
doi: 10.1093/heapol/1.1.67pmid: N/A
Abstract A community-based integrated health, family planning and social services programme in rural Egypt included, among other things, the distribution of oral rehydration salts (ORS) on a large scale. Since there was no prior experience of such a distribution in this area, an evaluation plan was developed specifically to provide rapid feedback through a series of mini-surveys. The mini-surveys were particularly valuable since the distribution of both ORS and contraceptives was staggered over a three year period, with three counties of Menoufia Governorate covered in the first year, three in the second and two in the third. Project officials were able to analyse one year's efforts in time to plan for the following year. Four different approaches to the distribution of oral rehydration salts were tried. Three months after each type of distribution took place, a mini-survey was conducted in the area targeted for the distribution. Results of the mini-surveys were analysed within two months of each survey, allowing programme officials ample time to consider the results and modify the delivery approach prior to the beginning of the subsequent rounds of programme activity. All four approaches were about equally successful in reaching the women in the villages and in communicating information. However, there were some negative reactions to the ORS distribution in the first three approaches. The last approach was the most successful, with many more women reporting that they would administer the treatment and, among those who would not, only a small percentage feeling that the treatment was harmful. These mini-surveys were very useful in quickly providing quantitative information on the manner in which women were reacting to the programme. However, mini-surveys would not be appropriate if project officials were interested in detailed characterization of women who correctly used oral rehydration salts or of women who felt the treatment would harm children. This content is only available as a PDF. © 1986 Oxford University Press
doi: 10.1093/heapol/1.1.75pmid: 10283015
Article PDF first page preview Close This content is only available as a PDF. © 1986 Oxford University Press
doi: 10.1093/heapol/1.1.77pmid: N/A
Article PDF first page preview Close This content is only available as a PDF. © 1986 Oxford University Press
Showing 1 to 10 of 17 Articles