Health Policy and Planning

Dominic Montagu

doi: 10.1093/heapol/17.2.121pmid: 12000772

Grouping existing providers under a franchised brand, supported by training, advertising and supplies, is a potentially important way of improving access to and assuring quality of some types of clinical medical services. While franchising has great potential to increase service delivery points and method acceptability, a number of challenges are inherent to the delivery model: controlling the quality of services provided by independent practitioners is difficult, positioning branded services to compete on either price or quality requires trade-offs between social goals and provider satisfaction, and understanding the motivations of clients may lead to organizational choices which do not maximize quality or minimize costs. This paper describes the structure and operation of existing franchises and presents a model of social franchise activities that will afford a context for analyzing choices in the design and implementation of health-related social franchises in developing countries. Oxford University Press « Previous | Next Article » Table of Contents This Article Health Policy Plan. (2002) 17 (2): 121-130. doi: 10.1093/heapol/17.2.121 » Abstract Free Full Text (PDF) Free Classifications Review article Services Article metrics Alert me when cited Alert me if corrected Find similar articles Similar articles in Web of Science Similar articles in PubMed Add to my archive Download citation Request Permissions Disclaimer Citing Articles Load citing article information Citing articles via CrossRef Citing articles via Scopus Citing articles via Web of Science Citing articles via Google Scholar Google Scholar Articles by Montagu, D. Search for related content PubMed PubMed citation Articles by Montagu, D. Related Content Load related web page information Share Email this article CiteULike Delicious Facebook Google+ Mendeley Twitter What's this? Search this journal: Advanced » Current Issue December 2015 30 (10) Alert me to new issues The Journal About this journal Publishers' Books for Review Recent E-Letters Rights & Permissions Dispatch date of the next issue We are mobile – find out more Journals Career Network Published in association with The London School of Hygiene and Tropical Medicine Impact factor: 3.470 5-Yr impact factor: 3.552 Editors-in-Chief Virginia Wiseman and Sandra Mounier-Jack View full editorial board For Authors Instructions to authors Online submission instructions Submit Now! Author Self Archiving Policy Open access options for authors visit Oxford Open This journal enables compliance with the NIH Public Access Policy Alerting Services Email table of contents Email Advance Access CiteTrack XML RSS feed Corporate Services Advertising sales Reprints Supplements

DP Béhague, H Gonçalves, J Dias Da Costa

doi: 10.1093/heapol/17.2.131pmid: 12000773

This paper explores the local political setting in which primary health care and community participation have been implemented in Pelotas, Brazil over the past two decades. We argue that in a medically plural setting with a mixture of private and public health care schemes, capitalist-based principles and ideals (such as the predominant role given to technology) shape generalized concepts of good clinical skills and quality of care, thereby regulating the medical system as a whole. The analysis shows that some women living in shantytowns reject the negative class-based associations made with their communities in a variety of ways, including the non-use of their local primary health care (PHC) centre which they considered to be a poor substitute for what the wealthy take for granted. Recent studies show that primary level antenatal care is of low quality when compared with other sectors. Nevertheless, local politicians and physicians often blamed various aspects of local ‘culture’ (folk health beliefs, low valuing of biomedicine, lack of modern concepts of community-building and altruism) for failed PHC programmes, contributing a prejudicial feedback cycle between frustrated professionals often engaging in prejudicial clinical practices and offended users. Rather than discuss community participation through vague concepts such as empowerment and citizenship, those involved in PHC reform would do well to take explicit (publicly stated) responsibility for the socio-political, financial and bureaucratic constraints to PHC. Oxford University Press « Previous | Next Article » Table of Contents This Article Health Policy Plan. (2002) 17 (2): 131-143. doi: 10.1093/heapol/17.2.131 » Abstract Free Full Text (PDF) Classifications Article Services Article metrics Alert me when cited Alert me if corrected Find similar articles Similar articles in Web of Science Similar articles in PubMed Add to my archive Download citation Request Permissions Disclaimer Citing Articles Load citing article information Citing articles via CrossRef Citing articles via Scopus Citing articles via Web of Science Citing articles via Google Scholar Google Scholar Articles by Béhague, D. Articles by Dias Da Costa, J. Search for related content PubMed PubMed citation Articles by Béhague, D. Articles by Gonçalves, H. Articles by Dias Da Costa, J. Related Content Load related web page information Share Email this article CiteULike Delicious Facebook Google+ Mendeley Twitter What's this? Search this journal: Advanced » Current Issue December 2015 30 (10) Alert me to new issues The Journal About this journal Publishers' Books for Review Recent E-Letters Rights & Permissions Dispatch date of the next issue We are mobile – find out more Journals Career Network Published in association with The London School of Hygiene and Tropical Medicine Impact factor: 3.470 5-Yr impact factor: 3.552 Editors-in-Chief Virginia Wiseman and Sandra Mounier-Jack View full editorial board For Authors Instructions to authors Online submission instructions Submit Now! Author Self Archiving Policy Open access options for authors visit Oxford Open This journal enables compliance with the NIH Public Access Policy Alerting Services Email table of contents Email Advance Access CiteTrack XML RSS feed Corporate Services Advertising sales Reprints Supplements

HL Guyatt, J Kinnear, M Burini, RW Snow

doi: 10.1093/heapol/17.2.144pmid: 12000774

The relative cost of indoor residual house-spraying (IRS) versus insecticide-treated bednets (ITNs) forms part of decisions regarding selective malaria prevention. This paper presents a cost comparison of these two approaches as recently implemented by Merlin, a UK emergency relief organization funded through international donor support and working in the highland districts of Gucha and Kisii in Kenya. The financial costs (cash expenditures) and the economic costs (including the opportunity costs of using existing staff and volunteers, and an annualized cost for capital items) were assessed. The financial cost for IRS was US$0.86 per person protected, compared with $4.21 for ITNs (reducing to $3.42 to the provider assuming cost recovery). The economic cost per person protected for IRS was $0.88, compared with $2.34 for ITNs. The costs for ITNs were sensitive to the number of nets sold per community group (‘efficiency’), as the delivery costs constituted upwards of 40% of the total cost. However, even marked increases in efficiency of these groups could not reduce the costs of ITNs to that comparable with IRS, except if more than one cycle of IRS was needed. The implications of predicted reductions in the cost of insecticide for both IRS and ITNs are also explored. The provision of itemized cost data allows predictions to be made on changes in the design of these programmes. Under almost all design scenarios, IRS would appear to be a more cost-efficient means of vector control in the Kenyan highlands. Oxford University Press « Previous | Next Article » Table of Contents This Article Health Policy Plan. (2002) 17 (2): 144-153. doi: 10.1093/heapol/17.2.144 » Abstract Free Full Text (PDF) Free Classifications Article Services Article metrics Alert me when cited Alert me if corrected Find similar articles Similar articles in Web of Science Similar articles in PubMed Add to my archive Download citation Request Permissions Disclaimer Citing Articles Load citing article information Citing articles via CrossRef Citing articles via Scopus Citing articles via Web of Science Citing articles via Google Scholar Google Scholar Articles by Guyatt, H. Articles by Snow, R. Search for related content PubMed PubMed citation Articles by Guyatt, H. Articles by Kinnear, J. Articles by Burini, M. Articles by Snow, R. Related Content Load related web page information Share Email this article CiteULike Delicious Facebook Google+ Mendeley Twitter What's this? Search this journal: Advanced » Current Issue December 2015 30 (10) Alert me to new issues The Journal About this journal Publishers' Books for Review Recent E-Letters Rights & Permissions Dispatch date of the next issue We are mobile – find out more Journals Career Network Published in association with The London School of Hygiene and Tropical Medicine Impact factor: 3.470 5-Yr impact factor: 3.552 Editors-in-Chief Virginia Wiseman and Sandra Mounier-Jack View full editorial board For Authors Instructions to authors Online submission instructions Submit Now! Author Self Archiving Policy Open access options for authors visit Oxford Open This journal enables compliance with the NIH Public Access Policy Alerting Services Email table of contents Email Advance Access CiteTrack XML RSS feed Corporate Services Advertising sales Reprints Supplements

A Coutsoudis, AE Goga, N Rollins, HM Coovadia, on behalf of the Child Health Group

doi: 10.1093/heapol/17.2.154pmid: 12000775

There is vigorous controversy around whether HIV-infected women in developing countries should choose formula or breastfeeding for their infants. Formula eliminates HIV transmission but incurs risk of increased mortality, whereas breastfeeding has multiple benefits but entails risk of HIV transmission. International guidelines are available but need to be strengthened. This commentary summarizes data on the scale and rate of mother-to-child transmission (MTCT) of HIV through breastfeeding, and the hazards and benefits of breast- and formula-feeding. The case against providing free or subsidized formula to HIV-infected mothers is based on the following: it exacerbates disadvantages of formula feeding; compromises free choice; targets beneficiaries erroneously; creates a false perception of endorsement by health workers; compromises breastfeeding; results in disclosure of HIV status; ignores hidden costs of preparation of formula; increases mixed breastfeeding, which is an unsatisfactory method for all women; requires organization and management of programmes that are complicated and costly; and finally increases the ‘spill-over’ effect into the normal breastfeeding population. Recommendations to minimize these drawbacks include use of affordable antiretrovirals to reduce MTCT; investments in high-quality, widely available HIV counselling; support for choice of feeding; and exclusive breastfeeding for those who choose to breastfeed. Oxford University Press « Previous | Next Article » Table of Contents This Article Health Policy Plan. (2002) 17 (2): 154-160. doi: 10.1093/heapol/17.2.154 » Abstract Free Full Text (PDF) Free Classifications Article Services Article metrics Alert me when cited Alert me if corrected Find similar articles Similar articles in Web of Science Similar articles in PubMed Add to my archive Download citation Request Permissions Disclaimer Citing Articles Load citing article information Citing articles via CrossRef Citing articles via Scopus Citing articles via Web of Science Citing articles via Google Scholar Google Scholar Articles by Coutsoudis, A. Search for related content PubMed PubMed citation Articles by Coutsoudis, A. Articles by Goga, A. Articles by Rollins, N. Articles by Coovadia, H. Related Content Load related web page information Share Email this article CiteULike Delicious Facebook Google+ Mendeley Twitter What's this? Search this journal: Advanced » Current Issue December 2015 30 (10) Alert me to new issues The Journal About this journal Publishers' Books for Review Recent E-Letters Rights & Permissions Dispatch date of the next issue We are mobile – find out more Journals Career Network Published in association with The London School of Hygiene and Tropical Medicine Impact factor: 3.470 5-Yr impact factor: 3.552 Editors-in-Chief Virginia Wiseman and Sandra Mounier-Jack View full editorial board For Authors Instructions to authors Online submission instructions Submit Now! Author Self Archiving Policy Open access options for authors visit Oxford Open This journal enables compliance with the NIH Public Access Policy Alerting Services Email table of contents Email Advance Access CiteTrack XML RSS feed Corporate Services Advertising sales Reprints Supplements

Elizabeth Herdman

doi: 10.1093/heapol/17.2.161pmid: 12000776

This paper reflects on the contemporary health policy debate in Hong Kong, and the shape assigned to particular ‘problems’. Health reform discourses are identified to reveal the tensions that exist between the dominant biomedical discourse that focuses on individual responsibility, lifestyle change and health education while articulating a community development approach to health care reform. A critical review of the Consultation Document on Health Care Reform in Hong Kong, entitled Lifelong Investment in Health , will reveal a rhetorical commitment to health care reform alongside proposals that suggest little understanding of the changes required to implement such reform. In fact, the document proposes a model of health care that not only remains within the biomedical paradigm, but which if enacted may extend the influence of medicine into the psychosocial sphere. Edelman has defined policy as ‘a set of shifting, diverse, and contradictory responses to a spectrum of political interests’. The starting point from this perspective is the identification of the discursive construction of policy problems and the associated ‘spectrum of political interests’. It is an attempt to reveal the operation of power in places in which administrative, political and professional discourses tend to obscure it. Oxford University Press « Previous | Next Article » Table of Contents This Article Health Policy Plan. (2002) 17 (2): 161-166. doi: 10.1093/heapol/17.2.161 » Abstract Free Full Text (PDF) Free Classifications Article Services Article metrics Alert me when cited Alert me if corrected Find similar articles Similar articles in Web of Science Similar articles in PubMed Add to my archive Download citation Request Permissions Disclaimer Citing Articles Load citing article information Citing articles via CrossRef Citing articles via Scopus Citing articles via Web of Science Citing articles via Google Scholar Google Scholar Articles by Herdman, E. Search for related content PubMed PubMed citation Articles by Herdman, E. Related Content Load related web page information Share Email this article CiteULike Delicious Facebook Google+ Mendeley Twitter What's this? Search this journal: Advanced » Current Issue December 2015 30 (10) Alert me to new issues The Journal About this journal Publishers' Books for Review Recent E-Letters Rights & Permissions Dispatch date of the next issue We are mobile – find out more Journals Career Network Published in association with The London School of Hygiene and Tropical Medicine Impact factor: 3.470 5-Yr impact factor: 3.552 Editors-in-Chief Virginia Wiseman and Sandra Mounier-Jack View full editorial board For Authors Instructions to authors Online submission instructions Submit Now! Author Self Archiving Policy Open access options for authors visit Oxford Open This journal enables compliance with the NIH Public Access Policy Alerting Services Email table of contents Email Advance Access CiteTrack XML RSS feed Corporate Services Advertising sales Reprints Supplements

Eric E Seiber, Jane T Bertrand

doi: 10.1093/heapol/17.2.167pmid: 12000777

Previous studies have demonstrated consistently that the Mayan women of Guatemala have a far lower level of contraceptive use than their ladino counterparts (e.g. 50% versus 13% in the 1998 Demographic and Health Survey – DHS). Most researchers and practitioners have attributed this to social, economic and cultural differences between the two groups that result in Mayans having a far lower demand for family planning than ladinos. This paper tests an alternative hypothesis: that the contraceptive supply environment may be more limited for Mayans than ladinos. This analysis uses an innovative approach of linking household level data from the 1995/6 Guatemala DHS and with facility-level data from the 1997 Providers Census for four highland departments in which the latter was conducted. On average, married women of reproductive age in the four departments lived 2 km from a facility that provided some type of contraception. Mayans and ladinos did not differ significantly in terms of (1) mean distance to the closest facility offering family planning services, or (2) mean distance to a facility providing each specific method (except injectables). Mayans were more likely to live closer to an APROFAM clinic, whereas ladinos were closer to a facility that offered access to injectables. Otherwise, the family planning supply environment differed little for the two groups. However, access may not be the determining factor in contraceptive use, given that less than 8% of users got their (last) contraceptive from the nearest facility. Moreover, APROFAM – which was the nearest facility for only 7% of the respondents in this study – was the source of supply for 48% of users. Although this study does not directly measure quality, the characteristics that differentiate APROFAM from other service providers point to quality as more important than physical access or cost in source of contraception among this group of users. Oxford University Press « Previous | Next Article » Table of Contents This Article Health Policy Plan. (2002) 17 (2): 167-177. doi: 10.1093/heapol/17.2.167 » Abstract Free Full Text (PDF) Free Classifications Article Services Article metrics Alert me when cited Alert me if corrected Find similar articles Similar articles in Web of Science Similar articles in PubMed Add to my archive Download citation Request Permissions Disclaimer Citing Articles Load citing article information Citing articles via CrossRef Citing articles via Scopus Citing articles via Web of Science Citing articles via Google Scholar Google Scholar Articles by Seiber, E. E. Articles by Bertrand, J. T. Search for related content PubMed PubMed citation Articles by Seiber, E. E. Articles by Bertrand, J. T. Related Content Load related web page information Share Email this article CiteULike Delicious Facebook Google+ Mendeley Twitter What's this? Search this journal: Advanced » Current Issue December 2015 30 (10) Alert me to new issues The Journal About this journal Publishers' Books for Review Recent E-Letters Rights & Permissions Dispatch date of the next issue We are mobile – find out more Journals Career Network Published in association with The London School of Hygiene and Tropical Medicine Impact factor: 3.470 5-Yr impact factor: 3.552 Editors-in-Chief Virginia Wiseman and Sandra Mounier-Jack View full editorial board For Authors Instructions to authors Online submission instructions Submit Now! Author Self Archiving Policy Open access options for authors visit Oxford Open This journal enables compliance with the NIH Public Access Policy Alerting Services Email table of contents Email Advance Access CiteTrack XML RSS feed Corporate Services Advertising sales Reprints Supplements

MA Khan, JD Walley, SN Witter, A Imran, N Safdar

doi: 10.1093/heapol/17.2.178pmid: 12000778

An economic study was conducted alongside a clinical trial at three sites in Pakistan to establish the costs and effectiveness of different strategies for implementing directly observed treatment (DOT) for tuberculosis. Patients were randomly allocated to one of three arms: DOTS with direct observation by health workers (at health centres or by community health workers); DOTS with direct observation by family members; and DOTS without direct observation. The clinical trial found no statistically significant difference in cure rate for the different arms. The economic study collected data on the full range of health service costs and patient costs of the different treatment arms. Data were also disaggregated by gender, rural and urban patients, by treatment site and by economic categories, to investigate the costs of the different strategies, their cost-effectiveness and the impact that they might have on patient compliance with treatment. The study found that direct observation by health centre-based health workers was the least cost-effective of the strategies tested (US$310 per case cured). This is an interesting result, as this is the model recommended by the World Health Organization and International Union against Tuberculosis and Lung Disease. Attending health centres daily during the first 2 months generated high patient costs (direct and in terms of time lost), yet cure rates for this group fell below those of the non-observed group (58%, compared with 62%). One factor suggested by this study is that the high costs of attending may be deterring patients, and in particular, economically active patients who have most to lose from the time taken by direct observation. Without stronger evidence of benefits, it is hard to justify the costs to health services and patients that this type of direct observation imposes. The self-administered group came out as most cost-effective ($164 per case cured). The community health worker sub-group achieved the highest cure rates (67%), with a cost per case only slightly higher than the self-administered group ($172 per case cured). This approach should be investigated further, along with other approaches to improving patient compliance. Oxford University Press « Previous | Next Article » Table of Contents This Article Health Policy Plan. (2002) 17 (2): 178-186. doi: 10.1093/heapol/17.2.178 » Abstract Free Full Text (PDF) Free Classifications Article Services Article metrics Alert me when cited Alert me if corrected Find similar articles Similar articles in Web of Science Similar articles in PubMed Add to my archive Download citation Request Permissions Disclaimer Citing Articles Load citing article information Citing articles via CrossRef Citing articles via Scopus Citing articles via Web of Science Citing articles via Google Scholar Google Scholar Articles by Khan, M. Articles by Safdar, N. Search for related content PubMed PubMed citation Articles by Khan, M. Articles by Walley, J. Articles by Witter, S. Articles by Imran, A. Articles by Safdar, N. Related Content Load related web page information Share Email this article CiteULike Delicious Facebook Google+ Mendeley Twitter What's this? Search this journal: Advanced » Current Issue December 2015 30 (10) Alert me to new issues The Journal About this journal Publishers' Books for Review Recent E-Letters Rights & Permissions Dispatch date of the next issue We are mobile – find out more Journals Career Network Published in association with The London School of Hygiene and Tropical Medicine Impact factor: 3.470 5-Yr impact factor: 3.552 Editors-in-Chief Virginia Wiseman and Sandra Mounier-Jack View full editorial board For Authors Instructions to authors Online submission instructions Submit Now! Author Self Archiving Policy Open access options for authors visit Oxford Open This journal enables compliance with the NIH Public Access Policy Alerting Services Email table of contents Email Advance Access CiteTrack XML RSS feed Corporate Services Advertising sales Reprints Supplements

Steven Forsythe, Gilly Arthur, Gilbert Ngatia, Roselyn Mutemi, Joseph Odhiambo, Charles Gilks

doi: 10.1093/heapol/17.2.187pmid: 12000779

Objective : Voluntary counselling and testing (VCT) should be an important component in a country’s HIV/AIDS prevention and care strategy. However, the high cost of VCT raises concerns about the affordability of VCT in low-income countries. This study was designed to assess the costs of VCT and to identify potential ways of introducing VCT more affordably. Methodology : An economic evaluation was performed of VCT services in two rural health centres in Thika District and an urban health centre in Nairobi, Kenya. A contingent valuation study was also performed among VCT clients. Estimates were developed regarding the national cost of offering VCT services in Kenya. Results : VCT added US$6800 per year to the average cost of providing services at each of these three health centres. The evaluation revealed that the incremental cost, from the government’s perspective, of adding VCT is approximately $16 per client. The estimated incremental cost per client is significantly less than a previous cost estimate in Kenya which estimated a cost per client of $26. The difference in cost estimates is in part attributable to the emphasis of this project on integrating VCT services into existing health centres, rather than creating stand-alone sites. The cost of VCT services might be further reduced to as little as $8 per client if a government health worker could perform the counselling. A contingent valuation study indicated that most VCT clients would be willing to pay at least $2 for the service. However, if the full cost of the service were charged to the client, less than 5% of clients indicated they were willing and able to pay for the service. Conclusions : Integrating services into existing health centres can significantly reduce the cost of VCT. Additional cost reductions may be feasible if health centre staff are hired to perform the counselling. Furthermore, it appears that some level of cost recovery from VCT clients is feasible and can contribute to sustainability, although it is very unlikely that the full cost of the service could be recovered from the clients. The national provision of VCT in all Kenyan health centres is likely to be an affordable option, although additional operational research is required to determine the most appropriate way of scaling up VCT services throughout the country. Oxford University Press « Previous | Next Article » Table of Contents This Article Health Policy Plan. (2002) 17 (2): 187-195. doi: 10.1093/heapol/17.2.187 » Abstract Free Full Text (PDF) Free Classifications Article Services Article metrics Alert me when cited Alert me if corrected Find similar articles Similar articles in Web of Science Similar articles in PubMed Add to my archive Download citation Request Permissions Disclaimer Citing Articles Load citing article information Citing articles via CrossRef Citing articles via Scopus Citing articles via Web of Science Citing articles via Google Scholar Google Scholar Articles by Forsythe, S. Articles by Gilks, C. Search for related content PubMed PubMed citation Articles by Forsythe, S. Articles by Arthur, G. Articles by Ngatia, G. Articles by Mutemi, R. Articles by Odhiambo, J. Articles by Gilks, C. Related Content Load related web page information Share Email this article CiteULike Delicious Facebook Google+ Mendeley Twitter What's this? Search this journal: Advanced » Current Issue December 2015 30 (10) Alert me to new issues The Journal About this journal Publishers' Books for Review Recent E-Letters Rights & Permissions Dispatch date of the next issue We are mobile – find out more Journals Career Network Published in association with The London School of Hygiene and Tropical Medicine Impact factor: 3.470 5-Yr impact factor: 3.552 Editors-in-Chief Virginia Wiseman and Sandra Mounier-Jack View full editorial board For Authors Instructions to authors Online submission instructions Submit Now! Author Self Archiving Policy Open access options for authors visit Oxford Open This journal enables compliance with the NIH Public Access Policy Alerting Services Email table of contents Email Advance Access CiteTrack XML RSS feed Corporate Services Advertising sales Reprints Supplements

Anne Philpott, Dermot Maher, Heiner Grosskurth

doi: 10.1093/heapol/17.2.196pmid: 12000780

The scale and severity of the impact of the global HIV/AIDS pandemic on low-income countries, mainly those in sub-Saharan Africa, is almost unimaginable to people in high-income countries. There is a particularly pressing need to understand better how to ensure the translation into policy and practice of important research findings in HIV/AIDS prevention and care in countries threatened by fast spreading HIV epidemics. The purpose of this paper is to review the findings and implications of a policy analysis case study of an HIV/AIDS clinical trial that has been successful in influencing HIV prevention policy relevant to low-income countries, in order to identify illustrative lessons for HIV/AIDS researchers in the future. The case study sought to detail the interaction between researchers and policy-makers for this particular case study to ascertain detailed analysis by these two groups on the interaction between research and policy. The major findings of the policy analysis case study were that policy shift was a cumulative but non-linear process, with the Mwanza trial placing a crucial role in both boosting and confirming existing policy movements. Researchers and policy-makers held similar longitudinal views of the process and political environment. Key moments of communication tended to involve personal contact. The important role played by people and organizations who could work in both the research and policy communities was often mentioned as crucial in enabling research relevant policy shifts. Researchers may absorb themselves in the technicalities of their study without considering their role in pursuing the wider policy implications. The impact of research on policy must be an integral element of every stage of the research process. The case study illustrates the need to take a contextual view of the interaction between research and policy, and understand how changing political contexts affect receptivity to research outcomes. This will increase the likelihood of research findings having an impact on policy. The review reflects the authors’ experiences of working for organizations in non-governmental organization, bilateral development agency and academic settings. Oxford University Press « Previous | Next Article » Table of Contents This Article Health Policy Plan. (2002) 17 (2): 196-201. doi: 10.1093/heapol/17.2.196 » Abstract Free Full Text (PDF) Free Classifications Article Services Article metrics Alert me when cited Alert me if corrected Find similar articles Similar articles in Web of Science Similar articles in PubMed Add to my archive Download citation Request Permissions Disclaimer Citing Articles Load citing article information Citing articles via CrossRef Citing articles via Scopus Citing articles via Web of Science Citing articles via Google Scholar Google Scholar Articles by Philpott, A. Articles by Grosskurth, H. Search for related content PubMed PubMed citation Articles by Philpott, A. Articles by Maher, D. Articles by Grosskurth, H. Related Content Load related web page information Share Email this article CiteULike Delicious Facebook Google+ Mendeley Twitter What's this? Search this journal: Advanced » Current Issue December 2015 30 (10) Alert me to new issues The Journal About this journal Publishers' Books for Review Recent E-Letters Rights & Permissions Dispatch date of the next issue We are mobile – find out more Journals Career Network Published in association with The London School of Hygiene and Tropical Medicine Impact factor: 3.470 5-Yr impact factor: 3.552 Editors-in-Chief Virginia Wiseman and Sandra Mounier-Jack View full editorial board For Authors Instructions to authors Online submission instructions Submit Now! Author Self Archiving Policy Open access options for authors visit Oxford Open This journal enables compliance with the NIH Public Access Policy Alerting Services Email table of contents Email Advance Access CiteTrack XML RSS feed Corporate Services Advertising sales Reprints Supplements

David Bishai, Louis W Niessen, Mohan Shrestha

doi: 10.1093/heapol/17.2.202pmid: 12000781

Improved community participation in the financing of primary health care (PHC) is important for sustaining quality and availability of care in developing countries. This study asks whether the social status of members on a local support committee is associated with community contributions to PHC. A survey of PHC financing was conducted at 42 health facilities in two rural districts of Nepal (Jumla and Nawal Parasi). Complete data were available for 37 clinics. At each health facility, a trained interviewer collected information from the clinic administrator about the caste characteristics of the Village Development Committees (VDC) and the financial contributions made by VDCs towards the operation of the health facilities. Bivariate and multivariate logistic regression assessed the likelihood of financial contribution as it related to the caste and gender composition of the VDC as well as other characteristics of the VDC and the facility. VDCs with a majority of committee members in castes other than the highest two had higher odds of contributing to the health centre. We conclude that local development committees with a greater representation of middle and low caste members are more likely to contribute financially to the local health facility. Future research must determine the factors that lead some villages to include low caste villagers in local government. Oxford University Press « Previous | Next Article » Table of Contents This Article Health Policy Plan. (2002) 17 (2): 202-206. doi: 10.1093/heapol/17.2.202 » Abstract Free Full Text (PDF) Free Classifications Research report Services Article metrics Alert me when cited Alert me if corrected Find similar articles Similar articles in Web of Science Similar articles in PubMed Add to my archive Download citation Request Permissions Disclaimer Citing Articles Load citing article information Citing articles via CrossRef Citing articles via Scopus Citing articles via Web of Science Citing articles via Google Scholar Google Scholar Articles by Bishai, D. Articles by Shrestha, M. Search for related content PubMed PubMed citation Articles by Bishai, D. Articles by Niessen, L. W. Articles by Shrestha, M. Related Content Load related web page information Share Email this article CiteULike Delicious Facebook Google+ Mendeley Twitter What's this? Search this journal: Advanced » Current Issue December 2015 30 (10) Alert me to new issues The Journal About this journal Publishers' Books for Review Recent E-Letters Rights & Permissions Dispatch date of the next issue We are mobile – find out more Journals Career Network Published in association with The London School of Hygiene and Tropical Medicine Impact factor: 3.470 5-Yr impact factor: 3.552 Editors-in-Chief Virginia Wiseman and Sandra Mounier-Jack View full editorial board For Authors Instructions to authors Online submission instructions Submit Now! Author Self Archiving Policy Open access options for authors visit Oxford Open This journal enables compliance with the NIH Public Access Policy Alerting Services Email table of contents Email Advance Access CiteTrack XML RSS feed Corporate Services Advertising sales Reprints Supplements