Health Care Reforms

2018 ◽  
pp. 50-74
Author(s):  
Purendra Prasad
Keyword(s):  
Health Care ◽  
Medical Treatment ◽  
Rural Areas ◽  
Urban Areas ◽  
Social Protection ◽  
Vulnerable Groups ◽  
National Commission ◽  
Health Care Reforms ◽  
Indian State

How do 35 crore people in India survive on Rs 32 per person per day in urban areas and Rs 26 per person per day in rural areas? The data from National Commission for Enterprises in the Unorganised Sector indicates that 79 per cent of workers in the unorganised sector live on an income of less than Rs 20 a day. The growing recognition of the devastating effect of illnesses on the capacity of the labouring poor to work, and the rising cost of medical treatment prompted the Indian state to propose a new set of reforms to provide social protection for the unorganized workers. This chapter critiques these reforms, focusing on the possible strategies of inclusion and greater access to the vulnerable groups.

scholarly journals Health Insurance in Myanmar: The Views and Perception of Healthcare Consumers and Health System Informants on the Establishment of a Nationwide Health Insurance System

Risks ◽  
2018 ◽  
Vol 6 (3) ◽  
pp. 81
Author(s):  
Marjolein van Rooijen ◽  
Chaw-Yin Myint ◽  
Milena Pavlova ◽  
Wim Groot
Keyword(s):  
Health Insurance ◽  
Health System ◽  
Rural Areas ◽  
Social Protection ◽  
Vulnerable Groups ◽  
Health Insurance System ◽  
Structured Interviews ◽  
Insurance System ◽  
Supplementary Health Insurance ◽  
Insurance Model

(1) Background: Health insurance and social protection in Myanmar are negligible, which leaves many citizens at risk of financial hardship in case of a serious illness. The aim of this study is to explore the views of healthcare consumers and compare them to the views of key informants on the design and implementation of a nationwide health insurance system in Myanmar. (2) Method: Data were collected through nine focus group discussions with healthcare consumers and six semi-structured interviews with key health system informants. (3) Results: The consumers supported a mandatory basic health insurance and voluntary supplementary health insurance. Tax-based funding was suggested as an option that can help to enhance healthcare utilization among the poor and vulnerable groups. However, a fully tax-based funding was perceived to have limited chances of success given the low level of government resources available. Community-based insurance, where community members pool money in a healthcare fund, was seen as more appropriate for the rural areas. (4) Conclusion: This study suggests a healthcare financing mechanism based on a mixed insurance model for the creation of nationwide health insurance. Further inquiry into the feasibility of the vital aspects of the nationwide health insurance is needed.

scholarly journals ASHAs in rural India, the ray of hope for diabetes care

2014 ◽  
Vol 02 (01) ◽  
pp. 018-024 ◽  
Author(s):  
Bharathi Bhatt
Keyword(s):  
Health Care ◽  
Rural Health ◽  
Diabetes Care ◽  
Rural Areas ◽  
Urban Areas ◽  
Communicable Diseases ◽  
Social Health ◽  
Resource Limited ◽  
Grass Root ◽  
Multi Stakeholder

AbstractOut of 1.21 billion population of India, 69% of them live in rural areas. There is a wide disparity in the distribution of health infrastructure and services in rural areas as compared to that of urban areas. The National Rural Health Mission (NRHM) launched in 2005, aimed to bridge this gap has introduced Accredited Social Health Activists (ASHAs), as health activists into the rural health care. ASHA is an acronym for Accredited Social Health Activists and she has been so far instrumental in facilitating institutionalised delivery, child immunisation, ensuring family planning, besides organising village nutrition day. She has been the vital link between the community and the health care. India, as a nation that is progressing is trying to combat communicable diseases significantly but it is also witnessing the surfacing of a different problem. There is an increasing prevalence of non-communicable diseases (NCDs), including diabetes which poses a big economic burden so much so that NCDs have been labelled as ′a health and developmental emergency′. Diabetes competes with other health concerns in a struggle to secure government health funding. In this resource-limited context, innovative methods are required to reach out to people at grass root levels. ASHA, which means hope in Sanskrit, can be true to her name in providing increased access to diabetes care to the rural population, if adequately trained and empowered. A multi-stakeholder approach through a public-private-people partnership (PPPP) is needed to tackle the issue with this kind of magnitude. The current review focuses on providing suggestions on utilising ASHAs′ services in spreading awareness on diabetes and ensuring that people with diabetes (PWD) receive optimal diabetes care.

scholarly journals Study of Working Experience in Remote Rural Areas after Medical Graduation

2015 ◽  
Vol 12 (2) ◽  
pp. 121-125
Author(s):  
KR Thapa ◽  
BK Shrestha ◽  
MD Bhattarai
Keyword(s):  
Health Care ◽  
Rural Areas ◽  
Urban Areas ◽  
Sampling Method ◽  
Postgraduate Training ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Remote Areas ◽  
Convenience Sampling ◽  
A Priority

Background Posting of doctors in remote rural areas has always been a priority for Government; however data are scarce in the country about experience of doctors of working in remote areas after medical graduation.Objective A questionnaire survey of doctors was planned to analyze their experience of working after graduation in remote rural areas in various parts of the country.Method The cross-sectional survey was done by convenience sampling method. A one-page questionnaire with one partially closed-end and five open-end type questions was distributed to the doctors who had worked in remote rural areas after graduation under various governments’ postings.Result Two-third of participants had their home in urban areas and 89.8% had stayed for 1 to 5 years. About half of the participants had difficulty in getting the posting in the remote areas of their choice. Most participants indicated provision of opportunities for Residential (postgraduate) Training as their reasons of going to remote areas as well as their suggestions to encourage young graduates to go there. Similarly most also suggested appropriate career, salary and incentives to encourage doctors to go to work in remote areas. About 85% of participants pointed out the major problem faced while posted in remote areas as difficulty in handling varied situations with no guidance or seniors available around.Conclusion The notable points indicated by the participants are centered on the opportunity for Residential Training and difficulties faced without such training. Residential Training is a priority to be considered while planning the health policy for optimum health care of people.Kathmandu University Medical Journal Vol.12(2) 2014: 121-125

scholarly journals Decomposing inequality in catastrophic health expenditure for self-reported hypertension household in Urban Shaanxi, China from 2008 to 2013: two waves’ cross-sectional study

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e023033 ◽  
Author(s):  
Yafei Si ◽  
Zhongliang Zhou ◽  
Min Su ◽  
Xiao Wang ◽  
Xin Lan ◽  
...  
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Health Expenditure ◽  
Economic Status ◽  
Cross Sectional Study ◽  
Catastrophic Health Expenditure ◽  
Urban China ◽  
Shaanxi Province ◽  
Vulnerable Groups ◽  
Cross Sectional

ObjectiveDespite the latest wave of China’s healthcare reform initiated in 2009 has achieved unprecedented progress in rural areas, little is known for specific vulnerable groups’ catastrophic health expenditure (CHE) in urban China. This study aims to estimate the trend of incidence, intensity and inequality of CHE in hypertension households (households with one or more than one hypertension patient) in urban Shaanxi, China from 2008 to 2013.MethodsBased on the fourth and the fifth National Health Service Surveys of Shaanxi, we identified 460 and 1289 households with hypertension in 2008 and 2013, respectively for our analysis. We classified hypertension households into two groups: simplex households (with hypertension only) and mixed households (with hypertension plus other non-communicable diseases). CHE would be identified if out-of-pocket healthcare expenditure was equal to or higher than 40% of a household’s capacity to pay. Concentration index and its decomposition based on Probit regressions were employed to measure the income-related inequality of CHE.ResultsWe find that CHE occurred in 11.2% of the simplex households and 22.1% of the mixed households in 2008, and the 21.5% of the simplex households and the 46.9% of mixed households incurred CHE in 2013. Furthermore, there were strong pro-poor inequalities in CHE in the simplex households (−0.279 and −0.283) and mixed households (−0.362 and −0.262) both in 2008 and 2013. The majority of observed inequalities in CHE could be associated with household economic status, household head’s health status and having elderly members.ConclusionWe find a sharp increase of CHE occurrence and the sustained strong pro-poor inequalities for simplex and mixed households in urban Shaanxi Province of China from 2008 to 2013. Our study suggests that more concerns are needed for the vulnerable groups such as hypertension households in urban areas of China.

scholarly journals Women with Disabilities in Nepal

2018 ◽  
Vol 9 ◽  
pp. 17-25
Author(s):  
Binod Khanda Timilsana
Keyword(s):  
Human Rights ◽  
Social Security ◽  
Rural Areas ◽  
Urban Areas ◽  
Social Protection ◽  
Disabled Persons ◽  
Women With Disabilities ◽  
Rural And Urban Areas ◽  
Rural And Urban ◽  
Disabled Women

 The women who have one or more impairments and experience barriers in society are the women with disability (WWD). Disabled women of all ages, in rural and urban areas, regardless of the severity of the impairment, sexual preference and cultural background or whether they live in the community or an institution are recognized as the WWD. As the Person with Disabilities are deprived, isolated, marginalized and excluded groups of the society, the women who have disability are one of the components of them. The social status of disabled women varies according to individual circumstances and to the country in which they live. Being a member of United Nations, Nepal recognized the human rights of people with disability in the year 1981. Accordingly, it enacted a special law known as the Disabled Persons Protection and Welfare Act, 1982 but even after 36 years of existence, the people with disabilities are often excluded from the mainstream of society and denied their human rights. Nepal is rich with legislative provisions but there is discrepancy between legislation and practices. Social security system is very poor in Nepal; disabled as well as economically marginalized people have not received any kind of social protection (food, shelter, clothes, health, education, and training). The strongest rights to social security may turn out to be nothing more than unfulfilled promises. Again most of the services are situated in urban areas and disabled people from rural areas at more risk. So it is mandatory to cater necessary services to all women with disabilities living in any part of Nepal for the respect, protect and fulfilling the commitment of government by human rights Instruments. The Sapta Gandaki JournalVol. IX, 2018 Feb. Page: 17-25

scholarly journals ‘Active ageing’: a qualitative study in six Caribbean countries

2009 ◽  
Vol 30 (1) ◽  
pp. 79-101 ◽  
Author(s):  
PATRICK CLOOS ◽  
CAROLINE F. ALLEN ◽  
BEATRIZ E. ALVARADO ◽  
MARIA VICTORIA ZUNZUNEGUI ◽  
DONALD T. SIMEON ◽  
...  
Keyword(s):  
Social Services ◽  
Rural Areas ◽  
Urban Areas ◽  
Social Protection ◽  
Economic Status ◽  
Home Care Services ◽  
Active Ageing ◽  
Socio Economic Status ◽  
Care Services ◽  
Urban And Rural Areas

ABSTRACTThe aim of this study was to document the perceptions of elders in six Caribbean countries about ‘active ageing’ and on the basis of their reports to make recommendations to improve their situation. Data were collected principally through 31 focus group discussions conducted in both urban and rural areas. Comparative analysis was carried out of the qualitative information, focusing on three components of ‘active ageing’: health and social services access and use, social support, and economic circumstances. Most of the participants were women, aged 60–79 years, of lower socio-economic status and from urban areas. Large disparities in the responses of Caribbean societies to population ageing were indicated, as well as unequal opportunities to obtain health care and social services, public transport, income and food by both socio-economic status and location. Home-care services are either insufficient or non-existent. Some elders receive social and financial support from relatives while others fear isolation and face deprivation. Social participation varies by place, physical condition, financial situation, association membership, and transport opportunities. Social protection benefits do not provide adequate income and some older people face food insecurity. It was concluded that a comprehensive and multi-sectoral approach using the ‘active ageing’ framework should be implemented to ensure a healthy ageing process.

scholarly journals Socioeconomic and Geographical Inequalities in Births by Caesarean Section Persist in the Context of Free Maternal Health Care: Evidence from a Cross-Sectional Survey of Southwestern and North Central, Nigeria

2019 ◽  
Author(s):  
Anthony Idowu Ajayi
Keyword(s):  
Health Care ◽  
Secondary Education ◽  
Maternal Health ◽  
Caesarean Section ◽  
Rural Areas ◽  
Urban Areas ◽  
Positive Impact ◽  
Health Care Service ◽  
Maternal Health Care ◽  
Monthly Income

Background User fee exemption for maternal and child health care service policy was introduced with a focus on providing free caesarean sections (CS) in Nigeria from 2011 to 2015. This policy had a positive impact on access to facility-based delivery, but its effect on socioeconomic and geographical inequality remains unclear. This study’s main objective is to examine access to birth by CS in the context of free maternal health care. Specifically, the study examines socio-demographic and geographical inequality in access to birth by CS among women who gave birth between 2011 and 2015 under the free maternal health care policy using a population-based survey data obtained from two of the six main regions of the country. Methods Data were obtained from 1227 women who gave birth during the period the policy was in operation selected using cluster random sampling between May and August 2016. Adjusted and unadjusted binary logistic regression models were used to examine whether there is socio-demographic and geographical inequality in access to birth by caesarean section. Results The overall caesarean section rate of 6.1% was found but varies by income (14.1% in monthly income of over $150 versus 4.9% in income of $150 and below), education (11.8% in women with higher education versus 3.9% among women with secondary education and less) and place of residence (7.8% in urban areas versus 3.6% in rural areas). Women who earn a monthly income of $150 or less were 48% less likely to have a birth by CS compared to those who earn more. Compared to women who were educated to tertiary level, women who had secondary education or less were 54% less likely to have birth by caesarean section. Conclusion This study shows that inequality in access to CS persists despite the implementation of free maternal health care services. Given the poor access to facilities with capabilities to offer CS in most rural areas, free maternal healthcare policy is not enough to make birth by CS universally accessible to all pregnant women in Nigeria.

scholarly journals Difficulties and Barriers of Primary Health Care Physicians in Rural Areas of Aseer Region, Saudi Arabia

2021 ◽  
Vol 19 (2) ◽  
Author(s):  
Mastor A.M. Alshahrani ◽  
Mohammed A. Alsaleem ◽  
Safar A. Alsaleem ◽  
Mohammed A. Alfaya ◽  
Muhammed A.Y. Alkhairi ◽  
...  
Keyword(s):  
Health Care ◽  
Saudi Arabia ◽  
Primary Health Care ◽  
Primary Healthcare ◽  
Rural Areas ◽  
Urban Areas ◽  
Social Life ◽  
Well Being ◽  
Primary Health ◽  
Primary Health Care Physicians

Aim of Study: To identify difficulties and barriers facing primary health care physicians in rural areas of Aseer Region, Saudi Arabia. Methods: This cross-sectional study was conducted at primary healthcare centers (PHCCs) belonging to the Saudi Ministry of Health, in rural areas of Aseer Region. A total of 134 physicians participated in the study. A validated study questionnaire was adapted and used for data collection. Results: Female physicians constituted 43.3% of respondents, age of 58.2% was 30-35 years, (Mean±SD: 32.8 ± 7.0 years), 54.5% were married, the salary of 76.1% was <10,000 SR, and the place of residence of 43.3% was in urban areas. Only 34.3% had opportunities for on-the-job continuing medical education, 33.6% were satisfied with medical equipment and resources, and 50% were dissatisfied with their salary. Internet service was present for 83.6% of participants. The social life of 83.6% was negatively affected, and 16.4% were exposed to violence at the workplace. Most participants had a favorable attitude toward working in rural areas, mainly in the form of professional satisfaction, pursuing postgraduate academic studies, building confidence as a clinician and provision of opportunities to upgrade knowledge and skills. Participants were less satisfied regarding several social factors, such as internet connectivity, isolation from family and relatives; received support from rural people, difficult schooling for children, but were not satisfied regarding PHCC infrastructure, their residential facilities, or earning more money. Conclusion: Serving within the rural healthcare system provides young physicians with an opportunity to build up their experience and to increase their confidence as physicians. However, important difficulties that they face are mainly social and financial. Hence, creating a health policy to safeguard the serving physicians’ career and providing facilities to promote personal and social well-being needs to be considered. Key words: Primary healthcare, rural health, difficulties, barriers, Saudi Arabia

scholarly journals Community resilience in post-socialist rural areas

2020 ◽  
Vol 32 (3) ◽  
pp. 59-75
Author(s):  
Sándor Papp
Keyword(s):  
Rural Communities ◽  
Rural Areas ◽  
Urban Areas ◽  
Path Dependence ◽  
Community Resilience ◽  
Vulnerable Groups ◽  
Community Members ◽  
Resilience Thinking ◽  
Path Dependent ◽  
Wine Region

Resilience thinking has become an increasingly popular topic in both academic and policy-making circles due to its normative interpretation, which assumes that resilience is the opposite of vulnerability. Vulnerable groups, communities, settlements, regions and nations have a greater likelihood of facing more serious consequences in the event of unpredictable, negative shocks. Based on this view, in general, rural communities and regions can be considered more vulnerable and hence less resilient to unknown, negative events, as the subsistence of these communities is more closely linked to their environments rather than to people living in urban areas. This is further exacerbated by the path dependence of having a post-socialist past: the ‘legacy’ of socialism that, in many cases, includes a relatively disadvantageous position, backwardness and intensification of peripheralisation processes. While there is no consensus on the concept of resilience itself, there are several approaches and perspectives related to possibly detecting signs of its existence in rural communities. Our aim to present how the notion of resilience can be operationalised at the farm level in post-socialist contexts based on three different perspectives in order to contribute resilience thinking related to post-socialist discourses. We illustrate how rural community resilience may be conceptualised based on the example of the grape- and wine-producing communities of Soltvadkert, Hungary and the Minis-Maderat wine region, Romania. Based on our qualitative methodological results, it can be stated that the resilience of a community or group, its properties reflecting resilience can be interpreted in several ways, which is partly location-dependent, partly path-dependent, however, it is highly dependent not only on embedded structures but also on activities that are constantly reproduced by community members.

Profile of the Current Psychiatrist Workforce in South Africa: Establishing a Baseline for Human Resource Planning and Strategy

2021 ◽  
Author(s):  
Bernard Janse van Rensburg ◽  
Carla Kotzé ◽  
Karis Moxley ◽  
Ugasvaree Subramaney ◽  
Zukiswa Zingela ◽  
...  
Keyword(s):  
Mental Health ◽  
South Africa ◽  
Health Care ◽  
Mental Health Care ◽  
Rural Areas ◽  
Urban Areas ◽  
Resource Planning ◽  
Data Repository ◽  
Care Needs ◽  
South African Society

Abstract The WHO Global Health Observatory Data Repository reports South Africa with 1.52 psychiatrists/100 000 of the population among other countries in Africa with 0.01 psychiatrists/100 000 (Chad, Burundi and Niger) to more than 30/100 000 for some countries in Europe. The overall situation, while being cognizant that mental health care is not only provided by specialist psychiatrists and that the current treatment gap may have to be addressed by strategies such as appropriate task sharing, suggests that there are actually too few psychiatrists to meet the country’s mental health care needs. To address the need to develop a strategy to increase the local specialist training and examination capacity, a situational review of currently practicing psychiatrists was undertaken by the [BLINDED] and the [BLINDED], using the South African Society of Psychiatrists (SASOP) membership database. The number, distribution and attributes of practicing psychiatrists were compared with international figures on the ratio of psychiatrists/100 000 population. In April 2019 there were 850 qualified psychiatrists actively practicing in the country and based on the national population figure of 55.6 million people (2016 Census), the psychiatrists/100 000 ratio was 1.53. This indicates no improvement between 2016 to 2019. From the SASOP database, we determined that about 80% of psychiatrists are working in the private sector - a much higher proportion than is usually quoted. As the vast majority of psychiatrists are practicing in urban areas in two provinces, Gauteng (n=350) and Western Cape (n=292), the ratio of psychiatrists/100 000 in these areas is relatively higher, at 2.6 and 5.0 respectively. Whereas rural areas in South Africa are largely without specialist mental health expertise, at a rate of 0.03/100 000 population. This investigation provides a discipline-specific situational review of the attributes and distribution of the current workforce of specialists in the country.

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