scholarly journals Care seeking for children with fever/cough or diarrhoea in Nepal: equity trends over the last 15 years

2017 ◽  
Vol 45 (2) ◽  
pp. 195-201 ◽  
Author(s):  
Mats Målqvist ◽  
Chahana Singh ◽  
Ashish Kc
Keyword(s):  
Time Trends ◽  
Health Access ◽  
Care Seeking ◽  
Health Coverage ◽  
Economic Determinants ◽  
Childhood Illnesses ◽  
Poor Households ◽  
Multiple Indicator Cluster Survey ◽  
Multiple Indicator ◽  
Universal Health

Aims: Childhood illnesses such as diarrhoea and pneumonia remain major contributors to child mortality globally and need to be continually targeted in pursuit of universal health coverage. This study analyses time trends in the prevalence of fever/cough and diarrhoea in Nepal and applies an equity lens in order to identify disadvantaged groups. Methods: Data from the Nepal Demographic Health Surveys of 2001, 2006, and 2011, together with data from the most recent Multiple Indicator Cluster Survey of 2014 performed in Nepal, were utilized for analysis. Results: Analyses revealed improvements (lower prevalence) of diarrhoea and fever/cough in children under five in Nepal over the last 15 years, with an equitable distribution of symptoms over socio-economic determinants. There was, however, a marked and maintained inequity in care seeking for these symptoms, with less educated mothers and those from poor households being only approximately half as likely to seek care for their children. Conclusions: Results highlight the persisting need for targeting care-seeking and societal barriers to treatment in order to achieve universal health access.

scholarly journals Determinants of health insurance enrolment in Ghana: evidence from three national household surveys

2019 ◽  
Vol 34 (8) ◽  
pp. 582-594 ◽  
Author(s):  
Paola Salari ◽  
Patricia Akweongo ◽  
Moses Aikins ◽  
Fabrizio Tediosi
Keyword(s):  
Health Insurance ◽  
Complex Dynamics ◽  
Living Standard ◽  
Household Surveys ◽  
Health Coverage ◽  
Economic Determinants ◽  
Logistic Regression Models ◽  
Multiple Indicator Cluster Survey ◽  
Multiple Indicator ◽  
The Relationship

Abstract In 2003, Ghana implemented a National Health Insurance Scheme (NHIS) to move towards Universal Health Coverage. NHIS enrolment is mandatory for all Ghanaians, but the most recent estimates show that coverage stands under 40%. The evidence on the relationship between socio-economic characteristics and NHIS enrolment is mixed, and comes mainly from studies conducted in a few areas. Therefore, in this study we investigate the socio-economic determinants of NHIS enrolment using three recent national household surveys. We used data from the Ghanaian Demographic and Health Survey conducted in 2014, the Multiple Indicator Cluster Survey conducted in 2011 and the sixth wave of the Ghana Living Standard Survey conducted in 2012–13. Given the multilevel nature of the three databases, we use multilevel logistic regression models to estimate the probability of enrolment for women and men separately. We used three levels of analysis: geographical clusters, household and individual units. We found that education, wealth, marital status—and to some extent—age were positively associated with enrolment. Furthermore, we found that enrolment was correlated with the type of occupation. The analyses of three national household surveys highlight the challenges of understanding the complex dynamics of factors contributing to low NHIS enrolment rates. The results indicate that current policies aimed at identifying and subsidizing underprivileged population groups might insufficiently encourage health insurance enrolment.

scholarly journals Improving health access for gender diverse children, youth, and emerging adults?

2018 ◽  
Vol 24 (2) ◽  
pp. 193-198 ◽  
Author(s):  
Pierre-Paul Tellier
Keyword(s):  
Health Care ◽  
Emerging Adults ◽  
Minority Stress ◽  
Preventive Health Care ◽  
Health Access ◽  
Health Practitioner ◽  
Health Coverage ◽  
Gender Diverse ◽  
Diverse Children ◽  
Universal Health

Gender diverse people are individuals who define their gender as different from the sex they were assigned as birth. This incongruence leads to a sense of discomfort within oneself, which according to the DSM-V is called gender dysphoria. The combination of dysphoria, ongoing stress, as outlined in the Minority Stress Theory (Meyer, 2003, Dohrenwend, 2000) and the stigma related to living in a society which traditionally defines gender as binary and rejects the notion of gender as fluid, is associated with psycho-social, mental, and physical health problems. Gender diverse children and young people require support from health practitioner to assist them not only in transitioning, if this is what they choose, but also to manage ongoing and preventive health care in a system which is not always welcoming and frequently hostile to them. In 2012 the United Nations General Assembly called for universal health coverage as a goal in the post-2015 Millennium Development Goal Framework. One step in attaining this goal is universal health access which is not currently being met for gender diverse individuals. Hence, we need to work together, with those that we serve, to develop appropriate, sensitive and accessible health care for all.

scholarly journals District-level health system strengthening for universal health coverage: evidence from a longitudinal cohort study in rural Madagascar, 2014-2018

2020 ◽  
Vol 5 (12) ◽  
pp. e003647
Author(s):  
Andres Garchitorena ◽  
Ann C Miller ◽  
Laura F Cordier ◽  
Marius Randriamanambintsoa ◽  
Hery-Tiana R Razanadrakato ◽  
...  
Keyword(s):  
Health System ◽  
Child Mortality ◽  
Universal Health Coverage ◽  
Mortality Rates ◽  
Health System Strengthening ◽  
Care Seeking ◽  
Health Coverage ◽  
Longitudinal Cohort ◽  
Geographical Inequalities ◽  
Universal Health

IntroductionDespite renewed commitment to universal health coverage and health system strengthening (HSS) to improve access to primary care, there is insufficient evidence to guide their design and implementation. To address this, we conducted an impact evaluation of an ongoing HSS initiative in rural Madagascar, combining data from a longitudinal cohort and primary health centres.MethodsWe carried out a district representative household survey at the start of the HSS intervention in 2014 in over 1500 households in Ifanadiana district, and conducted follow-up surveys at 2 and 4 years. At each time point, we estimated maternal, newborn and child health coverage; economic and geographical inequalities in coverage; and child mortality rates; both in the HSS intervention and control catchments. We used logistic regression models to evaluate changes associated with exposure to the HSS intervention. We also estimated changes in health centre per capita utilisation during 2013 to 2018.ResultsChild mortality rates decreased faster in the HSS than in the control catchment. We observed significant improvements in care seeking for children under 5 years of age (OR 1.23; 95% CI 1.05 to 1.44) and individuals of all ages (OR 1.37, 95% CI 1.19 to 1.58), but no significant differences in maternal care coverage. Economic inequalities in most coverage indicators were reduced, while geographical inequalities worsened in nearly half of the indicators.ConclusionThe results demonstrate improvements in care seeking and economic inequalities linked to the early stages of a HSS intervention in rural Madagascar. Additional improvements in this context of persistent geographical inequalities will require a stronger focus on community health.

scholarly journals Socioeconomic Barriers to Universal Health Coverage in Zimbabwe: Present Issues and Pathways Toward Progress

2019 ◽  
Vol 35 (1) ◽  
pp. 153-174
Author(s):  
Tatenda Goodman Nhapi
Keyword(s):  
Social Policy ◽  
Health Services ◽  
Social Security ◽  
Poverty Reduction ◽  
Health Sector ◽  
Health Access ◽  
Present System ◽  
Social Policies ◽  
Health Coverage ◽  
Universal Health

This article assesses Zimbabwean health services, using a social workers’ social development paradigm to analyze the dynamics of Zimbabwe’s Social Security program, focusing on universal health access for older persons, orphans, and vulnerable children. This article identifies the key factors that have done the most to shape health policy administration in the broader context of social policies and social security in Zimbabwe. The discussion is framed around the need for pro-poor social policies, social inclusivity, and the efforts to ensure universal health access. Despite numerous reports, newspaper op-eds and consultancy documents offering opinions on the state of social service delivery in the country, most critics lack empirical data and end up being very anecdotal as they critique the present system. The socioeconomic context of Zimbabwe is therefore analyzed here, with the best available statistical evidence provided, followed by assessment of social policy interventions. Current challenges to access health services are evaluated using a human rights-based social policy approach. The recent Zimbabwe Ministry of Finance-led consultative process crafted a 2016 document, the Poverty Reduction Strategies Papers (PRSPs), as an overall strategy for transforming the Zimbabwean health sector. The article concludes by recommending community-based health insurance approach as most appropriate intervention for ensuring health inclusivity and enhancing health for all in Zimbabwe.

scholarly journals A new hope: from neglect of the health sector to aspirations for Universal Health Coverage in Myanmar

2019 ◽  
Vol 34 (Supplement_1) ◽  
pp. i38-i46
Author(s):  
Alex Ergo ◽  
Thant Sin Htoo ◽  
Reena Badiani-Magnusson ◽  
Rivandra Royono
Keyword(s):  
Universal Health Coverage ◽  
Health Sector ◽  
Health Spending ◽  
Poverty Line ◽  
Political Support ◽  
Care Seeking ◽  
Health Coverage ◽  
Catastrophic Health Spending ◽  
Out Of Pocket Payments ◽  
Universal Health

Abstract Myanmar’s health sector has received low levels of public spending since 1975. Combined with the country’s historic political and economic isolation, poor economic management and multiple internal armed conflicts, these limited resources have translated into low coverage of even the most basic services and into poor health outcomes with wide disparities. They have also resulted in out-of-pocket payments for health as a proportion of total health spending being among the highest in the world. The Government of Myanmar has now affirmed its commitment to moving toward Universal Health Coverage. This commitment is reflected in the National Health Plan 2017–2021. Drawing upon analysis of data from the Myanmar Poverty and Living Conditions Survey 2015 and using the country’s revised methodology to estimate poverty, this paper explores some of the consequences of Myanmar’s excessive reliance on out-of-pocket funding as the main source of health financing. Around 481 000 households in Myanmar experienced catastrophic health spending in 2015. Of this group, 185 000 households lived below the national poverty line. Households that experienced catastrophic health spending spent, on average, 54.7% of their total capacity to pay on health. Of all Myanmar households that went to a health facility in 2015, ∼28% took loans and ∼13% sold their assets to cover health spending. In that same year, ∼1.7 million people fell below the national poverty line due to health spending. The paper then discusses how ongoing reforms could help alleviate the financial hardship associated with care-seeking. With current political will to reform the health system, a conducive macro-economic environment, and the relatively limited vested interests, Myanmar has a window of opportunity to achieve significant progress towards UHC. Continued high-level political support and strong leadership will be needed to keep reforms on track.

scholarly journals Akses Jaminan Kesehatan Nasional pada Pekerja Seks Perempuan

2015 ◽  
Vol 9 (4) ◽  
pp. 308
Author(s):  
Ni Made Sri Nopiyani ◽  
Putu Ayu Indrayathi ◽  
Rina Listyowati ◽  
I Ketut Suarjana ◽  
Pande Putu Januraga
Keyword(s):  
Universal Health Coverage ◽  
Sex Workers ◽  
Insurance Coverage ◽  
Health Access ◽  
Health Coverage ◽  
Depth Interview ◽  
Negative Perceptions ◽  
Universal Health ◽  
Individual Service

AbstrakPekerja seks perempuan (PSP) merupakan kelompok yang termarginalkan secara sosial dan memiliki kerentanan yang tinggi terhadap masalah kesehatan. Upaya perluasan Jaminan Kesehatan Nasional (JKN) pada PSP masih terbatas sehingga penting dilakukan untuk mendukung pencapaian universal health coverage. Penelitian ini bertujuan untuk memperoleh gambaran mengenai akses JKN pada PSP di Denpasar. Penelitian ini merupakan studi kualitatif. Data dikumpulkan melalui wawancara mendalam terhadap 15 orang PSP dan empat orang mucikari di Denpasar pada Agustus hingga Oktober 2014. Hasil wawancara diolah dengan analisis tematik. Kerangka analisis yang digunakan adalah The Health Access Livelihood Framework. Kepemilikan JKN pada PSP di Denpasar masih rendah, meskipun sebagian PSP memiliki kemauan untuk menjadi peserta JKN dan memiliki kemampuan membayar iuran JKN. Faktor penghambat akses JKN pada PSP adalah rendahnya pengetahuan mengenai prosedur pendaftaran dan portabilitas JKN, kekhawatiran keberlanjutan pembayaran iuran, persepsi buruk mengenai kualitas layanan yang akan diterima jika menggunakan JKN, ketidaklengkapan administrasi kependudukan serta kebijakan yang mengharuskan peserta bukan penerima bantuan iuran (Non-PBI) Mandiri untuk mendaftarkan seluruh anggota keluarga. Akses JKN pada PSP terhambat oleh faktor-faktor individual, layanan dan kebijakan yang perlu diatasi untuk meningkatkan cakupan JKN pada PSP. AbstractFemale sex workers (FSW) is marginalized social group having a high vulnerability of health problems. Effort to expand national health insurance on FSW is still limited, so it is necessarily performed in order to support the achievement of universal health coverage. This study aimed to obtain the depiction of the insurance access among FSW in Denpasar. This study was qualitative. Data was collected through in-depth interview of 15 FSW and four pimps in Denpasar from August to October 2014. The interview result was analyzed using thematic analysis. The analysis framework used was The Health Access Livelihood Framework. The insurance ownership among FSW in Denpasar was low, even though some FSW were willing to be participants and afford to pay the premium. Factors inhibiting the insurance access were the lack of knowledge regarding registration procedures and portability, fear of premium payment sustainability, negative perceptions of quality of services that would be received if using the insurance, incomplete population administration and policy requiring independent non-premium support receiver participants to register all of their family members. The insurance access among FSW was hindered by individual, service and policy factors that need to be conquered to increase the insurance coverage among FSW.

scholarly journals Timbang Besarnya Manfaat dari Salah Sasar Penerima Bantuan Iuran Jaminan Kesehatan

2017 ◽  
Vol 2 (2) ◽  
Author(s):  
Prastuti Soewondo
Keyword(s):  
Total Population ◽  
National Level ◽  
Social Health Insurance ◽  
Eastern Region ◽  
Health Coverage ◽  
Indonesian Population ◽  
Poor Households ◽  
Economic Survey ◽  
The Government ◽  
Universal Health

Abstrak Salah satu kebijakan pemerintah dalam percepatan capaian Jaminan Kesehatan Semesta bagi seluruh penduduk adalah mem­berikan keringanan keuangan dengan membayarkan iuran Jaminan Kesehatan bagi 92.4 juta masyarakat miskin dan rentan kemiskinan yang mewakili sekitar 35% dari total populasi. Kelompok masyarakat ini disebut sebagai Penerima Bantuan Iuran (PBI). Studi ini mengkaji seberapa banyak masyarakat miskin dan rentan yang telah menerima kebijakan pemerintah dalam pemberian subsidi jaminan kesehatan. Data penelitian menggunakan data Survei Sosial Ekonomi Nasional tahun 2016, khu­susnya data konsumsi rumah tangga dan status kepemilikan berbagai jenis jaminan kesehatan. Hasil menunjukkan bahwa, pada tingkat nasional, bantuan subsidi iuran jaminan kesehatan telah dinikmati oleh mayoritas (51%) rumah tangga miskin dan rentan kemiskinan, terlebih lagi rumah tangga yang tinggal di wilayah Timur Indonesia (58%). Bersama dengan Jamkes­da, 59,5% rumah tangga miskin dan rentan kemiskinan (66,4% di wilayah Timur) telah menerima manfaat proteksi jaminan kesehatan. Capaian kebijakan pemerintah ini patutlah dicatat, walaupun level cakupan harus terus ditingkatkan. Janganlah ini ditutupi oleh isu salah sasaran PBI ke sekitar 3% rumah tangga kaya yang dibesar-besarkan untuk menarik perhatian massa. Abstract One of the foremost government policies implemented in achieving Universal Health Coverage for the Indonesian population is the provision of financial assistance through contribution of Social Health Insurance for 92.4 million targeted poor and near poor house­holds. This segment of the population is referred to as Penerima Bantuan Iuran (PBI) and represents about 35% of the total population. This study reveals the government’s progress in protecting the health of this sub-population. The data is derived from the 2016 Na­tional Social Economic Survey. The results indicate that, at the national level, the government’s health protection program has reached the majority of poor and near poor household (51%), especially those residing in Eastern part of the country (58%). Together with local government’s support, 59.5% of poor and near poor households (66.4% in Eastern region) have been insured. While improvements in coverage should still be top policy agenda, this achievement of the government deserves more appreciation. We show that misalloca­tion of PBI to wealthy households is only small (3%), yet often broadcasted with much hype to create agitation. 

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