scholarly journals Strengthening social accountability in ways that build inclusion, institutionalization and scale: reflections on FHS experience

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Sara Bennett ◽  
Eizabeth Ekirapa-Kiracho ◽  
Shehrin Shaila Mahmood ◽  
Ligia Paina ◽  
David H. Peters
Keyword(s):  
Health Services ◽  
Low Income ◽  
Rural Areas ◽  
Social Accountability ◽  
Special Issue ◽  
Final Phase ◽  
Future Health ◽  
The Poor ◽  
Theories Of Change ◽  
Equity Effects

AbstractThis editorial provides an introduction to the special issue on “Lessons about intervening in accountability ecosystems: implementation of community scorecards in Bangladesh and Uganda”. We start by describing the rationale for this work in the two study countries. While our project, the Future Health Systems (FHS) project, had been working over the course of more than a decade to strengthen health services, particularly for low income households in rural areas, our teams increasingly recognized how difficult it would be to sustain service improvements without fundamental changes to local accountabilities. Accordingly, in the final phase of the project 2016–2018, we designed, implemented and assessed community scorecard initiatives, in both Bangladesh and Uganda, with the aim of informing the design of a scalable social accountability initiative that could fundamentally shift the dynamics of health system accountability in favor of the poor and marginalized.We describe the particular characteristics of our approach to this task. Specifically we (i) conducted a mapping of accountabilities in each of the contexts so as to understand how our actions may interact with existing accountability mechanisms (ii) developed detailed theories of change that unpacked the mechanisms through which we anticipated the community scorecards would have effect, as well as how they would be institutionalized; and (iii) monitored closely the extent of inclusion and the equity effects of the scorecards. In summarizing this approach, we articulate the contributions made by different papers in this volume.

scholarly journals The Nexus between Mobile Money Regulation, Innovative Technology and the Promotion of Financial Inclusion in Zimbabwe

2021 ◽  
Vol 24 ◽  
pp. 1-33
Author(s):  
Howard Chitimira ◽  
Elfas Torerai
Keyword(s):  
Low Income ◽  
Rural Areas ◽  
Financial Services ◽  
Banking Sector ◽  
Regulatory Framework ◽  
Financial Inclusion ◽  
Innovative Technology ◽  
Technological Innovations ◽  
Mobile Money ◽  
The Poor

The advent of mobile money innovations has given people in rural areas, informal settlements and other poor communities an opportunity to participate in Zimbabwe's mainstream financial economy. However, the technology-driven money services have presented some challenges to the traditional banking sector in general and the regulation of financial services in particular. Firstly, most mobile money services are products of telecommunication corporations, which are not banks. Telecommunication companies use their network reach to provide mobile money services via mobile devices at a cheaper cost than banks across the country in Zimbabwe. As such, banks face unprecedented competition from telecommunications companies that are venturing into financial services. It also appears that prudential regulation of banks cannot keep up with the fast pace at which technological innovations are developing and this has created a disjuncture between the regulation and the use of technological innovations to promote financial inclusion in Zimbabwe. The Banking Act [Chapter 24:20] 9 of 1999, the Reserve Bank of Zimbabwe Act [Chapter 22:15] 5 of 1999 and the National Payment Systems Act [Chapter 24:23] 21 of 2001 have a limited scope in terms of the regulation of mobile money services in Zimbabwe. The Ministry of Finance and Economic Development launched the National Financial Inclusion Strategy (NFIS) 2016-2020 to provide impetus to the financial inclusion of the poor, unbanked and low-income earners in Zimbabwe. However, the NFIS appears to push more for bank-led financial inclusion than it does for innovation-driven initiatives such as mobile money services. This article highlights the positive influence of mobile money services in improving financial inclusion for the poor, unbanked and low-income earners in Zimbabwe. The article also seeks to point out gaps and flaws in the financial services regulatory framework that may limit the potential of mobile money services to reach more people so that they actively participate in the Zimbabwean economy. It is submitted that the Zimbabwean mobile money services regulations and the financial regulatory framework should be carefully amended in line with the recent innovations in mobile money to adequately regulate the use of mobile money services and innovative technology to address the financial exclusion of the poor, unbanked and low-income earners in Zimbabwe.

scholarly journals Patient perspectives on hypertension management in health system of Sri Lanka: a qualitative study

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e031773
Author(s):  
Manuja Perera ◽  
Chamini Kanatiwela de Silva ◽  
Saeideh Tavajoh ◽  
Anuradhani Kasturiratne ◽  
Nathathasa Vihangi Luke ◽  
...  
Keyword(s):  
Sri Lanka ◽  
Health Services ◽  
Low Income ◽  
Rural Areas ◽  
Healthcare Professionals ◽  
Public Awareness ◽  
Uncontrolled Hypertension ◽  
Hypertension Management ◽  
Antihypertensive Medications ◽  
Patient Pathways

IntroductionUncontrolled hypertension is the leading risk factor for mortality globally, including low-income and middle-income countries (LMICs). However, pathways for seeking hypertension care and patients’ experience with the utilisation of health services for hypertension in LMICs are not well understood.ObjectivesThis study aimed to explore patients’ perspectives on different dimensions of accessibility and availability of healthcare for the management of uncontrolled hypertension in Sri Lanka.SettingPrimary care in rural areas in Sri Lanka.Participants20 patients with hypertension were purposively sampled from an ongoing study of Control of Blood Pressure and Risk Attenuation in rural Bangladesh, Pakistan, Sri Lanka.MethodWe conducted in-depth interviews with patients. Interviews were audio-recorded and transcribed into local language (Sinhala) and translated to English. Thematic analysis was used and patient pathways on their experiences accessing care from government and private clinics are mapped out.ResultsOverall, most patients alluded to the fact that their hypertension was diagnosed accidentally in an unrelated visit to a healthcare provider and revealed lack of adherence and consuming alternatives as barriers to control hypertension. Referring to the theme ‘Accessibility and availability of hypertension care’, patients complained of distance to the hospitals, long waiting time and shortage of medicine supplies at government clinics as the main barriers to accessing health services. They often resorted to private physicians and paid out of pocket when they experienced acute symptoms attributable to hypertension. Considering the theme ‘Approachability and ability to perceive’, the majority of patients mentioned increasing public awareness, training healthcare professionals for effective communication as areas of improvement. Under the theme ‘Appropriateness and ability to engage’, few patients were aware of the names or purpose of their medications and reportedly missed doses frequently. Reminders from family members were considered a major facilitator to adherence to antihypertensive medications. Patients welcomed the idea of outreach services for hypertension and health education closer to home in the theme ‘Things the patients reported to improve the system’.ConclusionPatients identified several barriers to accessing hypertension care in Sri Lanka. Measures recommended improving hypertension management in Sri Lanka including public education on hypertension, better communication between healthcare professionals and patients, and efforts to improve access and understanding of antihypertensive medications.Trial registration numberNCT02657746.

Competency requirements for middle and senior managers in community health services

2013 ◽  
Vol 19 (3) ◽  
pp. 256 ◽  
Author(s):  
Zhanming Liang ◽  
Peter F. Howard ◽  
Lee C. Koh ◽  
Sandra Leggat
Keyword(s):  
Health Service ◽  
Health Services ◽  
Community Health ◽  
Rural Areas ◽  
Online Survey ◽  
Service Management ◽  
Core Competencies ◽  
Community Health Services ◽  
Health Care Environment ◽  
Future Health

The Australian health system has been subjected to rapid changes in the last 20 years to meet increasingly unmet health needs. Improvement of the efficiency and comprehensiveness of community-based services is one of the solutions to reducing the increasing demand for hospital care. Competent managers are one of the key contributors to effective and efficient health service delivery. However, the understanding of what makes a competent manager, especially in the community health services (CHS), is limited. Using an exploratory and mixed-methods approach, including focus group discussions and an online survey, this study identified five key competencies required by senior and mid-level CHS managers in metropolitan, regional and rural areas of Victoria: Interpersonal, communication qualities and relationship management; Operations, administration and resource management; Knowledge of the health care environment; Leading and managing change; and Evidence-informed decision-making. This study confirms that core competencies do exist across different management levels and improves our understanding of managerial competency requirements for middle to senior CHS managers, with implications for current and future health service management workforce development.

Special Issue on ‘Immunopotentiating ability of medicinal plants against the chronic diseases’

2014 ◽  
Vol 3 (6) ◽  
pp. 297-298
Author(s):  
Lavkush Dwivedi
Keyword(s):  
Drug Resistance ◽  
Immune System ◽  
Side Effects ◽  
Medicinal Plants ◽  
Rural Areas ◽  
Causes Of Death ◽  
Genetic Resource ◽  
Special Issue ◽  
The Poor ◽  
The World

Chronic illness such as cardiovascular diseases, AIDS, diabetes, and cancer are the leading causes of death and disability in India. They contribute around 53% of all deaths, and projected to increase in the next 25 years. Though, allopathic treatment therapies are in operation but due to higher cost and limited availability, they are short reached to the poor especially in rural areas. Increasing drug resistance and often side effects have additionally questioned to their reliability. Hence, the alterna-tive therapies with better efficacy and free of above limitations have emerged as immediate need to be developed to keep mankind hale and hearty. Immunopotentiating approaches advo-cating to the repair and restoration of the immune system to normal state are looked as better alter-natives to satisfy the current need via researches on medicinal plants. Fortunately, India with the presence of 8000 species has been great repository of medicinal plants and richest genetic resource of them in the world.

Two Models for Change in the Health Services in Zimbabwe

1985 ◽  
Vol 15 (3) ◽  
pp. 451-468 ◽  
Author(s):  
Gerald Bloom
Keyword(s):  
Health Services ◽  
Rural Areas ◽  
Health Workers ◽  
Private Insurance ◽  
Health Sector ◽  
Developed Countries ◽  
Insurance Companies ◽  
Political Commitment ◽  
Future Health ◽  
Mortality And Morbidity

The health situation in pre-Independence Zimbabwe was much as elsewhere in the Third World. While the majority suffered excess mortality and morbidity, the affluent enjoyed a health status similar to that of the populations of developed countries. The health services also showed the familiar pattern, with expenditure concentrated on sophisticated facilities in the towns, leaving the rural majority with practically no services at all. With the coming of Majority Rule, the previous pattern of controlling access to facilities on the basis of race could not continue. Two broad routes forward were defined. On the one hand, the private doctors, the private insurance companies, and the settler state proposed a model based on improving urban facilities, depending on a trickle-down to eventually answer the needs of the rural people. On the other hand, the post-Independence Ministry of Health advocated a policy of concentrating on developing services in the rural areas. The pattern of the future health service will depend on the capacity of the senior health planners and on the enthusiasm of front-line health workers but, of overriding importance will be the political commitment to answer the needs of the majority and the outcome of the inevitable struggle for access to scarce health sector resources.

Poverty and forest degradation: introduction to the special issue

2004 ◽  
Vol 9 (2) ◽  
pp. 131-134 ◽  
Author(s):  
GERALD E. SHIVELY
Keyword(s):  
Low Income ◽  
Statistical Power ◽  
Smallholder Farmers ◽  
Forest Degradation ◽  
Small Data ◽  
Special Issue ◽  
The Poor ◽  
Institutional Forces ◽  
Simplifying Assumptions ◽  
Forest Use

This special issue focuses on the poor and their role in forest degradation. The idea that the poor are both agents of forest degradation and victims of forest loss is not new. Neither is the observation that unsustainable rates of forest use by smallholder farmers arises as a result of a complex interplay of incentives, constraints, and institutional forces. For researchers and policy makers concerned with natural resource use in low-income settings, theory is often useful, but rarely adequate to explain behavioural patterns. Unambiguous theoretical findings tend to flow only from substantial sets of simplifying assumptions, and such assumptions, measured against the observed facts of smallholder agriculture, seem largely untenable. Unfortunately much empirical research on the topic suffers from an opposite problem. In settings where, at any point in time, everything matters and nothing is held constant, econometric findings are frequently weak. The combination of heterogeneity of circumstance, homogeneity of market signals, and limitations on smallholder response generally overwhelms the statistical power of small data sets, often collected with different purposes in mind.

scholarly journals Participatory Processes in Planning for Self-Help Housing Provision in South Africa: Policies and Challenges

2018 ◽  
Vol 5 (1) ◽  
pp. 24-36
Author(s):  
Sithembiso Lindelihle Myeni ◽  
Bongekile YC Mvuyana
Keyword(s):  
South Africa ◽  
Low Income ◽  
Rural Areas ◽  
Local Community ◽  
Housing Development ◽  
Community Members ◽  
Self Help ◽  
The Poor ◽  
Planning Phase ◽  
Participatory Processes

In contemporary post-apartheid a number of housing policies have been made since the 1994 democratic dispensation in an attempt to solve housing problems especially for poor and low-income population in South Africa. The most recent policy has been the Comprehensive Housing Plan for the Development of Integrated Sustainable Human Settlements commonly known as the Breaking New Ground (BNG) housing plan of 2004. The aims of this paper are to present an overview and empirical analysis on research and emerging legitimisation of the participation of informal institutions in planning phase for housing development in rural areas. This paper analyses public participatory processes in the planning phase of rural housing project(s) in Jozini Municipality in KwaZulu-Natal. Since the establishment of a fully-fledged local government institutions and the promulgation of the BNG in 2004, inhabitants have experienced materialisation of new housing opportunities for community members. These opportunities created during the planning phase which results to community members benefiting in housing development excludes the poor in the process of self-help subsidy administration and housing allocation. Grounded on the works of Foucauldian scholars especially the ‘discourse of power’ in participation, the paper argues that the local community members not only embody the local knowledge to be accessed, but their participation presents an important entry point to the political decision-making needed for collecting differing viewpoints and interests but also for initiating the negotiations needed that would lead to coordination, if not cooperation for housing development. We propose that participatory processes that are beneficiary to the poor are best understood when traced over time as a dynamic response to a constantly unfolding-project related intervention.

scholarly journals The Factors Influencing Urban Health Services among Ethnic Groups in the U.S.

2020 ◽  
Vol 10 (3) ◽  
pp. 77
Author(s):  
Linda Martinez ◽  
Henry O’Lawrence
Keyword(s):  
Health Services ◽  
Urban Health ◽  
Low Income ◽  
Rural Areas ◽  
Urban Areas ◽  
Health Inequities ◽  
World Health ◽  
Factors Influencing ◽  
Urban Health Services ◽  
The U.S

The purpose of this study is to conduct a non-systematic meth-analysis of a literature review by way of reviewing research that was found in any databases under the terms “urban health services” in order to document the major factors influencing urban health among minorities; and if there are any policies that promote health and prevent disease. Data from current the U.S. Bureau of Labor Statistics and the World Health Organization also provided significant findings. This study also explores the underlying conditions and root causes contributing to health inequities and the interdependent nature of the factors that create them, by drawing from existing literature and syntheses on health disparities and health inequities. Even though public services, such as health and health service provisions in urban areas may be much better than those in rural areas, it has not been proven if it is the case for less disadvantaged populations living in the urban cities. This study highlights many of the issues leading to health inequities, such as social economic status, ethnicity, and age differences. There is a need to reduce health inequities among high-middle and low-income groups by providing or equalizing health opportunities across the socioeconomic groups.

scholarly journals Perilaku Pencarian Pengobatan pada Penduduk dengan Gejala Depresi

2020 ◽  
Vol 30 (1) ◽  
pp. 45-54
Author(s):  
Rofingatul Mubasyiroh ◽  
Sri Idaiani ◽  
Indri Yunita Suryaputri
Keyword(s):  
Mental Health ◽  
Depressive Symptoms ◽  
Health Services ◽  
Low Income ◽  
Rural Areas ◽  
Vulnerable Groups ◽  
Related Factors ◽  
Middle Income ◽  
Adult Age ◽  
Seeking Behavior

Abstract Mental health is part of health. Depression is one of the common mental health related to other health problems and a big contributor to Years Life with Disability (YLD). However, it is estimated that three are still 76% and 85% of sufferers in low-income and middle-income countries who do not received services to deal with the problems they experience. This study is a further analysis of IFLS-5 data to see the treatment seeking behavior in people with depressive symptoms and its related factors. The analysis was conducted on population aged 15 years and above. The proportion of depressive symptoms was 23.4% with a higher proportion of women, the populatin not working, living in large families, in the adolescent to young adult age group, and continuing to decline with increasing age. Some 12.5% of the population with depressive symptoms seek treatment . It appears that women have more significant opportunities to access health services. Opportunities to access health services were greater with increasing age. All kind of insurance ownership and living in urban are proven to significantly increase one’s chances of accessiong health services. The still low search for treatment is a joint task to minimize the , by paying more attention to vulnerable groups such as young people, not having insurance and living in rural areas. Abstrak Kesehatan jiwa merupakan bagian dari kesehatan. Depresi adalah salah satu common mental health yang berkaitan dengan masalah kesehatan yang lain, dan penyumbang Years Life with Disability (YLD) yang besar. Namun diperkirakan masih ada 76% dan 85% penderita di negara pendapatan rendah dan negara berpendapatan menengah yang tidak mendapatkan layanan penanganan masalah gangguan yang mereka alami. Penelitian ini merupakan analisis lanjut data IFLS-5 untuk melihat gambaran perilaku pencarian pengobatan pada penduduk dengan kondisi gejala depresi serta faktor yang berkaitan dengannya. Analisis dilakukan pada penduduk usia 15 tahun ke atas. Proporsi gangguan gejala depresi sebesar 23,4%, dengan proporsi lebih tinggi pada perempuan, penduduk tidak bekerja, tinggal dalam keluarga besar, pada kelompok usia remaja-dewasa muda, dan terus menurun seiring peningkatan usia. Sejumlah 12,5% penduduk dengan gejala depresi yang melakukan pencarian pengobatan. Tampak bahwa perempuan lebih berpeluang signifikan untuk mengakses layanan kesehatan. Peluang untuk mengakses layanan kesehatan semakin besar seiring peningkatan usia. Kepemilikan asuransi (semua jenis asuransi) dan tinggal di wilayah perkotaan terbukti signifikan meningkatkan peluang seseorang mengakses layanan kesehatan. Masih rendahnya pencarian pengobatan menjadi tugas bersama untuk memperkecil treatment gap, dengan lebih memperhatikan kelompok rentan seperti usia muda, tidak memiliki asuransi, dan tinggal di perdesaan.

scholarly journals Assessing catastrophic out-of-pocket payments in Ethiopia’s health system

2020 ◽  
Author(s):  
Amarech G. Obse ◽  
John E. Ataguba
Keyword(s):  
Health Services ◽  
Universal Health Coverage ◽  
Low Income ◽  
Household Expenditure ◽  
Financial Protection ◽  
Health Coverage ◽  
The Poor ◽  
Out Of Pocket Payments ◽  
Food Expenditure ◽  
Universal Health

Abstract Background: Providing adequate financial protection for all remains an essentialaspect of Universal Health Coverage (UHC). In Ethiopia, although the government has introduced reforms, out-of-pocket (OOP) spending accounts for 37% of current health expenditure in 2016. This is considered high enough to lead to financial catastrophe—a situation where a household spends more than a given fraction of its expenditure (or capacity to pay) OOP on health services. This study assessedfinancial catastrophe resulting from OOP health spending in Ethiopia. Methods: Data come fromthe Ethiopian Household Consumption Expenditure Survey (HCES) 2010/11 with about 28,000 households. The incidence and intensity of catastrophic spending were estimated using rank-dependent thresholds that are different depending on household income levels—the thresholds become lower for low-income households. Initial thresholds used ranged between 5% and 25% of total household expenditure, and between 20% and 40% of household non-food expenditure. Concentration indices are used to assess whether financial catastrophe is more prevalent among the poor or rich. Results: Atthe 10% initial threshold of total household expenditure, financial catastrophe was estimated at 4.08%, translating to over 668,000 households. At an initial threshold of 40% of total household non-food expenditure, about 0.82% or about 133,600 households incurred financial catastrophe, paying more thantheir rank-dependent thresholds. Financialcatastrophe was more prevalent among poorer and urban households, butthere was a mixed pattern across Ethiopia’s 11 regions. Conclusion: Financialcatastrophe resulting from paying OOP for health services exists in Ethiopia, affecting over 100,000 households. The low incidence compared to other studies may suggest that government’s initiatives like the fee-waiver and exemption systems have been successful, but the prevalence of financial catastrophe among the poor may signify that more is needed to achieve universal financial protection in Ethiopia. Keywords: Universal health coverage; financial catastrophe; Ethiopia

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