scholarly journals Forgone healthcare and financial burden due to out-of-pocket payments in Bangladesh: a multilevel analysis

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Md. Mizanur Rahman ◽  
Md. Rashedul Islam ◽  
Md. Shafiur Rahman ◽  
Fahima Hossain ◽  
Ashraful Alam ◽  
...  
Keyword(s):  
Health Services ◽  
Multilevel Analysis ◽  
Health Facility ◽  
Financial Burden ◽  
Safety Net ◽  
Access To Health Services ◽  
Financing System ◽  
Access To Health ◽  
Out Of Pocket Payments ◽  
Nationally Representative

Abstract Background Ensuring access to health services for all is the main goal of universal health coverage (UHC) plan. Out-of-pocket (OOP) payment still remains the main source of funding for healthcare in Bangladesh. The association between barriers to accessing healthcare and over-reliance on OOP payments has not been explored in Bangladesh using nationally representative household survey data. This study is a novel attempt to examine the burden of OOP payment and forgone healthcare in Bangladesh, and further explores the inequalities in catastrophic health expenditures (CHE) and forgone healthcare at the national and sub-national levels. Methods This study used data from the most recent nationally representative cross-sectional survey, Bangladesh Household Income and Expenditure Survey, conducted in 2016–17 (N = 39,124). In order to identify potential determinants of CHE and forgone healthcare, multilevel Poisson regression was used. Inequalities in CHE and forgone healthcare were measured using the slope index of inequality. Results Around 25% of individuals incurred CHE and 14% of the population had forgone healthcare for any reasons. The most common reasons for forgone healthcare were treatment cost (17%), followed by none to accompany or need for permission (5%), and distance to health facility (3%). Multilevel analysis indicated that financial burden and forgone care was higher among households with older populations or chronic illness, and those who utilize either public or private health facilities. Household consumption quintile had a linear negative association with forgone care and positive association with CHE. Conclusion This study calls for incorporation of social safety net in health financing system, increase health facility, and gives priority to the disadvantaged population to ensure access to health services for all.

scholarly journals Are nurses meeting the needs of men in primary care?

2017 ◽  
Vol 23 (4) ◽  
pp. 319
Author(s):  
Del Lovett ◽  
Bodil Rasmussen ◽  
Carol Holden ◽  
Patricia M. Livingston
Keyword(s):  
Health Services ◽  
Healthcare Access ◽  
Men’S Health ◽  
Men's Health ◽  
Service Access ◽  
Access To Health Services ◽  
Financing System ◽  
Healthcare Needs ◽  
Comprehensive Primary Health Care ◽  
Access To Health

Meeting men’s health needs by improving healthcare service access is a key objective of comprehensive primary health care. The aims of this qualitative study were to explore the perception of nurses in men’s health services and to describe men’s expectation of the nurse. The comparative component identifies the barriers and facilitators to improved access to health services. A purposive sample of 19 nurses and 20 men was recruited from metropolitan and regional settings in the state of Victoria, Australia, and each participant was interviewed individually or as part of three focus groups. The main findings were: nurses and men were unclear on the role of the nurse in men’s health; and health promotion provided by nurses was predominantly opportunistic. Both participant groups indicated barriers to healthcare access related to: the culture and environment in general practice; limitation of Australia’s Medicare healthcare financing system; out-of-pocket costs, waiting time and lack of extended hours; and men not wanting to be perceived as complainers. Facilitators related to: positive inter-professional relations; effective communication; personal qualities; and level of preparedness of nurse education. The findings demonstrate a need for the role to be better understood by both men and nurses in order to develop alternative approaches to meeting men’s healthcare needs.

scholarly journals Health Facility-based Counselling and Community Outreach are Associated with Maternal Dietary Practices in a Cross-sectional Study from Tanzania

2021 ◽  
Author(s):  
Kirk A. Dearden ◽  
Ramu Bishwakarma ◽  
Benjamin T. Crookston ◽  
Benesta T. Masau ◽  
Generose I. Mulokozi
Keyword(s):  
Health Services ◽  
Community Health ◽  
Health Worker ◽  
Health Facility ◽  
Community Health Worker ◽  
Children's Health ◽  
Dietary Behaviors ◽  
Access To Health Services ◽  
Dietary Practices ◽  
Access To Health

Abstract Background: Anemia and underweight among women are major public health challenges. Access to health services can improve dietary behaviors and women’s nutritional status. We examined whether exposure to health services is associated with women’s dietary practices in Tanzania.Methods: Data come from a two-stage, randomized baseline survey among 5,000 female primary caregivers prior to implementing a maternal and child nutrition program. We ran frequencies on women’s exposure to existing health facility-based counselling, community health worker visits, and attendance at women’s support groups. We examined associations between exposure to these interventions and maternal diets and adjusted for sociodemographic covariates using ordinary least squares regression and ordered logistic regression.Results: A third of the sample (34.1 percent) had received any antenatal care (ANC) during their most recent pregnancy or had been advised by anyone about nutrition (37.0 percent). 68.0 percent had never had a community health worker (CHW) speak to them about their children’s health and 9.4 percent had participated in a women’s group. Only 8.0 percent of mothers ate more than usual during pregnancy and 7.1 percent ate more types of foods. After adjusting for mother’s age, education and household assets, women who received nutrition advice were 1.3 times (95 percent CI: 1.1, 1.7) more likely than mothers who did not to eat more during pregnancy. Receiving ANC and advice on nutrition before, during, and after pregnancy and delivery were highly associated with the mother eating more types of foods. Hearing from a CHW about children’s health but not support group attendance was often associated with various dietary practices. Almost all measures of access to health services were significantly associated with mothers’ frequency of eating in the previous 24 hours. Receiving advice on nutrition during pregnancy and after giving birth and CHW contact were associated with mothers’ dietary diversity in the previous 24 hours. Conclusions: Several program exposure variables—especially being counselled about nutrition—were associated with improved dietary practices. Improving service delivery at scale may contribute to improved dietary behaviors in larger populations, given the associations we describe, along with findings from the existing literature.

scholarly journals Exploring TB-Related Knowledge, Attitude, Behaviour, and Practice among Migrant Workers in Tajikistan

2011 ◽  
Vol 2011 ◽  
pp. 1-10 ◽  
Author(s):  
Christopher Gilpin ◽  
Pierpaolo de Colombani ◽  
Sayohat Hasanova ◽  
Umrinisso Sirodjiddinova
Keyword(s):  
Health Services ◽  
Migrant Workers ◽  
Legal Status ◽  
Financial Burden ◽  
Destination Country ◽  
Access To Health Services ◽  
Host Countries ◽  
Access To Health ◽  
Tuberculosis Diagnosis ◽  
Working And Living Conditions

A knowledge, attitude, behaviour, and practice survey was conducted among labour migrants in Tajikistan to elucidate key factors influencing access to tuberculosis diagnosis and care both in their labour destination country and at home. 509 labour migrants were interviewed in Khaton and Rasht Valley regions in Tajikistan using a standardised questionnaire. In addition, in-depth interviews were conducted among ten tuberculosis patients who had recently worked abroad. The study showed that migrants have increased vulnerability to tuberculosis due to the working and living conditions in the destination country and that access to health services is limited due to their legal status or the high cost of health services abroad. The average knowledge of migrants regarding tuberculosis is low and misconceptions are frequent. In Tajikistan, although tuberculosis drugs are usually provided free of charge, tuberculosis diagnosis and ancillary treatment are charged, thus creating a significant financial burden for patients and their families. Improving the access of labour migrants to affordable early diagnosis and treatment in both host countries and Tajikistan is a priority.

scholarly journals Health facility-based counselling and community outreach are associated with maternal dietary practices in a cross-sectional study from Tanzania

BMC Nutrition ◽  
2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Kirk A. Dearden ◽  
Ramu Bishwakarma ◽  
Benjamin T. Crookston ◽  
Benesta T. Masau ◽  
Generose I. Mulokozi
Keyword(s):  
Health Services ◽  
Antenatal Care ◽  
Community Health ◽  
Health Worker ◽  
Health Facility ◽  
Dietary Behaviors ◽  
Access To Health Services ◽  
Dietary Practices ◽  
Cross Sectional ◽  
Access To Health

Abstract Background Anemia and underweight among women are major public health challenges. Access to health services can improve dietary behaviors and women’s nutritional status. We examined whether exposure to health services is associated with women’s dietary practices in Tanzania. Methods Data come from a cross-sectional baseline survey among 5000 female primary caregivers who were randomly selected via two-stage sampling, prior to implementing a maternal and child nutrition program. We ran frequencies on women’s exposure to existing health facility-based counselling, community health worker visits, and attendance at women’s support groups. We examined associations between exposure to these interventions and maternal diets and adjusted for sociodemographic covariates using ordinary least squares regression and ordered logistic regression. Results A third of the sample (34.1%) had received any antenatal care (ANC) during their most recent pregnancy or had been advised by anyone about nutrition (37.0%). 68.0% had never had a community health worker (CHW) speak to them about their children’s health and 9.4% had participated in a women’s group. Only 8.0% of mothers ate more than usual during pregnancy and 7.1% ate more types of foods. After adjusting for mother’s age, education and household assets, women who received nutrition advice were 1.3 times (95% CI: 1.1, 1.7) more likely than mothers who did not to eat more during pregnancy. Receiving antenatal care (ANC) and advice on nutrition before, during, and after pregnancy and delivery were highly associated with the mother eating more types of foods. Hearing from a CHW about children’s health but not support group attendance was often associated with various dietary practices. Almost all measures of access to health services were significantly associated with mothers’ frequency of eating in the previous 24 h. Receiving advice on nutrition during pregnancy and after giving birth and CHW contact were associated with mothers’ dietary diversity in the previous 24 h. Conclusions Several program exposure variables—especially being counselled about nutrition—were associated with improved dietary practices. Improving service delivery at scale may contribute to improved dietary behaviors in larger populations, given the associations we describe, along with findings from the existing literature.

scholarly journals The effects of medicines availability and stock-outs on household’s utilization of healthcare services in Dodoma region, Tanzania

2020 ◽  
Vol 35 (3) ◽  
pp. 323-333 ◽  
Author(s):  
August Kuwawenaruwa ◽  
Kaspar Wyss ◽  
Karin Wiedenmayer ◽  
Emmy Metta ◽  
Fabrizio Tediosi
Keyword(s):  
Health Services ◽  
Health Facility ◽  
Healthcare Utilization ◽  
Low Income ◽  
Essential Medicines ◽  
Access To Health Services ◽  
Cross Sectional ◽  
Access To Health ◽  
Catchment Areas ◽  
Medicine Availability

Abstract Low- and middle-income countries have been undertaking health finance reforms to address shortages of medicines. However, data are lacking on how medicine availability and stock-outs influence access to health services in Tanzania. The current study assesses the effects of medicine availability and stock-outs on healthcare utilization in Dodoma region, Tanzania. We conducted a cross-sectional study that combined information from households and healthcare facility surveys. A total of 4 hospitals and 89 public primary health facilities were surveyed. The facility surveys included observation, record review over a 3-month period prior to survey date, and interviews with key staff. In addition, 1237 households within the health facility catchment areas were interviewed. Data from the facility survey were linked with data from the household survey. Descriptive analysis and multivariate logistic regressions models were used to assess the effects of medicine availability and stock-outs on utilization patterns and to identify additional household-level factors associated with health service utilization. Eighteen medicines were selected as ‘tracers’ to assess availability more generally, and these were continuously available in ∼70% of the time in facilities across all districts over 3 months of review. The main analysis showed that household’s healthcare utilization was positively and significantly associated with continuous availability of all essential medicines for the surveyed facilities [odds ratio (OR) 3.49, 95% confidence interval (CI) 1.02–12.04; P = 0.047]. Healthcare utilization was positively associated with household membership in the community health insurance funds (OR 1.97, 95% CI 1.23–3.17; P = 0.005) and exposure to healthcare education (OR 2.75, 95% CI 1.84–4.08; P = 0.000). These results highlight the importance of medicine availability in promoting access to health services in low-income settings. Effective planning and medicine supply management from national to health facility level is an important component of quality health services.

Trends in access to health services and financial protection in China between 2003 and 2011: a cross-sectional study

The Lancet ◽  
2012 ◽  
Vol 379 (9818) ◽  
pp. 805-814 ◽  
Author(s):  
Qun Meng ◽  
Ling Xu ◽  
Yaoguang Zhang ◽  
Juncheng Qian ◽  
Min Cai ◽  
...  
Keyword(s):  
Health Services ◽  
Cross Sectional Study ◽  
Financial Protection ◽  
Sectional Study ◽  
Access To Health Services ◽  
Cross Sectional ◽  
Access To Health

scholarly journals Medical Ethnobiology and Indigenous Knowledge System Found In Darai Ethnic Group of Chitwan, Nepal

2016 ◽  
Vol 21 (1) ◽  
pp. 103-111 ◽  
Author(s):  
Manisha Poudel ◽  
Nanda Bahadur Singh
Keyword(s):  
Health Services ◽  
Indigenous Knowledge ◽  
Ethnic Group ◽  
Animal Species ◽  
Knowledge System ◽  
Easy Access ◽  
Access To Health Services ◽  
Medicinal Purpose ◽  
Indigenous Knowledge System ◽  
Access To Health

The present study focuses on traditional usages of animals and plants species for medicinal purpose and indigenous knowledge system existent in Darai ethnic group of Mangalpur VDC, Chitwan, Nepal. A total of 28 animal species and 76 plant species were found to be used by Darai people to treat 22 and 36 different ailments, respectively. Darai people have their own indigenous knowledge for making various bamboo products and fishing equipments and local drink (moat/muna). The existence of knowledge associated with animals and plants and their medicinal utility is currently threatened mainly due to modernization, easy access to health services, lack of interest of youngsters, few local healers and fading of ethnic characters of Darai ethnic group. Thus, documentation of such knowledge has become an urgent need.Journal of Institute of Science and TechnologyVolume 21, Issue 1, August 2016, page: 103-111

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