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Social Science and Medicine. 1992 May; 34(9):959-64.Insufficient information contributes to failure in markets. Government officials also use it to justify intervention in the health sector in the developing countries. Further, in these countries,health care workers have misused pharmaceuticals considerable as well as make improper diagnoses. Moreover both health practitioners and the general public do not always follow instructions on drug use. A shortage of information on appropriate use may indeed cause these problems. A staff member of the World Bank proposes a methodology to use to balance 2 competing risks. Either public health officials allow drugs to be available to consumers over the counter or they require a prescription from a licensed health professional. The risks include obvious diagnostic errors made my consumers untrained in medicine and patients not receiving needed, potentially life saving, drugs. Since there is a shortage of medical personnel in most developing countries, people face considerable obstacles (e.g., travel time and expense) when it comes time to go to a licensed medical facility. The proposed methodology to evaluate the tradeoff between the 2 risks involves looking at the problems as one of determining the value of a more accurate diagnosis through the intervention of a skilled professional as a specific and costly mechanism for acquiring an accurate diagnosis. The article applies the model to illustrative examples to identify the information to answer the regulatory issue question. Further the model also allows public health policy makers to determine the appropriate level of training needed for medical professionals and to evaluate projects which improve public access to information on the use of drugs.
In: African research studies in population information, education and communication, compiled and edited by Tony Johnston, Aart de Zeeuw, and Waithira Gikonyo. Nairobi, Kenya, United Nations Population Fund [UNFPA], 1991. 54-72.Researchers arranged for interviews with 300 female discontinuing clients at 2 maternal and child health/family planning (MCH/FP) clinics in Mauritius and followed 230 of them to explain what happens to women who discontinue coming to the MCH/FP clinic. 26% of all women in the sample stopped using MCH/FP clinic services for fertility related reasons. The 2 leading reasons were desire for pregnancy (15.2% of all women) followed by husband absent or sexually inactive (5.2%). Further 30.1% switched to a competing contraceptive provider, especially a factory based provider (11.3%). They tended to switch providers because the new provider was more accessible or they were either dissatisfied with the quality of services at the MCH/FP clinic or the new clinic had an advantage over the MCH/FP clinic. 43.9% switched from scientific family planning methods to either natural or traditional family planning methods. These women tended no to wander out of the house and to be poorly educated, of an ethnic minority group, and >35 years old. In fact, 26.1% used natural family planning because of dissatisfaction with either the contraceptive methods themselves or the quality of services provided. Much attendance discontinuity was determined by misperceptions about ongoing or long term contraceptive use. This indicated that clinic counselors should become more sensitive to and fully address the problems and side effects of contraceptive method use. In conclusion, the MCH/FP clinics should focus their information, education, and communication efforts on the women who switched to unscientific or natural methods.
Inquiry. 1975 Jun; 12(2 Suppl):148-55.The intention in this discussion is to describe the health care system in a rural area of 1 not atypical developing country, Ghana. Some of the deficiencies of the system are reviewed from a sociological perspective, and the components of 1 potential approach for reducing the health problems in this and similar situations are outlined. About 12% of Ghana's 8.5 million population (1970) live in the larger cities and urban areas. The majority of the population lives in small towns and especially in villages and hamlets scattered throughout the country. The country has about 670 physicians registered, but most of these physicians are concentrated in the urban areas. In the rural areas, the existing health care delivery system consists of a regional hospital offering specialized services, with decentralized and less specialized services extending toward the periphery of the system. What this means is 1 or more district level hospital and a modest number of health centers and posts throughout the rural areas. Emphasis in this decentralized system is on static health facilities that provide elementary medical care primarily on an outpatient basis, referral of the more complicated and/or serious cases to the system's higher levels, and various mother and child preventive health services. Also there are individuals and mobile teams to monitor sanitary conditions and provide immunization coverage to large portions of the population on a campaign basis. This pattern of health care may be found in similar form throughout most of the countries of the developing world. There have been concerted efforts to increase the availability and efficiency of health care delivered throughout Ghana, but there are prominent problems. In the Wenchi District there are 4 mission hospitals located in the 3 largest towns. These hospitals have their own outpatient activities and receive patients who are referred from the more peripheral government health facilities. There is a reasonable distribution of health personnel in the district, and a large proportion of the population uses the modern health facilities. Given a theoretical commitment to the reasons why a rural health care provision system should be based on community involvement and activities, the World Health Organization is trying to work with governments who want to implement such a program. Certain operational components are necessary. A specific project is planned for the Wenchi district. Preparatory work includes codification of various potential village projects in the form of simple procedures that can be carried out by village health workers, should the community identify related needs and adopt such projects. These project guides must also include training instructions, supervisory and resupply guidelines, instructions for referral of more complicated cases, and evaluation procedures which can be used and understood at the village level. Coordination and cooperation procedures will have to be established at both the district and subdistrict levels.