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Providing Family Planning Services at Primary Care Organizations after the Exclusion of Planned Parenthood from Publicly Funded Programs in Texas: Early Qualitative Evidence.
Health Services Research. 2017 Oct 20;OBJECTIVE: To explore organizations' experiences providing family planning during the first year of an expanded primary care program in Texas. DATA SOURCES: Between November 2014 and February 2015, in-depth interviews were conducted with program administrators at 30 organizations: 7 women's health organizations, 13 established primary care contractors (e.g., community health centers, public health departments), and 10 new primary care contractors. STUDY DESIGN: Interviews addressed organizational capacities to expand family planning and integrate services with primary care. DATA EXTRACTION: Interview transcripts were analyzed using a theme-based approach. Themes were compared across the three types of organizations. PRINCIPAL FINDINGS: Established and new primary care contractors identified several challenges expanding family planning services, which were uncommon among women's health organizations. Clinicians often lacked training to provide intrauterine devices and contraceptive implants. Organizations often recruited existing clients into family planning services, rather than expanding their patient base, and new contractors found family planning difficult to integrate because of clients' other health needs. Primary care contractors frequently described contraceptive provision protocols that were not evidence-based. CONCLUSIONS: Many primary care organizations in Texas initially lacked the capacity to provide evidence-based family planning services that women's health organizations already provided. (c) Health Research and Educational Trust.
Contraception. 2011 Oct; 84(4):339-41.This editorial focuses on a strategy to expand contraceptive coverage through the development of a numerical International Statistical Classifications of Diseases (ICD) code for "unwanted fertility." It explains how this strategy would work, how to make the strategy happen through a revision process, and defining unwanted fertility as a medical problem. Copyright © 2011 Elsevier Inc. All rights reserved.
Do health sector reforms have their intended impacts? The World Bank's Health VIII project in Gansu province, China.
Journal of Health Economics. 2007 May; 26(3):505-535.This paper combines differences-in-differences with propensity score matching to estimate the impacts of a health reform project in China that combined supply-side interventions aimed at improving the effectiveness and quality of care with demand-side measures aimed at expanding health insurance and providing financial support to the very poor. Data from household, village and facility surveys suggest the project reduced out-of-pocket spending, and the incidence of catastrophic spending and impoverishment through health expenses. Little impact is detected on the use of services, and while the evidence points to the project reducing sickness days, the evidence on health outcomes is mixed. (author's)
Geneva, Switzerland, World Health Organization [WHO], 2006. 32 p. (Moving Towards Universal Coverage. Issues in Maternal-Newborn Health and Poverty No. 3)The aim of this paper is to provide a systematic review of the evidence of the impact on economic growth of investments in maternal--newborn health (MNH). The methodology used for the review includes a systematic search for published literature in relevant electronic databases. In the paper, we review five studies: four empirical and one theoretical. One of the empirical papers measures health by infant mortality. The study finds that a 1/1000-point reduction in the infant mortality rate leads to an increase in the level of State Domestic Product by Indian Rs 2.70 and an increase in the average growth rate per year of 0.145%. Similar results are reported for other health measures in other studies. Our main conclusion, however, is that the area lacks research and that considerably more is needed before any advice can be provided to policy-makers about the contribution to growth of investments in MNH. Specifically, first and foremost, studies are needed that explicitly analyse the impact of MNH on level and growth of output. Second, we suggest the use of more comprehensive MNH measures that consider the health of both mothers and newborns and aspects of ill-health other than death, such as measures of quality of life, functional limitations, mental health and sickness absenteeism. Third, estimates of the effects of MNH on growth need to be controlled for other health dimensions, i.e. aspects that may confound the impact of MNH. Fourth, studies are needed of the effects on determinants of growth in order to understand better the links between MNH and growth. Fifth, studies based on smaller geographical areas within countries and longer time series are needed, in order to obtain more precise estimates and also better estimates of the long-term growth paths. Finally, we suggest compilation of other data sets on microeconomic data, for example, to study effects at firm level of MNH on labour productivity through inability to work, disability, sick days, etc. (author's)
Geneva, Switzerland, World Health Organization [WHO], 2006. 37 p. (Moving Towards Universal Coverage. Issues in Maternal-Newborn Health and Poverty No. 2)The aim of this paper is to provide a systematic review of the estimation of the cost of illness (COI) related to maternal-newborn ill-health (MNIH). The methodology used for the review includes a systematic search on electronic databases for published literature and manual searches for the identification of grey (unpublished) literature. Searches are based on the major electronic databases and also on the home pages of some major international organizations. While the problems of MNIH are well known and the importance of conducting COI studies is understood, knowledge is still lacking about the magnitude of the costs of MNIH at the societal level. After a search of the existing electronic databases, only one published paper was found to be relevant for the review; four grey studies (using REDUCE Safe Motherhood model) were also directly relevant. The published study estimates most of the cost components associated with a particular complication of MNIH -- emergency obstetric care (EmOC) -- and reports a total average cost per user of EmOC in the range of US$ 177-369 in Bangladesh. The unpublished studies based on the REDUCE model illustrate the MNIH issue more directly and elaborately; however, they estimate merely the productivity cost for four African countries. The model estimates a huge amount of productivity losses associated with MNIH: an annual total of about US$ 95 million for Ethiopia and about US$ 85 million for Uganda. To formulate an idea of issues related to data, measurement and methodology the present study also reviews COI studies on other related diseases that are similar to those on MNIH. The review reveals some difficulties in measurement and proposes to incorporate some relevant cost components that MNIH cause society and also suggests probable data sources for COI studies of MNIH. Although it is evident that MNIH results in suffering for women and children and hinders economic development through its huge burden for society, in order to stimulate further policy debate regarding its significance future research efforts should be directed towards theoretically sound and comprehensive COI studies with use of longitudinal and experimental data. (author's)
International Journal of Health Planning and Management. 2006 Oct-Dec; 21(4):297-312.After the break-up of the Soviet Union, the country of Georgia suffered from intense civil unrest and socio-economic deterioration, which particularly affected the health sector. To remedy the situation, the government initiated health sector reform, which introduced major changes in healthcare financing in Georgia: the previously free healthcare model was replaced by social insurance, and patients were required to pay out-of-pocket for services not covered by insurance. This paper is an attempt to determine if the health system of Georgia is reaching the WHO health system goals of improved health status, responsiveness to patients' needs (consumer satisfaction), and financial risk protection as a result of health reforms. (author's)
Choices. 2001 Dec; 4.We are facing the most devastating global epidemic in modern history. Over 60 million people have been infected. In the worst affected countries one in four adults are now living with HIV/AIDS, a disproportionate number of younger women and girls. More than 80 percent are in their twenties. The result is a devastating hollowing out of communities, leaving only the very young and the very old and thrusting millions of families deeper into poverty. Meeting this challenge means progress on three fronts: first, preventing new infections and reversing the spread of the epidemic; second, expanding equitable access to new HIV treatments; third, alleviating the disastrous impact of AIDS on human development. Effectively responding to HIV/AIDS requires a wide range of initiatives under strong national political leadership, including sex education in schools, public awareness campaigns, programmes in the workplace, mobilization of religious and community leaders, action to mitigate the impact on poverty and essential social services, support for orphans and tough policy decisions in ministries of finance to ensure optimal allocation of resources to cope with the crisis. (excerpt)
Women's Health Journal. 2003 Apr-Jun; (2):13-15.I feel that such opportunities are very important because in general the women's health movement has not been very involved in the analysis of neoliberal reforms in Latin America and the Caribbean. However, it is interesting to note that in the 1980s and 90s the women's movement -unlike the movement in defense of health- addressed the issue of health from a rights-based perspective, even though this term was not yet used. Those of us who were involved in the movement to defend health talked about how to apply the reform, how to improve it, but the issue of health as a right was not in our discourse. Based on this experience, it is important that organized women become involved in the analysis of the reform, At one point, the international agencies called together those of us specializing in gender and other key representatives of the women's movement to contribute a gender perspective to the neoliberal reforms. In hindsight, it is clear that we weren't on the same page: a perspective based on rights as the guiding principle for analyzing health was attempting to interface with an approach to health that has absolutely nothing to do with rights. In order to overcome this impasse, the women's movement needs to strengthen its alliances with other sectors critical of the neoliberal reforms and learn more about other non-neoliberal proposals for health sector reform such as that implemented in Brazil, for example. Of course, we must not forget Cuba's reform which was developed in the context of a revolutionary process. (excerpt)
Summary measures of population health in the context of the WHO framework for health system performance assessment.
In: Summary measures of population health: concepts, ethics, measurement and applications, edited by C.J.L. Murray, J.A. Salomon, C.D. Mathers and A.D. Lopez. Geneva, Switzerland, World Health Organization [WHO], 2002. 1-11.This volume addresses the conceptual, ethical, empirical and technical challenges in summarizing the health of populations. This is critical for monitoring whether levels of population health are improving over time and for understanding why health differs across settings. At the same time, it is also important to recognize that improving population health is not the only goal of health policy and to understand the way health improvements interact with these other goals. For that reason, we briefly review the World Health Organization (WHO) framework for assessing the performance of health systems and the role of summary measures of population health (SMPH) in this framework. Following the recent peer review of the methodology used for health system performance by WHO (Anand et al. 2002), this framework will continue to evolve in response to the detailed recommendations of the scientific peer review group and to ongoing scientific debates and research. (excerpt)
Our families, our friends: an action guide. Mobilize your community for HIV / AIDS prevention and care.
[Bangkok, Thailand], United Nations Development Programme [UNDP], South East Asia HIV and Development Project, 2000. vi, 30 p. (Best Practice Documentation on Community Mobilization for HIV / AIDS: Case of Thailand)Community actions on the prevention and control of AIDS are initiated based on the community’s needs. The community hospital may play an important role in promoting and supporting care for people with HIV/AIDS (PWHA) within their area. In turn, the sustainability of controlling HIV problems in the community is based on the strength of that community. Therefore, building resources within the community should be promoted, so that those concerned understand the problems, provide acceptance to PWHA, and work together to reduce the impact of HIV/AIDS. Religious leaders can play a major role in providing support and encouraging social change towards the acceptance of PWHA. Self-help groups are very important community units, they provide care, psychosocial support and generate income for PWHA. The work plan of activities needs to be flexible, based on the needs of PWHA and their community. This action guide can help people in your community to understand how to help one another and work together for their mutual benefit, now and in the future. (excerpt)
[Unpublished] .  p.The UN promotes protection of international human rights including workers' rights for all. At the same time, the UN is also attempting to define policies recognizing the impact of HIV/AIDS on the lives of its employees and accordingly is attempting to develop corresponding strategies of prevention and care. In fact, the UN system has undertaken an initiative aimed at harmonizing and coordinating the existing medical insurance policies of various agencies. This effort aims to provide equitable access to HIV/AIDS care and support to all UN employees and their families. Several activities being implemented by the UN to promote HIV/AIDS protection for its employees include awareness building within the UN system, care, dissemination of information, and education and sensitivity training.
AVSC NEWS. 1997 Summer; 35(2):1, 8.Two recent laws adopted by the Colombian Ministry of Health have had a detrimental effect on access to family planning (FP) services and have affected AVSC's work in that country, which is widely regarded as a trendsetter in reproductive health and FP among Latin American nations. One of the laws, which went into effect in 1993, provides universal health care regardless of ability to pay and allows people to choose between public or private health facilities. This law fails to specify, however, which FP services are covered, and the new agencies that act as liaisons between individuals, employers, and hospitals or clinics are unwilling to provide coverage for sterilization or contraception. Individuals who have paid for insurance resist paying an extra amount for contraception. The other law, enacted in 1991, restricts the delivery of anesthesia to anesthesiologists. In hospitals without full-time anesthesiologists, this has impeded delivery of many outpatient surgical procedures or treatment of incomplete abortion. It also prevents performance of female sterilization under local anesthesia. The laws have halted much of AVSC's work in establishing services for female sterilization under local anesthesia in public hospitals. AVSC has responded to the laws by working to help public and private sector providers manage the changes, producing a public information brochure, disseminating the law to service providers, and training anesthesiologists to promote female sterilization. In 1996, the 1993 law was clarified to ensure access to reproductive health and FP services.
AIDS WEEKLY PLUS. 1996 Nov 18; 18-9.According to World Health Organization (WHO) Jakarta representative Dr. Stefano Lazzari, in an address to the First Asian Conference on Healthcare Insurance, the total number of human immunodeficiency virus (HIV) cases in Asia will increase to 8-10 million by the year 2000, if current trends hold. He said that WHO estimated 25.5 million adults and 2.4 million children globally had HIV; 19 million were in sub-Saharan Africa, 5 million were in South and Southeast Asia, and 1.6 million were in Latin America. Asia's high-risk sexual behavior, coupled with a population size much larger than Africa's, provides the basis for an expected incidence higher than anywhere else in the world by the year 2000. While the annual number of HIV cases in Africa will peak by 1995-1996, it will continue to increase in Asia, where the disease arrived later. India will have 5 million cases, making it the most infected country. While the current WHO estimate of more than 5 million HIV infections in Southeast Asia is nearly 18% of the global total, the proportion of the region's officially reported acquired immunodeficiency syndrome (AIDS) cases is less than 2% of the global total. The average time for advanced AIDS to develop is around 10 years. Life insurance premiums will rise with the increasing number of deaths due to AIDS, and the cost of treatment for those with advanced AIDS will be very expensive. The estimated cost of treating an HIV-infected person in Thailand is $5000 to $8000. Protease inhibitors cost $15,000 to $20,000 annually. Sivam Subramaniam, Asia Insurance Review, stated that insurance companies must protect themselves while treating patients with sensitivity, and he noted that the part of Indonesian society that could afford private insurance, the rich, was not the group most at risk for HIV infection.
WORLD OF WORK. 1996 Sep-Oct; (17):10-1.Viet Nam's shift toward a market-oriented economy has been associated with annual gross domestic product growth of more than 8% over the past 5 years. At the same time, the emergence of private-sector enterprises and subsequent closure of many state-run enterprises have had profound implications for Viet Nam's social protection systems. At present, only 5.6 million of the country's 33 million workers are covered under the state-run social insurance system. In 1995, the government moved to include private enterprises with 10 or more employees in its state benefits system. The International Labor Organization (ILO) has been working with the Vietnamese Government to design and implement a social security system that would extend coverage progressively to excluded sectors and provide support to workers who have become unemployed as a result of the economic transition process. At its Eighth National Congress, the Vietnamese Communist Party approved a 5-year social and economic plan calling for such an expansion of the social insurance system as well as for a guaranteed standard of living for pensioners. To facilitate anticipated changes, activities that were previously divided between the Ministry of Labor, Invalids, and Social Affairs and the Vietnam General Confederation of Labor have been assigned to the newly formed Vietnam Social Insurance (VSI) Organization. Under consideration is a plan to combine some VSI activities with those of the Vietnam Health Insurance Organization. The ILO will assist with training, computerization, and social security fund investing. Noncompliance is a major obstacle to planned expansion of the social security system; about 90% of private firms are still not paying into the system.
JOURNAL OF THE INTERNATIONAL ASSOCIATION OF PHYSICIANS IN AIDS CARE. 1995 Mar; 1(2):34.After a 4-day meeting of African health officials, professors, nongovernmental specialists, and parliamentarians in Paris, Dr. Ebrahim Samba, World Health Organization (WHO) regional director called for change in the way the continent's governments, peoples, and international benefactors approach health care. WHO and the World Bank published a study, "Better Health for Africa," which suggests low-income African countries can overhaul their health systems and offer services for $13 per person per year; the average per capita is now $14 (range, $10-$100). In some countries consumers only receive $12 worth of benefits for each $100 spent on drugs by the public sector. The new approach calls for comprehensive plans to reach the greatest number of people with appropriate care while integrating care with clean water and sanitation. Health ministries currently focus on sophisticated services in the cities that benefit a small and relatively prosperous segment of society. Dr. Olikoye Ransome-Kuti, former Nigerian Health Minister, noted that people pay a lot in both the formal and informal (traditional healers) health settings, and that health insurance and user fees could finance this. Edward Elmendorf, a World Bank specialist on human resources and poverty, stated that wider use of health insurance would free some of the funds used by advanced hospitals for meeting the needs of the entire population, and that, according to the report's panel, user fees, even in impoverished areas, produced better services and consumers who value the information and medications they receive. Wadi Haddad, World Bank senior advisor for human development, said there is a consensus among international donors to encourage health care reform, for which each country would develop its own plan and priorities. Donors, who finance about 20% of health costs in Africa, are also urging governments to address education of women, clean water, and poverty. The Bank has pledged $1.4 billion in loans for 30 countries to reform their health care systems.
Population Reports. Series J: Family Planning Programs. 1991 Nov; (39):1-31.This report discusses the challenges and costs involved in meeting the future needs for family planning in developing countries. Estimates of current expenditures for family planning go as high as $4.5 billion. According to a UNFPA report, developing country governments contribute 75% of the payments for family planning, with donor agencies contributing 15%, and users paying for 10%. Although current expenditures cover the needs of about 315 million couples of reproductive age in developing countries, this number of couples accounts for only 44% of all married women of reproductive age. Meeting all current contraceptive needs would require an additional $1 to $1.4 billion. By the year 2000, as many as 600 million couples could require family planning, costing as much as $11 billion a year. While the brunt of the responsibility for covering these costs will remain in the hand of governments and donor agencies (governments spend only 0.4% of their total budget on family planning and only 1% of all development assistance goes towards family planning), a wide array of approaches can be utilized to help meet costs. The report provides detailed discussions on the following approaches: 1) retail sales and fee-for-services providers, which involves an expanded role for the commercial sector and an increased emphasis on marketing; 2) 3rd-party coverage, which means paying for family planning service through social security institutions, insurance plans, etc.; 3) public-private collaboration (social marketing, employment-based services, etc.); 4) cost recovery, such as instituting fees in public and private nonprofit family planning clinics; and 5) improvements in efficiency.
JOURNAL OF TROPICAL MEDICINE AND HYGIENE. 1989 Aug; 92(4):229-41.This general discussion on health economics provides an historical overview as well as a discussion of some of the developments and deficiencies in health economics in developing countries, broadly focused on expenditure and financing studies, cost benefit and cost effectiveness, local costing studies and health planning. In 1963, it was found that as GDP rose so did health expenditures, that countries with similar per capita income spent different percentages of GDp on health services, that the private sector involvement was greater than the public, and that hospitals received most of the money. Countries were encouraged to conduct further studies. The World Bank has successfully stimulated discussion. However, lacking the expenditure studies, cost benefits are hampered by the availability of epidemiological data and poor cost information, and geared toward studies on how to cut costs for immediate goals, or specific diseases, rather than on practical advice to governments. 1 such study helped identify that most cost effective allocation of resources. The limited local cost studies are particular to understanding specific costs of immunization versus antenatal visits; however, the usefulness of such preliminary information reveals wide variability between countries. The Health for All initiatives and the limited resources in developing countries have placed health planning in a central position with Ministries of Health. Due to prior mistakes in planning an excess number of trained medical staff are underutilized and present needs have been defined as developing local PHC support staff. The WHO expectation of 5% of GNP for health service was unfulfilled because larger donor aid and local resources have not been sufficient even with strong posturing, and over ambitious plans were made unrealistically. Since 1987, WHO has provided economic strategies but the economic crises changed the needs. Many questions remain and consultants are too few, improperly trained, or unavailable for the appropriate time period: unacceptable solutions, coupled with a confusing World bank prospectus for action when more research is needed. Intersectorial collaboration has not provided answers to priorities or addressed the interactions among nutrition and agricultural policy, education and lifestyle, water and sanitation and the economy. The research agenda should include: the identification of the determinants of health, key elements of primary health care (PHC), cost of delivering PHC, hospital efficiency, health manpower mix, adequate procurement and distribution, appropriate technology, user charges for financing, health insurance, and community financing.
In: Cost recovery in the health care sector: selected country studies in West Africa, by Ronald J. Vogel. Washington, D.C., The World Bank, 1988. 126-58. (World Bank Technical Paper No. 82)This chapter is a case analysis of Ghana's health care sector based on a 2-week mission that included site visits to the Christian Hospital Association, which coordinates 35 mission hospitals and 34 mission clinics with the USAID mission and UNICEF in Accra; interviews and analysis of the cost recovery questionnaire given to key planners and health personnel in Accra; site visits to the Government's Industrial Holding Company (GIHOC); and to the Ridge and Korle Bu Hospitals in Accra. Ghana faced severe economic hardship during the 1980's affecting the ability of the health sector to function effectively. Between 1978- 83 per capital health expenditures declined from US 63.6 cents to US 8.3 cents while raising again in 1985 to US 23.0 cents and between 1981-84 physician emigration went from 1700 to 800 because of low morale and the low government pay scale. Under the auspices of the World Bank and the International Monetary Fund, cost recovery for health care was instituted in 1983 and is becoming more comprehensive in coverage. Ghana's cost recovery ratio went from 7.9% in 1986 to 12.1% in 1987. In 1983 the Government revised its 1983 cost recovery law mandating "cost recovery for all government health-care institutions, and creating a uniform collecting and reporting system. It also insisted on full-cost pricing for drugs and pharmaceuticals." The major policy questions addressed in this chapter are: 1) the structure of health care prices and the amounts of revenue collected; 2) patient reaction to cost recovery; 3) equity aspects; and 4) administrative problems and collection costs.