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  1. 1

    Government health care charges: is equity being abandoned? A discussion paper.

    Gilson L

    London, England, London School of Hygiene and Tropical Medicine, Evaluation and Planning Centre for Health Care, 1988 Spring. 75 p. (EPC Publication No. 15)

    In response to the resource shortages of government health systems in developing countries, the World Bank has called for charges to be introduced for some types of government health care. While this call may seem to be a pragmatic response to the sector's financing problems, it is also tied closely to the current political emphasis on greater efficiency. Equity considerations are of 2ndary importance. This paper challenges the World Bank's support for health care fees on 2 grounds. 1rstly, the limited importance given to equity within its proposals. 2ndly, the failure to address the problems of implementing its fee strategy. To support this challenge, the different political perceptions of social justice and the importance of equity as a policy goal are explored. The World Bank's position can be characterized as liberal tending towards libertarian and it is argued that the Bank is predisposed towards change in health financing systems by its support for the market-based allocation of care. This predisposition leads the Bank to overlook the difficulties of implementing a fee system that benefits the poor: inability to pay fees, unwillingness to use government care, the difficulty of making payment exemptions and the barriers to retaining fee revenue and using it effectively within government health systems. Starting instead from a collectivist emphasis on equity, alternative options for addressing the problems of resource shortages are also suggested. Improving the performance of government health systems within the available resources is the top priority and the feasibility of implementing other financing options is linked to such an improvement. Policy change should be promoted because it will improve the current situation and not for its own sake.
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  2. 2

    Report of a WHO Meeting on Adolescent Sexuality and Reproductive Health: Educational and Service Aspects, Mexico City, 28 April - 2 May 1980.

    World Health Organization [WHO]

    [Unpublished] 1981. 69 p. (MCH/RHA/81.1)

    In 1977, the Maternal and Child Health Unit of the World Health Organization (WHO) collaborated with the International Planned Parenthood Federation in the design and implementation of a cross-cultural survey in an effort to fill the gaps in available country-specific information on the reproductive health needs of adolescents and the information, education, and services available to them. The premise was that the use of a well-designed survey instrument would provide a global picture of the issues surrounding adolescent sexuality and reproductive health. The surveys were used as background information for the WHO Meeting on Adolescent Sexuality and Reproductive Health: Educational and Service Aspects, held in Mexico in May 1980. The objectives of the meeting were: to review the needs and problems related to sexuality and reproductive health of adolescents; to identify priority research issues related to these needs; to identify appropriate approaches including strategies and channels to meet these needs, including education, health, and social services; and to suggest specific follow-up activities to the recommendations of the meeting. To establish a working outline for the discussions which were to take place during the meeting, extensive background material was presented by some of the participants. These papers, included in an annex, focused on the health and social aspects of pregnancy in adolescents and on adolescents in a changing society, especially in the context of their sexuality and reproductive behavior. A system of plenary sessions and small group discussions took place during the meeting. Based on the background papers and the reports of the 4 working groups, the full meeting developed 4 issues for specific consideration: an adolescent overview; a conceptual model; strategies for action; and specific recommendations. These 4 issues are covered in detail in this report of the meeting. The meeting participants repeatedly emphasized the need to involve adolescents, policy makers, and potential service providers in a program which is not predetermined and sufficiently flexible to permit the participation of all concerned. Meeting participants recommended the development of a series of community-based pilot projects on educational and service programs in sexuality and reproductive health for and with adolescents, action research to support the development of the pilot projects, a focus on youth participation in programs addressed to meet the specific needs of adolescents, and attention directed to encouraging youth to assume responsibility in program development. Summary reports of the cross-cultural survey are included in this report.
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  3. 3

    Planning for health and development: a strategic perspective for technical cooperation. Volume II. Technical background papers.

    Family Health Care

    Washington, D.C., Family Health Care, 1979, Sep 13. 2 281 p.

    This volume is 1 of a series of Family Health Care Reports. Section I of Volume II gives a detailed rationale for comprehensive multisectoral planning for health. Definitions, theoretical models and arguments, and empirical documentation of intersectoral linkages and implications for health programming are taken up. This section is background material for section IV (Volume I)--planning for health elements of a strategic perspective for National Health Development. Included is a lengthy examination of the empirical evidence supporting intersectoral approaches to health and development programming. Section II of Volume II gives the framework for assessment of planning for health in less developed countries. Empirical and qualitative approaches to assessment are discussed. An introduction to the analytic approach is given under the empirical approach. Cross-country analysis, the health planning process and the distribution of wealth is discussed. Experiences of less-developed countries are given in the section on qualitative approach as are assistance efforts of the World Health Organization and the US Agency for International Development. Training in international health planning is also covered. This section is background material for section II (Volume I)--assessment of experiences in planning for health in less-developed countries. The results of an empirical approach to assessment are largely used as input to section III, B.1--experiences of less-developed countries. The results of the qualitative approach to assessment correspond to each and every section of the assessment findings (Section III.B) in Volume I. The bibliography provides a list of general reference works relevant to planning for health and development in the Third World.
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