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HEALTH POLICY AND PLANNING. 1996 Dec; 11(4):428-37.Health sectors are being restructured in many parts of the world to shift the financial burden of health care away from the public sector onto individual citizens. This paper describes a study conducted to investigate the willingness of patients and households to pay for rural district hospital services in northwestern Tanzania. Surveys conducted included interviews with 500 outpatients and 293 inpatients at 3 district-level hospitals, interviews with 1500 households, and discussions with 22 focus groups within the catchment areas of the primary health care programs of these hospitals. Information was collected on the willingness to pay fees for certain hospital services, willingness to become a member of a local insurance system, and exemptions for cost-sharing. The surveys found a considerable willingness among respondents to pay for district hospital services. However, most respondents favored a local insurance system over user fee systems, a finding which applied at all places and in all of the surveys. More female respondents favored a local insurance scheme. The conditions needed to introduce a local insurance system are discussed.
PEOPLE AND THE PLANET. 1992; 1(1-2):22-5.A representative of the Naam movement, a grass-roots organization of women in Burkina Faso, Ramata Sawadogo, speaks about her work as a health educator. She had worked in the health system but became disillusioned because most health problems of her clients were related to poverty. Now she works with the Naam movement to help spread the acceptance of family planning. Within the last 1 or 2 generations, women are having twice as many children because the traditional birth-spacing customs are in decline. Ms. Sawadogo explains the effect of large families by analogy with the local custom of planting only 2 millet seeds per hill. She also emphasizes to people that family planning includes treatment for infertility, sexually transmitted diseases, and menstrual problems. Now even mothers-in-law are beginning to realize the need for family planning. Marked changes in attitudes are evident because people can discuss and even laugh at sexual issues, which were formerly taboo even between spouses. Men are helping women with their work to some extent, or lending them bicycles to go to market. Another dramatic success of the Naam movement is the soap-making enterprise, with soap sales totaling US$135/week, the equivalent of a civil servant's salary. Women are trading vegetables and their labor to pay back loans for soap-making equipment. Ms. Sawadogo urged clinic staff to treat local farmers with extreme courtesy, since their reception will influence whole villages about the motivation of those offering family planning.
Medical Anthropology. 1985 Winter; 9(1):49-56.In order to make health services more accessible at the village level, the State of Karnataka began a Primary Health Care (PHC) Program involving Health Guides (HGs). These are local villagers who are trained in basic health services and who work in their own village. This research was conducted among village community members living in the Mysore District, where HGs had been working for 1 year. A total of 240 household members were interviewed using pretested, semi-structured survey instruments in 30 selected villages. Results indicate that 70% of the household members surveyed were aware of the HG scheme, and 58% said the HG was always or often available to them. According to the official guidelines set down by the State of Karnataka, the village community was requested to recommend 2 or 3 persons considered suitable by them to become HG candidates. However, survey results indicate that 99.6% had not been involved in the selection process in any way. When asked what the 4 most important functions of the HGs were, the household members responded overwhelmingly (98.3%) that the sole function was treating minor ailments. More of the household members surveyed went to the HGs to receive medical services than to any other persons. Of those who made HG contact, 52.2% reported that they were very satisfied and 44.4% said they had been partially satisfied by the medical services they had received. The vast majority of the community reported that they felt very little work was being done in the area of prevention (soakage pits, sanitary latrines, water supply, family planning and immunization). But these items were not perceived to be very important and seem to have little impact on the community's acceptance of the HG scheme and on its further continuation and expansion. A large majority of those interviewed wanted the HGs to visit their homes more often for health-related services. 20% of the community household members said they would be in favor of financing the HG honorarium or the HG drug supply, currently provided by the Government of India and the State of Karnataka. Finally, 92.1% felt the HG scheme should be continued in their area and 91.7% felt it should be expanded to other areas of the State. Suggestions are offered regarding ways to improve the community participation in this pilot area. Examples include regular home vistis by the HGs to all households using complete up-to-date household surveys; pictorial signs aroung the village area to advertise HG services; spending more time during training sessions on preventive aspects of the HG job and the adequate explanation of the philosophy of the HG scheme, with particular stress on the importance of preventive and promotive services. Such steps will ensure relevancy of the programs, ensure success of immediate activities, and pave the way for long-term changes in the communities themselves.