| 1. Peer Reviewed Title: Improved access to comprehensive emergency obstetric care and its effect on institutional maternal mortality in rural Mali. Author: Fournier P; Dumont A; Tourigny C; Dunkley G; Drame S Source: Bulletin of the World Health Organization. 2009 Jan;87(1):30-8. Abstract: OBJECTIVE: To evaluate the effect of a national referral system that aims to reduce maternal mortality rates through improving access to and the quality of emergency obstetric care in rural Mali (sub-Saharan Africa). METHODS: A maternity referral system that included basic and comprehensive emergency obstetric care, transportation to obstetric health services and community cost-sharing schemes was implemented in six rural health districts in Kayes region between December 2002 and November 2005. In an uncontrolled 'before and after' study, we recorded all obstetric emergencies, major obstetric interventions and maternal deaths during a 4-year observation period (1 January 2003 to 30 November 2006): the year prior to the intervention (P-1); the year of the intervention (P0), and 1 and 2 years after the intervention (P1 and P2, respectively). The primary outcome was the risk of death among obstetric emergency patients, calculated with crude case fatality rates and crude odds ratios. Analyses were adjusted for confounding variables using logistic regression. FINDINGS: The number of women receiving emergency obstetric care doubled between P-1 and P2, and the rate of major obstetric interventions (mainly Caesarean sections) performed for absolute maternal indications increased from 0.13% in P-1 to 0.46% in P2. In women treated for an obstetric emergency, the risk of death 2 years after implementing the intervention was half the risk recorded before the intervention (odds ratio, OR: 0.48; 95% confidence interval, CI: 0.30-0.76). Maternal mortality rates decreased more among women referred for emergency obstetric care than among those who presented to the district health centre without referral. Nearly half (47.5%) of the reduction in deaths was attributable to fewer deaths from haemorrhage. CONCLUSION: The intervention showed rapid effects due to the availability of major obstetric interventions in district health centres, reduced transport time to such centres for treatment, and reduced financial barriers to care. Our results show that national programmes can be implemented in low-income countries without major external funding and that they can rapidly improve the coverage of obstetric services and significantly reduce the risk of death associated with obstetric complications. Language: English Keywords: MALI | RESEARCH REPORT | CLINICAL RESEARCH | WOMEN IN DEVELOPMENT | RURAL POPULATION | PREGNANT WOMEN | EMERGENCY SERVICES | PROGRAM ACCESSIBILITY | COMMUNITY HEALTH SERVICES | MATERNAL MORTALITY | HEALTH SERVICES EVALUATION | TRANSPORTATION | OBSTETRICS | PREGNANCY COMPLICATIONS | COMMUNITY FINANCING | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Research Methodology | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Health Services | Delivery of Health Care | Health | Program Evaluation | Programs | Organization and Administration | Primary Health Care | Mortality | Population Dynamics | Medicine | Diseases | Financial Activities Document Number: 341163 |
2.  Peer Reviewed Title: Community-based health insurance and access to maternal health services: Evidence from three West African countries. Author: Smith KV; Sulzbach S Source: Social Science and Medicine. 2008 Jun;66(12):2460-2473. Abstract: Community-based health insurance (CBHI) has been incorporated into the health financing strategies of governments and communities in several Sub-Saharan African countries. Despite the support for and proliferation of CBHI schemes in this region, empirical evidence on how CBHI impacts access to health care, particularly maternal health services, is very limited. We use recent household surveys in three West African countries - Senegal, Mali, and Ghana - to examine the relationship between CBHI membership and access to formal sector maternal health care. We find that membership in a CBHI scheme is positively associated with the use of maternal health services, particularly in areas where utilization rates are very low and for more expensive delivery-related care. Our findings suggest, however, that membership in a CBHI scheme is not sufficient to influence maternal health behaviors - it is the inclusion of maternal health care in the benefits package that makes a difference. While many questions remain about CBHI, this study provides preliminary evidence suggesting that CBHI is a potential demand-side mechanism to increase maternal health care access. However, complementary supply-side interventions to improve quality of and geographic access to health care are also critical for improving health outcomes in this region. (author's) Language: English Keywords: SENEGAL | MALI | GHANA | RESEARCH REPORT | SURVEYS | CROSS SECTIONAL ANALYSIS | HEALTH INSURANCE | COMMUNITY FINANCING | MATERNAL HEALTH | PROGRAM ACCESSIBILITY | UTILIZATION OF HEALTH CARE | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Sampling Studies | Studies | Research Methodology | Financial Activities | Economic Factors | Health | Program Evaluation | Programs | Organization and Administration | Health Services | Delivery of Health Care Document Number: 326625 |
| 3. Peer Reviewed Title: Reducing financial barriers to emergency obstetric care: experience of cost-sharing mechanism in a district hospital in Burkina Faso. Author: Richard F; Ouedraogo C; Compaore J; Dubourg D; De Brouwere V Source: Tropical Medicine and International Health. 2007 Aug;12(8):972-981. Abstract: The objective was to describe the implementation of a cost-sharing system for emergency obstetric care in an urban health district of Ouagadougou, Burkina Faso and analyse its results after 1 year of activity. Service availability and use, service quality, knowledge of the cost-sharing system in the community and financial viability of the system were measured before and after the system was implemented. Different sources of data were used: community survey, anthropological study, routine data from hospital files and registers and specific data collected on major obstetric interventions (MOI) in all the hospitals utilized by the district population. Direct costs of MOI were collected for each patient through an individual form and monitored during the year 2005. Rates of MOI for absolute maternal indications (AMI) were calculated for the period 2003-2005. The direct cost of a MOI was on average 136US$, including referral cost. Through the costsharing system this amount was shared between families (46US$), health centres (15US$), Ministry of Health (38US$) and local authority (37US$). The scheme was started in January 2005. The rate of cost recovery was 91.3% and the balance at the end of 2005 was slightly positive (4.7% of the total contribution). The number of emergency referrals by health centres increased from 84 in 2004 to 683 in 2005. MOI per 100 expected births increased from 1.95% in 2003 to 3.56% in 2005 and MOI for AMI increased from 0.75% to 1.42%. The dramatic increase in MOI suggests that the cost-sharing scheme decreased financial and geographical barriers to emergency obstetric care. Other positive effects on quality of care were documented but the sustainability of such a system remains uncertain in the dynamic context of Burkina Faso (decentralization). (author's) Language: English Keywords: BURKINA FASO | RESEARCH REPORT | PRE-POST TESTS | OBSTETRICS | OBSTETRICAL SURGERY | EMERGENCY SERVICES | COMMUNITY FINANCING | ECONOMIC FACTORS | QUALITY OF HEALTH CARE | IMPLEMENTATION | PROGRAM ACCESSIBILITY | PROGRAM EFFICIENCY | PROGRAM EVALUATION | PROGRAM SUSTAINABILITY | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Programs | Organization and Administration | Medicine | Health Services | Delivery of Health Care | Health | Surgery | Treatment | Medical Procedures | Financial Activities | Health Services Evaluation Document Number: 313773 |
4.  Title: Community-based health financing and child health. Author: Makinen M; Franco LM; Sulzbach S; Diop FP; Burgert C Source: Bethesda, Maryland, Abt Associates, Partners for Health Reform Plus [PHRplus], 2006 Sep. 11 p. (CBHF and Child HealthUSAID Contract No. HRN-C-00-00-00019-00USAID Development Experience Clearinghouse DocID / Order No. PN-ADI-062) Abstract: The purpose of this brief is to look into systematically collected data related to the scenario above. It reports on the analysis of the effects that membership in community-based health financing schemes (or mutual health organizations [MHOs]) has on the use of health services when a member is ill or injured and, specifically, on five priority child health services (immunizations, vitamin A supplementation, treatment of diarrheal disease, and prevention and treatment of malaria). The results come from household surveys performed by the Partners for Health Reformplus project (PHRplus) in the three West African countries of Ghana, Mali, and Senegal in 2004, though the Mali survey offers more comprehensive results, given its focus on child health. (excerpt) Language: English Keywords: GHANA | MALI | SENEGAL | RESEARCH REPORT | HOUSEHOLDS | COMMUNITY FINANCING | HEALTH INSURANCE | CHILD HEALTH SERVICES | UTILIZATION OF HEALTH CARE | ORAL REHYDRATION | IMMUNIZATION | FOOD SUPPLEMENTATION | BED NETS | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Family and Household | Sociocultural Factors | Financial Activities | Economic Factors | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Treatment | Medical Procedures | Medicine | Nutrition Programs | Parasite Control | Public Health Document Number: 315069 |
| 5. Title: Lessons from the first generation of integrated population, health, and environment projects. Author: Pielemeier J Source: Washington, D.C., Population Reference Bureau [PRB], 2006 Sep. 4 p. Abstract: How can isolated fishing communities reverse the double-edged sword of declining fisheries and growing families? And how can upland farmers better feed their families without destroying forest cover and increasing erosion? An assessment that I led for the David and Lucile Packard Foundation and the U.S. Agency for International Development (USAID) found that an integrated approach to these issues that simultaneously addresses conservation, family planning, and health needs is providing successful models for action from the Philippines to Madagascar. (excerpt) Language: English Keywords: PHILIPPINES | MADAGASCAR | SUMMARY REPORT | USAID | COMMUNITY | FISHING | POPULATION PRESSURE | COMMUNITY FINANCING | FAMILY PLANNING | REPRODUCTIVE HEALTH | SOCIAL MOBILIZATION | HEALTH | ENVIRONMENT | NONGOVERNMENTAL ORGANIZATIONS | Developing Countries | Asia, Southeastern | Asia | Africa, Southern | Africa, Sub Saharan | Africa | Government Agencies | Organizations | Political Factors | Sociocultural Factors | Residence Characteristics | Population Distribution | Geographic Factors | Population | Occupations | Human Resources | Economic Factors | Carrying Capacity | Natural Resources | Financial Activities | Social Change Document Number: 310530 |
| 6. Peer Reviewed Title: Use and misuse of a discount voucher scheme as a subsidy for insecticide-treated nets for malaria control in southern Tanzania. Author: Tami A; Mbati J; Nathan R; Mponda H; Lengeler C Source: Health Policy and Planning. 2006;21(1):1-9. Abstract: Since 1997, discount vouchers for insecticide-treated nets (ITNs) have been used in two rural districts of southern Tanzania as a way to target subsidies to children under 5 years and pregnant women. We assessed appropriate use and misuse of discount vouchers through a follow-up study of 104 randomly selected vouchers. We traced these vouchers from their original issue in mother-and-child health (MCH) clinics through to being redeemed at a sales agent. We found that all vouchers that reached the target population (100%, 56/56) were used to buy an ITN. Moreover, 94% of the ITNs bought with vouchers were used by those intended, women and children under 5 years. However, up to 48% (50/104) of the vouchers had been misused at the clinics that issued them. Nevertheless, large-scale misuse occurred only at three of 21 clinics. Although most women slept under a net while pregnant, the use of voucher-subsidized ITNs during pregnancy was low despite widespread knowledge of the scheme. Parents had apparently decided to buy the subsidized ITNs once the child was born and not during pregnancy. Importantly, in 20% of households the only existing net had been bought with a voucher. Our findings suggest that vouchers are properly used by the target population, and that to minimize voucher leakage, control measures are needed at MCH clinics and to a certain extent for commercial sales agents. Increased awareness among the whole community on the right to receive a discount voucher may also help to control misuse at health facilities. (author's) Language: English Keywords: TANZANIA | RESEARCH REPORT | COMMUNITY FINANCING | MALARIA | PESTICIDES | BED NETS | MALARIA PREVENTION | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Financial Activities | Economic Factors | Parasitic Diseases | Diseases | Ingredients and Chemicals | Parasite Control | Public Health | Health Document Number: 299341 |
| 7. Title: An assessment of community-based health financing activities in Uganda. Author: Derriennic Y; Wolf K; Kiwanuka-Mukiibi P Source: Bethesda, Maryland, Abt Associates, Partners for Health Reform Plus, 2005 Feb. [44] p. (USAID Contract No. HRN-C-00-00-00019-00USAID Development Experience Clearinghouse DocID / Order No: PN-ADC-194) Abstract: The Partners for Health Reformplus Project (PHRplus), in conjunction with the Uganda Community Based Health Financing Association (UCBHFA), conducted an assessment of community-based health financing (CBHF) schemes in Uganda. The purpose of the assessment was to identify good practices/models and key obstacles to sustainability in terms of governance and management, financial management and viability, risk management, marketing and membership incentives, community buy-in, and impact on quality of life of members. The PHRplus team conducted key informant interviews and focus group discussions with CBHF scheme managers, current scheme members, and former members. These data were supplemented by records from the UCBHFA and a desk review of relevant literature. The assessment revealed that scheme membership improved overall quality of life for scheme members; however, community participation and management practices should be strengthened to improve scheme viability and sustainability. The findings will be shared among scheme managers and support organizations to improve CBHF schemes’ long-term sustainability. (author's) Language: English Keywords: UGANDA | RESEARCH REPORT | FOCUS GROUPS | ADULTS | NONGOVERNMENTAL ORGANIZATIONS | FINANCIAL ACTIVITIES | COMMUNITY FINANCING | COMMUNITY HEALTH SERVICES | HEALTH INSURANCE | QUALITY OF LIFE | SOCIAL MARKETING | HEALTH SERVICES EVALUATION | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Data Collection | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | Organizations | Economic Factors | Primary Health Care | Health Services | Delivery of Health Care | Health | Social Welfare | Marketing | Program Evaluation | Programs | Organization and Administration Document Number: 287654 |
| 8. Peer Reviewed Title: Community-based health insurance in poor rural China: the distribution of net benefits. Author: Wang H; Yip W; Zhang L; Wang L; Hsiao W Source: Health Policy and Planning. 2005 Nov;20(6):366-374. Abstract: The collapse of China's Cooperative Medical System (CMS) in 1978 resulted in the lack of an organized financing scheme for health care, adversely affecting rural farmers' access to health care, especially among the poor. The Chinese government recently announced a policy to re-establish some forms of community-based insurance (CBI). Many existing schemes involve low premiums but high co-payments. We hypothesized that such benefit design leads to unequal distribution of the 'net benefits' (NB) - benefits net of payment - because even though low premiums are more affordable to poor farmers, high co-payments may have a significant deterrent effect on the poor in the use of services in CBI. To test this hypothesis empirically, we estimated the probability of farmers joining a re-established CBI using logistic regression, and the utilization of health care services for those who joined the scheme using the two-part model. Based on the estimations, we predicted the distribution of NB among those who joined the CBI and for the entire population in the community. Our data came from a household survey of 4160 members of 1173 households conducted in six villages in Fengshan Township, Guizhou Province, China. Three principal findings emerged from this study. First, income is an important factor influencing farmers' decision to join a CBI despite the premium representing a very small fraction of household income. Secondly, both income and health status influence enrolees' utilization of health services: richer/sicker participants obtain greater NB from the CBI than poorer/healthier members, meaning that the poorer/healthier participants subsidize the rich/sick. Thirdly, wealthy farmers benefit the most from the CBI with low premium and high co-payment features at every level of health status. In conclusion, policy recommendations related to the improvement of the benefit distribution of CBI schemes are made based on the results from this study. (author's) Language: English Keywords: CHINA | PROGRESS REPORT | ESTIMATION TECHNIQUES | RURAL POPULATION | COMMUNITY | PROGRAM ACCESSIBILITY | GOVERNMENT FINANCING | HEALTH INSURANCE | COMMUNITY FINANCING | RURAL HEALTH SERVICES | INEQUALITIES | UTILIZATION OF HEALTH CARE | INCOME | MICROECONOMIC FACTORS | Developing Countries | Asia, Eastern | Asia | Research Methodology | Population Characteristics | Demographic Factors | Population | Residence Characteristics | Population Distribution | Geographic Factors | Program Evaluation | Programs | Organization and Administration | Financial Activities | Economic Factors | Health Services | Delivery of Health Care | Health | Socioeconomic Factors Document Number: 294164 |
| 9. Title: 21 questions on CBHF: an overview of community-based health financing. Author: Bennett S; Kelley AG; Silvers B Source: Bethesda, Maryland, Abt Associates, Partners for Health Reform Plus, 2004 Mar. [20] p. (USAID Contract No. HRN-C-00-00-00019-00) Abstract: This document aims to answer basic questions on CBHF (community-based health financing) that might be posed by policymakers and technical assistance providers interested in this topic. The questions and answers are not designed to provide a detailed guide for scheme managers on how to set up CBHF schemes; rather they aim to provide to decision makers in ministries of health and finance, international organizations, and non-governmental organizations a broad outline of how schemes are set up and how they operate, and an overview of their advantages and limitations. Moreover, although CBHF schemes are a type of insurance, this document does not try to cover insurance theory. The bibliography at the end of this paper provides additional resources that readers should consult to learn more about the detailed steps in setting up a CBHF scheme, or about insurance theory. The text draws upon the extensive field experience the Partners for Health Reformplus project (PHRplus) has with CBHF schemes. While much of this field experience is from sub-Saharan Africa, particularly West Africa, the lessons learned from these countries may be applicable to other regions of the world. (excerpt) Language: English Keywords: DEVELOPING COUNTRIES | CRITIQUE | LOW INCOME POPULATION | POLICYMAKERS | ADMINISTRATIVE PERSONNEL | COMMUNITY HEALTH SERVICES | COMMUNITY FINANCING | COST EFFECTIVENESS | SOCIOECONOMIC FACTORS | DELIVERY OF HEALTH CARE | Social Class | Socioeconomic Status | Economic Factors | Organization and Administration | Primary Health Care | Health Services | Health | Financial Activities | Evaluation Indexes | Quantitative Evaluation | Evaluation Document Number: 279110 |
| 10. Title: Estimating the cost of providing home-based care for HIV / AIDS in Rwanda. [Estimation du coût de la dispense de soins à domicile aux personnes atteintes du VIH/SIDA au Rwanda] Author: Chandler R; Decker C; Nziyige B Source: Bethesda, Maryland, Abt Associates, Partners for Health Reform Plus, 2004 Jun. xiv, 32 p (USAID Contract No. HRN-C-00-00-00019-00) Abstract: Home-based care (HBC) for HIV/AIDS is increasingly looked to as a more accessible and affordable alternative to more costly inpatient care, both for patients who are unable to travel to or pay for inpatient care as well as for governments that must fund inpatient facilities. Partners for Health Reformplus estimated the cost of HBC for HIV in Rwanda, based on a sample of eight programs offering care in early 2004. The sample comprised facility- and community-based programs. Both types of program implement the medical care recommended in the Ministry of Health guidelines for HBC. Facility-based care focuses on health care, utilizing a combination of health professionals and volunteers, delivering higher levels of care and offering referrals to facilities with which they are associated. Community-based care offers a more holistic approach including psychosocial support, not only to people living with HIV/AIDS but to entire households. The study found that facility-based care has higher estimated costs per client than community-based care, with monthly costs per client ranging from approximately $ 31.20 to $36.01 per month, the cost of community-based care ranged from $ 12.75 to $ 24.53 per month. Up to 50 percent of program costs are attributed to food assistance – highlighting the poverty faced by many households. Staff and per diem costs account for 12-37 percent of total costs. Drugs and medical supplies costs account for small percentage of total costs, averaging only 2 percent of total costs. Both types of program rely on volunteer assistance, and staff attrition is a concern. (author's) French Abstract: La dispense de soins à domicile (home-based care ou HBC) aux personnes atteintes du VIH/SIDA est de plus en plus considérée comme une solution plus pratique et économique que les coûteux séjours en hôpital. Elle est vue comme un avantage tant par les patients qui sont dans l'incapacité de se déplacer ou n'ont pas les moyens de se faire hospitaliser que par les autorités qui financent les structures hospitalières. Le projet Partners for Health Reformplus (PHRplus) de l'USAID a estimé le coût de la formule HBC pour le traitement du VIH au Rwanda en se basant sur un échantillon de huit programmes de dispense de soins aux séropositifs en vigueur au début de l'année 2004. L'échantillon comprenait des programmes d'activités à base clinique et des programmes d'activités à base communautaire. Les deux types de programmes dispensent le type de soins préconisés dans les directives formulées par le ministère rwandais de la santé en matière d'HBC. Les soins dispensés dans le cadre d'activités à base clinique sont axés sur la santé et reposent sur l'intervention mixte de professionnels médicaux et de bénévoles qui fournissent des soins de niveau plus élevé et sont en mesure d'orienter les patients vers des établissements auxquels ils sont affiliés. Les soins dispensés dans le cadre d'activités à base communautaire reposent sur une approche plus globale des patients et comprennent un soutien psychologique tant aux personnes infectées par le VIH/SIDA qu'à tous les membres des familles concernées. Selon l'étude, les soins dispensés dans le cadre d'activités à base clinique sont plus coûteux que ceux dispensés dans le cadre d'activités à base communautaire, le coût mensuel estimatif par personne étant en moyenne compris entre 31,20 US$ et 36,01 US$ pour les premiers, et de 12,75 US$ et 24,53 US$ pour les seconds. Jusqu'à 50 % des coûts de ces programmes sont attribuables à la fourniture d'assistance alimentaire, ce qui est indicatif de la pauvreté qui règne dans de nombreux foyers. Les frais de personnel et les indemnités journalières représentent entre 12 et 37 % des coûts totaux. Les médicaments et fournitures médicales ne représentent qu'un faible pourcentage (en moyenne 2 %) des coûts totaux. Les deux types de programmes dépendent de l'assistance de volontaires et souffrent d'un problème de déperdition d'effectifs. (de l'auteur) Language: English Keywords: RWANDA | METHODOLOGICAL STUDIES | EVALUATION METHODOLOGY | ESTIMATION TECHNIQUES | PERSONS LIVING WITH HIV/AIDS | HEALTH PERSONNEL | HOME CARE | HIV INFECTIONS | AIDS PREVENTION | COST EFFECTIVENESS | COMMUNITY HEALTH SERVICES | COMMUNITY FINANCING | Africa, Central | Africa, Sub Saharan | Africa | Developing Countries | Evaluation | Research Methodology | Viral Diseases | Diseases | Delivery of Health Care | Health | Health Services | AIDS | Evaluation Indexes | Quantitative Evaluation | Primary Health Care | Financial Activities | Economic Factors Document Number: 275491 |
| 11. Title: Helping Zambian communities support children at risk. Author: Dadian M Source: Arlington, Virginia, Family Health International [FHI], Institute for HIV / AIDS, 2004. 6 p. (Snapshots from the FieldUSAID Cooperative Agreement No. HRN-A-00-97-00017-00) Abstract: The wide swath of pain and loss created by the AIDS pandemic does not end with the death of individuals but reverberates for years, as nations and communities lose members of their most productive age group: teachers, farmers, civil servants, industrial workers, health care workers and more. Perhaps the most difficult ongoing loss, though, is suffered by children whose parents sicken and die from the disease. Families affected by AIDS that have not yet lost a parent also struggle to cope with medical expenses and financial strain, the inability of sick parents to work or care for the family, stigmatization and fears for the future. In addition to suffering severe emotional trauma and dislocation, orphans and vulnerable children are far more likely to experience poverty, neglect, poor health and lack of education. They face uncertain futures, often without inheritance or training for a future occupation. In Zambia, more than three-quarters of the country's estimated one million orphans have lost at least one parent to AIDS, a number that--given the country's soaring HIV prevalence of 20 percent-- could double by 2010. Extended families and communities have struggled for years to find ways to support orphans and vulnerable children (OVC), and community-based organizations in Zambia were among the first to respond. (excerpt) Language: English Keywords: ZAMBIA | PROGRESS REPORT | COMMUNITY | CHILD | ORPHANS AND VULNERABLE CHILDREN | AIDS | INTEGRATED PROGRAMS | TRAINING PROGRAMS | COMMUNITY FINANCING | COMMUNITY PARTICIPATION | PROGRAM ACTIVITIES | PROGRAM EFFECTIVENESS | MENTAL HEALTH | CHILD HEALTH | RESOURCE ALLOCATION | HOUSEHOLDS | HUMAN RIGHTS | EDUCATION | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Residence Characteristics | Population Distribution | Geographic Factors | Population | Youth | Age Factors | Population Characteristics | Demographic Factors | Family and Household | Sociocultural Factors | HIV Infections | Viral Diseases | Diseases | Programs | Organization and Administration | Financial Activities | Economic Factors | Program Evaluation | Health | Political Factors Document Number: 310078 |
| 12. Title: Social participation in the development of mutual health organizations in Senegal. [Participation sociale au développement de mutuelles de santé au Sénégal] Author: Franco LM; Mbengue C; Atim C Source: Bethesda, Maryland, Abt Associates, Partners for Health Reform Plus, 2004 Nov. [66] p. (USAID Contract No. HRN-C-00-95-00024USAID Contract No. HRN-C-00-00-00019-00) Abstract: Mutual health organizations (MHOs) are currently being promoted as a means of expanding financial access to health care services to the informal sectors and poorer populations in developing countries. Social participation has been a key element in the development of the MHO movement, yet it has been little researched. This qualitative, exploratory study examines the processes used to engage communities and the role social participation currently plays in MHO creation and functioning. The study presents a conceptual framework for the inputs, processes, and intermediate outcomes of social participation, proposes a series of dimensions of participation and criteria to assess the level of participation, and then examines qualitative data from focus group discussions with eight MHOs in Senegal. The findings indicate that although the structures developed and strategies used during the creation phase of the MHOs (encouraged by the various MHO promoters) do engender active engagement of internal stakeholders, participation tends to wane with time, and newer members are not as likely to show the same commitment. Leadership worthy of trust and decentralizing management structures appear to be key elements for maintaining participation. The need to maintain social participation throughout the life of the MHO is critical to its long-term viability and its ability to provide critical access to health care for its members and beneficiaries. MHOs themselves need to explore explicit strategies for encouraging participation of its membership, and promoters need to examine ways to support and strengthen these efforts. However, the importance of political, moral, and logistical support of external stakeholders (such as local governments, health districts, and the ministry of health) should not be underestimated – they play a key role in ensuring the viability of the MHO, which is necessary for its continuity. (author's) French Abstract: Les mutuelles de santé (MS) font actuellement l'objet de promotion comme constituant un moyen d'étendre l'accès financier aux services de soins de santé pour le secteur informel et les populations les plus pauvres dans les pays en développement. La participation sociale a été un élément clé dans le développement du mouvement des mutuelles de santé, cependant elle a très peu fait l'objet de recherches. Cette étude qualitative et exploratoire examine les processus utilisés pour s'adresser aux communautés et le rôle que la participation sociale joue actuellement dans la création et le fonctionnement des MS. Cette étude présente un cadre conceptuel pour les contributions, processus, et résultats intermédiaires de la participation sociale, propose une série de dimensions de la participation et de critères d'évaluation du niveau de participation, et ensuite examine des données qualitatives générées par des discussions de groupe avec huit MS sénégalaises. Selon les résultats, bien que les structures développées et les stratégies utilisées au cours de la phase de création de MS (encouragées par les différents promoteurs de MS) engendrent bien un engagement actif des acteurs internes, la participation tend à s'effilocher avec le temps, et les nouveaux membres ne font pas preuve du même engagement. Un leadership digne de confiance et des structures de gestion décentralisées semblent constituer les éléments clés pour maintenir la participation. La nécessité de maintenir la participation sociale à travers l'existence de la MS est d'une importance capitale pour sa viabilité à long terme et sa capacité à fournir un accès critique aux soins de santé à ses membres et bénéficiaires. Quant aux MS, il faut qu'elles explorent elles-mêmes des stratégies explicites d'encouragement de la participation de leurs membres et que les promoteurs étudient les moyens d'appuyer et de renforcer ces efforts. Cependant, il ne faudrait pas sous-estimer l'importance du soutien politique, moral et logistique des acteurs externes (tels que les autorités locales, les districts de santé et le ministère de la santé) : ils jouent un rôle clé dans la garantie de la viabilité de la MS, qui est nécessaire à sa continuité. (de l'auteur) Language: English Keywords: SENEGAL | RESEARCH REPORT | QUALITATIVE RESEARCH | LOW INCOME POPULATION | HEALTH SERVICES | PROGRAM ACCESSIBILITY | COMMUNITY PARTICIPATION | HEALTH INSURANCE | COMMUNITY FINANCING | PROGRAM DEVELOPMENT | PROGRAM SUSTAINABILITY | DECENTRALIZATION | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Research Methodology | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Delivery of Health Care | Health | Program Evaluation | Programs | Organization and Administration | Financial Activities Document Number: 280469 |
| 13. Peer Reviewed Title: Bill Gates throws down gauntlet to medical researchers. Author: Ashraf H Source: Lancet. 2003 Feb 1;361(9355):404. Abstract: The initiative will provide grants of up to $20 million per project to scientists around the world. A statement by the initiative emphasised the need for “cross discipline integration across programs, organizations, and institutions”. Among the projects that might be considered by the initiative are: “Identifying an ‘Achilles heel’ to block reactivation of latent TB, finding novel approaches to preventing and treating HIV, and investigating ways to make mosquitoes incapable of transmitting diseases such as malaria, dengue, and West Nile.” (excerpt) Language: English Keywords: GLOBAL | CONFERENCES AND CONGRESSES | DISEASE TRANSMISSION CONTROL | COMMUNITY FINANCING | COMMUNITY RELATIONS | RESEARCH AND DEVELOPMENT | PROGRAM DEVELOPMENT | FOUNDATIONS | Prevention and Control | Diseases | Financial Activities | Economic Factors | Group Processes | Social Behavior | Behavior | Technology | Programs | Organization and Administration | Organizations Document Number: 175248 |
| 14. Title: Antiretroviral treatment and research in resource-poor countries [letter] Author: Hirschel B Source: Lancet. 2003 Feb 1;361(9355):434-435. Abstract: The author describes his experiences in requesting funding from the Rockefeller Fund and the Global Fund against AIDS, Tuberculosis and for a randomized trial of two types of treatment interruptions compared with continuous therapy in Thailand, Argentina, Canada, Australia, and Switzerland. While he was able to get support for the developed country studies, he was not successful with the Thailand and Argentina studies. Language: English Keywords: DEVELOPING COUNTRIES | CRITIQUE | HIV INFECTIONS | AIDS | TREATMENT | RESEARCH AND DEVELOPMENT | COMMUNITY FINANCING | Viral Diseases | Diseases | Technology | Economic Factors | Financial Activities Document Number: 175249 |
| 15. Title: "If many push together, it can be done": Reproductive health and women's savings and credit in Nepal. Author: Arens T; Caudill D; Gautam S; Haberland N; Nakarmi G Source: In: Responding to Cairo. Case studies of changing practice in reproductive health and family planning, edited by Nicole Haberland, Diana Measham. New York, New York, Population Council, 2002. :395-414. Abstract: This chapter describes how a community development and family planning program in Nepal reoriented itself to a broader reproductive health (RH) approach. It sought to expand the range of clinical services available to poor rural women, including addressing more complex and controversial issues such as the availability of high-quality, early abortion services, and to address some of the social and economic issues that perpetuate women's poor RH. Language: English Keywords: NEPAL | SUMMARY REPORT | LOW INCOME POPULATION | WOMEN | RURAL POPULATION | COMMUNITY DEVELOPMENT | FAMILY PLANNING PROGRAMS | REPRODUCTIVE HEALTH | HEALTH SERVICES | TRAINING ACTIVITIES | COMMUNITY FINANCING | Developing Countries | Asia, Southern | Asia | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Demographic Factors | Population | Population Characteristics | Social Development | Family Planning | Programs | Organization and Administration | Health | Delivery of Health Care | Training Programs | Education | Financial Activities Document Number: 169287 |
| 16. Peer Reviewed Title: Beneficial effects of a woman-focused development programme on child survival: evidence from rural Bangladesh. Author: Bhuiya A; Chowdhury M Source: Social Science and Medicine. 2002 Nov;55(9):1553-1560. Abstract: This paper reports results from a prospective study of the impact of a woman-focused development program on child survival in Matlab, a rural area of Bangladesh. The program was targeted to households owning <50 decimals of land and members selling more than 100 days of labor for living in a year. Program components included formation of women's groups for saving and credit, training on skill development, functional literacy including legal and social awareness, and technical and marketing support to projects undertaken with the loan money from the organization. A total of 13,549 children born alive during 1988-97 in the study area were included in the study. Hazards of mortality during pre- and post-intervention periods were compared among the program participants and non-participants controlling the effects of other relevant variables. There has been a substantial reduction in mortality during the post-intervention period; however, the reduction was much greater for infants whose mothers participated in the development program compared to infants of non-participant mothers from similar socioeconomic background. In a relative sense, there has been a 52% reduction of the pre-intervention level hazard of death of children during infancy of participant mothers compared to 31% reduction for the infants of non-participant mothers from similar socioeconomic background. There had also been a substantial reduction in hazard of death during childhood (1-4 year age group), however, the reduction was statistically similar for all groups of children irrespective of their mothers' participation in the development programs. (author's) Language: English Keywords: BANGLADESH | CHILD SURVIVAL | COMMUNITY FINANCING | HOUSEHOLDS | IMPACT | MORTALITY | PROGRAMS | PROSPECTIVE STUDIES | RURAL AREAS | SUMMARY REPORT | WOMEN | WOMEN IN DEVELOPMENT | Asia, Southern | Asia | Developing Countries | Survivorship | Length of Life | Population Dynamics | Demographic Factors | Population | Financial Activities | Economic Factors | Family and Household | Communication | Organization and Administration | Studies | Research Methodology | Geographic Factors | Economic Development Document Number: 171400 |
| 17. Title: ASA: profile of a successful microfinance institution. Author: Choudhury SH; Kamal M Source: Development Bulletin. 2002 Feb;(57):45-47. Abstract: ASA, the Association for Social Advancement, is a Bangladeshi NGO, the acronym for which spells the word ‘hope’ in Bangla. ASA specialises in microfinance and is one of the largest and fastest growing microfinance institutions in the country. It differs from the Grameen Bank in its approach to individual clients and its focus on the mobilisation of voluntary savings. It represents a successful model recognised internationally as a self-reliant and financially sustainable institution that is being replicated in several countries and is contributing to capacity building for poverty reduction and rural development at home and abroad. (excerpt) Language: English Keywords: BANGLADESH | PROGRESS REPORT | CASE STUDIES | EXPERIMENTAL MODELS | NONGOVERNMENTAL ORGANIZATIONS | COMMUNITY | MICROECONOMIC FACTORS | FINANCIAL ACTIVITIES | POVERTY | DEVELOPMENT PLANS | COMMUNITY FINANCING | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Organizations | Residence Characteristics | Population Distribution | Geographic Factors | Population | Economic Factors | Socioeconomic Factors Document Number: 192246 |
| 18. Title: Microfinance as a vehicle for educating the poor. Author: Dunford C Source: Development Bulletin. 2002 Feb;(57):111-114. Abstract: Microfinance can be a powerful tool for giving the poor more economic options. However, the very poor need more than microfinance to address the causes and conditions of their poverty. Ideally, they would have access to a coordinated combination of microfinance and other development services to improve business, income and assets, health, nutrition, family planning, education of children, social support networks, and so on. The question is how to ensure a ‘coordinated combination’ of appropriate services, especially in rural communities and other communities where multiple services are simply unavailable. Microfinance practitioners are often motivated to provide non-financial services to their clients, because they recognise the need and hear the demand. However, the legitimate concern for sustainability, interpreted as the financial viability of the microfinance service as a business, has made practitioners very cautious about non-financial add-ons. They believe that add-ons can only be a drag on the drive for sustainability. Where other, non-financial service organisations can provide these other services for the same clients, some microfinance practitioners have fostered referrals and common points of service with their nonfinancial counterparts. But most microfinance institutions (MFIs) feel compelled or prefer to focus solely on the financial needs of their clients and do not attempt to meet their non-financial ones. On the other hand, group-based microfinance provides a good opportunity to provide low-cost education services needed by the poor, if only to improve their performance as microfinance clients. This is especially true for village banking and related delivery systems (for example, Grameen Bank) that bring large groups of relatively poor clients together in regular meetings. Good, nonformal adult education techniques can be used effectively at these meetings to cover a variety of topics. Examples include promoting changes in child care, personal health habits, and use of local health services, as well as improvement of business skills that enable microfinance clients to put their loans to more productive use and generate more profit and savings. (excerpt) Language: English Keywords: DEVELOPING COUNTRIES | PROGRESS REPORT | EVALUATION | CASE STUDIES | LOW INCOME POPULATION | HOUSEHOLDS | NONGOVERNMENTAL ORGANIZATIONS | GOVERNMENT | MICROECONOMIC FACTORS | FINANCIAL ACTIVITIES | DEVELOPMENT POLICY | COMMUNITY FINANCING | GOVERNMENT PROGRAMS | INTEGRATED PROGRAMS | POVERTY | Studies | Research Methodology | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Family and Household | Organizations | Political Factors | Policy | Programs | Organization and Administration Document Number: 192253 |
| 19. Title: Maternal health financing profile: Burkina Faso. [Financement de la santé maternelle : Profil du Burkina Faso] Author: Edmond J; Comfort A; Leighton C Source: Bethesda, Maryland, Abt Associates, Partners for Health Reform Plus, 2002 Nov. vii, 17 p. (USAID Contract No. HRN-C-00-00-00019-00) Abstract: The purpose of this paper is to provide an overview of the maternal health situation in Burkina Faso and to examine current trends and activities with respect to financing of maternal health services, specifically deliveries assisted by skilled birth attendants. The paper begins by giving a picture of the current status of women’s health and factors relating to poor maternal health outcomes, then examines historical information of how women in Burkina Faso pay for maternal health services, such as antenatal care, deliveries with skilled birth attendants, and consultations. The paper offers policy recommendations on the financing of these services. (excerpt) French Abstract: Ce rapport a pour objectif de présenter une vue d'ensemble de l'état de la santé maternelle au Burkina Faso et d'étudier les actuelles tendances et initiatives touchant au financement des services de santé maternelle, notamment celui des accouchements assistés par du personnel de santé qualifié. À titre d'introduction, le rapport brosse le tableau de la santé maternelle actuelle au Burkina Faso et des facteurs contribuant au faible niveau d'obtention de soins obstétricaux. Il fait ensuite la synthèse de données historiques sur la manière dont les femmes burkinaises s'acquittent des frais afférant à leur santé maternelle dans le cadre, par exemple, de soins prénatals, d'accouchements assistés par du personnel de santé qualifié et de consultations. Le rapport formule enfin des recommandations sur la manière de financer ces services de soins. (extrait) Language: English Keywords: BURKINA FASO | RESEARCH REPORT | EVALUATION | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | MATERNAL HEALTH SERVICES | FINANCIAL ACTIVITIES | DECENTRALIZATION | COMMUNITY FINANCING | COMMUNITY HEALTH SERVICES | FEES | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Economic Development | Economic Factors | Population Characteristics | Demographic Factors | Population | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health Document Number: 275492 |
| 20. Title: Preliminary review of community-based health financing schemes and their potential for addressing HIV / AIDS needs in sub-Saharan Africa. Author: Hsi CN; Edmond J; Comfort A Source: Bethesda, Maryland, Abt Associates, Partners for Health Reform Plus, 2002 Jun. xiv, 30 p. (USAID Contract No. HRN-C-00-00-00019-00) Abstract: The HIV/AIDS epidemic is present in many of the countries in Africa where Community-Based Health Financing (CBHF) schemes have taken hold, and it poses many problems for these communities and schemes due to the dynamic nature and pattern of transmission, the complexity of treatment regimens, the challenges of prevention, and the costs of delivering HIV/AIDS services. The Partners for Health Reformplus project (PHRplus) has been providing technical assistance to a number of CBHF schemes in sub-Saharan Africa over the past several years in areas such as financial management, social mobilization, and risk management. This paper examines what these existing CBHF schemes in sub-Saharan Africa have done to address HIV/AIDS in terms of providing prevention and/or care and support services in the benefits package through either implicit or explicit mechanisms. The findings reveal that CBHF schemes know very little about the prevalence of HIV in their membership pool due to a lack of voluntary testing and counseling; nor are they aware of the impact that HIV/AIDS is having on their members. Some schemes cover HIV-positive patients implicitly because scheme benefits include coverage for specific diseases and conditions that may be HIV related. Other schemes do not cover HIV-related diseases but refer those perceived as having HIV/AIDS to national AIDS control programs. HIV/AIDS poses problems both to the financial sustainability of a CBHF scheme and to the scheme’s capacity to provide quality health services for HIV-related health problems. Based on the dearth of knowledge on the subject and the limited findings, this paper recommends two areas for further research and investigation: 1) examine whether it is feasible or desirable for international donors and governments to contract with CBHF schemes in order to provide HIV/AIDS services; 2) explore various aspects of incorporating HIV prevention and care and support services into existing benefits packages of CBHF schemes, or how they can link with existing non-governmental organizations that provide HIV/AIDS services. (author's) Language: English Keywords: AFRICA, SUB SAHARAN | TECHNICAL REPORT | PERSONS LIVING WITH HIV/AIDS | USAID | COMMUNITY HEALTH SERVICES | COMMUNITY FINANCING | HIV PREVENTION | TREATMENT | COST EFFECTIVENESS | RISK REDUCTION BEHAVIOR | DELIVERY OF HEALTH CARE | HIV TESTING | AIDS | HIV | PREVENTION AND CONTROL | PUBLIC HEALTH | Africa | Developing Countries | HIV Infections | Viral Diseases | Diseases | Government Agencies | Organizations | Primary Health Care | Health Services | Health | Financial Activities | Economic Factors | Evaluation Indexes | Quantitative Evaluation | Evaluation | Behavior | Laboratory Examinations and Diagnoses | Examinations and Diagnoses Document Number: 274031 |
| 21. Peer Reviewed Title: Donor dealings: the impact of international donor aid on sexual and reproductive health services. Author: Mayhew SH Source: International Family Planning Perspectives. 2002 Dec;28(4):220-224. Abstract: Since the Cairo International Conference on Population and Development (ICPD) in 1994, international donors to population and AIDS programs have been called on to respond to the ICPD goals for expanded and holistic reproductive health services. How have they met the call? Do donors really support post-Cairo sexual and reproductive health services, or do we need to look for new models of assistance? To explore these questions, I look first at the changing face of donors to sexual and reproductive health, the nature of their support and the inherent problems associated with their support. I then consider whether and how donors support the Cairo agenda, and discuss the opportunities presented by recent health systems changes. (excerpt) Language: English Keywords: GLOBAL | CRITIQUE | REPRODUCTIVE HEALTH | COMMUNITY FINANCING | HEALTH SERVICES | FOREIGN AID | IMPACT | Health | Financial Activities | Economic Factors | Delivery of Health Care | Communication Document Number: 173511 |
| 22. Peer Reviewed Title: Altruistic willingness to pay in community-based sales of insecticide-treated nets exists in Nigeria. Author: Onwujekwe O; Chima R; Shu E; Nwagbo D; Akpala C Source: Social Science and Medicine. 2002;54:519-27. Abstract: The objective of this study was to determine whether households who are willing to pay for insecticide-treated nets (ITNs) for themselves are prepared to contribute for the ITNs to be purchased for the indigent community members who cannot afford the nets. This was in the framework of community-based and directed sales for ITNs. The study was conducted in four malaria holoendemic communities in southeastern Nigeria. Contingent valuation method was used to determine the altruistic willingness to pay (WTP) from randomly selected household heads or their representatives, which was elicited using an open-ended question. Theoretical validity was assessed using the Tobit model. Median altruistic WTP ranged from $0.11-$0.21 across the four communities (95 Naira = $1.00). However, using a pooled data from the four communities, the mean was $0.34. In Tobit estimation, altruistic WTP varied significantly with two of the communities; the respondents were resident in, sex, marital status and the amount of savings of the respondent. It also varied significantly with the respondents' WTP for their own ITNs and average monthly household expenditures to treat malaria (p < 0.05). Altruistic WTP will exist in community-based and directed sales of ITNs. Thus, there can be intra-community subsidization by the rich for the poor who may not be able to pay for the nets. Community mobilization and sensitization should be used to encourage able households to actually pay at least the amounts they have stated. (author's) Language: English Keywords: NIGERIA | RESEARCH REPORT | VALIDITY | MALARIA PREVENTION | TREATMENT | COMMUNITY FINANCING | BED NETS | FUNDRAISING | ATTITUDES | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Measurement | Research Methodology | Malaria | Parasitic Diseases | Diseases | Financial Activities | Economic Factors | Parasite Control | Public Health | Health | Psychological Factors | Behavior Document Number: 165448 |
| 23. Title: Community-directed treatment with ivermectin in two Nigerian communities: an analysis of first year start-up processes, costs and consequences. Author: Onwujekwe O; Chima R; Shu E; Okonkwo P Source: Health Policy. 2002 Oct;62(1):31-51. Abstract: Objectives: To determine the start-up processes, costs and consequences of community-directed treatment with ivermectin (CDTI) in two onchocerciasis endemic rural towns of Southeast Nigeria; namely Achi and Nike. The other objectives were to discover the community-financing mechanisms, local ivermectin distribution strategies and communities’ organisational capacity to handle the programme. Methods: Structured questionnaires, informal interviews, observations, discussions with community members at general village assemblies and community outreach lectures were used at different stages of the study. Result: The towns had the organisational capacity to implement the programme. Coverage with ivermectin was between 31–73% in Achi (mean=58.6%), and 36.6–72% in Nike (mean=61.95%). The unit financial costs were $0.17 in Nike and $0.13 in Achi, but the unit aggregate cost was $0.37 in Nike and $0.39 in Achi. When research costs were removed, the unit aggregate cost was $0.22 in Achi and $0.20 in Nike. Provider’s financial costs and communities’ non-financial costs were the biggest contributors to the aggregate cost. The cost would decrease in subsequent years since the research cost and parts of the mobilisation and training costs would not be incurred after the first year. Conclusion: Governments and sponsors of CDTI should find means of continuously strengthening the programme and providing technical support to the communities. As both CDTI and communities are dynamic entities, continuous health education campaigns are needed to keep reminding the people of the benefit of long-term ivermectin distribution, together with the need for community ownership of the programme. (author's) Language: English Keywords: NIGERIA | RESEARCH REPORT | INTERVIEWS | RURAL AREAS | COMMUNITY | ONCHOCERCIASIS | TREATMENT | COMMUNITY HEALTH SERVICES | COMMUNITY FINANCING | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Data Collection | Research Methodology | Geographic Factors | Population | Residence Characteristics | Population Distribution | Parasitic Diseases | Diseases | Primary Health Care | Health Services | Delivery of Health Care | Health | Financial Activities | Economic Factors Document Number: 178964 |
| 24. Peer Reviewed Title: Quality of hysterectomy care in rural Gujarat: the role of community-based health insurance. Author: Ranson MK; John KR Source: Reproductive Health Matters. 2002 Nov;10(20):70-81. Abstract: Community-based health insurance (CBHI) may be a mechanism for improving the quality of health care available to people outside the formal sector in developing countries. The purpose of this paper is to identify problems associated with the quality of hysterectomy care accessed by members of SEWA (Self-Employed Women’s Association), an Indian CBHI scheme, and discuss mechanisms that would optimize quality of care. Data on hysterectomy care were collected through a review of 63 insurance claims and semi-structured interviews with 12 providers. Quality of hysterectomy care accessed by SEWA’s members varied from potentially dangerous to excellent. Dangerous conditions included operating theatres without separate hand-washing facilities or proper lighting, the absence of qualified nursing staff, performing hysterectomy on demand, removing both ovaries without consulting or notifying the patient, and failing to send the excised organs for histopathology, even when signs were suggestive of disease. Women paid substantial amounts of money, even for poor and potentially dangerous care. In order to improve the quality of care for its members, a CBHI scheme can: (1) gather data on the costs and complications for each provider, and investigate where these are excessive; (2) use incentives to encourage providers to make efficient and equitable resource allocations; (3) contract with providers giving a high standard of care or who agree to certain conditions; and (4) inform and advise doctors and the insured about the costs and benefits of different interventions. In the case of SEWA, it is most feasible to identify a limited number of hospitals providing better quality care and contract directly with them. (author's) Language: English Keywords: INDIA | RESEARCH REPORT | KAP SURVEYS | RURAL POPULATION | WOMEN IN DEVELOPMENT | QUALITY OF HEALTH CARE | HYSTERECTOMY | COMMUNITY FINANCING | HEALTH INSURANCE | CASE HISTORIES | INCENTIVES | COST EFFECTIVENESS | RESOURCE ALLOCATION | Asia, Southern | Asia | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Gynecologic Surgery | Urogenital Surgery | Surgery | Treatment | Financial Activities | Data Collection | Policy | Evaluation Indexes | Quantitative Evaluation | Evaluation Document Number: 278090 |
| 25. Peer Reviewed Title: Tanzania loses Global Fund money because of internal wrangling. Author: Siringi S Source: Lancet. 2002 Dec 7;360(9348):1848. Abstract: Plans by officials from the Global Fund to Fight AIDS, Tuberculosis, and Malaria to announce their first grant of US$12 million for insecticide-treated bednets in Tanzania to protect infants from malaria were shelved after the country's Finance Ministry decided it would control the money rather than the Health Ministry. The East African country’s Finance Ministry wanted the money to be deposited into a general account, to enable it to determine how the money would be spent. (excerpt) Language: English Keywords: TANZANIA | HIV PREVENTION | AIDS PREVENTION | FUNDS | COMMUNITY FINANCING | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | HIV Infections | Viral Diseases | Diseases | AIDS | Financial Activities | Economic Factors Document Number: 173607 |
| 26. Title: Community development strategies and their role in promoting an alternative development approach in the South Pacific region. Author: Wallace H Source: Development Bulletin. 2002 Jul;(58):56-59. Abstract: One of the major challenges facing island nations of the South Pacific is establishing effective sustainable development policies and practices. At the policy and planning level, considerable tension exists between an interest in short-term economic gain and long-term social development concerns. In particular, the mainstream economic development approach widely adopted or imposed, threatens both the nature of traditional Pacific island cultures and the quality of the physical environment. A breakdown in traditional value systems and a rise in social problems is closely linked to environmental destruction in the Pacific islands. In identifying an alternative approach to existing dominant development models in the Pacific islands, this article argues that a community development approach can help formulate and facilitate an appropriate and workable alternative. The South Pacific provides some clear examples of how community development strategies can bridge the gap between policy and practice, and emphasise collaborative action at local, regional, national and global levels. This article will also examine particular community development initiatives which address issues of environmental sustainability in the South Pacific region, and which illustrate the successful convergence of theory and practice, based on an alternative vision of development. (excerpt) Language: English Keywords: OCEANIA | PROGRESS REPORT | EVALUATION | COMMUNITY | COMMUNITY PARTICIPATION | COMMUNITY FINANCING | DEVELOPMENT POLICY | SUSTAINABLE DEVELOPMENT | ENVIRONMENTAL PROTECTION | POLITICAL FACTORS | FUNDS | FOREIGN AID | Developing Countries | Residence Characteristics | Population Distribution | Geographic Factors | Population | Organization and Administration | Financial Activities | Economic Factors | Policy | Economic Development | Natural Resources | Environment Document Number: 192315 |
| 27. Title: Breaking the cycle of debt. Concern Worldwide's "village banking" program creates positive returns. Source: Monday Developments. 2001 Aug 6;19(14):11. Abstract: Concern Worldwide is an organization that works in partnership with Cambodians to realize the goal of breaking the endless cycle of poverty and debt in the country. The organization has established a network of village banks that provide small loans to villagers. With the provision of cheap locals sources, the scope for yearly investment in agricultural products will be higher. Concern Worldwide offers loans to villagers at a rate of 3-5% interest per month, which do not need collateral, instead, the group members are required to guarantee each other's loans. The local banks provide access to credit and savings facilities in the rural areas. This gives poor farmers the opportunity to break the cycle of debt. Without the local banks, the people will be forced to turn moneylenders and pay extortionate interest. Moreover, Concern Worldwide encourages participation of women. Language: English Keywords: CAMBODIA | FINANCIAL ACTIVITIES | INCOME GENERATION PROGRAMS | COMMUNITY FINANCING | POVERTY | PREVENTION AND CONTROL | Developing Countries | Asia, Southeastern | Asia | Economic Factors | Economic Development | Socioeconomic Factors | Diseases Document Number: 159657 |
| 28. Title: Maternal Life International awarded grant for AIDS care in Africa. Source: AIDS WEEKLY. 2000 Aug 7;:24-5. Abstract: Maternal Life International (MLI) has been awarded a US$273,000 grant by Bristol-Myers Squibb to implement a parish-nurse program for AIDS prevention and care in 25 communities in Swaziland, Africa. The program was developed by MLI in collaboration with Dr. Cynthia Gustafson and will provide a range of services, including hospice/home-based care for AIDS patients, HIV testing and counseling, and HIV/AIDS community education. The parish-nurse model reflects a holistic approach to health care inclusive of the spiritual and social dimensions of AIDS care. According to MLI, the starting point for the program begins with acknowledging the life and dignity of the human person. Moreover, the program will work together with the Roman Catholic Church of Swaziland, 25 parish nurses initially trained in the parish-nurse model. In addition, MLI has initiated projects in Cameroon, Malawi, Ghana and Yucatan State in Mexico in addition to its work in Swaziland. Language: English Keywords: AFRICA | SUMMARY REPORT | PROGRAMS | AIDS PREVENTION | HIV PREVENTION | COMMUNITY FINANCING | GRANTS | Developing Countries | Organization and Administration | AIDS | HIV Infections | Viral Diseases | Diseases | Financial Activities | Economic Factors Document Number: 151672 |
| 29. Title: [Community participation: an alternative for sustainable financing of health in Djibouti] La participation communautaire: une alternative pour un financement durable de la sante a Djibouti. Author: Abdi MH Source: In: Sante et sante de reproduction, [compiled by] Morocco. Institut National de Statistique et d'Economie Appliquee. ; Programme de Formation en Population et Developpement Durable. Rabat, Morocco, Institut National de Statistique et d'Economie Appliquee, Programme de Formation en Population et Developpement Durable, 2000. [58] p. (Population et Developpement Durable: Serie de Recherches Monographiques, Vol. 6) Abstract: In Africa, health systems financing is the main problem to resolve in order to make health services credible. This paper explores alternatives to Djibouti's public financing crisis created by declines in both government revenue and public development aid. Specifically, the report critically analyzes the financing system currently too dependent upon the State budget, highlights potentially positive outcomes of sectoral reforms, considers the important and necessary war against corruption, and demonstrates that community participation could generate sustainable health services financing. The report includes the following sections: the country's socioeconomic context, Djibouti's healthcare system, need versus resources, recent strategic choices, conditions leading to community participation, perspectives on and limits to community financing, ongoing participation and integrating population into development, and general conclusions. The analysis of healthcare financing helps one to understand the feasibility and possible effects of existing models upon health services functioning and the populations which use such services. Moreover, such analysis sheds light upon the relationships existing between the health and economic systems by way of the health budget, the degree to which the healthcare system is a part of the national economy, and how to encourage community financing while targeting poor people, educating adults, and increasing school participation rates among young girls. French Abstract: Ce travail de l'INSEA (Institut National de Statistiques et d'Économie Appliquée) met l'accent sur les alternatives à la crise du financement public en République de Djibouti dues au contexte défavorable: d'où l'impact négatif sur la population vulnérable qui bénéficiait de la quasi-gratuité des services sanitaires. La crise économique a eu des conséquences néfastes sur les secteurs sociaux en général et la santé en particulier. La participation communautaire ne serait possible qu'avec l'introduction en même temps d'une baisse des coûts de production des soins. Pour remédier aux difficultés financières en vue d'un développement durable, la participation communautaire n'est pas le seul moyen, il s'y ajoute la démocratisation, la scolarisation des filles, la privatisation des entreprises publiques et la promotion du rôle de la femme. Language: French Keywords: DJIBOUTI | RESEARCH REPORT | COMMUNITY FINANCING | COMMUNITY PARTICIPATION | HEALTH SERVICES | NEEDS | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Financial Activities | Economic Factors | Organization and Administration | Delivery of Health Care | Health Document Number: 161531 |
| 30. Title: Targeting women in micro-finance schemes: objectives and outcomes. Author: Mumtaz S Source: Pakistan Development Review. 2000 Winter;39(4 Pt 2):877-890. Abstract: In this paper we examine the gender component of the Urban Poverty Alleviation Project (UPAP) initiated by the National Rural Support Programme (NRSP) in Rawalpindi and Islamabad. The examination is based on the preliminary findings of an anthropological study entitled Credit, Gender, and Household Welfare, conducted at PIDE under the supervision of the author, from September-November, 2000. UPAP gives loans to self-constituted groups of women who would be considered uncreditworthy by normal banking standards. (excerpt) Language: English Keywords: PAKISTAN | SUMMARY REPORT | ADULTS | WOMEN | LOW INCOME POPULATION | COMMUNITY FINANCING | INCOME GENERATION PROGRAMS | POVERTY | PREVENTION AND CONTROL | Asia, Southern | Asia | Developing Countries | Age Factors | Population Characteristics | Demographic Factors | Population | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Financial Activities | Economic Development | Diseases Document Number: 174246 |
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