1.  Title: The economic burden of HIV and AIDS on households in Nigeria. Author: Adedigba MA; Naidoo S; Abegunde A; Olagundoye O; Adejuyigbe E; Fakande I Source: African Journal of AIDS Research. 2009 Apr;8(1):107-114. Abstract: The study estimates the economic burden of HIV and AIDS on households in a Nigerian population. The data derive from a cross-sectional survey of households affected by HIV or AIDS in Ife-Ijesa Zone, Osun State, Nigeria. The sample consisted of 117 purposively selected, consenting adult HIV patients attending a general and teaching hospital. Participants were asked to self-report monetary expenses for HIV-related care, loss of savings, and funeral costs. The data show a significantly sharp drop in the participants' household income as a result of care for HIV-related illnesses, from the time of knowing one's HIV status to the time of illness, among three occupational categories (artisans, civil servants and unemployed; p = 0.02). Mean income among those in the unemployed category fell by 84.1%, income among artisans dropped by 72.6%, and income among civil servants decreased by 44.4%. The monetary loss during the course of HIV-related illnesses was heaviest for the artisan group, followed by the unemployed and the civil servants. Those who had lost a substantial part of their savings to HIV-related care were most numerous among the unemployed, followed by artisans and civil servants. Out of 16 households, 11 (42.3%) had received support from relatives during a funeral ceremony. There was a significant association between the occupational group and working for more hours after illness ( 2 = 9.28, df = 4; p = 0.05). Nearly all orphaned children were distributed to the extended family following the AIDS death of a parent. Among all the occupational groups, borrowing from a cooperative society during the course of HIV-related sickness was the commonest form. The findings add to data showing that despite the extended family support system, adult deaths due to AIDS continue to undermine the viability of sub-Saharan African households. Language: English Keywords: NIGERIA | RESEARCH REPORT | SAMPLING STUDIES | HOUSEHOLDS | AIDS | HIV INFECTIONS | ECONOMIC FACTORS | EXPENDITURES | INCOME | POVERTY | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Studies | Research Methodology | Family and Household | Sociocultural Factors | Viral Diseases | Diseases | Financial Activities | Socioeconomic Factors Document Number: 341292 |
| 2. Peer Reviewed Title: Incidence and correlates of 'catastrophic' maternal health care expenditure in India. Author: Bonu S; Bhushan I; Rani M; Anderson I Source: Health Policy and Planning. 2009 Aug 17; Abstract: Using data from the 60(th) round of the National Sample Survey of India (2004), the study investigates the incidence and correlates of 'catastrophic' maternal expenditure (ME) in India. Data on ME come from 6879 births that took place during 365 days prior to the survey. The study adapts earlier definitions and methods for catastrophic total health care expenditure to measure 'catastrophic' ME as: (i) maternal health care expenditure more than 10% of the annual normative household consumption expenditure (ME-1), and (ii) maternal health care expenditure more than 40% of the annual 'capacity to pay' (ME-2). The 'capacity to pay' was derived by subtracting state-wise poverty-line household expenditure from household consumption expenditure. The average maternal expenditure varied by place of delivery: US$9.5, US$24.7 and US$104.3 for birth at home, in a public facility and in a private facility, respectively. Sixteen per cent of households incurred ME of more than 10% of total household consumption expenditure (ME-1), while 51% households incurred ME of more than 40% of household 'capacity to pay' (ME-2). While incidence of ME-1 increased with income decile, the reverse was observed for ME-2, reflecting higher non-utilization of institutional maternal care and its non-affordability among poorer households. All the households from the poorest decile and 99% from the second poorest decile paid more than 40% of their capacity to pay. Multivariate regression results indicate that antenatal care and delivery care in private facilities increased the chances of ME-1 and ME-2 (P < 0.001). Measuring maternal expenditure against 'capacity to pay' (ME-2) may be better than measuring it as a proportion of overall household expenditure when assessing financial constraints in the use of maternal services. Improving the performance of the public sector, appropriate regulation of and partnership with the private sector, and effective direct cash transfers to pregnant women in the poorest households may increase utilization of maternal services and reduce the financial distress associated with ME. Language: English Keywords: INDIA | RESEARCH REPORT | EXPENDITURES | INCIDENCE | MATERNAL HEALTH | UTILIZATION OF HEALTH CARE | MATERNAL-CHILD HEALTH SERVICES | FEES | Asia, Southern | Asia | Developing Countries | Financial Activities | Economic Factors | Measurement | Research Methodology | Health | Health Services | Delivery of Health Care | Primary Health Care Document Number: 342553 |
| 3. Peer Reviewed Title: Estimating inequalities in ownership of insecticide treated nets: does the choice of socio-economic status measure matter? Author: Chuma J; Molyneux C Source: Health Policy and Planning. 2009 Mar;24(2):83-93. Abstract: Research on the impact of socio-economic status (SES) on access to health care services and on health status is important for allocating resources and designing pro-poor policies. Socio-economic differences are increasingly assessed using asset indices as proxy measures for SES. For example, several studies use asset indices to estimate inequities in ownership and use of insecticide treated nets as a way of monitoring progress towards meeting the Abuja targets. The validity of different SES measures has only been tested in a limited number of settings, however, and there is little information on how choice of welfare measure influences study findings, conclusions and policy recommendations. In this paper, we demonstrate that household SES classification can depend on the SES measure selected. Using data from a household survey in coastal Kenya (n = 285 rural and 467 urban households), we first classify households into SES quintiles using both expenditure and asset data. Household SES classification is found to differ when separate rural and urban asset indices, or a combined asset index, are used. We then use data on bednet ownership to compare inequalities in ownership within each setting by the SES measure selected. Results show a weak correlation between asset index and monthly expenditure in both settings: wider inequalities in bednet ownership are observed in the rural sample when expenditure is used as the SES measure [Concentration Index (CI) = 0.1024 expenditure quintiles; 0.005 asset quintiles]; the opposite is observed in the urban sample (CI = 0.0518 expenditure quintiles; 0.126 asset quintiles). We conclude that the choice of SES measure does matter. Given the practical advantages of asset approaches, we recommend continued refinement of these approaches. In the meantime, careful selection of SES measure is required for every study, depending on the health policy issue of interest, the research context and, inevitably, pragmatic considerations. Language: English Keywords: KENYA | RESEARCH REPORT | LOW INCOME POPULATION | SOCIOECONOMIC STATUS | EXPENDITURES | BED NETS | MALARIA PREVENTION | HEALTH STATUS INDEXES | HEALTH POLICY | HEALTH SERVICES | PROGRAM ACCESSIBILITY | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Social Class | Socioeconomic Factors | Economic Factors | Financial Activities | Parasite Control | Public Health | Health | Malaria | Parasitic Diseases | Diseases | Policy | Political Factors | Sociocultural Factors | Delivery of Health Care | Program Evaluation | Programs | Organization and Administration Document Number: 331225 |
| 4. Title: Systematic analysis of research underfunding in maternal and perinatal health. Author: Fisk NM; Atun R Source: BJOG. 2009 Feb;116(3):347-56. Abstract: BACKGROUND: Little published evidence supports the widely held contention that research in pregnancy is underfunded compared with other disease areas. OBJECTIVES: To assess absolute and relative government and charitable funding for maternal and perinatal research in the UK and internationally. SEARCH STRATEGY, SELECTION CRITERIA, DATA COLLECTION, AND ANALYSIS: Major research funding bodies and alliances were identified from an Internet search and discussions with opinion leaders/senior investigators. Websites and annual reports were reviewed for details of strategy, research spend, grants awarded, and allocation to maternal and/or perinatal disease using generic and disease-specific search terms. MAIN RESULTS: Within the imprecision in the data sets, < or =1% of health research spend in the UK was on maternal/perinatal health. Other countries fared better with 1-4% investment, although nonexclusive categorisation may render this an overestimate. In low-resource settings, government funders focused on infectious disease but not maternal and perinatal health despite high relative disease burden, while global philanthropy concentrated on service provision rather than research. Although research expenditure has been deemed as appropriate for 'reproductive health' disease burden in the UK, there are no data on the equity of maternal/perinatal research spend against disease burden, which globally may justify a manyfold increase. AUTHOR'S CONCLUSIONS: This systematic review of research expenditure and priorities from national and international funding bodies suggests relative underinvestment in maternal/perinatal health. Contributing factors include the low political priority given to women's health, the challenging nature of clinical research in pregnancy, and research capacity dearth as a consequence of chronic underinvestment. Language: English Keywords: UNITED KINGDOM | LITERATURE REVIEW | EVALUATION | POLICYMAKERS | GOVERNMENT | NONGOVERNMENTAL ORGANIZATIONS | CHILDBIRTH | MATERNAL-CHILD HEALTH SERVICES | FINANCIAL ACTIVITIES | ECONOMIC FACTORS | PREGNANCY | GRANTS | RESEARCH ACTIVITIES | EXPENDITURES | Developed Countries | Europe, Western | Europe | Administrative Personnel | Organization and Administration | Political Factors | Sociocultural Factors | Organizations | Pregnancy Outcomes | Reproduction | Primary Health Care | Health Services | Delivery of Health Care | Health | Research Methodology Document Number: 331089 |
| 5. Peer Reviewed Title: Exploring the costs and economic consequences of unsafe abortion in Mexico City before legalisation. Author: Levin C; Grossman D; Berdichevsky K; Diaz C; Aracena B; Garcia SG Source: Reproductive Health Matters. 2009 May;17(33):120-132. Abstract: An assessment of abortion outcomes and costs to the health care system in Mexico City was conducted in 2005 at a mix of public and private facilities prior to the legalisation of abortion. Data were obtained from hospital staff, administrative records and patients. Direct cost estimates included personnel, drugs, disposable supplies, and medical equipment for inducing abortion or treating incomplete abortions and other complications. Indirect patient costs for travel, childcare and lost wages were also estimated. The average cost per abortion with dilatation and curettage was US $143. For manual vacuum aspiration it was US $111 in three public hospitals and US $53 at a private clinic. The average cost of medical abortion with misoprostol alone was US $79. The average cost of treating severe abortion complications at the public hospitals ranged from US $601 to over US $2,100. Increasing access to manual vacuum aspiration and early abortion with misoprostol could reduce government costs by 62%, with potential savings of up to US $1.6 million per year. Reducing complications by improving access to safe services in outpatient settings would further reduce the costs of abortion care, with significant benefits both to Mexico's health care system and women seeking abortion. Additional research is needed to explore whether cost savings have been realised post-legalisation. Spanish Abstract: En 2005, antes de la legalización del aborto en el Distrito Federal de México, se realizó una evaluación del impacto y los costos del aborto en el sistema de salud del D.F., en diversos establecimientos públicos y privados. Se obtuvieron datos de personal hospitalario, registros administrativos y pacientes. Los cálculos de costos directos incluían personal, medicamentos, suministros desechables, y equipo médico para inducir el aborto o tratar abortos incompletos y otras complicaciones. También se calcularon los costos indirectos de las pacientes en viajes, cuido de niños y sueldos perdidos. El costo promedio por cada aborto con dilatación y curetaje fue de US $143. Para la aspiración manual endouterina (AMEU), fue de US $111 en tres hospitales públicos y US $53 en una clínica privada. El costo promedio del aborto inducido con misoprostol solo fue de US $79. El costo promedio de tratar las complicaciones graves del aborto en los hospitales públicos varió de US $601 a más de US $2,100. Al ampliar el acceso a la AMEU y al aborto precoz con misoprostol, se podrían disminuir los costos gubernamentales en un 62%, un posible ahorro de hasta US $1.6 millones al año. Al disminuir las complicaciones tras mejorar el acceso a los servicios seguros en ámbitos ambulatorios, disminuirían también los costos de la atención del aborto, lo cual sería un gran beneficio tanto para el sistema de salud de México como para las mujeres que buscan servicios de aborto. Aún se necesitan más investigaciones para explorar si se han logrado ahorros en costos post-legalización. French Abstract: En 2005, avant la légalisation de l'avortement, on a évalué les résultats et le coût de l'avortement sur le système sanitaire à Mexico, dans des établissements publics et privés. Les données ont été obtenues auprès du personnel hospitalier et des patientes, et dans les dossiers administratifs. Les estimations directes des coûts incluaient le personnel, les médicaments, les consommables et l'équipement médical pour provoquer l'avortement ou traiter les avortements incomplets et d'autres complications. Les frais indirects de déplacement, de garde d'enfants et de perte de gain des patientes ont aussi été calculés. Le coût moyen par avortement avec dilatation et curetage était de $US143. Par aspiration manuelle, il était de $US 111 dans trois hôpitaux publics et $US 53 dans une clinique privée. Le coût moyen de l'avortement médicamenteux avec du misoprostol seul était de $US 79. En moyenne, le traitement des complications graves de l'avortement dans les hôpitaux publics allait de $US 601 à plus de $US 2100. Un accès élargi à l'aspiration manuelle et à l'avortement précoce au misoprostol permettrait de réduire de 62% les coûts gouvernementaux, avec des économies potentielles se chiffrant à $US 1,6 million par an. En réduisant les complications par l'amélioration de l'accès à des services ambulatoires sûrs, on diminuerait encore le coût des soins de l'avortement, avec de nets avantages pour le système de santé mexicain et les femmes souhaitant avorter. Il faut mener des recherches supplémentaires pour déterminer si des économies ont été réalisées après l'adoption de la légalisation. Language: English Keywords: MEXICO | URBAN AREAS | RESEARCH REPORT | CLIENTS | ABORTION | ABORTION LAW | EXPENDITURES | FEES | CERVICAL DILATATION | CURETTAGE | PROGRAM ACCESSIBILITY | COST BENEFIT ANALYSIS | North America | Americas | Developing Countries | Geographic Factors | Population | Program Activities | Programs | Organization and Administration | Fertility Control, Postconception | Family Planning | Financial Activities | Economic Factors | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Obstetrical Surgery | Surgery | Program Evaluation | Quantitative Evaluation | Evaluation Document Number: 342021 Notification |
6.  Title: Family-Friendly Workplace: A model for estimating the cost savings of implementing family-friendly policies. Author: Plosky WD; Winfrey B Source: Washington, D.C., Futures Group International, Health Policy Initiative, 2009 Jan. 21 p. (USAID Contract No. GPO-I-01-05-00040-00) Abstract: The Family-Friendly Workplace (FFW) Model is designed to engage individuals and groups from diverse institutions in all sectors to make workplaces more family-friendly. The FFW model will help reproductive health advocates and employers of women understand the benefits and costs of implementing policies that support women in their reproductive years. Users of the model may be human resource departments of medium-sized and large companies, family planning advocates, maternal health advocates or groups representing women in the workplace. Language: English Keywords: GLOBAL | SUMMARY REPORT | MANUAL | WOMEN | WORKPLACE | FAMILY POLICY | REPRODUCTIVE HEALTH | EXPENDITURES | COST BENEFIT ANALYSIS | PREGNANCY | WORKPLAN | MATERNITY BENEFITS | Demographic Factors | Population | Employment | Macroeconomic Factors | Economic Factors | Social Policy | Policy | Political Factors | Sociocultural Factors | Health | Financial Activities | Quantitative Evaluation | Evaluation | Reproduction | Planning | Organization and Administration | Microeconomic Factors Document Number: 331541 |
| 7. Title: Acute diarrhea in children after 2004 tsunami, Andaman Islands [letter] Author: Roy S; Bhattacharya D; Ghoshal SR; Thanasekaran K; Bharadwaj AP; Singhania M; Sugunan AP Source: Emerging Infectious Diseases. 2009 May;15(5):849-50. Abstract: This letter to the editor discusses the incidence of acute diarrhea among children from the Andaman Islands. The findings show that acute diarrhea decreased within months of the 2004 tsunami and highlights the importance of public health and sanitation measures after a natural disaster. Language: English Keywords: INDIA | CRITIQUE | CHILDREN | NATURAL DISASTERS | DIARRHEA | INCIDENCE | SANITATION | WATER QUALITY | WATER SUPPLY | DISASTER RELIEF | EXPENDITURES | PUBLIC HEALTH | Asia, Southern | Asia | Developing Countries | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Environment | Diseases | Measurement | Research Methodology | Health | Water | Natural Resources | Financial Activities | Economic Factors Document Number: 341996 |
| 8. Title: Purchase of drinking water is associated with increased child morbidity and mortality among urban slum-dwelling families in Indonesia. Author: Semba RD; de Pee S; Kraemer K; Sun K; Thorne-Lyman A; Moench-Pfanner R; Sari M; Akhter N; Bloem MW Source: International Journal of Hygiene and Environmental Health. 2009 Jul;212(4):387-97. Abstract: In developing countries, poor families in urban slums often do not receive municipal services including water. The objectives of our study were to characterize families who purchased drinking water and to examine the relation between purchasing drinking water and child morbidity and mortality in urban slums of Indonesia, using data collected between 1999 and 2003. Of 143,126 families, 46.8% purchased inexpensive drinking water from street vendors, 47.4% did not purchase water, i.e., had running or spring/well water within household, and 5.8% purchased more expensive water in the previous 7 days. Families that purchased inexpensive drinking water had less educated parents, a more crowded household, a father who smoked, and lower socioeconomic level compared with the other families. Among children of families that purchased inexpensive drinking water, did not purchase drinking water, or purchased more expensive water, the prevalence was, respectively, for diarrhea in last 7 days (11.2%, 8.1%, 7.7%), underweight (28.9%, 24.1%, 24.1%), stunting (35.6%, 30.5%, 30.5%), wasting (12.0%, 10.5%, 10.9%), family history of infant mortality (8.0%, 5.6%, 5.1%), and of under-five child mortality (10.4%, 7.1%, 6.4%) (all P<0.0001). Use of inexpensive drinking water was associated with under-five child mortality (Odds Ratio [O.R.] 1.32, 95% Confidence Interval [C.I.] 1.20-1.45, P<0.0001) and diarrhea (O.R. 1.43, 95% C.I. 1.29-1.60, P<0.0001) in multivariate logistic regression models, adjusting for potential confounders. Purchase of inexpensive drinking water was common and associated with greater child malnutrition, diarrhea, and infant and under-five child mortality in the family. Greater efforts must be made to ensure access to safe drinking water, a basic human right and target of the Millennium Development Goals, in urban slums. Language: English Keywords: INDONESIA | SLUMS | RESEARCH REPORT | SAMPLING STUDIES | CHILDREN | HOUSEHOLDS | WATER SUPPLY | EXPENDITURES | CHILD MORTALITY | INFANT MORTALITY | DIARRHEA | MALNUTRITION | PREVALENCE | Developing Countries | Asia, Southeastern | Asia | Urbanization | Urban Population Distribution | Population Distribution | Geographic Factors | Population | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Family and Household | Sociocultural Factors | Natural Resources | Environment | Financial Activities | Economic Factors | Mortality | Population Dynamics | Diseases | Nutrition Disorders | Measurement Document Number: 342114 |
| 9. Title: Afghanistan: Paying NGOs for performance in a postconflict setting. Author: Sondorp E; Palmer N; Strong L; Wali A Source: In: Performance incentives for global health: potential and pitfalls, [by] Rena Eichler, Ruth Levine and the Performance-Based Incentives Working Group. Washington, D.C., Center for Global Development, 2009. :139-164. Abstract: Large-scale contracting of nongovernmental organizations can deliver essential services to the population, even in a postconflict setting with weak service delivery capacity. Government stewardship of the health sector can be enhanced with services delivered by contracted nongovernmental organizations. Results suggest that nongovernmental organizations that are paid based partly on results perform better than those that are paid for expenditures on inputs, although this evidence is far from conclusive. Language: English Keywords: AFGHANISTAN | RESEARCH REPORT | NONGOVERNMENTAL ORGANIZATIONS | HEALTH SERVICES | EXPENDITURES | FINANCIAL ACTIVITIES | PROGRAM ACTIVITIES | PROGRAM EVALUATION | MONITORING | Asia, Southern | Asia | Developing Countries | Organizations | Political Factors | Sociocultural Factors | Delivery of Health Care | Health | Economic Factors | Programs | Organization and Administration | Evaluation Document Number: 331455 |
| 10. Peer Reviewed Title: Care-seeking behavior and out-of-pocket expenditure for sick newborns among urban poor in Lucknow, northern India: a prospective follow-up study. Author: Srivastava NM; Awasthi S; Agarwal GG Source: BMC Health Services Research. 2009;9:61. Abstract: BACKGROUND: The state of Uttar Pradesh, India accounts for one-quarter of India's neonatal deaths and 8 percent of those worldwide. More than half (52%) of these deaths occur due to infections. In order to achieve Millennium Development Goal-4 of reducing child mortality by two-thirds by the year 2015, it is important to study factors which affect neonatal health. In Uttar Pradesh there is meager data for spending on health care in general and neonates in particular. METHODS: The study was conducted at an urban Reproductive and Child Health (RCH) center and a District hospital. Neonates were enrolled within 48 hours of birth and were followed-up once at 6 weeks +/- 15 days at the OPD of the respective hospitals or at home. This study assessed (1) distribution of neonatal illnesses and different health providers sought (2) distribution of out-of-pocket expenditures by type of illness and type of health provider sought (3) socio-economic distribution of neonatal illnesses, care-seeking behavior and out-of-pocket expenditures. Per-protocol analysis was performed. RESULTS: Five hundred and ten neonates were enrolled and 481(94.4%) were followed-up. Parents of 50.3% (242/481) neonates reported at least one symptom of illness. Of these 22.3% (107/481) neonates had illnesses with at least one reported Integrated Management of Neonatal and Childhood Illnesses (IMNCI) danger sign. Among IMNCI illnesses, point prevalence of septicemia was 6.2% and pneumonia was 5.2% while among non-IMNCI illnesses point prevalence of upper respiratory infection was 9.5%, and diarrhea was 7%. Community based non-government dispensers (NGDs) were leading health providers (37.6%). Mean monthly income of families was 2804 Indian Rupees (INR) (range: 800 to 14000; n = 510), where US$ 1 = 42 INR. Mean out-of-pocket expenditure on neonatal illness was 547.5 INR (range: 1 to 15000; n = 202) and mean out-of-pocket expenditure for hospitalization was 4993 INR (range: 41 to 15000; n = 17). All hospitalizations were for IMNCI illnesses. Neonates from lower income strata were less likely to receive any medical care (p < 0.0001) and were also less likely to be seen by a Government provider (p = 0.03). CONCLUSION: Since more than half of the neonates have morbidity and out-of-pocket expenditure on neonatal illnesses often exceeds the family income of the lower strata of the low income group in the community, there is a need to either introduce health insurance scheme or subsidize health care for them. Also, since NGDs, half of which could be unqualified are leading health providers, qualified medical care-seeking for sick newborns should be promoted in urban Lucknow. Language: English Keywords: INDIA | RESEARCH REPORT | PROSPECTIVE STUDIES | URBAN POPULATION | INFANT | CLIENTS | EXPENDITURES | PRIMARY HEALTH CARE | BEHAVIOR | HEALTH SERVICES | UTILIZATION OF HEALTH CARE | CHILD HEALTH | FEES | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Youth | Age Factors | Program Activities | Programs | Organization and Administration | Financial Activities | Economic Factors | Delivery of Health Care | Health Document Number: 342508 |
| 11. Peer Reviewed Title: Gender differences in perception and care-seeking for illness of newborns in rural Uttar Pradesh, India. Author: Willis JR; Kumar V; Mohanty S; Singh P; Singh V; Baqui AH; Awasthi S; Singh JV; Santosham M; Darmstadt GL Source: Journal of Health, Population, and Nutrition. 2009 Feb;27(1):62-71. Abstract: Although gender-based health disparities are prevalent in India, very little data are available on care-seeking patterns for newborns. In total, 255 mothers were prospectively interviewed about their perceptions and action surrounding the health of their newborns in rural Uttar Pradesh, India. Perception of illness was significantly lower in incidence (adjusted odds ratio=0.56, 95% confidence interval 0.33-0.94) among households with female versus male newborns. While the overall use of healthcare providers was similar across gender, the average expenditure for healthcare during the neonatal period was nearly four-fold higher in households with males (Rs 243.3 +/- 537.2) compared to females (Rs 65.7 +/- 100.7) (p=0.07). Households with female newborns used cheaper public care providers whereas those with males preferred to use private unqualified providers perceived to deliver more satisfactory care. These results suggest that, during the neonatal period, care-seeking for girls is neglected compared to boys, laying a foundation for programmes and further research to address gender differences in neonatal health in India. Language: English Keywords: INDIA | RESEARCH REPORT | RURAL POPULATION | INFANT | INFANT HEALTH | EXPENDITURES | PRIMARY HEALTH CARE | HEALTH FACILITIES | PERCEPTION | BEHAVIOR | INEQUALITIES | GENDER ISSUES | Asia, Southern | Asia | Developing Countries | Population Characteristics | Demographic Factors | Population | Youth | Age Factors | Child Health | Health | Financial Activities | Economic Factors | Health Services | Delivery of Health Care | Psychological Factors | Socioeconomic Factors | Sociocultural Factors Document Number: 330902 |
| 12. Peer Reviewed Title: Assessment of the health system and policy environment as a critical complement to tracking intervention coverage for maternal, newborn, and child health. Author: Countdown Working Group on Health Policy and Health Systems Source: Lancet. 2008 Apr 12;371(9620):1284-1293. Abstract: In 2008, the Countdown to 2015 initiative identified 68 priority countries for action on maternal, newborn, and child health. Much attention was paid to monitoring country-level progress in achieving high and equitable coverage with interventions effective in reducing mortality of mothers, newborn infants, and children up to 5 years of age. To have a broader understanding of the environment in which health services are delivered and health outcomes are produced is essential to increase intervention coverage. Programmes to address MNCH rely on health systems to generate information needed for effective decisions and to achieve the expected outcomes. Governance and leadership are needed throughout the process not only to create policies and implement them but also to assure quality and efficiency of care, to finance health services sufficiently and in an equitable way, and to manage the health workforce. We present a systematic approach to assess the wider health system and policy environment neededto achieve positive outcomes for maternal, newborn, and child health. We report on results from 13 indicators and show gaps in policy adoption as well as weaknesses in other health system building blocks. We identify areas for future action in measurement of key indicators and their use to support decision making. We hope that this information will provide an additional dimension to the discussions on feasible and sustainable solutions to accelerate progress towards Millennium Development Goals 4 and 5, both at the global level but most importantly in individual countries. (author's) Language: English Keywords: GLOBAL | RESEARCH REPORT | GOALS | SOCIAL DEVELOPMENT | MATERNAL HEALTH | CHILD HEALTH | CHILD MORTALITY | PREVENTION AND CONTROL | HEALTH POLICY | HEALTH SERVICES | DELIVERY OF HEALTH CARE | EXPENDITURES | FINANCIAL ACTIVITIES | INTERVENTIONS | PROGRAM EVALUATION | Planning | Organization and Administration | Economic Factors | Health | Mortality | Population Dynamics | Demographic Factors | Population | Diseases | Policy | Political Factors | Sociocultural Factors | Programs Document Number: 326155 |
| 13. Title: Donor support for contraceptives and condoms for STI / HIV prevention 2008. Author: United Nations Population Fund [UNFPA] Source: [New York, New York], UNFPA, 2008. 30 p. Abstract: Since 1990, the United Nations Population Fund (UNFPA) has been tracking donor support for contraceptives and condoms for STI / HIV prevention. The Fund publishes an annual report based on this donor database to enhance the coordination among partners at all levels to continue progress toward universal access to sexual and reproductive health, as set forth in the ICPD Programme of Action and, subsequently, the Millennium Development Goals. This report represents the 2008 installment of the series and has three main sections. The first section summarizes patterns and trends—by method, by donor and by region—in donor support from 2000-2008. The second section takes a closer look at donor support for male and female condoms over time and by region. The third and final section compares aggregate donor support to global contraceptive need for 2000-2008 and provides projections of contraceptive needs through 2015. (Excerpt) Language: English Keywords: GLOBAL | ANNUAL REPORT | UNFPA | HIV PREVENTION | SEXUALLY TRANSMITTED DISEASE PREVENTION | CONDOMS | FEMALE CONDOMS | CONTRACEPTIVE AGENTS | CONTRACEPTIVE METHODS | FOREIGN AID | EXPENDITURES | NEEDS | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | HIV Infections | Viral Diseases | Diseases | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Barrier Methods | Contraception | Family Planning | Vaginal Barrier Methods | Financial Activities | Economic Factors Document Number: 331842 |
| 14. Peer Reviewed Title: Macroeconomic and household-level impacts of HIV/AIDS in Botswana. Author: Jefferis K; Kinghorn A; Siphambe H; Thurlow J Source: AIDS. 2008 Jul;22 Suppl 1:S113-9. Abstract: OBJECTIVE: To measure the impact of HIV/AIDS on economic growth and poverty in Botswana and estimate how providing treatment can mitigate its effects. METHODS: Demographic and financial projections were combined with economic simulation models, including a macroeconomic growth model and a macro-microeconomic computable general equilibrium and microsimulation model. RESULTS: HIV/AIDS significantly reduces economic growth and increases household poverty. The impact is now severe enough to be affecting the economy as a whole, and threatens to pull some of the uninfected population into poverty. Providing antiretroviral therapy can partly offset this negative effect. Treatment increases health's share of government expenditure only marginally, because it increases economic growth and because withholding treatment raises the cost of other health services. CONCLUSION: Botswana's treatment programme is appropriate from a macroeconomic perspective. Conducting macroeconomic impact assessments is important in countries where prevalence rates are particularly high. Language: English Keywords: BOTSWANA | RESEARCH REPORT | COMPARATIVE STUDIES | HIV INFECTIONS | AIDS | ECONOMIC DEVELOPMENT | POVERTY | GOVERNMENT FINANCING | ECONOMIC FACTORS | COMPUTERS | EXPENDITURES | HEALTH SERVICES | ECONOMIC MODEL | ANTIRETROVIRAL THERAPY | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Viral Diseases | Diseases | Socioeconomic Factors | Financial Activities | Information Processing | Information | Delivery of Health Care | Health | Theoretical Models | HIV Document Number: 328251 |
| 15. Peer Reviewed Title: Crowding out effect of tobacco expenditure and its implications on household resource allocation in India. Author: John RM Source: Social Science and Medicine. 2008 Mar;66(6):1356-1367. Abstract: This paper examines whether spending on tobacco crowds out expenditure on basic needs and whether it has implications on nutrition intake and household resource allocation in India. The paper uses a household sample survey from India for the year 1999-2000. A system of quadratic conditional Engel curves was estimated for a set of 10 broad groups of commodities. The results suggest that tobacco consuming households had lower consumption of certain commodities such as milk, education, clean fuels and entertainment which may have more direct bearing on women and children in the household than on men suggesting possible 'gender effects' and biases in the allocation of goods and services within the household. Tobacco spending was also found to have negative effects on per capita nutrition intake. The nature of crowding out was found to be similar in low- and high-income households. (author's) Language: English Keywords: INDIA | RESEARCH REPORT | NUTRITION SURVEYS | MATHEMATICAL MODEL | HOUSEHOLDS | CHILDREN | TOBACCO USE | EXPENDITURES | RESOURCE ALLOCATION | HOME ECONOMICS | NUTRITION | HOUSEHOLD CONSUMPTION | SEX FACTORS | Developing Countries | Asia, Southern | Asia | Health | Theoretical Models | Research Methodology | Family and Household | Sociocultural Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Behavior | Financial Activities | Economic Factors | Microeconomic Factors Document Number: 324677 |
| 16. Peer Reviewed Title: User fee exemptions are not enough: out-of-pocket payments for 'free' delivery services in rural Tanzania. Author: Kruk ME; Mbaruku G; Rockers PC; Galea S Source: Tropical Medicine and International Health. 2008 Dec;13(12):1442-51. Abstract: OBJECTIVE: To identify the main drivers of costs of facility delivery and the financial consequences for households among rural women in Tanzania, a country with a policy of delivery fee exemptions. METHODS: We selected a representative sample of households in a rural district in western Tanzania. Women who given birth within 5 years were asked about payments for doctor's/nurse's fees, drugs, non-medical supplies, medical tests, maternity waiting home, transport and other expenses. Wealth was assessed using a household asset index. We estimated the proportion of women who cut down on spending or borrowed money/sold household items to pay for delivery in each wealth group. RESULTS: In all, 73.3% of women with facility delivery reported having made out-of-pocket payments for delivery-related costs. The average cost was 6272 Tanzanian shillings (TZS), [95% Confidence Interval (CI): 4916, 7628] or 5.0 United States dollars. Transport costs (53.6%) and provider fees (26.6%) were the largest cost components in government facilities. Deliveries in mission facilities were twice as expensive as those in government facilities. Nearly half (48.3%) of women reported cutting down on spending or borrowing money/selling household assets to pay for delivery, with the poor reporting this most frequently. CONCLUSION: Out-of-pocket payments for facility delivery were substantial and were driven by high transport costs, unofficial provider payments, and preference for mission facilities, which levy user charges. Novel approaches to financing maternal health services, such as subsidies for transport and care from private providers, are required to reduce the cost barriers to attended delivery. Language: English Keywords: TANZANIA | RESEARCH REPORT | STATISTICAL STUDIES | RURAL POPULATION | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | FEES | EXAMINATIONS AND DIAGNOSES | DRUGS | MATERNAL HEALTH SERVICES | TRANSPORTATION | HOME ECONOMICS | EXPENDITURES | CHILDBIRTH | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Financial Activities | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Treatment | Maternal-Child Health Services | Primary Health Care | Microeconomic Factors | Pregnancy Outcomes | Pregnancy | Reproduction Document Number: 330043 |
| 17. Peer Reviewed Title: Export of health services from developing countries: The case of Tunisia. Author: Lautier M Source: Social Science and Medicine. 2008 Jul;67(1):101-110. Abstract: Although the subject of health services exports by developing countries has been much discussed, the phenomenon is still in its early stage, and its real implications are not yet clear. Given the rapid development in this area, little empirical data are available. This paper aims to fill this gap by providing reliable data on consumption of health services abroad (GATS mode 2 of international service supply). It starts by assessing the magnitude of the volume of international trade in health services. This is followed by an indepth analysis of the case of Tunisia based on an original field research. Because of the high quality of its health sector and its proximity with Europe, Tunisia has the highest export potential for health services in the Middle-East and North Africa (MEAN) Region. Health services exports may represent a quarter of Tunisia's private health sector output and generate jobs for 5000 employees. If one takes into account tourism expenses by the incoming patient (and their relatives), these exports contribute to nearly 1% of the country's total exports. Finally, this case study highlights the regional dimension of external demand for health services and the predominance of South-South trade. (author's) Language: English Keywords: TUNISIA | DEVELOPING COUNTRIES | RESEARCH REPORT | CASE STUDIES | HEALTH SERVICES | TRAVEL AND TOURISM | PRIVATE SECTOR | PUBLIC SECTOR | EXPENDITURES | BRAIN DRAIN | HUMAN RESOURCES | Africa, North | Africa | Studies | Research Methodology | Delivery of Health Care | Health | Behavior | Macroeconomic Factors | Economic Factors | Financial Activities | International Migration | Migration | Population Dynamics | Demographic Factors | Population Document Number: 327252 |
| 18. Peer Reviewed Title: China's health system performance. Author: Liu Y; Rao K; Wu J; Gakidou E Source: Lancet. 2008 Nov 29;372(9653):1914-23. Abstract: We created a comprehensive set of health-system performance measurements for China nationally and regionally, with health-system coverage and catastrophic medical spending as major indicators. With respect to performance of health-care delivery, China has done well in provision of maternal and child health services, but poorly in addressing non-communicable diseases. For example, coverage of hospital delivery increased from 20% in 1993 to 62% in 2003 for women living in rural areas. However, effective coverage of hypertension treatment was only 12% for patients living in urban areas and 7% for those in rural areas in 2004. With respect to performance of health-care financing, 14% of urban and 16% of rural households incurred catastrophic medical expenditure in 2003. Furthermore, 15% of urban and 22% of rural residents had affordability difficulties when accessing health care. Although health-system coverage improved for both urban and rural areas from 1993 to 2003, affordability difficulties had worsened in rural areas. Additionally, substantial inter-regional and intra-regional inequalities in health-system coverage and health-care affordability measures exist. People with low income not only receive lower health-system coverage than those with high income, but also have an increased probability of either not seeking health care when ill or undergoing catastrophic medical spending. China's current health-system reform efforts need to be assessed for their effect on performance indicators, for which substantial data gaps exist. Language: English Keywords: CHINA | CRITIQUE | EVALUATION INDEXES | RURAL POPULATION | URBAN POPULATION | HEALTH STATUS INDEXES | QUALITY OF HEALTH CARE | EXPENDITURES | COMMUNICABLE DISEASE CONTROL | HYPERTENSION | PROGRAM ACCESSIBILITY | DELIVERY OF HEALTH CARE | INEQUALITIES | HUMAN GEOGRAPHY | ECONOMIC FACTORS | Asia, Eastern | Asia | Developing Countries | Quantitative Evaluation | Evaluation | Population Characteristics | Demographic Factors | Population | Health | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Financial Activities | Health Services | Vascular Diseases | Diseases | Socioeconomic Factors | Geography | Social Sciences | Science | Sociocultural Factors Document Number: 329368 |
| 19. Title: Use and cost of medication in low risk pregnant women. Author: Maeda ST; Secoli SR Source: Revista Latino-Americana de Enfermagem. 2008 Mar-Apr;16(2):266-271. Abstract: The objective of the present study is to assess the use of medication by pregnant women; classify them regarding therapy group and its risk category; and identify the cost of these drugs. The sample is formed by 47 pregnant women, in the 20 to 29 year-old age group, from July 2001 to June 2003, in the city of São Paulo. A specific instrument was used for data collection in family charts and others from the Sistema de Informação da Atenção Básica (Primary Care System Information). Average of medications used by pregnant woman was 3.63. Iron sulfate was the most commonly used, followed by antibiotics (78.7%). Regarding risk category, 34.1% of medications belonged to category B and 16.5% to category C. In the calculation of total costs of care, expenses with medication accounted for 11.13%. We have seen the need for assessing further the criteria for use, especially of medications of category C. The higher costs were related to antimicrobials for the treatment of infections. (author's) Language: English Keywords: BRAZIL | RESEARCH REPORT | SAMPLING STUDIES | PREGNANT WOMEN | DRUGS | EXPENDITURES | RISK ASSESSMENT | Developing Countries | South America, Eastern | South America | Latin America | Americas | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Financial Activities | Economic Factors | Evaluation Document Number: 327449 |
| 20. Peer Reviewed Title: From strategy development to routine implementation: the cost of Intermittent Preventive Treatment in Infants for malaria control. Author: Manzi F; Hutton G; Schellenberg J; Tanner M; Alonso P; Mshinda H; Schellenberg D Source: BMC Health Services Research. 2008;8:165. Abstract: BACKGROUND: Achieving the Millennium Development Goals for health requires a massive scaling-up of interventions in Sub Saharan Africa. Intermittent Preventive Treatment in infants (IPTi) is a promising new tool for malaria control. Although efficacy information is available for many interventions, there is a dearth of data on the resources required for scaling up of health interventions. METHOD: We worked in partnership with the Ministry of Health and Social Welfare (MoHSW) to develop an IPTi strategy that could be implemented and managed by routine health services. We tracked health system and other costs of (1) developing the strategy and (2) maintaining routine implementation of the strategy in five districts in southern Tanzania. Financial costs were extracted and summarized from a costing template and semi-structured interviews were conducted with key informants to record time and resources spent on IPTi activities. RESULTS: The estimated financial cost to start-up and run IPTi in the wholeof Tanzania in 2005 was US$1,486,284. Start-up costs of US$36,363 were incurred at the national level, mainly on the development of Behaviour Change Communication (BCC) materials, stakeholders' meetings and other consultations. The annual running cost at national level for intervention management and monitoring and drug purchase was estimated at US$459,096. Start-up costs at the district level were US$7,885 per district, mainly expenditure on training. Annual running costs were US$170 per district, mainly for printing of BCC materials. There was no incremental financial expenditure needed to deliver the intervention in health facilities as supplies were delivered alongside routine vaccinations and available health workers performed the activities without working overtime. The economic cost was estimated at 23 US cents per IPTi dose delivered. CONCLUSION: The costs presented here show the order of magnitude of expenditures needed to initiate and to implement IPTi at national scale in settings with high Expanded Programme on Immunization (EPI) coverage. The IPTi intervention appears to be affordable even within the budget constraints of Ministries of Health of most sub-Saharan African countries. Language: English Keywords: TANZANIA | EVALUATION REPORT | COST BENEFIT ANALYSIS | INFANT | PREVENTIVE MEDICINE | MALARIA PREVENTION | COST EFFECTIVENESS | MANAGEMENT | MONITORING | EXPENDITURES | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Evaluation | Quantitative Evaluation | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Medicine | Health Services | Delivery of Health Care | Health | Malaria | Parasitic Diseases | Diseases | Evaluation Indexes | Organization and Administration | Financial Activities | Economic Factors Document Number: 328436 |
| 21. Peer Reviewed Title: Child survival gains in Tanzania: Analysis of data from demographic and health surveys. Author: Masanja H; de Savigny D; Smithson P; Schellenberg J; John T Source: Lancet. 2008 Apr 12;371(9620):1276-1283. Abstract: A recent national survey in Tanzania reported that mortality in children younger than 5 years dropped by 24% over the 5 years between 2000 and 2004. We aimed to investigate yearly changes to identify what might have contributed to this reduction and to investigate the prospects for meeting the Millennium Development Goal for child survival (MDG 4). We analysed data from the four demographic and health surveys done in Tanzania since 1990 to generate estimates of mortality in children younger than 5 years for every 1-year period before each survey back to 1990. We estimated trends in mortality between 1990 and 2004 by fitting Lowess regression, and forecasted trends in mortality in 2005 to 2015. We aimed to investigate contextual factors, whether part of Tanzania's health system or not, that could have affected child mortality. Disaggregated estimates of mortality showed a sharp acceleration in the reduction in mortality in children younger than 5 years in Tanzania between 2000 and 2004. In 1990, the point estimate of mortality was 141.5 (95% CI 141.5-141.5) deaths per 1000 livebirths. This was reduced by 40%, to reach a point estimate of 83.2 (95% CI 70.1-96.3) deaths per 1000 livebirths in 2004. The change in absolute risk was 58.4 (95% CI 32.7-83.8; p less than 0.0001). Between 1999 and 2004 we noted important improvements in Tanzania's health system, including doubled public expenditure on health; decentralisation and sector-wide basket funding; and increased coverage of key child-survival interventions, such as integrated management of childhood illness, insecticide-treated nets, vitamin A supplementation, immunisation, and exclusive breastfeeding. Other determinants of child survival that are not related to the health system did not change between 1999 and 2004, except for a slow increase in the HIV/AIDS burden. Tanzania could attain MDG 4 if this trend of improved child survival were to be sustained. Investment in health systems and scaling up interventions can produce rapid gains in child survival. (author's) Language: English Keywords: TANZANIA | RESEARCH REPORT | DATA ANALYSIS | DEMOGRAPHIC AND HEALTH SURVEYS | CHILD MORTALITY | DECENTRALIZATION | FUNDS | EXPENDITURES | CHILD HEALTH | BED NETS | MALARIA PREVENTION | CHILD SURVIVAL | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Research Methodology | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Mortality | Political Factors | Sociocultural Factors | Financial Activities | Economic Factors | Health | Parasite Control | Public Health | Malaria | Parasitic Diseases | Diseases | Survivorship | Length of Life Document Number: 326153 |
| 22. Peer Reviewed Title: Effect of HIV/AIDS on household welfare in Uganda rural communities: a review. Author: Nabyonga-Orem J; Bazeyo W; Okema A; Karamagi H; Walker O Source: East African Medical Journal. 2008 Apr;85(4):187-96. Abstract: OBJECTIVES: To assess the impact of HIV/AIDS on household welfare. Explore the relationship between HIV/AIDS and poverty especially in relation to the Poverty Eradication Action Plan as well as make policy recommendations regarding action necessary to reverse or reduce the impact of HIV/AIDS on households (HHs). DATA SOURCES: A cross-sectional study that utilised qualitative and quantitative research methods. Data were collected on the socio demographic profile; level of income; illness incidence and failure to work; loss of income due to illness; health expenditures for the last two months and modes of coping with health care costs. STUDY SELECTION: Study districts were selected based on regional representation and the HIV seroprevalence rates. The country is divided in four regions and the district with the highest seroprevalence in each region was selected. DATA EXTRACTION: Data was entered and analysed using EPINFO and proportions expressed as percentages. DATA SYNTHESIS: There were no children headed HHs among the controls and female and widowed HHs heads were more among the infected/affected HHs. The total average two months' expenditure on health care for control HHs was US $25 compared to US $95, for infected/affected HHs. Thirty two point two percent of HH heads who had missed work in the previous month gave illness as reason in the control group compared to 77.2% among infected/affected HHs. Fifty nine percent of these reported to have lost all their source of income as a result of the illness and 2.3% had salaries reduced. Twenty seven percent of the control HHs had children of school going age not attending school compared to 49% among the infected/affected HHs. Only 1.2% among the controls and 8.1% in the affected gave looking after the sick as reason. Methods of coping with cost of health care included sale of assets and withdrawing savings. CONCLUSION: The study shows that HIV/AIDS impoverishes affected/infected households. Language: English Keywords: UGANDA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | HOUSEHOLDS | SOCIAL WELFARE | INCOME | SOCIOECONOMIC STATUS | AIDS | IMPACT | EXPENDITURES | POVERTY | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Family and Household | Sociocultural Factors | Economic Factors | Socioeconomic Factors | HIV Infections | Viral Diseases | Diseases | Communication | Financial Activities Document Number: 328707 |
| 23. Peer Reviewed Title: The costs of introducing artemisinin-based combination therapy: evidence from district-wide implementation in rural Tanzania. Author: Njau JD; Goodman CA; Kachur SP; Mulligan J; Munkondya JS Source: Malaria Journal. 2008 Jan 7;7:4. Abstract: The development of antimalarial drug resistance has led to increasing calls for the introduction of artemisinin-based combination therapy (ACT). However, little evidence is available on the full costs associated with changing national malaria treatment policy. This paper presents findings on the actual drug and non-drug costs associated with deploying ACT in one district in Tanzania, and uses these data to estimate the nationwide costs of implementation in a setting where identification of malaria cases is primarily dependant on clinical diagnosis. Detailed data were collected over a three year period on the financial costs of providing ACT in Rufiji District as part of a large scale effectiveness evaluation, including costs of drugs, distribution, training, treatment guidelines and other information, education and communication (IEC) materials and publicity. The district-level costs were scaled up to estimate the costs of nationwide implementation, using four scenarios to extrapolate variable costs. The total district costs of implementing ACT over the three year period were slightly over one million USD, with drug purchases accounting for 72.8% of this total. The composite (best) estimate of nationwide costs for the first three years of ACT implementation was 48.3 million USD (1.29 USD per capita), which varied between 21 and 67.1 million USD in the sensitivity analysis (2003 USD). In all estimates drug costs constituted the majority of total costs. However, non-drug costs such as IEC materials, drug distribution, communication, and health worker training were also substantial, accounting for 31.4% of overall ACT implementation costs in the best estimate scenario. Annual implementation costs are equivalent to 9.5% of Tanzania's recurrent health sector budget, and 28.7% of annual expenditure on medical supplies, implying a 6-fold increase in the national budget for malaria treatment. The costs of implementing ACT are substantial. Although drug purchases constituted a majority of total costs, non-drugcosts were also considerable. It is clear that substantial external resources will be required to facilitate and sustain effective ACT delivery across Tanzania and other malaria-endemic countries. (author's) Language: English Keywords: TANZANIA | RURAL AREAS | RESEARCH REPORT | MALARIA PREVENTION | ANTIMALARIAL DRUGS | DELIVERY OF HEALTH CARE | IMPLEMENTATION | EXPENDITURES | DRUG RESISTANCE | HEALTH POLICY | DISTRIBUTIONAL ACTIVITIES | TRAINING ACTIVITIES | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Geographic Factors | Population | Malaria | Parasitic Diseases | Diseases | Health | Programs | Organization and Administration | Financial Activities | Economic Factors | Treatment | Medical Procedures | Medicine | Health Services | Policy | Political Factors | Sociocultural Factors | Program Activities | Training Programs | Education Document Number: 326264 |
| 24. Title: Analyzing health equity using household survey data: a guide to techniques and their implementation. Author: O'Donnell O; van Doorslaer E; Wagstaff A; Lindelow M Source: Washington, D.C., World Bank, 2008. [230] p. (WBI Learning Resources Series) Abstract: This volume has a simple aim: to provide researchers and analysts with a step-by-step practical guide to the measurement of a variety of aspects of health equity. Each chapter includes worked examples and computer code. We hope that these guides, and the easy-to-implement computer routines contained in them, will stimulate yet more analysis in the field of health equity, especially in developing countries. We hope this, in turn, will lead to more comprehensive monitoring of trends in health equity, a better understanding of the causes of these inequities, more extensive evaluation of the impacts of development programs on health equity, and more effective policies and programs to reduce inequities in the health sector. (author's) Language: English Keywords: DEVELOPING COUNTRIES | TECHNICAL REPORT | DATA ANALYSIS | SURVEYS | RESEARCH METHODOLOGY | INCIDENCE | HOUSEHOLDS | HEALTH | CHILD SURVIVAL | ANTHROPOMETRY | STANDARD OF LIVING | MEASUREMENT | QUALITY OF HEALTH CARE | UTILIZATION OF HEALTH CARE | HEALTH SERVICES | FEES | EXPENDITURES | POVERTY | SOCIAL PROTECTION | Sampling Studies | Studies | Family and Household | Sociocultural Factors | Survivorship | Length of Life | Mortality | Population Dynamics | Demographic Factors | Population | Economic Factors | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Delivery of Health Care | Financial Activities | Socioeconomic Factors | Political Factors Document Number: 324700 |
| 25. Peer Reviewed Title: Using in-depth qualitative data to enhance our understanding of quantitative results regarding the impact of HIV and AIDS on households in rural Uganda. Author: Seeley J; Biraro S; Shafer LA; Nasirumbi P; Foster S; Whitworth J; Grosskurth H Source: Social Science and Medicine. 2008 Nov;67(9):1434-46. Abstract: Two significant challenges face researchers tracking HIV-related socio-economic and demographic change over time in large cohort studies. Firstly, data collected in cohort studies established to describe the dynamics of HIV infection may contain no systematic data on household consumption expenditures which is an established measure of current and long-run household welfare. The second challenge is the choice of the unit of analysis in order to recognise and record impact; this is because most cohorts use the household as that unit. This means that the influence of factors outside that unit cannot easily be tracked. In this paper we show how a detailed understanding of the impact of HIV and AIDS on wider families and social networks, obtained through in-depth longitudinal research with a small number of households, can shed light on the findings from quantitative analysis from a larger cohort in the same population in rural Uganda. The findings of large-scale survey data from more than 2000 households over a 12-year period showed a lack of a strong association between poverty, HIV status and/or death of the household head. In-depth ethnographic research with 26 households in 1991/2 and a restudy of the same households in 2006/7 provide insights into the reasons for this finding: the choice of socio-economic indicators and support from other family and community members play a part in affecting survey findings on the impact of HIV at household level. One other factor is important in explaining the findings. HIV-infected family members from outside the household may drain resources from the household, so looking at the impact of HIV and AIDS on people's wider families provides pointers to why those who have not had an AIDS-related death in their own household may have failed to prosper. Our qualitative findings show that AIDS may well throw households into disarray and poverty, but more often reduces development and hinders families from getting out of poverty. Used strategically, small longitudinal studies can provide important information with which to explain patterns observed in large-scale quantitative datasets. Language: English Keywords: UGANDA | RESEARCH REPORT | LONGITUDINAL STUDIES | PERSONS LIVING WITH HIV/AIDS | HOUSEHOLDS | HIV INFECTIONS | AIDS | IMPACT | SOCIOECONOMIC FACTORS | EXPENDITURES | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Viral Diseases | Diseases | Family and Household | Sociocultural Factors | Communication | Economic Factors | Financial Activities Document Number: 329691 |
| 26. Title: Public funding for family planning, sterilization and abortion services, FY 1980-2006. Author: Sonfield A; Alrich C; Gold RB Source: New York, New York, Guttmacher Institute, 2008 Jan. 36 p. (Occasional Report No. 38) Abstract: This report presents the results of a survey of FY 2006 public expenditures for family planning client services, family planning education and outreach activities, sterilization services and abortion services. We look at expenditures nationally, for each state and for each funding source. We also compare FY 2006 data for family planning client services with those from a series of prior surveys between FY 1980 and FY 2001. As in past reports, we also look at data on abortion utilization; because of restrictive reporting requirements and other policies around abortion, it is the only of the services for which reasonable estimates of utilization are universally available. The data in this article represent the most complete summary of public funding available. Given the methodological concerns mentioned below, however, the data (along with data from prior surveys) should be considered an approximation, rather than a precise accounting. (excerpt) Language: English Keywords: UNITED STATES OF AMERICA | SUMMARY REPORT | RESEARCH METHODOLOGY | FAMILY PLANNING | FAMILY PLANNING ACCEPTORS | TITLE 19 MEDICAL ASSISTANCE | EXPENDITURES | STERILIZATION, SEXUAL | FUNDS | ABORTION | SOCIAL POLICY | HEALTH SERVICES | Developed Countries | North America | Americas | Family Planning Programs | Public Assistance | Government Financing | Financial Activities | Economic Factors | Fertility Control, Postconception | Policy | Political Factors | Sociocultural Factors | Delivery of Health Care | Health Document Number: 324692 Notification |
| 27. Peer Reviewed Title: Costa Rica: Achievements of a heterodox health policy. Author: Unger JP; De Paepe P; Buitron R; Woors W Source: American Journal of Public Health. 2008 Apr;98(4):636-643. Abstract: Costa Rica is a middle-income country with a strong governmental emphasis on human development. For more than half a century, its health policies have applied the principles of equity and solidarity to strengthen access to care through public services and universal social health insurance. Costa Rica's population measures of health service coverage, health service use, and health status are excellent, and in the Americas, life expectancy in Costa Rica is second only to that in Canada. Many of these outcomes can be linked to the performance of the public health care system. However, the current emphasis of international aid organizations on privatization of health services threatens the accomplishments and universality of the Costa Rican health care system. (author's) Language: English Keywords: COSTA RICA | SUMMARY REPORT | LITERATURE REVIEW | PRIVATE SECTOR | HEALTH POLICY | HEALTH SERVICES | QUALITY OF HEALTH CARE | HEALTH INSURANCE | SOCIOECONOMIC FACTORS | POLITICAL FACTORS | ECONOMIC FACTORS | EXPENDITURES | FEES | Central America | Latin America | Americas | Developing Countries | Macroeconomic Factors | Policy | Sociocultural Factors | Delivery of Health Care | Health | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Financial Activities Document Number: 325535 |
| 28. Title: The changing epidemiology of prevalent diagnosed HIV infections in Taiwan, 1984-2005. Author: Yang CH; Yang SY; Shen MH; Kuo HS Source: International Journal On Drug Policy. 2008 Aug;19(4):317-23. Abstract: By the end of 2005, there were 10,158 reported cases of HIV infections in Taiwan, of them, 2,403 had developed full blown AIDS, and 1,333 had died. It represented an average annual increase of 15% in HIV diagnoses before 2003. The most common route of transmission is through men having sex with men followed by heterosexual contact, while infections through injecting drug use (IDUs) remained low. However, the number of newly reported HIV infections has been rising sharply since 2003, mainly among IDUs. The consequences of this HIV/IDU epidemic include a rapid increase in female HIV/AIDS patients and a decreased mean age of HIV/AIDS cases. Only 2% of patients in the IDU group have been diagnosed with AIDS, suggesting that most IDU cases are in the early stage of HIV infections. HIV/AIDS patients are provided with free medical care by the government in Taiwan, including anti-retroviral treatment. The case fatality rate of AIDS cases declined gradually from 64% in 1996 to 8.9% in 2005. Patients in the IDU group seek medical care less frequently than patients in the sexual contact group. Statistics show that 61.4% of patients in the IDU group did not seek HIV-related medical care, significantly higher compared to the sexual contact group. The Taiwanese government implemented a trial "Harm Reduction Programme," which involved a needle-syringe programme (NSP) and substitution treatment, in August 2005. After 1 year's pilot study, the HIV incidence in cities with NSP decreased from 13.9 to 13.3 per 100,000 persons compared to an incidence increase from 11.5 to 15.3 per 100,000 persons in cities without NSP. We scaled up the programme to cover the whole of Taiwan in July 2006 and are expecting to see the efficacy in the near future. Language: English Keywords: TAIWAN | RESEARCH REPORT | EPIDEMIOLOGY | PREVALENCE | IV DRUG USERS | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | HIV TESTING | AIDS | EXPENDITURES | Asia, Eastern | Asia | Developed Countries | Public Health | Health | Measurement | Research Methodology | Drug Use and Abuse | Behavior | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Financial Activities | Economic Factors Document Number: 328626 |
| 29. Title: [Hospital expenditures for five diseases of high economic impact] Gasto hospitalario de cinco patologias de alto impacto economico. Author: Zambrana M; Zurita B; Ramirez Tde J; Coria I Source: Revista Medica Del Instituto Mexicano Del Seguro Social. 2008 Jan-Feb;46(1):43-50. Abstract: OBJECTIVE: to identify by gender and age group, the hospital expenditures of the diseases that have the major economic impact at Instituto Mexicano del Seguro Social through using the diagnosis related groups (DRG) classification system and by estimating their associated costs. METHODS: DRG system served to estimate hospital expenditures for five diseases: hypertension, type 2 diabetes, chronic renal failure, cervical cancer and HIV/AIDS. DRG allow for better estimation given that consider cost adjustment based on the amount of resources employed in the treatment of different episodes. RESULTS: in the year 2002, 6.7 % of the hospital budget was assigned to the care of these five diseases. 42.6 % of the expenditures were allocated to patients aged 60 years and older and 22.3 % to patients from 50 to 59 years of age. Regarding diabetes mellitus and hypertension, care to patients over the age of 60 reached values of 55 % and 57 % of hospital expenditures respectively. Chronic renal failure and cervical cancer reached 60.5 % and 72.8 % of the expenditures, which were concentrated in patients aged 59 years or less; HIV/AIDS expenditures were distributed among patients from 20 to 50 years of age, the highest percentage (41.7 %) was in the group of 30 to 39 years of age. CONCLUSIONS: It is relevant to develop classification and information tools that consider the type of patients receiving hospital care, that are able to monitor changes due to the demographic and epidemiologic transition processes, and that allow for sensitive outcomes measurement. These tools will help in achieving an adequate financing and planning of health expenditures. Language: Spanish Keywords: MEXICO | RESEARCH REPORT | HOSPITALS | CLIENTS | EXPENDITURES | HYPERTENSION | DIABETES | RENAL EFFECTS | CERVICAL CANCER | HIV INFECTIONS | AIDS | MEASUREMENT | North America | Americas | Developing Countries | Health Facilities | Delivery of Health Care | Health | Program Activities | Programs | Organization and Administration | Financial Activities | Economic Factors | Vascular Diseases | Diseases | Urogenital Effects | Urogenital System | Physiology | Biology | Cancer | Neoplasms | Viral Diseases | Research Methodology Document Number: 328907 |
| 30. Title: Socioeconomic impacts of and resource requirements for HIV and AIDS. Author: Association of Southeast Asian Nations [ASEAN]; Constella Futures. Health Policy Initiative Source: Jakarta, Indonesia, ASEAN, 2007 Jun. 96 p. (Contract No. HRN-C-00-00-00006-00Contract No. GPO-I-01-05-00040-00) Abstract: The Assessment of the Socioeconomic Impact of HIV and AIDS is the second activity under the UDAID Cooperation with ASEAN through the Operational Framework for the ASEAN Work Programme on HIV/AIDS. The work programme identifies the need to understand the socioeconomic impact of HIV and AIDS on the region in order to inform advocacy for increased political commitment and leadership and, thus, increased financial, human, and institutional resources for HIV and AIDS. This overview addresses several key questions: Why is it important to know the impacts of HIV and AIDS in low-prevalence countries and how significant at the impacts? What can be done and what will it cost? What are the important implications for action? (excerpt) Language: English Keywords: ASIA, SOUTHEASTERN | PROGRESS REPORT | EVALUATION | POLICYMAKERS | SOCIOECONOMIC FACTORS | RESOURCE ALLOCATION | HIV PREVENTION | AIDS PREVENTION | IMPACT | EXPENDITURES | GOVERNMENT FINANCING | GOVERNMENT PROGRAMS | HEALTH POLICY | NEEDS ASSESSMENT | Developing Countries | Asia | Administrative Personnel | Organization and Administration | Economic Factors | Financial Activities | HIV Infections | Viral Diseases | Diseases | AIDS | Communication | Programs | Policy | Political Factors | Sociocultural Factors Document Number: 322895 |
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