Referral to hospital in Nepal: 4 years' experience in one rural district

Formal referral systems have been proposed as a strategy to improve access to secondary care, yet their implementation can be problematic. This paper describes data from referrals in one rural district in Nepal over a four year period. Whilst the characteristics of those patients attending hospital after referral were similar to those described in other developing countries, the rate (1.0 per 1,000 population per year) is much lower, especially when compared to estimated need. Geographical and other barriers to access to secondary care in rural Nepal are discussed

Rebuilding health care in Iraq

The effects of three wars within 25 years, a decade of international sanctions, and a brutal regime have had tragic consequences on Iraq’s health system and on the health of the Iraqi people. While the scale of these problems is becoming clearer, it has been difficult in the current security situation to know how best to respond to requests for help. A workshop organised by the International Committee of the Faculty of Public Health (FPH) in November 2003 has now addressed this very issue. This paper describes the health service needs presented at the workshop by representatives from the Department for International Development (DFID), World Health Organisation (WHO), International Non-Governmental Organisations (INGOs) and, most importantly, Iraq’s Ministry of Health. We will also consider current responses and how professional public health bodies from around the world might contribute to the development of Iraq’s health sector

Barriers to better care for people with AIDS in developing countries

Access to good quality antiretroviral treatment has transformed the prognosis for people with AIDS in the developed world. Although it is feasible and desirable to deliver antiretroviral drugs in resource poor settings,few of the 95% of people with HIV and AIDS who live in developing countries receive them. The World Health Organization has launched a programme to deliver antiretroviral drugs to three million people with AIDS in the developing world by 2005, the “3 by 5” initiative. We identify some of the challenges faced by the initiative, focusing on delivery of care

An extended theory of planned behavior intervention for older adults with type 2 diabetes and cardiovascular disease

A randomized controlled trial evaluated the effectiveness of a 4-wk extended theory of planned behavior (TPB) intervention to promote regular physical activity and healthy eating among older adults diagnosed with Type 2 diabetes or cardiovascular disease (N = 183). Participants completed TPB measures of attitude, subjective norm, perceived behavioral control, and intention, as well as planning and behavior, at preintervention and 1 wk and 6 wk postintervention for each behavior. No significant time-by-condition effects emerged for healthy eating. For physical activity, significant time-by-condition effects were found for behavior, intention, planning, perceived behavioral control, and subjective norm. In particular, compared with control participants, the intervention group showed short-term improvements in physical activity and planning, with further analyses indicating that the effect of the intervention on behavior was mediated by planning. The results indicate that TPB-based interventions including planning strategies may encourage physical activity among older people with diabetes and cardiovascular disease