Latin America: Capital Accumulation, Health and the Role of International Institutions

Objectives: This article analyzes the transformation of the health sector during the second half of the twentieth century and presents information on the role that international institutions play in capital accumulation

The Decentralization of Health Services: From Theory to Practice

Objectives: There are two main objectives in this work: first, to discuss the lack of consensus on the concept of decentralization as well as the difficulty of measuring the level of decentralization in a health system and, second, to identify its supporters, their reasons and the results achieved after decentralization in Latin America

Mexico's Health System: More Comprehensive Reform Needed

Jason Lakin discusses and critiques a Policy Forum that reviews 25 years of reform to the Mexican health system and argues that more comprehensive reform is needed

Enquesta preliminar de càries dentària en la població escolar del Priorat, la Ribera d'Ebre i la Terra Alta: objectius i metodologia (I.ª part)

Podeu consultar la segona part de l'article a: http://hdl.handle.net/2445/112051Hi ha una notable escassetat de dades i d'estudis epidemiològics sobre la magnitud del problema de la càries dentària a Catalunya i a la resta d'Espanya. L'únic treball realitzat a Espanya prou important per poder extreure'n resultats significatius és el que va realitzar la Direcció General de Sanitat, durant els anys 1968-1969, entre la població escolar..

Resultats de l'enquesta preliminar de càries dentària en la població escolar del Priorat, Ribera d'Ebre i Terra Alta (2.ª part)

Podeu consultar la primera part de l'article a: http://hdl.handle.net/2445/106530Hi ha una elevada prevalença de càries dentària en la població d'edat escolar d'aquestes tres comarques. Així, la prevalença de càries en dents permanents és del 71,7%. Les xifres són encara més preocupants si considerem la càries en dents temporals. En aquest cas, el 91% dels nens de 6 a 14 anys té algun tipus de càries

Human resources: the Cinderella of health sector reform in Latin America

Human resources are the most important assets of any health system, and health workforce problems have for decades limited the efficiency and quality of Latin America health systems. World Bank-led reforms aimed at increasing equity, efficiency, quality of care and user satisfaction did not attempt to resolve the human resources problems that had been identified in multiple health sector assessments. However, the two most important reform policies – decentralization and privatization – have had a negative impact on the conditions of employment and prompted opposition from organized professionals and unions. In several countries of the region, the workforce became the most important obstacle to successful reform. This article is based on fieldwork and a review of the literature. It discusses the reasons that led health workers to oppose reform; the institutional and legal constraints to implementing reform as originally designed; the mismatch between the types of personnel needed for reform and the availability of professionals; the deficiencies of the reform implementation process; and the regulatory weaknesses of the region. The discussion presents workforce strategies that the reforms could have included to achieve the intended goals, and the need to take into account the values and political realities of the countries. The authors suggest that autochthonous solutions are more likely to succeed than solutions imported from the outside

Use of social audits to examine unofficial payments in government health services: experience in South Asia, Africa, and Europe

<p>Abstract</p> <p>Background</p> <p>Unofficial payments in health services around the world are widespread and as varied as the health systems in which they occur. We reviewed the main lessons from social audits of petty corruption in health services in South Asia (Bangladesh, Pakistan), Africa (Uganda and South Africa) and Europe (Baltic States).</p> <p>Methods</p> <p>The social audits varied in purpose and scope. All covered representative sample communities and involved household interviews, focus group discussions, institutional reviews of health facilities, interviews with service providers and discussions with health authorities. Most audits questioned households about views on health services, perceived corruption in the services, and use of government and other health services. Questions to service users asked about making official and unofficial payments, amounts paid, service delivery indicators, and satisfaction with the service.</p> <p>Results</p> <p>Contextual differences between the countries affected the forms of petty corruption and factors related to it. Most households in all countries held negative views about government health services and many perceived these services as corrupt. There was little evidence that better off service users were more likely to make an unofficial payment, or that making such a payment was associated with better or quicker service; those who paid unofficially to health care workers were not more satisfied with the service. In South Asia, where we conducted repeated social audits, only a minority of households chose to use government health services and their use declined over time in favour of other providers. Focus groups indicated that reasons for avoiding government health services included the need to pay for supposedly free services and the non-availability of medicines in facilities, often perceived as due to diversion of the supplied medicines.</p> <p>Conclusions</p> <p>Unofficial expenses for medical care represent a disproportionate cost for vulnerable families; the very people who need to make use of supposedly free government services, and are a barrier to the use of these services. Patient dissatisfaction due to petty corruption may contribute to abandonment of government health services. The social audits informed plans for tackling corruption in health services.</p