Measuring Inequalities in the Distribution of Health Workers: The case of Tanzania.

The overall human resource shortages and the distributional inequalities in the health workforce in many developing countries are well acknowledged. However, little has been done to measure the degree of inequality systematically. Moreover, few attempts have been made to analyse the implications of using alternative measures of health care needs in the measurement of health workforce distributional inequalities. Most studies have implicitly relied on population levels as the only criterion for measuring health care needs. This paper attempts to achieve two objectives. First, it describes and measures health worker distributional inequalities in Tanzania on a per capita basis; second, it suggests and applies additional health care needs indicators in the measurement of distributional inequalities. We plotted Lorenz and concentration curves to illustrate graphically the distribution of the total health workforce and the cadre-specific (skill mix) distributions. Alternative indicators of health care needs were illustrated by concentration curves. Inequalities were measured by calculating Gini and concentration indices.\ud There are significant inequalities in the distribution of health workers per capita. Overall, the population quintile with the fewest health workers per capita accounts for only 8% of all health workers, while the quintile with the most health workers accounts for 46%. Inequality is perceptible across both urban and rural districts. Skill mix inequalities are also large. Districts with a small share of the health workforce (relative to their population levels have an even smaller share of highly trained medical personnel. A small share of highly trained personnel is compensated by a larger share of clinical officers (a middle-level cadre) but not by a larger share of untrained health workers. Clinical officers are relatively equally distributed. Distributional inequalities tend to be more pronounced when under-five deaths are used as an indicator of health care needs. Conversely, if health care needs are measured by HIV prevalence, the distributional inequalities appear to decline. The measure of inequality in the distribution of the health workforce may depend strongly on the underlying measure of health care needs. In cases of a non-uniform distribution of health care needs across geographical areas, other measures of health care needs than population levels may have to be developed in order to ensure a more meaningful measurement of distributional inequalities of the health workforce

A Reporting Framework for Describing and a Typology for Categorizing and Analyzing the Designs of Health Care Pay for Performance Schemes

Table S1. Search strategy output for Cochrane database. This table details the search strategy employed to identify relevant studies and reviews used in the manuscript. This includes the database searched, years covered, and number of citations. Table S2. Summary of identified reviews. This table outlines the relevant reviews and P4P evaluation studies identified from our search strategy, which informed our reporting framework and typology. Table S3. Search strategy output for economic theories to inform the P4P typology. This table details the search strategy employed to identify relevant economic theories that were used to construct the P4P typology. This includes the database searched, years covered, and number of citations. Table S4. Application of the typology on selected identified P4P schemes. This table outlines the results of applying the P4P typology to categorized identified P4P schemes. Table S5. P4P studies used in testing the inter-rater reliability of the P4P typology. This table list out the P4P studies that were selected for the raters to apply the P4P typology. Table S6. Rater population. This table describes the rater population i.e. qualifications, research experience, and experience with P4P in healthcare. Table S7. Sources of disagreement between raters. This table highlights the items on the P4P typology that were sources of disagreement between he raters. Table S8. An example of source of disagreement between raters (risk). This table details text extracts from the sample P4P study and describes the reason for disagreement between raters testing the P4P typology. (DOCX 127 kb

The significance of variation in the susceptibility of Schistosoma mansoni to the antischistosomal drug oxamniquine

Clinical and laboratory evidence is reviewed which shows that there is a great deal of variation in the susceptibility of Schistosoma mansoni to oxamniquine. This variation occurs both among endemic regions and within endemic regions in Brazil and Kenya. It is genetically controlled. It is suggested that the parasite possesses a large capacity for developing resistance to the drug and that resistance will develop where sufficient drug pressure is maintained

Using remote sensing and geographic information systems to identify villages at high risk for rhodesiense sleeping sickness in Uganda.

Geographic information systems (GIS) and remote sensing were used to identify villages at high risk for sleeping sickness, as defined by reported incidence. Landsat Enhanced Thematic Mapper (ETM) satellite data were classified to obtain a map of land cover, and the Normalised Difference Vegetation Index (NDVI) and Landsat band 5 were derived as unclassified measures of vegetation density and soil moisture, respectively. GIS functions were used to determine the areas of land cover types and mean NDVI and band 5 values within 1.5 km radii of 389 villages where sleeping sickness incidence had been estimated. Analysis using backward binary logistic regression found proximity to swampland and low population density to be predictive of reported sleeping sickness presence, with distance to the sleeping sickness hospital as an important confounding variable. These findings demonstrate the potential of remote sensing and GIS to characterize village-level risk of sleeping sickness in endemic regions

The Guidance and Counseling Interventions Given to Students Who Abuse Alcohol: Case of Kenyan Public Day Secondary Schools

Alcohol is one of the most abused drugs among the youth in the world today and this is one of the reasons leading to poor performance by Kenyan secondary school students in national examinations. The purpose of this study was to identify the guidance and counseling interventions given to public secondary school students who abuse alcohol. The study was grounded on the social learning and person centered theories of counseling. The target population comprised of 70 guidance and counseling teachers, selected from 70 public secondary schools in Meru county, Kenya. Out of these, a sample of 10 guidance and counseling teachers was selected from 10 secondary schools in Imenti South sub-county. The researcher employed purposive and simple random sampling techniques to arrive at the required number of respondents. Data were collected interview schedules. A pilot study was carried out two weeks to the actual study to ascertain the suitability of this research instrument for collecting the required data. Validity of the instrument was assessed via the Rasch model, using data from the pilot study. The collected data were analyzed descriptively in themes as they emerged. Findings revealed that parental involvement, use of external speakers, use of student families and use of peer counselors were the counseling strategies mostly used to manage the alcohol abuse situation in schools