Factors that influence household health care utilization patterns in two districts of Zambia : a rural - urban comparative evaluation

Includes bibliographical references (leaves 111-116).This research project was undertaken with the primary objective of determining whether there are differential household health care utilization patterns between rural and urban areas in Zambia and what factors, if any, are responsible for such spatial variations. The factors considered in this study include: the gender of the household head, age of individual household members, religious affiliation of the household, the marital status of the household head, the size of the household, the educational status of the household head, the household head's employment status, and the socio-economic status of the household. The data was collected using a household health survey with questionnaires administered to the household head. A total of 660 households (3,150 persons) were sampled, 320 households (1,696 persons) in Chipata District and 340 households (1,454 persons) in Ndola District. The data included information on socio-economic and demographic factors that have been regularly considered in the theoretical literature and empirical evidence as impacting upon household and individual decision-making when it comes to utilization of both formal and informal care. A multinomial logistic regression model was used to analyse the data quantitatively in Stata® Version 8.0 software. Close to a quarter ofthe overall sample admitted to suffering an illness or injury in the 4-week period preceding the interview. Self-care at the household level was the most frequently reported type of care chosen for minor and moderate illnesses or injuries (35.80 percent). Bivariate analysis and the multinomial logistic regression results indicate that the variables considered not only produce differential effects on household health care utilization patterns in both districts but also that the effects are different depending on location of the household. The results from our sample analyses show that household religious affiliation (Christianity) is negatively associated with formal health care utilization in the urban area while the age of the individual increases the household's utilization of formal and informal care, and the gender of the household head (female), hislher marital status, educational attainment, and employment status all have a positive impact on formal health care use in the rural area

Organisational culture and trust as influences over the implementation of equity-oriented policy in two South African case study hospitals

BACKGROUND: This paper uses the concepts of organisational culture and organisational trust to explore the implementation of equity-oriented policies - the Uniform Patient Fee Schedule (UPFS) and Patients' Rights Charter (PRC) - in two South African district hospitals. It contributes to the small literatures on organisational culture and trust in low- and middle-income country health systems, and broader work on health systems' people-centeredness and "software". METHODS: The research entailed semi-structured interviews (Hospital A n = 115, Hospital B n = 80) with provincial, regional, district and hospital managers, as well as clinical and non-clinical hospital staff, hospital board members, and patients; observations of policy implementation, organisational functioning, staff interactions and patient-provider interactions; and structured surveys operationalising the Competing Values Framework for measuring organisational culture (Hospital A n = 155, Hospital B n = 77) and Organisational Trust Inventory (Hospital A n = 185, Hospital B n = 92) for assessing staff-manager trust. RESULTS: Regarding the UPFS, the hospitals' implementation approaches were similar in that both primarily understood it to be about revenue generation, granting fee exemptions was not a major focus, and considerable activity, facility management support, and provincial support was mobilised behind the UPFS. The hospitals' PRC paths diverged quite significantly, as Hospital A was more explicit in communicating and implementing the PRC, while the policy also enjoyed stronger managerial support in Hospital A than Hospital B. Beneath these experiences lie differences in how people's values, decisions and relationships influence health system functioning and in how the nature of policies, culture, trust and power dynamics can combine to create enabling or disabling micro-level implementation environments. CONCLUSIONS: Achieving equity in practice requires managers to take account of "unseen" but important factors such as organisational culture and trust, which are key aspects of the organisational context that can profoundly influence policies. In addition to implementation "hardware" such as putting in place necessary staff and resources, it emphasises "software" implementation tasks such as relationship management and the negotiation of values, where equity-oriented policies might be interpreted as challenging health workers' status and values, and paying careful attention to how policies are practically framed and translated into practice, to ensure key equity aspects are not neglected

Prerequisites for National Health Insurance in South Africa: Results of a national household survey

Background. National Health Insurance (NHI) is currently high on the health policy agenda. The intention of this financing system is to promote efficiency and the equitable distribution of financial and human resources, improving health outcomes for the majority. However, there are some key prerequisites that need to be in place before an NHI can achieve these goals. Objectives. To explore public perceptions on what changes in the public health system are necessary to ensure acceptability and sustainability of an NHI, and whether South Africans are ready for a change in the health system. Methods. A cross-sectional nationally representative survey of 4 800 households was undertaken, using a structured questionnaire. Data were analysed in STATA IC10. Results and conclusions. There is dissatisfaction with both public and private sectors, suggesting South Africans are ready for health system change. Concerns about the quality of public sector services relate primarily to patient-provider engagements (empathic staff attitudes, communication and confidentiality issues), cleanliness of facilities and drug availability. There are concerns about the affordability of medical schemes and how the profit motive affects private providers’ behaviour. South Africans do not appear to be well acquainted or generally supportive of the notion of risk cross-subsidies. However, there is strong support for income cross-subsidies. Public engagement is essential to improve understanding of the core principles of universal pre-payment mechanisms and the rationale for the development of NHI. Importantly, public support for pre-payment is unlikely to be forthcoming unless there is confidence in the availability of quality health services

Pre-requisites for National Health Insurance in South Africa: Results of a national household survey

Background: National Health Insurance (NHI) is currently high on the health policy agenda. The intention of this financing system is to promote efficiency and the equitable distribution of financial and human resources, improving health outcomes for the majority. However, there are some key pre-requisites that need to be in place before NHI can achieve these goals. Objectives: To explore: • public perceptions on what changes in the public health system are necessary to ensure acceptability and sustainability of an NHI, and • whether South Africans are ready for a change in the health system. Methods: A cross-sectional nationally representative survey of 4,800 households was undertaken, using a structured questionnaire. Data were analysed in STATA IC10. Results and conclusions: There is dis-satisfaction with both public and private sectors, suggesting South Africans are ready for health system change. Concerns about the quality of public sector services relate primarily to patient-provider engagements (empathic staff attitudes, communication and confidentiality issues), cleanliness of facilities and drug availability. There are concerns about the affordability of medical schemes and how the profit motive affects private providers’ behaviour. South Africans do not appear to be well acquainted nor generally supportive of the notion of risk cross-subsidies. However, there is strong support for income cross-subsidies. Public engagement is essential to improve understanding of the core principles of universal pre-payment mechanisms and the rationale for the development of NHI. Importantly, public support for pre-payment is unlikely to be forthcoming unless there is confidence in the availability of quality health services