‘They say we are money minded’ exploring experiences of formal private for-profit health providers towards contribution to pro-poor access in post conflict Northern Uganda

From Crossref journal articles via Jisc Publications RouterSuzanne Fustukian - ORCID: 0000-0002-4570-5800 https://orcid.org/0000-0002-4570-5800Background: The perception within literature and populace is that the private for-profit sector is for the rich only, and this characteristic results in behaviours that hinder advancement of Universal health coverage (UHC) goals. The context of Northern Uganda presents an opportunity for understanding how the private sector continues to thrive in settings with high poverty levels and history of conflict.Objective: The study aimed at understanding access mechanisms employed by the formal private for-profit providers (FPFPs) to enable pro-poor access to health services in post conflict Northern Uganda.Methods: Data collection was conducted in Gulu municipality in 2015 using Organisational survey of 45 registered formal private for-profit providers (FPFPs),10 life histories, and 13 key informant interviews. Descriptive statistics were generated for the quantitative findings whereas qualitative findings were analysed thematically.Results: FPFPs pragmatically employed various access mechanisms and these included fee exemptions and provision of free services, fee reductions, use of loan books, breaking down doses and partial payments. Most mechanisms were preceded by managers’ subjective identification of the poor, while operationalisation heavily depended on the managers’ availability and trust between the provider and the customer. For a few FPFPs, partnerships with Non-governmental organisations (NGOs) and government enabled provision of free, albeit mainly preventive services, including immunisation, consultations, screening for blood pressure and family planning. Challenges such as quality issues, information asymmetry and standardisation of charges arose during implementation of the mechanisms.Conclusion: The identification of the poor by the FPFPs was subjective and unsystematic. FPFPs implemented various innovations to ensure pro-poor access to health services. However, they face a continuous dilemma of balancing the profit maximization and altruism objectives. Implementation of some pro-poor mechanisms raises concerns included those related to quality and standardisation of pricing.The publication of this work has also been funded as part of a supplement under SPEED project [HUM/2014/341-585], funding code is ZGHA-2020-C4168..pubpu

The commercialization of traditional medicine in modern Cambodia.

** From PubMed via Jisc Publications Router. ** History: accepted 18-09-2017.Globally, traditional medicine has long been used to address relatively common illness, mental ill health and during childbirth and post-natal care. However, traditional medicine is primarily provided by the private sector and it is unclear how far expenditures on traditional medicine contribute to household impoverishment. A life history method was used to understand the health seeking experience of 24 households over the last 60-years in Cambodia, a country with high out-of-pocket expenditures for health. The life histories suggest that traditional medicine in Cambodia has been undergoing a process of commercialization, with significant impacts on poor households. In the earlier lives of respondents, payments for traditional medicine were reported to have been flexible, voluntary or appropriate to patients' financial means. In contrast, contemporary practitioners appear to seek immediate cash payments that have frequently led to considerable debt and asset sales by traditional medicine users. Given traditional medicine's popularity as a source of treatment in Cambodia and its potential to contribute to household impoverishment, we suggest that it needs to be included in a national conversation about achieving Universal Health Coverage in the country. [Abstract copyright: The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.]sch_iih33pub4997pub

Socio-cultural change in conflict and post conflict settings: Five decades of giving birth in Cambodia

From Springer Nature via Jisc Publications RouterBackground: This paper explores the changing experience of giving birth in Cambodia over a 53-year period. During this time, Cambodian people experienced armed conflict, extreme privation, foreign invasion, and civil unrest. Methods: An historical perspective was used to explore the changing place and nature of birth assistance given to Cambodian women between 1950 and 2013. Twenty-four life histories of poor and non-poor Cambodians aged 40–74 were gathered and analysed using a grounded thematic approach. Results: In the early lives of the respondents, almost all births occurred at home and were assisted by Traditional Birth Attendants. In modern times, towards the end of their lives, the respondents’ grand-children and great grand-children are almost universally born in institutions in which skilled birth attendants are available. Respondents recognise that this is partly due to the availability of modern health care facilities but also describe the process by which attitudes to institutional and homebirth changed over time. Interviews can also chart the increasing awareness of the risks of homebirth, somewhat influenced by the success of health education messages transmitted by public health authorities. Conclusions: The life histories provide insight into the factors driving the underlying cultural change: a modernising supply side; improving transport and communications infrastructure. In addition, a step-change occurred in the aftermath of the conflict with significant influence of extensive contact with the Vietnamese recognised. Trial registration: None.Funding sources for this research was the ReBUILD Consortium. The role of the funding body in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript was zero.13pubpu

Social movements and public health advocacy in action : the UK people's health movement

There are growing calls within public health for researchers and practitioners working to improve and protect the public's health to become more involved in politics and advocacy. Such a move takes practitioners and researchers beyond the traditional, evidence-based public health paradigm, raising potential dilemmas and risks for those who undertake such work. Drawing on the example of the People's Health Movement, this short paper argues that advocacy and social movements are an essential component of public health's efforts to achieve great health equity. It outlines how the Scottish branch of the People's Health Movement sought to overcome potential tensions between public health evidence and advocacy by developing a regional manifesto for health via transparent and democratic processes which combine empirical and experiential evidence. We suggest that this is an illustrative example of how potential tensions between public health research and advocacy can be overcome, through bottom–up movements of solidarity and action

Weighing the options for delivery care in rural Malawi: community perceptions of a policy promoting exclusive skilled birth attendance and banning traditional birth attendants

From Crossref via Jisc Publications RouterHistory: epub 2019-04-02, issued 2019-04-02Article version: Vo

Weighing the options for delivery care in rural Malawi: Community perceptions of a policy promoting exclusive skilled birth attendance and banning traditional birth attendants

From PubMed via Jisc Publications RouterItem not available in this repository.To address its persistently high maternal mortality, the Malawi government has prioritized strategies promoting skilled birth attendance and institutional delivery. However, in a country where 80% of the population resides in rural areas, the barriers to institutional deliveries are considerable. As a response, Malawi issued Community Guidelines in 2007 that both promoted skilled birth attendance and banned the utilization of traditional birth attendants for routine deliveries. This grounded theory study used interviews and focus groups to explore community actors' perceptions regarding the implementation of this policy and the related affects that arose from its implementation. The results revealed the complexity of decision-making and delivery care-seeking behaviours in rural areas of Malawi in the context of this policy. Although women and other actors seemed to agree that institutional deliveries were safer when complications occurred, this did not necessarily ensure their compliance. Furthermore, implementation of the 2007 Community Policy aggravated some of the barriers women already faced. This innovative bottom-up analysis of policy implementation showed that the policy had further ruptured linkages between community and health facilities, which were ultimately detrimental to the continuum of care. This study helps fill an important gap in research concerning maternal health policy implementation in Low and middle income countries (LMICs), by focusing on the perceptions of those at the receiving end of policy change. It highlights the need for globally promoted policies and strategies to take better account of local realities.34pub

Application of social network analysis in the assessment of organization infrastructure for service delivery: a three district case study from post-conflict northern Uganda

From Crossref via Jisc Publications RouterHistory: epub 2017-06-16, issued 2017-06-16, ppub 2017-10-0

Sex or sensibility? : the making of chaste women and promiscuous men in a Sri Lankan university setting

It is often claimed that education confers a range of benefits to individuals. From realising their thinking capacities to overcoming class boundaries, the outcomes of education are considered especially beneficial for women. Feminist theorists make a direct and strong link between education and female autonomy. Those who critique this line of thinking point to the numerous societal and structural factors which come into play in preventing education from delivering its promises of a world with greater productivity, equality and freedom. However even these critics concur that higher education does help to overcome the many structural inequalities which affect the everyday lives of women and also men from lower socio-economic backgrounds. This thesis explores the ways in which the sexuality of students, at a Sri Lankan university, is constructed. It looks at the extent to which social factors – be it through personal interactions, established norms or explicit rules – exert control over and determine how individuals can express their sexuality in a setting which is ostensibly liberating and progressive. Based on 15 months of fieldwork at the University of Kelaniya, the findings are used to argue that when it comes to constructing their sexuality students continue to be constrained by a reiteration of social and cultural expectations which are at play in larger society. The onus on women to uphold these expectations is reinforced by other women and the men play a key role in ensuring their maintenance. Hailing predominantly from working-class backgrounds, these young women expect university education to provide them with the ticket out of their workingclass background to better opportunities. Thus they endeavour to maintain, produce and reproduce social norms which will mark them as respectable and chaste women. The potentiality of a better life offered by university education becomes the very thing that constrains women students from using their autonomy to express their independence and sexuality. Based on these findings, it is then argued that since higher education itself is shaped and constrained by factors of nationalism, class and gender, the numerous benefits it offers to women do not always provide them with the autonomy that is needed to overcome the double standards that apply to how sexuality is constructed in most societies. The intersections between gender, class and nationalism dominated the milieu in which this Sri Lankan university is placed and thus it is these factors, rather than education, which determined the ways in which women could construct their sexuality. The aspirations brought on through their university education of a better life, rather than liberating them, further constrained their behaviours. As such these women engaged in a system of surveillance – both of self and the other – which maintained and reproduced notions of respectability and sexual sobriety in their everyday behaviours.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Sub-national assessment of aid effectiveness: A case study of post-conflict districts in Uganda

Background: In post-conflict settings, many state and non-state actors interact at the sub-national levels in rebuilding health systems by providing funds, delivering vital interventions and building capacity of local governments to shoulder their roles. Aid relationships among actors at sub-national level represent a vital lever for health system development. This study was undertaken to assess the aid-effectiveness in post-conflict districts of northern Uganda. Method: This was a three district cross sectional study conducted from January to April 2013. A two stage snowball approach used to construct a relational-network for each district. Managers of organizations (ego) involved service delivery were interviewed and asked to list the external organizations (alters) that contribute to three key services. For each inter-organizational relationship (tie) a custom-made tool designed to reflect the aid-effectiveness in the Paris Declaration was used. Results: Three hundred eighty four relational ties between the organizations were generated from a total of 85 organizations interviewed. Satisfaction with aid relationships was mostly determined by 1) the extent ego was able to negotiate own priorities, 2) ego's awareness of expected results, and 3) provision of feedback about ego's performance. Respectively, the B coefficients were 16%, 38% and 19%. Disaggregated analysis show that satisfaction of fund-holders was also determined by addressing own priorities (30%), while provider satisfaction was mostly determined by awareness of expected results (66%) and feedback on performance (23%). All results were significant at p-value of 0.05. Overall, the regression models in these analyses accounted for 44% to 62% of the findings. Conclusion: Sub-national assessment of aid effectiveness is feasible with indicators adapted from the global parameters. These findings illustrate the focus on results domain and less on ownership and resourcing domains. The capacity and space for sub-national level authorities to negotiate local priorities requires more attention especially for health system development in post-conflict settings. 2017 The Author(s).sch_iih13pub4801pub