High food prices: The what, who, and how of proposed policy actions

"The complex causes of the current food and agriculture crisis require a comprehensive response. In view of the urgency of assisting people and countries in need, the first set of policy actions— an emergency package—consists of steps that can yield immediate impact: 1. expand emergency responses and humanitarian assistance to food-insecure people and people threatening government legitimacy, 2. eliminate agricultural export bans and export restrictions, 3. undertake fast-impact food production programs in key areas, and 4. change biofuel policies. A second set of actions—a resilience package—consists of the following steps: 5. calm markets with the use of market-oriented regulation of speculation, shared public grain stocks, strengthened food-import financing, and reliable food aid; 6. invest in social protection; 7. scale up investments for sustained agricultural growth; and 8. complete the Doha Round of World Trade Organization (WTO) negotiations. Investment in these actions calls for additional resources. Policymakers should consider mobilizing resources from four sources: the winners from the commodity boom among countries; the community of traditional and new donor countries; direct or indirect progressive taxation and reallocation of public expenditures in the affected countries themselves; and mobilization of private sector finance, including through improved outreach of banking to agriculture. Because of countries' diverse situations, the design of programs must be country driven and country owned. Accountability for sound implementation must also rest with countries. At the same time, a new international architecture for the governance of agriculture, food, and nutrition is needed to effectively implement the initiatives described, and especially their international public goods components. Global and national action is needed, through existing mechanisms, well-coordinated special initiatives, and possibly a special fund." from TextFood prices, Food supply, Food demand, Social protection, Agricultural research, Agricultural policy, Agricultural subsidies,

Los altos precios de los alimentos: El ‘qué', ‘quién' y ‘cómo' de las acciones de política propuestas

"La complejidad de las causas de la actual crisis alimentaria y agrícola requiere de una respuesta integral. En vista de que es urgente prestar asistencia a las poblaciones y los países necesitados, la primera serie de acciones de política —un paquete de emergencia— consiste en varios pasos para generar un impacto inmediato: 1. Incrementar las acciones de emergencia y la ayuda humanitaria para incluir a las poblaciones que experimentan inseguridad alimentaria y a las que amenazan la legitimidad gubernamental; 2. Eliminar la prohibición y las restricciones a las exportaciones agrícolas; 3. Emprender programas que permitan rápidamente expandir la oferta alimentaria en áreas clave; y, 4. Modificar las políticas de los biocombustibles. Una segunda serie de acciones de política —un paquete de resiliencia socioeconómica— consiste en los siguientes pasos: 5. Proveer tranquilidad en los mercados mediante una regulación de los movimientos especulativos a través de instrumentos de mercado, reservas públicas y compartidas de granos, un mayor financiamiento para la importación de alimentos, y una ayuda alimentaria confiable; 6. Invertir en protección social; 7. Incrementar paulatinamente las inversiones para un crecimiento agrícola sostenido; y, 8. Concluir las negociaciones de la Ronda de Doha de la Organización Mundial del Comercio (OMC). La inversión en estas acciones requiere de recursos adicionales. Las instancias decisorias deberán considerar la movilización de recursos provenientes de cuatro fuentes: los países que se han beneficiado del auge de los commodities agrícolas; la comunidad de países donantes, tanto tradicionales como nuevos; impuestos proporcionales, directos o indirectos, y la reasignación del gasto público en los propios países afectados; y la movilización de los recursos financieros del sector privado, lo que incluye una ampliación en la cobertura de los servicios financieros para la agricultura. Debido a las diversas situaciones que enfrentan, los mismos países deben dirigir y apropiarse del diseño de los programas. La rendición de cuentas en cuanto a una implementación acertada también deberá recaer en los países. Al mismo tiempo, se necesita una nueva estructura internacional de gobernabilidad para la agricultura, la alimentación y la nutrición, a fin de implementar de forma eficaz las iniciativas descritas, especialmente los componentes relativos a los bienes públicos internacionales. También es necesaria la acción, tanto en el ámbito mundial como nacional, a través de los mecanismos existentes, iniciativas especiales muy bien coordinadas y posiblemente un fondo especial." from TextFood prices, Food supply, Food demand, Social protection, Agricultural research, Agricultural policy, Agricultural subsidies,

Hohe Nahrungsmittelpreise: Konzept f �r die Wege aus der Krise

"Die vielschichtigen Ursachen der gegenw�rtigen Krise im Bereich der Nahrungsmittelproduktion und Landwirtschaft erfordern eine umfassende globale Antwort. Angesichts der dringend benötigen Hilfe besteht der erste Ma�nahmenkatalog – ein Notfallpaket – aus Programmen, die sofort wirken: 1. Ausweiten der Soforthilfe und der humanit�ren Unterst�tzung f�r Menschen, deren Versorgung nicht gesichert ist, sowie dort, wo die Legitimit�t der Regierung bedroht ist 2. Abschaffung der landwirtschaftlichen Exportverbote und Exportbeschr�nkungen 3. Durchf�hrung von Programmen, die Nahrungsmittelproduktion in wichtigen Regionen steigern und schnell wirksam sind 4. �nderung der Agrar-Treibstoffpolitik Der zweite Ma�nahmenkatalog – ein Nachhaltigkeitspaket – besteht aus folgenden Komponenten: 5. Beruhigung der M�rkte durch marktorientierte Regulierung der Spekulation, Koordination öffentlicher Getreidevorr�te, Finanzierung von Nahrungsmittelimporten und verl�ssliche Nahrungsmittelhilfe in armen L�ndern 6. investieren in Ma�nahmen zur sozialen Absicherung 7. Ausweitung des Investitionsvolumens f�r nachhaltiges landwirtschaftliches Wachstum und 8. erfolgreicher Abschluss der Verhandlungen im Rahmen der Doha Runde der Welthandelsorganisation (WTO) Diese Ma�nahmen erfordern zus�tzliche finanzielle Ressourcen. Die Politik sollte daf�r vier Quellen ins Auge fassen: (1) die L�nder, die als Gewinner aus dem Rohstoffboom hervorgegangen sind, (2) die Gemeinschaft der alten und neuen Geberl�nder, (3) direkte oder indirekte progressive Besteuerung und Umschichtung der öffentlichen Ausgaben in den betroffenen L�ndern selbst, (4) Mobilisierung von Finanzmitteln des privaten Sektors, u.a. durch ein verst�rktes Engagement des Bankwesens in der Landwirtschaft. Aufgrund der unterschiedlichen Lage, in der sich die L�nder befinden, muss die Planung der Programme vom jeweiligen Land gef�hrt werden. Die L�nder sind auch verantwortlich f�r eine solide Implementierung ihrer Programme. Gleichzeitig wird eine straffere internationale Architektur f�r die Politik in den Bereichen Landwirtschaft, Nahrungsmittel und Ern�hrung gefordert, um die oben beschriebenen Initiativen wirksam zu implementieren; besonders die Komponenten, die öffentliche G�ter betreffen. Die Umsetzung der Ma�nahmen auf globaler und nationaler Ebene sollte mit existierenden Mechanismen und gut aufeinander abgestimmten speziellen Initiativen erfolgen. Ein �Sonderfonds zur Weltern�hrung“ w�rde die f�r eine effektive Koordination notwendigen Anreize schaffen." from TextFood prices, Food supply, Food demand, Social protection, Agricultural research, Agricultural policy, Agricultural subsidies,

User fees in private non-for-profit hospitals in Uganda: a survey and intervention for equity

BACKGROUND: In developing countries, user fees may represent an important source of revenues for private-non-for-profit hospitals, but they may also affect access, use and equity. METHODS: This survey was conducted in ten hospitals of the Uganda Catholic Medical Bureau to assess differences in user fees policies and to propose changes that would better fit with the social concern explicitly pursued by the Bureau. Through a review of relevant hospital documents and reports, and through interviews with key informants, health workers and users, hospital and non-hospital cost was calculated, as well as overall expenditure and revenues. Lower fees were applied in some pilot hospitals after the survey. RESULTS: The percentage of revenues from user fees varied between 6% and 89% (average 40%). Some hospitals were more successful than others in getting external aid and government subsidies. These hospitals were applying lower fees and flat rates, and were offering free essential services to encourage access, as opposed to the fee-for-service policies implemented in less successful hospitals. The wide variation in user fees among hospitals was not justified by differences in case mix. None of the hospitals had a policy for exemption of the poor; the few users that actually got exempted were not really poor. To pay hospital and non-hospital expenses, about one third of users had to borrow money or sell goods and property. The fee system applied after the survey, based on flat and lower rates, brought about an increase in access and use of hospital services. CONCLUSION: Our results confirm that user fees represent an unfair mechanism of financing for health services because they exclude the poor and the sick. To mitigate this effect, flat rates and lower fees for the most vulnerable users were introduced to replace the fee-for-service system in some hospitals after the survey. The results are encouraging: hospital use, especially for pregnancy, childbirth and childhood illness, increased immediately, with no detrimental effect on overall revenues. A more equitable user fees system is possible

Socio-economic differences and health seeking behaviour for the diagnosis and treatment of malaria: a case study of four local government areas operating the Bamako initiative programme in south-east Nigeria

BACKGROUND: Malaria is one of the leading causes of mortality and morbidity in Nigeria. It is not known how user fees introduced under the Bamako Initiative (BI) system affect healthcare seeking among different socio-economic groups in Nigeria for diagnosis and treatment of malaria. Reliable information is needed to initiate new policy thrusts to protect the poor from the adverse effect of user fees. METHODS: Structured questionnaires were used to collect information from 1594 female household primary care givers or household head on their socio-economic and demographic status and use of malaria diagnosis and treatment services. Principal components analysis was used to create a socio-economic status index which was decomposed into quartiles and chi-square for trends was used to calculate for any statistical difference. RESULTS: The study showed that self diagnosis was the commonest form of diagnosis by the respondents. This was followed by diagnosis through laboratory tests, community health workers, family members and traditional healers. The initial choice of care for malaria was a visit to the patent medicine dealers for most respondents. This was followed by visit to the government hospitals, the BI health centres, traditional medicine healers, private clinics, community health workers and does nothing at home. Furthermore, the private health facilities were the initial choice of treatment for the majority with a decline among those choosing them as a second source of care and an increase in the utilization of public health facilities as a second choice of care. Self diagnosis was practiced more by the poorer households while the least poor used the patent medicine dealers and community health workers less often for diagnosis of malaria. The least poor groups had a higher probability of seeking treatment at the BI health centres (creating equity problem in BI), hospitals, and private clinics and in using laboratory procedures. The least poor also used the patent medicine dealers and community health workers less often for the treatment of malaria. The richer households complained more about poor staff attitude and lack of drugs as their reasons for not attending the BI health centres. The factors that encourage people to use services in BI health centres were availability of good services, proximity of the centres to the homes and polite health workers. CONCLUSIONS: Factors deterring people from using BI centres should be eliminated. The use of laboratory services for the diagnosis of malaria by the poor should be encouraged through appropriate information, education and communication which at the long run will be more cost effective and cost saving for them while devising means of reducing the equity gap created. This could be done by granting a properly worked out and implemented fee exemptions to the poor or completely abolishing user fees for the diagnosis and treatment of malaria in BI health centres

Treatment choices for fevers in children under-five years in a rural Ghanaian district

<p>Abstract</p> <p>Background</p> <p>Health care demand studies help to examine the behaviour of individuals and households during illnesses. Few of existing health care demand studies examine the choice of treatment services for childhood illnesses. Besides, in their analyses, many of the existing studies compare alternative treatment options to a single option, usually self-medication. This study aims at examining the factors that influence the choices that caregivers of children under-five years make regarding treatment of fevers due to malaria and pneumonia in a rural setting. The study also examines how the choice of alternative treatment options compare with each other.</p> <p>Methods</p> <p>The study uses data from a 2006 household socio-economic survey and health and demographic surveillance covering caregivers of 529 children under-five years of age in the Dangme West District and applies a multinomial probit technique to model the choice of treatment services for fevers in under-fives in rural Ghana. Four health care options are considered: self-medication, over-the-counter providers, public providers and private providers.</p> <p>Results</p> <p>The findings indicate that longer travel, waiting and treatment times encourage people to use self-medication and over-the-counter providers compared to public and private providers. Caregivers with health insurance coverage also use care from public providers compared to over-the-counter or private providers. Caregivers with higher incomes use public and private providers over self-medication while higher treatment charges and longer times at public facilities encourage caregivers to resort to private providers. Besides, caregivers of female under-fives use self-care while caregivers of male under-fives use public providers instead of self-care, implying gender disparity in the choice of treatment.</p> <p>Conclusions</p> <p>The results of this study imply that efforts at curbing under-five mortality due to malaria and pneumonia need to take into account care-seeking behaviour of caregivers of under-fives as well as implementation of strategies.</p

Treatment-seeking for febrile illness in north-east India: an epidemiological study in the malaria endemic zone

<p>Abstract</p> <p>Background</p> <p>This paper studies the determinants of utilization of health care services, especially for treatment of febrile illness in the malaria endemic area of north-east India.</p> <p>Methods</p> <p>An area served by two districts of Upper Assam representing people living in malaria endemic area was selected for household survey. A sample of 1,989 households, in which at least one member of household suffered from febrile illness during last three months and received treatment from health service providers, were selected randomly and interviewed by using the structured questionnaire. The individual characteristics of patients including social indicators, area of residence and distance of health service centers has been used to discriminate or group the patients with respect to their initial and final choice of service providers.</p> <p>Results</p> <p>Of 1,989 surveyed households, initial choice of treatment-seeking for febrile illness was self-medication (17.8%), traditional healer <it>(Vaidya)</it>(39.2%), government (29.3%) and private (13.7%) health services. Multinomial logistic regression (MLR) analysis exhibits the influence of occupation, area of residence and ethnicity on choice of health service providers. The traditional system of medicine was commonly used by the people living in remote areas compared with towns. As all the febrile cases finally received treatment either from government or private health service providers, the odds (Multivariate Rate Ratio) was almost three-times higher in favour of government services for lower households income people compared to private.</p> <p>Conclusion</p> <p>The study indicates the popular use of self-medication and traditional system especially in remote areas, which may be the main cause of delay in diagnosis of malaria. The malaria training given to the paramedical staff to assist the health care delivery needs to be intensified and expanded in north-east India. The people who are economically poor and living in remote areas mainly visit the government health service providers for seeking treatment. So, the improvement of quality health services in government health sector and provision of health education to people would increase the utilization of government health services and thereby improve the health quality of the people.</p

The stigma of mental illness in Southern Ghana: attitudes of the urban population and patients’ views

PURPOSE: Stigma is a frequent accompaniment of mental illness leading to a number of detrimental consequences. Most research into the stigma connected to mental illness was conducted in the developed world. So far, few data exist on countries in sub-Saharan Africa and no data have been published on population attitudes towards mental illness in Ghana. Even less is known about the stigma actually perceived by the mentally ill persons themselves. METHOD: A convenience sample of 403 participants (210 men, mean age 32.4 ± 12.3 years) from urban regions in Accra, Cape Coast and Pantang filled in the Community Attitudes towards the Mentally Ill (CAMI) questionnaire. In addition, 105 patients (75 men, mean age 35.9 ± 11.0 years) of Ghana's three psychiatric hospitals (Accra Psychiatry Hospital, Ankaful Hospital, Pantang Hospital) answered the Perceived Stigma and Discrimination Scale. RESULTS: High levels of stigma prevailed in the population as shown by high proportions of assent to items expressing authoritarian and socially restrictive views, coexisting with agreement with more benevolent attitudes. A higher level of education was associated with more positive attitudes on all subscales (Authoritarianism, Social Restrictiveness, Benevolence and Acceptance of Community Based Mental Health Services). The patients reported a high degree of experienced stigma with secrecy concerning the illness as a widespread coping strategy. Perceived stigma was not associated with sex or age. DISCUSSION: The extent of stigmatising attitudes within the urban population of Southern Ghana is in line with the scant research in other countries in sub-Saharan Africa and mirrored by the experienced stigma reported by the patients. These results have to be seen in the context of the extreme scarcity of resources within the Ghanaian psychiatric system. Anti-stigma efforts should include interventions for mentally ill persons themselves and not exclusively focus on public attitudes