The chronic underfunding of the system imposes serious limitations on the overall expansion of the SUS, particularly at the secondary and tertiary levels . In addition to ensuring adequate and sustained funding for the SUS, initiatives require support to increase access in all levels of care, and to improve the management of health services. Finally, continued monitoring of UHC indicators is recommended, with the goal of subsidizing policies to promote greater equity inhealth care provision andin the decrease of health determinants and risks.
In the 42 years since independence, Bangladesh has made some substantial progressin the health sector, which is all the more remarkable when compared with other countries in the region [1– 5]. However, this achievement is not uniform across all health indicators. The coverage of many critical health services is still quite low. The country’s health system is struggling to meet basic standards for quality of care because of a shortage of skilled health workers, the large number of unregulated private service providers, irregular supplies of drugs, inadequate public financing, high out-of-pocket expenses, and lack of proper monitoringand supervision mechanisms. Further complicating the situation is the increasing burden of non-communicable diseases, and the absence of any pre-payment risk pooling mechanisms. Bangladesh faces a daunting challenge in achieving the goal of universalhealthcoverage (UHC).
ultimate goal of UHC is directly linked to eliminating inequities: to ensure that all people who need health services are able to get them, without experiencing undue financial hardship [8,10]. However, unless they are designed with an equity-oriented approach, movements toward UHC may facilitate early and/or accelerated gains for advantaged subgroups, while leaving others behind . This ‘‘trickle down’’ implementation may worsen the situation for disadvantaged populations according to the inverse care law , and may exacerbate inequalities if universality is not fully achieved . Thus, monitoring inequalities is fundamental to track the impact of health interventions that aim for universality, to ensure that the process leaves no disadvantaged group behind, and to promote concurrent or hastened progress among the most disadvantaged and across the social gradient . Recommendations surrounding the post-2015 development agenda [7,15] as well as UHC [8,16,17] have called for focused attention on monitoring the reduction of inequalities [8,16,17]. Indeed, the emerging global movement toward UHC presents opportunities for the widespread promotion and mainstreaming of health inequality monitoring at the global level. Advocates for health equity would be judicious to adopt a united front to rally for equity-related indicators and targets that are likely to be accepted and implemented by diverse stakeholders. Establishing methods and targets for global monitoring facilitates global comparisons that are meaningful and substantive ways of measuring and reporting progressin a set of common indicators.
Historic rates of progressin intervention coverage are available for several indicators related to the coverage of interventions for the health MDGs. Table 3 shows the year in which 80% and 95% coverage will be exceeded, on the basis of data from 33 low- and middle-income countries with two national surveys (Demographic andHealth Survey [DHS] or Multiple Indicator Cluster Survey [MICS]); one survey was carried out in the 1990s, and one at least ten years later. The average survey interval is 12 years and the most recent survey was on average conducted in 2009. The computations are done for five indicators including antenatal care (at least one visit), skilled birth attendance, full immunization coverage among children 1 year old, family planning need satisfied, and a summary coverage index based on the unweighted Table 2. Intervention coverage indicators with quality dimension or with additional indicators to capture service quality, and source of data.
Despite the achievement of UHC, challenges remain. An increased burden from NCDs is evident. Series of the NHES showed increased prevalence of overweight and obesity and diabetes in both male and female adults over the last two decades (Text S1). The cost pressure to all schemes from an increased demand for long-term treatments prompts policy attention towards effective primary, secondary, and tertiary preventions of
Since 2003, the Government of Ghana has been implementing the National Health Insurance Scheme (NHIS) as the main strategy to progressively bridge financial access barriers and provide a social risk protection system . The scheme complements the Community-based Health Planning and Services program—the national strategy to progressively reduce geograph- ical access barriers to health services . The concurrent strengthening of the District Health Systems will contribute to improving health outcomes.
UHC as a major global health goal is not only a political, but also an ethical endeavor. The WHO, as the United Nations specialized agency for international public health, has a unique mandate and longstanding history of advocating for access to healthcare for all. WHO’s 1946 Constitution proclaimed as one of its basic value statements that “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.” 2 In 1978, the Declaration of Alma Ata called
It is now recognised that the volume of nocturnal urine produced is a critical aetiological factor in many individuals with nocturia. Global polyuria (GPu) is the overproduction of urine occurring over 24 hours (>2.8 litres of urine/24 hr or >40 ml/ kg). A common cause is diabetes mellitus, where high circulating glucose levels lead to an osmotic diuresis. In diabetes insipidus (DI) the kidneys are unable to suiciently concentrate the urine due to a lack of arginine vasopressin (AVP) (or anti-diuretic hormone) production in the posterior pituitary gland (cranial DI), or loss of renal sensitivity to the hormone (renal DI). Other causes include excessive drinking (either habitual or due to psychiatric causes) and an excessive intake of protein drinks, causing an osmotic diuresis.
The within school variation in CCT coverage seems to isolate the most endogenous dimension of variation in our independent variable. Therefore, if we want to use school fixed effects to control for unobserved neighborhood characteristics, we need to use our instrument for Bolsa Família coverage. Column 4 presents a reduced form regression of crime on our instrument, showing that the instrument is negatively correlated with crime rates. In short, schools with a higher number of students between ages 16 and 17 in 2006 experienced larger declines in crime in 2008 and 2009, when the CCT coverage was expanded to these age groups. In column 5, we use the instrument to isolate the supposedly exogenous dimension of variation in Bolsa Família coverage. The coefficient is negative and statistically significant and, surprisingly, almost identical to the coefficients presented in columns 1 and 2, where we did not use school fixed effects. So, for the case of high schools, the simple conditional correlation between CCT coverageand crime seems to give a very accurate estimate of the causal effect. The key identifying assumption here is that the age composition of schools in 2006 was indeed associated with changes incoverage after 2008 and that, additionally, there was no other connection between age composition and variations in crime apart from that working through CCT coverage. 6 We present some evidence to support these two assumptions in the following tables.
24. The impact of the PHC strategy has been greater in countries with less inequality in income distribution, regardless of absolute income levels. In contrast, the impact of PHC has been much lower in poor countries with high inequality of income distribution. For example, total fertility rates closer to the replacement level, indicating a more advanced stage of demographic transition, were reached in countries with more equitable income distribution—not necessarily in the richest countries. Aspects directly associated with the implementation of the PHC strategy, such as public health expenditure, access to safe drinking water, births attended by a trained professional, or literacy, reveal significant geographical, gender-based, and socioeconomic inequalities when disaggregated by level and, above all, by income. This evidence documents the impact of the goal of HFA and the need to incorporate an equity perspective into PHC, which was the fundamental inspiration of the Declaration of Alma-Ata.
This paper analyzes, from a survey applied to the entire state of Rio de Janeiro through a sample research, perceptions and representations of men and women about productive and reproductive work in our society. In order to do this, the survey takes up some issues already explored and analyzed in previous research conducted in 2003 and introduces new variables. The resulting information offers a rich panorama that can be analyzed together with other data sources provided by the Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics/ IBGE ) in order to outline the process of deconstruction of traditional gender identities. In this sense, perceptions about the roles of family, state and market in the possible arrangements under discussion vary greatly depending on the respondent's profile. Generally speaking, it highlights the fact that historically important variables such as educational level have a modified importance because of the increasing complexity of ongoing dynamics in recent years.
Meanwhile, we are left with the control measures for Aedes aegypti, which must be im- plemented by society as whole. However, the development of clean technologies that reduce the vector population requires support from research agencies. In addition, health profes- sionals and services must continue their efforts to provide timely and appropriate care for persons that fall ill to dengue, in the final effort to reduce case-fatality to a minimum.
as evaluation and continuous improvement of health programs, competencies on information technologies for healthcare, environmental health, global healthand preparedness for emergencies and disasters, although reported fairly positively, did not reach means of 4.41. 6) Other elements that contribute to the preparedness of students to promote UniversalHealth – i.e. ethics; human rights; social justice; understanding of different cultures and the impact of culture on human life; leadership; advocacy; health services coordination and administration; healthand therapeutic education for patients and groups in the community; knowledge of the principles of patient, family, and community centered care – should be fostered in LAC schools through learning experiences in PHC settings. Additionally, curriculum content should support the strengthening of health systems through UniversalHealth values and PHC, with a focus on the country’s healthcare context and priorities (8) .
The WHO Commission on the Social Determinants of Health addressed the complexity of health deter- minants through the concept of the social determinants of health. These are the conditions in which people are born, grow, live, work and age and they are shaped by the distribution of money, power and resources at global, national and local levels. The Rio Political Declaration on Social Determinants of Health, adopted in 2011, highlighted that it requires political commitment and momentum to address social determinants and growing inequalities inhealth within and between countries. But the profit driven NCD epidemic - which hits the poor and the “fragile middle” hardest - requires an equal political concern for the commercial determinants of health. Emerging economies should take the lead in this area of global health because the health, social and economic consequences for their societies are staggering.
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Abstract: Global monitoring of intervention coverage is a cornerstone of international efforts to improve reproduc- tive, maternal, newborn, and child health. In this review, we examine the process and implications of selecting a core set of coverage indicators for global monitoring, using as examples the processes used by the Countdown to 2015 for Maternal, Newborn and Child Survival and the Commission on Accountability for Women’s and Chil- dren’s Health. We describe how the generation of data for global monitoring involves five iterative steps: develop- ment of standard indicator definitions and measurement approaches to ensure comparability across countries; collection of high-quality data at the country level; compilation of country data at the global level; organiza- tion of global databases; and rounds of data quality checking. Regular and rigorous technical review processes that involve high-level decision makers and experts familiar with indicator measurement are needed to maximize uptake and to ensure that indicators used for global monitoring are selected on the basis of available evidence of intervention effectiveness, feasibility of measurement, and data availability as well as program- matic relevance. Experience from recent initiatives illus- trates the challenges of striking this balance as well as strategies for reducing the tensions inherent in the indicator selection process. We conclude that more attention and continued investment need to be directed to global monitoring, to support both the process of global database development and the selection of sets of coverage indicators to promote accountability. The stakes are high, because these indicators can drive policy and program development at the country and global level, and ultimately impact the health of women and children and the communities where they live.
Using long-lasting insecticidal nets (LLINs) can reduce malaria morbidity and mortality, and expanding the LLIN population coverage has been proven to be an effective health intervention toward reducing the incidence of malaria (Bennett et al. 2012; Walker et al. 2016; Winskill et al. 2017). The international financial crisis poses a significant challenge for malaria vector control, andhealth policy decision-makers (and donors) frequently have to choose between two interventions based on cost- effectiveness analyses. Despite of the considerable international investment made for malaria control over the past 15 years, worldwide funding fell by 8% between 2013 and 2014 (WHO 2015). However, spending on commodities rose 40-fold between 2004 and 2014 and accounted for about 82% of recorded international malaria spending in 2014, whereas LLINs were responsible for 63% of total spending (WHO 2015). Funding for the provision of LLINs can continue to decrease (WHO 2012) and it is necessary to ensure the efficient allocation of LLINs and their appropriate use. Even for existing LLIN delivery models in mass free campaigns, it is necessary to ensure that the existing delivery model is the most cost-effective and sustainable for country-wide campaigns. Most of the economic evaluation studies compare the distribution of LLINs through various mechanisms (e.g. campaigns through fixed sites andhealth facilities, campaigns carried out using prenatal care services, and campaigns integrated with immunization) or distribution of LLINs with other malaria control strategies, such as indoor residual spraying (IRS), and intermittent preventive treatment in pregnant women (IPTp), among others. Recently, Ntuku et al. (2017) evaluated a fixed delivery strategy and a door-to- door strategy including hang-up activities in Kasaï Occidental Province in Democratic Republic of Congo. Their findings show that the fixed delivery strategy achieved a higher LLIN coverage at lower delivery cost compared with the door-to-door strategy. In 2015, Mozambique piloted a new model of LLIN delivery in mass free campaign (Arroz et al. 2017). The mass free campaigns in Mozambique make use of community channel (defined as the route through which the LLINs f low to the end user), and the LLINs distribution takes place in community distribution centers. Two rural districts were intervened with the new LLIN delivery model, and two served as the control, maintaining the standard delivery model. Immediate results of this pilot showed that 87.8% (302,648/344,770) of planned LLINs were distributed in the intervention districts compared to 77.1% (219,613/284,873) in the control districts [OR: 2.14 (95% CI 2.11– 2.16)] (Arroz et al. 2017).
As has been seen, healthcoverage, elected by the WHO to “ensure” access to health care for the millions of human beings whose rights are not respected, is problematic in itself. It is important to understand how this was made possible and the possible ways of overcoming this contradic- tion. With regard to the irst question - “how” – the answer is practically unanimous: by obeying the logic of the market and neoliberal rationale, which regard health as a consumer good rather than a human right constituted from the mo- ment of birth that should be enjoyed by all hu- mankind 48 .
where is a set of linear restrictions that transforms the unrestricted model (1) on restricted model (2). 8 In our case, the restriction implies that the age, trend and (orthogonal) time dummies are sufficient to explain the behavior of each estimated statistic order across cells and over time. Imposing the restrictions means estimating weighted least squares regressions on the grouped data, for each quantile and education group separately. This procedure will give us consistent estimates of . Under the null that the restrictions are valid, the minimized value follows a chi-square distribution with degrees of freedom equal to the number of restrictions. In order to construct the test statistics, we only have to sum up the weighted squared residuals, that is, the estimated percentiles minus the predicted values minus the orthogonal time dummies.