Public Health Commons^™

Women's Participation In Disaster Relief And Recovery, Ayse Yonder, Sengul Akcar, Prema Gopalan

Poverty, Gender, and Youth

Too little attention has been given to the gender-differentiated effects of natural disasters, that is, women’s losses relative to men’s, how women’s work time and conditions change (both in terms of care-giving and income-generating work), or how disaster-related aid and entitlement programs include or marginalize affected women. The detailed case studies from three earthquake-stricken areas in India and Turkey that are contained in this issue of SEEDS help fill this information gap. They provide examples of how low-income women who have lost everything can form groups and become active participants in the relief and recovery process. Readers learn how women …

Reciprocal Effects Of Health And Economic Well-Being Among Older Adults In Taiwan And Beijing, Kristine R. Baker, Mary Beth Ofstedal, Zachary Zimmer, Zhe Tang, Yi-Li Chuang

Poverty, Gender, and Youth

The objectives of this Population Council study are threefold: 1) to examine whether socioeconomic status disparities in health are found in non-Western settings; 2) to assess whether socioeconomic status gradients in health endure into older ages; and 3) to evaluate the direction of causality between health and socioeconomic status. Findings provide evidence for reciprocal effects of economic well-being and health among older adults in both Taiwan and Beijing. Those with higher levels of economic well-being have lower levels of functional limitation over time, and those with higher levels of functional limitation have lower levels of economic well-being over time. Consistent …

The Impact Of Childhood Mortality On Fertility In Six Rural Thanas Of Bangladesh, Mian Bazle Hossain, James F. Phillips, Thomas K. Legrand

Poverty, Gender, and Youth

This Population Council working paper examines the causal structure of the relationship between child mortality events and subsequent fertility during a time of rapid decline in fertility in Bangladesh. Results lend support to the hypothesis of an insurance effect, while demonstrating that its demographic significance is likely to be less prominent than that of replacement behavior. Findings indicate that the insurance motive remains intact even after total fertility declined to fewer than three children per woman. The well-documented role of gender bias as a determinant of child health and survival is also a factor in child-replacement decisionmaking. Although the rapid …

The Changing Context Of Sexual Initiation In Sub-Saharan Africa, Barbara Mensch, Monica J. Grant, Ann K. Blanc

Poverty, Gender, and Youth

This working paper investigates the links between changing age at marriage and premarital sexual behavior in 27 sub-Saharan African countries in which Demographic and Health Surveys were conducted between 1994 and 2003. Using multiple-decrement life tables to examine the competing risks of premarital sex and marriage without prior sexual experience, we answer the largely unaddressed question of how reductions in the prevalence of early marriage have affected the likelihood of initiating premarital sex. Our analysis reveals that although the age of first sexual activity has either remained the same or increased, a shift in the context of sexual debut from …

Kutibu Majeraha, Kutia Matumaini: Ushirikiano Wa Watanzania Dhidi Ya Fistula Obstetrikia, Thoraya Ahmed Obaid, Erica Chong

Poverty, Gender, and Youth

This edition of Quality/Calidad/Qualité describes a partnership formed to combat obstetric fistula in Tanzania. The Bugando Medical Center, the Women’s Dignity Project, the Tanzania Midwives Association, and the government cooperated on an extensive program for surgical repair, prevention, and policy research and activities. Lessons learned: 1) Fistula programs need to address social as well as medical issues. 2) Most repairs are successful, making an enormous difference in women’s lives. 3) Relatively little funding is necessary to start up a fistula program. 4) Fistula programs are vehicles for broader conversations about gender and poverty.

How Many Years Of Life Could Be Saved If Malaria Were Eliminated From A Hyperendemic Area Of Northern Ghana?, Ayaga A. Bawah, Fred N. Binka

Poverty, Gender, and Youth

For some time, Chinese government policies have treated rural and urban areas very differently, and a by-product of China’s rapid development seems to be an even greater differentiation between urban and rural social and economic life. Over the next several decades, in part because of rapid fertility declines and in part as a result of mortality declines at older ages, China and other developing countries will experience enormous increases in the proportion of older adults and the proportion of the “oldest-old.” It is reasonable to expect that these age structure changes will alter the provision of health care, making an …

Transferring Ghana's System Of Evidence-Based Health Program Development: Program For An Initial Exchange With Sierra Leone And Burkina Faso, Frontiers In Reproductive Health

Reproductive Health

Ghana’s Community-based Health Planning and Services (CHPS) experiment demonstrated that mobilizing community volunteerism, in combination with retraining and redeploying nurses to village-based locations reduced childhood mortality rates in that country. Thus, CHPS has become the government’s primary strategy for realizing universal access to health care. This report provides a description of an initial exchange organized by the Ghana Health Service, the Navrongo Health Research Centre, and the Population Council to explore ways of transferring and adapting these evidence-based strategies to other countries in the region. The exchange included representatives from the Sierra Leone Ministry of Health and Sanitation and the …

Cross-Cultural Adaptation Of Reproductive Health Services In Bolivia, Fernando Gonzales Salguero, Antonieta Martin, Rosario Perez Mendoza, Ricardo Vernon

Reproductive Health

The Bolivian Ministry of Health and Sports and the Integral Health Project, with the technical assistance of the Population Council’s Frontiers in Reproductive Health Program (FRONTIERS), tested several strategies to make health services in Bolivia more culturally appropriate for the country’s indigenous peoples. The goal of the project was to increase women’s access to, use of, and satisfaction with health services in general, and reproductive health services in particular, through: a) enhanced understanding and acceptance of the “other” culture; b) improving communication skills; c) facilitating and promoting use of the Quechua language in clinics; d) systematically screening clients’ health service …

Operations Research To Improve Postabortion (Pac) Services In Three Public Hospitals, Bolivia, Fernando Gonzales Salguero, Mariel Loayza

Reproductive Health

In the last five years, Pathfinder Bolivia has provided technical assistance, training and equipment to the Ministry of Health (MOH) to implement postabortion care (PAC) services in eight hospitals. They invited Frontiers in Reproductive Health (FRONTIERS) to provide the technical assistance and training for conducting operations research (OR) activities. This report describes the second stage of this collaborative effort as presented in a three-day workshop attended by providers and staff members of the participant hospitals. During the workshop, participants received OR training and developed draft OR proposals seeking to improve PAC service delivery problems identified during the first study. The …

Use Of Systematic Screening To Increase The Provision Of Reproductive Health Services In Bolivia, James R. Foreit, Ricardo Vernon, Patricia Riveros Hamel

Reproductive Health

The objective of this study was to determine if the use of a checklist to screen for unmet service needs could increase the number of services per visit provided to clients using rural Bolivian health facilities. Measurement included changes in services per visit before and after the introduction of the intervention, and a comparison of services received at screened and non-screened visits. Findings show that, to the degree that provider compliance can be secured, systematic screening of clients appears to be an effective method for reducing unmet health service needs. The findings of this study replicate those of other studies …

Willingness-To-Pay For Services Provided By The Clinical Services Improvement Project (Csi) In Egypt, John H. Bratt, Nahla G. Abdel-Tawab, Magdi A. Ibrahim, Mohammed Edress

Reproductive Health

Willingness-to-pay (WTP) surveys are increasingly used in reproductive health programs to predict the impact of price changes on revenues, utilization, and client profile. The FRONTIERS program worked with the Clinical Services Improvement (CSI) project and the Cairo Demographic Center to carry out a WTP survey in six CSI clinics in Egypt. The survey found that most clients would be willing to pay higher prices for CSI services, and WTP did not vary much by client economic status. However, predictive validity was low when all reasons for client discontinuation were included. WTP surveys have the potential to be useful tools for …

An Assessment Of Trends In The Use Of The Iud In Ghana: National Results Dissemination And Utilization, Ivy Osei, John Gyapong, Monica Wanjiru, Ian Askew

Reproductive Health

The overall aim of this study was to inform the Ghana Health Service, USAID, and other partners involved in providing family planning services in Ghana about future directions that could be taken to reinvigorate the IUD within the context of a family planning service based on the principles of free and informed choice. The Health Research Unit conducted the study, with technical assistance from FRONTIERS and funding from USAID. The findings showed that the declining interest in and use of the IUD as a family planning method could be attributed to several factors, including negative perceptions and false beliefs about …

Improving The Ghanaian Safe Motherhood Programme, Ivy Osei, Bertha Garshong, Gertrude Banahene, John Gyapong, Placide Tapsoba, Ian Askew, Clement Ahiadeke, Richard Killian, Edward Bonku, Perle Combary, William Sampson

Reproductive Health

Prior to the Ghana Ministry of Health scaling up the country’s Safe Motherhood program, they requested support from the Population Council’s USAID-funded Frontiers in Reproductive Health program to undertake an operations research study to evaluate and compare the cost-effectiveness of two training approaches and other performance improvement interventions. The study measured and compared changes in provider knowledge and skills and the costs of implementing a three-week residential vs. self-paced learning (SPL) approach. The SPL approach costs more per trainer than the traditional residential approach, both in financial costs alone and when opportunity costs are added, however, a cost-effectiveness analysis showed …

Improving Access To Long-Term Contraceptives In Rural Guatemala Through The Ministry Of Health, Edwin Montufar, Carlos Morales, Ricardo Vernon, Carlos Brambila, Jorge Solorzano

Reproductive Health

The purpose of this study was to test a model to train nurse auxiliaries at health centers and posts in Guatemala and to determine whether these providers could deliver adequate, cost-effective services. The training model consisted of: a) selection of nurse auxiliaries; b) two-day group training; c) on-the-job training, including work with actual clients at the trainees’ work centers; and d) certification of trainees who had conducted at least five quality insertions under supervision. This study has shown that nonprofessional health providers can effectively provide quality IUD services in Guatemala. The main recommendation derived from the project is to scale …

Expanding Access To Vasectomy Services In The Ministry Of Health Of Guatemala, Blanca De Rodriguez, Ricardo Vernon, Jorge Solorzano

Reproductive Health

This project tested the effectiveness of a systemic model for introducing vasectomy in service delivery units of the Guatemalan Ministry of Health (MOH), which has four basic components: a) the self-selection of health units according to their response to an invitation to participate in the project; b) the development of a counseling and information model for potential clients; c) training and sensitizing of health teams; and d) on-site training of surgeons. The report concludes that the introduction model for vasectomy in the MOH centers was successful. A high proportion of hospitals that identified vasectomy candidates finished the process, and the …

Systematic Screening As A Strategy To Increase Services Integration And Revenues In Honduras, Ricardo Vernon, James R. Foreit, Fiorella Mancini, Suyapa Pavon, Jheisy Torres

Reproductive Health

This operations research study, undertaken by the Honduras Family Planning Association (Asociación Hondureña de Planificación de Familia—ASHONPLAFA), tested the effectiveness of systematic screening to increase the number of services and revenue per visit in a reproductive health program. Despite monitoring plans, provider compliance with the intervention was low; the overall proportion of clients screened was less than 11 percent, and the frequency of screening varied greatly by clinic contact point. Although the study did not show an increase in the mean number of services per client, the negative results could reasonably be attributed to lack of implementation of the intervention. …

Systematic Screening To Integrate Reproductive Health Services In India, N.P. Das, Urvi Shah, Varsha Chitania, Pratibha Patel, M.E. Khan, Anurag Mishra, James R. Foreit

Reproductive Health

This study, conducted in large public clinics and small health posts in the city of Vadodara, India, tested the effectiveness of a systematic screening technique in integrating reproductive health services at the provider level. The objective was to determine if women screened during clinic visits received more services, appointments, and referrals per visit than women who were not screened. Results show that in experimental group clinics the number of services per visit increased while control clinics experienced a slight decrease; the effect of systematic screening was smaller in health posts than in clinics. In experimental posts, services per visit increased …

Nursing Staff Dynamics And Implications For Maternal Health Provision In Public Health Facilities In The Context Of Hiv/Aids, Loveday Penn-Kekana, Duane Blaauw, Khin San Tint, Desiree Monareng, Jane Chege

Reproductive Health

This study, carried out in Limpopo, KwaZulu-Natal, and Mpumalanga provinces in South Africa, aimed to document nursing staff dynamics in maternal health services, and to explore the factors associated with these dynamics. The study found that a high percentage of nursing staff working in public facilities were demotivated, burnt out, and were considering leaving the facility where they were working. A range of factors, both financial and nonfinancial, were associated with nurses considering going overseas: inadequate pay, poor promotion, feeling unsupported by management, and having bad relationships at work were all associated with lack of organizational commitment. As a result …

Feasibility Of Introducing A Comprehensive Package Of Antenatal Care Services In Rural Public Clinics In South Africa, Jane Chege, Ian Askew, Nzwakie Mosery, Mbali Ndube-Nxumalo, Busi Kunene, Mags Beksinska, Janet Dalton, Ester Snyman, Wilem Sturm, Preshny Moodley

Reproductive Health

The Maternal, Child and Women’s Health Unit, in collaboration with the Population Council’s FRONTIERS in Reproductive Health (FRONTIERS) program, the Reproductive Health Research Unit of the University of Witwatersrand, and the Department of Medical Microbiology and Infectious Diseases of the Nelson Mandela School of Medicine, University of Natal, developed and then pilot-tested this revised model in KwaZulu-Natal, South Africa. The project’s objective was to develop and test an improved and integrated antenatal care program for public-sector clinics that would increase the range and quality of services received by pregnant women and improve their reproductive health behavior and status. Various problems, …

Using Systematic Screening To Increase Integration Of Reproductive Health Services Delivery In Senegal, Diouratie Sanogo, Ricardo Vernon, James R. Foreit, Awa M. Coll-Seck, Colonel Adama Adoye, Laty G. Ndoye, Cheikh Bamba Diop, Balla Mbacke Mboup, Omar Sarr

Reproductive Health

This study tested the systematic screening technique to increase the integration of reproductive health services in Senegal. The study took place in four urban health posts in the city of Dakar and three rural health posts in the district of Kebemer. A before and after design tested the hypothesis that the use of the systematic screening tool would result in more services received per client visit. In Dakar, services per visit increased significantly by 20 percent, while in Kebemer, services per visit also increased significantly by 35 percent. The study also examined several techniques to improve provider compliance with the …

Evaluating Awareness Of Community Health And Human Services By The Hispanic Population In Lexington, Kentucky, Pilar Corbellini

MPA/MPP/MPFM Capstone Projects

Over the past 10 years, Hispanics, predominately Mexicans, have become a notable component of immigration in Kentucky. At the same time, the city of Lexington has striven to increase and stimulate community efforts to help and support people in need. Over 2000 non-profit organizations exist in the city and surrounding areas that unite community support to assist people seeking help.

Among non-profit agencies, particularly the United Way of the Bluegrass, there is a perceived idea that people in need and seeking help are overwhelmed with information about available community human and health services. Notwithstanding this perception, a different reality seems …

The Challenge Of Health Care Delivery In Connecticut, Joanne M. Bortone, Michael Emery, Patricia W. Walker

Occupational Therapy Faculty Publications

The challenge of health care is explored by Jody Bortone, Michael J. Emery, and Patricia W. Walker in chapter six of Public Policy in Connecticut. They focus particularly on the shortage of health care professionals in the Connecticut workforce, the increasing difficulty Connecticut residents face with respect to accessing and receiving appropriate health care services, and the rising costs associated with the many dimensions of health care. The authors conclude their essay with a very specific set of remedial measures designed to resolve the disturbing trends in the state's health care system.

Obesity And The Struggle Within Ourselves, Maxwell Gregg Bloche

Georgetown Law Faculty Publications and Other Works

The author argues that we ought to treat our eating, exercise habits, and girth as personal matters, for the most part, but that law can and should make a contribution, as an ally of our longer-term will against our immediate cravings. Law can be our ally in this fashion without command-and-control intrusion into our private lives. Such intrusion is at odds with our core beliefs and unlikely to produce public health success. It is more likely to provoke popular backlash--one reason why some who stand to gain from our unhealthy dining choices try to cast government efforts to inform these …

Public Health Abstracts 2004

Florida Public Health Review

No abstract provided.

Public Health, Primary Care, And Privatization

Florida Public Health Review

No abstract provided.

Perceptions And Practices Of Indiana School Superintendents In Response To The Problem Of Sick Building Syndrome, Janet Elaine Hiller

All-Inclusive List of Electronic Theses and Dissertations

The purpose of this study was to compare the perceptions and practices of Indiana public school superintendents who represent two groups, those who had experienced building exposure to mold and those who had not experienced building exposure to mold. Seventy-five Indiana public school superintendents responded to the opinionnaire with a return rate of 81.5%. Results indicate that: (1) Indiana public school superintendents who had not experienced building exposure to mold had higher mean values than those who had experienced building exposure to mold relative to closing only classrooms affected by mold and to relocating staff and students exposed to mold; …

Mainecare Behavioral Health Care Expenditures State Fiscal Years 1996 – 2002, Susan Payne Phd, Stuart Bratesman Mpp, David Lambert Phd

Disability & Aging

No abstract provided.

Promotion Of Jump Rope In An Elementary School

Florida Public Health Review

No abstract provided.

The Effects Of Copayments On The Use Of Medical Services And Prescription Drugs In Utah's Medicaid Program, Leighton Ku, Elaine Deschamps, Judi Hilman

Health Policy and Management Faculty Publications

In recent years, a number of states have increased cost-sharing for low-income Medicaid beneficiaries as one approach to Medicaid cost-containment. While copayments have been most commonly applied to prescription drugs, they also have been assessed for other services, such as physician visits, hospital admission, or outpatient clinic use.

Prior research has found that when low-income patients are required to pay more for health care services or for prescription drugs, they use fewer services or medications.[2] In some cases, their health could deteriorate, with the result that they may subsequently require more expensive emergency room or inpatient hospital care. While …

Reexamining Mandatory Hiv Partner Notification In Florida

Florida Public Health Review

No abstract provided.