Medicine and Health Commons^™

Forced Migration And The Survival Needs Of The Nigerian Child, Ngozi Diwunma Obidike

Journal of Global Initiatives: Policy, Pedagogy, Perspective

This article identifies the survival needs of the forced migrant Nigerian child as well as the extent to which the identified needs are satisfied. The population consisted of 600 forced migrant children and 10 emergency workers who were chosen based on their experiences being forced migrants. A questionnaire was used for the study. The result showed) among other things, that although the need for food, clean water, education, peace, and shelter were identified as the five most essential needs, other needs were also identified as necessary for the children's survival. Based on the results, recommendations were made.

Uncertain Health Insurance Coverage And Unmet Children’S Health Care Needs, Jennifer E. Devoe, Moira Ray, Lisa Krois, Matthew J. Carlson

Sociology Faculty Publications and Presentations

BACKGROUND AND OBJECTIVES: The State Children's Health Insurance Program (SCHIP) has improved insurance coverage rates. However, children's enrollment status in SCHIP frequently changes, which can leave families with uncertainty about their children's coverage status. We examined whether insurance uncertainty was associated with unmet health care needs.

METHODS: We compared self-reported survey data from 2,681 low-income Oregon families to state administrative data and identified children with uncertain coverage. We conducted cross-sectional multivariate analyses using a series of logistic regression models to test the association between uncertain coverage and unmet health care needs. RESULTS: The health insurance status for 13.2% of children …

Gendered Disparities In Take-Ups Of Employee Health Benefits, Jennifer Reid Keene, Anastasia H. Prokos

Sociology Faculty Research

Using a sample of 2,271 workers from the 2002 National Study of the Changing Workforce whose employers offered personal health insurance, this article investigates the gendered nature of health insurance benefit take-ups. These analyses include family and employment characteristics in addition to employers’ contributions to health insurance premiums, a measure that is unexamined in sociological analyses of health benefits. Progressive logistic regression models predict the effects of gender and family characteristics. Results indicate that women with employed spouses are less likely to take up their own health benefits than are comparable men, net of basic employment characteristics. Gender differences disappear, …

Données Démographiques Pour Développement Ii—De La Recherche À L'Intervention: Améliorer L'Accès Et L'Utilsation Des Données Par Les Médias, Population Council

Poverty, Gender, and Youth

This policy brief describes the Population Council’s project to improve access and use of demographic, health, and other public sector data that are essential evidence for development policy planning and evaluation. In many countries, access to data is limited and, when data are available, the format is rarely user-friendly for nonprofessionals, limiting their potential applications. In recent years, the Population Council has examined access to and sharing of data through case studies in Ethiopia, Ghana, Senegal, and Uganda. In phase II of the project, the Council will strive to promote domestic demand for data by working with key intermediaries—the media.

Performance Measures And Pilot Evaluation Of Georgia’S Medical Assistance Program For Population Below The Poverty Line, Tamar Chitashvili

Muskie School Capstones and Dissertations

In recent years the Georgian health care system has been undergoing fundamental reforms aimed at improving the population’s health status by increasing financial and geographic access to high-quality health care. To address limited financial access to health services of the poor, and protect them from catastrophic expenditures associated with illnesses and improve equity, the government restructured the centralized, financially and administratively unsustainable social security system, with a liberal welfare system focusing on providing a safety net for the poor.

Scaling Up, Lourdes Hernández-Cordero, Susan P. Sturm, Kathleen Klink, Allan J. Formicola

Faculty Scholarship

Moments of crisis require big, bold ideas. In this chapter we will zoom out of our close examination of the Northern Manhattan Community Voices Collaborative experience to propose ways to scale up the things that worked for us in order to make them applicable at a national level. With this chapter we honor the intent of the W. K. Kellogg Foundation in its support of learning laboratories across the nation. Our goal is to contribute to the collective dialogue on how to improve the health care system. Specifically, we propose that making a healthier nation and reducing health care costs …

The Treatment Action Campaign's First Decade: Success Achieved?, Jung Cho

Honors Scholar Theses

South Africa is known to have the largest HIV epidemic in the world with 5.7 million people currently living with HIV, according to UNAIDS. In light of the crisis, South Africa's Treatment Action Campaign (TAC) has led the social movement for increased treatment access for people living with HIV through lobbying the government, multinational pharmaceutical companies, and grassroots campaigning. Since it's founding a decade ago, TAC has been highly acclaimed both regionally and internationally for its success. In order to determine the success of this social movement organization, social movement theories, such as mobilization potential, external political opportunity structure, and …

Children's Health Insurance Program: The Dynamics Of Federalism And Health Care Policy, Erik White

Political Science Theses and Capstones

On February 4^th, 2009, President Obama signed into law the reauthorization of the Children Health Insurance Program. The federal government will now spend 30 billion dollars towards the goal of ensuring that more children in the United States are insured. I investigate this particular health care policy and look at the different dynamics that affect the ultimate goal of universal health insurance for children. Because this program allows for state flexibility under broad federal guidelines, one is able to look at individual states, and their particular actions and characteristics, to determine the best approach to insuring the most …

Building The Foundation For A Healthy Life: Individuals, Communities And The State, John W. Seavey, Josephine B. Porter, Barbara Arrington

The University Dialogue

No abstract provided.

Evaluation Of Hiv Counseling And Testing In Anc Settings And Adherence To Short Course Antiretroviral Prophylaxis For Pmtct In Francistown, Botswana, Carolyn Baek, Tracy Creek, Lee Ann Jones, Louis Apicella, Jennifer Redner, Naomi Rutenberg

HIV and AIDS

The vast majority of children infected with HIV are the result of mother-to-child transmission (MTCT) of the virus during pregnancy, labor, or breastfeeding. Botswana is one of the first countries in the developing world with a national prevention program (PMTCT) to reduce vertical transmission. The Horizons Program of the Population Council, in collaboration with the Centers for Disease Control and Prevention (CDC) and Premiere Personnel in Botswana, conducted an evaluation to describe the adherence of pregnant women to the current PMTCT regimen. The report recommends standardizing post-test counseling content through the use of job aids and adapting existing WHO materials, …

Kenya's Fertility Transition: Trends, Determinants And Implications For Policy And Programmes, Ian Askew, Alex C. Ezeh, John Bongaarts, John Townsend

Reproductive Health

In Africa, fertility rates in the 1990s declined less rapidly than had been projected, and in a few cases the fertility transition appears to have stalled. This development has serious implications for future population growth because projected population size is sensitive to minor variations in current fertility trends. The 16 countries with three DHS surveys in sub-Saharan Africa can be divided into three subgroups: stalled transitions, insignificant declines, and significant declines. Half of the 16 countries experienced a stall, and an additional two experienced insignificant declines. The Population Council prepared a series of demographic and policy analyses that drew from …

Global Trends In Aids Mortality, John Bongaarts, Francois Pelletier, Patrick Gerland

Poverty, Gender, and Youth

This working paper reviews the evolution of the HIV/AIDS epidemic and provides estimates of past trends and future projections of AIDS mortality indicators, including numbers of AIDS deaths, the proportion of all deaths that are due to AIDS, and life expectancy. A cumulative total of 24 million people have died from AIDS between 1980 and 2007, and by 2030 this total is projected to reach 75 million. Despite the rapid spread of this new disease during the 1980s and 1990s, the epidemic has reached a major turning point in recent years as the rate of new infections peaked and began …

Reference Guides For Health Care Organizations Seeking Accreditation For High-Quality, Gender-Sensitive Reproductive Health Services, Patricia Riveros, Erica Palenque, Ricardo Vernon, Ignacio Carreno, John H. Bratt

Reproductive Health

Bolivia’s Integral Health Coordination Program (PROCOSI), a network of 33 nongovernmental organizations (NGOs) providing reproductive health care, has long promoted gender sensitivity as a necessary component of high-quality health care. PROCOSI encourages member NGOs to address gender-based differences in roles, relationships, access to services, and service needs in their reproductive health programs. The Reference Guides in this publication provide guidance to help health-care organizations and NGOs implement high-quality, gender-sensitive standards to achieve certification for their member clinics and administrative centers. The procedures and standards included here are based on the process developed by PROCOSI, but the approach and standards can …

Reference Guides For Health Care Organizations Seeking Accreditation For High-Quality, Gender-Sensitive Reproductive Health Services—Appendixes, Patricia Riveros, Erica Palenque, Ricardo Vernon, Ignacio Carreno, John H. Bratt

Reproductive Health

Bolivia’s Integral Health Coordination Program (PROCOSI), a network of 33 nongovernmental organizations (NGOs) providing reproductive health care, has long promoted gender sensitivity as a necessary component of high-quality health care. PROCOSI encourages member NGOs to address gender-based differences in roles, relationships, access to services, and service needs in their reproductive health programs. Included in this document are the Appendixes to “The Reference Guides for Health Care Organizations Seeking Accreditation for High-Quality, Gender-Sensitive Reproductive Health Services,” which provide guidance to help health-care organizations and NGOs implement high-quality, gender-sensitive standards to achieve certification for their member clinics and administrative centers. The procedures …

Global Health And Politics: Julia Alvarez’ Saving The World, Amrita Das

The Coastal Review

Julia Alvarez’ novel Saving the World (2006) is a comment on the politics of Global Health. Alvarez reconstructs the tale of Isabel Sendales y Gomez, the lone female participant in the early 19th century’s Spanish Royal Expedition to eradicate smallpox around the world, mainly in the Spanish colonies. The historical narrative is paralleled by the tale of Alma Rodríguez, a 21st Century Dominican American author who is faced with a similar situation, aiding in an idealistic project to eradicate AIDS in the Dominican Republic. Alvarez’ work throws into sharp relief what happens when the philanthropic ideals of healing the world …

Assessment Of Risk Factors For Hiv Infection Among Men Who Have Sex With Men In The Metropolitan Area Of Campinas City, Brazil, Using Respondent-Driven Sampling, Maeve De Mello, Adriana De Araujo Pinho, Magda Chinaglia, Waimar Tun, Aristides Barbosa Junior, Maria Cristina, F.J. Ilario, Paulo Reis, Regina C.S. Salles, Suzanne Westman, Juan Diaz

HIV and AIDS

The Population Council, in collaboration with the Brazil Ministry of Health, the Municipal Program of STD/AIDS of Campinas, and the US Centers for Disease Control and Prevention/Global AIDS Program/Brazil, conducted a study to characterize the sociodemographic, behavioral, and environmental factors associated with subgroups of MSM who are most at risk for HIV infection. This research is the first Brazilian study to provide population-based estimates for HIV, syphilis, and HIV-related risk behaviors using an innovative sampling technique to reach members of the target population. Our data suggest the importance for HIV prevention programs to address not only sexual risk reduction, but …

Is It Feasible To Integrate Alcohol-Related Risk Reduction Counseling Into Vct Services? Findings From Kenya, Caroline Mackenzie, Karusa Kiragu, George Odingo, Rukia Yassin, Peter Shikuku, Patrick Angala, Nduku Kilonzo, William Sinkele, Melania Akinyi

HIV and AIDS

In Kenya, an estimated 30 percent of men report to be alcohol users which may be fueling the HIV pandemic, due to its association with high-risk sexual behavior and reduced inhibitions. The Population Council’s Horizons program collaborated on a study to improve screening of clients for alcohol use, provision of feedback of screening results, and referrals to care and support during voluntary testing and counseling (VCT) for HIV. Overall, the results indicate that it is feasible to integrate alcohol risk reduction counseling into VCT, and that it is generally accepted by providers and clients alike. This study therefore supports the …

Promoting Gender Equity As A Strategy To Reduce Hiv Risk And Gender-Based Violence Among Young Men In India, Ravi K. Verma, Julie Pulerwitz, Vaishali Sharma Mahendra, Sujata Khandekar, A.K. Singh, S.S. Das, Sunil Mehra, Anita Nura, Gary Barker

HIV and AIDS

The Horizons Program, CORO for Literacy, MAMTA, and Instituto Promundo developed, piloted, and scaled-up a behavior-change intervention in India to examine the effectiveness of interventions to improve young men’s attitudes toward gender roles and sexual relationships, and to reduce HIV risk behaviors and partner violence. The results of this study suggest that young men became less supportive of inequitable gender norms after participating in the interventions. Similarly, there were significant improvements among intervention participants in key outcome indicators, including condom use, partner communication, partner violence, and attitudes toward PLHIV. To maximize the chances of long-term sustainability of these positive changes, …

Catalyzing Personal And Social Change Around Gender, Sexuality, And Hiv: Impact Evaluation Of Puntos De Encuentro´S Communication Strategy In Nicaragua, Irela Solorzano, Amy Bank, Rodolfo Pena, Henry Espinoza, Mary Ellsberg, Julie Pulerwitz

HIV and AIDS

Somos Diferentes, Somos Iguales (SDSI) is a communication for social change strategy whose objective is to prevent future HIV infections in Nicaragua, through mass communication actions that include educational entertainment programs, strengthening of local capacity, and the development of alliances within the communities. This report presents the results of an interinstitutional evaluation to explore the impact of SDSI on gender equity, stigma reduction, personalization of risk perception, knowledge and use of services, interpersonal communication, HIV prevention practices, and individual and collective effectiveness for HIV prevention. The impact evaluation showed that the SDSI strategy made a great contribution in key aspects …

Propiciando Cambio Personal Y Social Alrededor Del Género, Sexualidad Y Vih: Evaluación De Impacto De La Estrategia De Comunicación De Puntos De Encuentro En Nicaragua, Irela Solorzano, Amy Bank, Rodolfo Pena, Henry Espinoza, Mary Ellsberg, Julie Pulerwitz

HIV and AIDS

Somos Diferentes, Somos Iguales (SDSI) is a communication for social change strategy whose objective is to prevent future HIV infections in Nicaragua, through mass communication actions that include educational entertainment programs, strengthening of local capacity, and the development of alliances within the communities. This report presents the results of an interinstitutional evaluation to explore the impact of SDSI on gender equity, stigma reduction, personalization of risk perception, knowledge and use of services, interpersonal communication, HIV prevention practices, and individual and collective effectiveness for HIV prevention. The impact evaluation showed that the SDSI strategy made a great contribution in key aspects …

Caring For Caregivers: An Hiv/Aids Workplace Intervention For Hospital Staff In Zambia—Evaluation Results, Karusa Kiragu, Mutinta Nyumbu, Thabale J. Ngulube, Panganani Njobvu, Chilufya Mwaba, Arthur Kalimbwe, Spike Bradford

HIV and AIDS

The Horizons Program collaborated on a Caring for Caregivers initiative in Zambia whose objective was to develop and test a risk-reduction workplace program for hospital staff. This was motivated by the recognition that hospital workers are often overlooked in HIV programming, and yet many are infected or affected by HIV. It was also motivated by the fact that hospital staff are heterogeneous, with both clinical and non-clinical staff having varying levels of understanding regarding HIV transmission. Caring for Caregivers was a peer education program targeted at hospital staff and implemented in two hospitals in Zambia, with a combined staff of …

Repositioning Postnatal Care In A High Hiv Environment: Swaziland, Charlotte E. Warren, Rachel Shongwe, Allen Waligo, Mohammed Mahdi, Goldy Mazia, Indira Narayanan

HIV and AIDS

This Horizons report from the Swaziland Ministry of Health and Social Welfare discusses findings from an intervention which aimed to reposition postnatal care within the context of a high HIV prevalence environment. The objectives were to determine if changes to the sexual and reproductive health guidelines on postnatal care would result in the timely and quality provision of key components of essential maternal and newborn care in the postnatal period, increase utilization of postnatal care services among all postpartum women, and improve the care and follow up of HIV-positive postpartum women and their infants. The study confirms that the introduction …

Improving Hospital-Based Quality Of Care In Vietnam By Reducing Hiv-Related Stigma And Discrimination, Khuat Thi Hai Oanh, Kim Ashburn, Julie Pulerwitz, Jessica Ogden, Laura Nyblade

HIV and AIDS

To address HIV-related stigma and discrimination, and improve the quality of care in the healthcare setting in Vietnam, the Institute for Social and Development Studies, the International Center for Research on Women, and the Horizons Program conducted intervention research in four hospitals. The study team conceptualized two fundamental causes of HIV-related stigma: 1) fear of casual transmission; and 2) negative values/social judgments and associations between HIV and certain behaviors and groups, such as sex workers and injecting drug users. Both intervention strategies successfully reduced stigma and discrimination toward HIV-positive patients in these healthcare settings. The findings show that addressing stigma …

Assessment Of Risk Factors For Hiv Infection In Female Sex Workers And Men Who Have Sex With Men In Ciudad Del Este, Paraguay, Magda Chinaglia, Waimar Tun, Maeve Mello, Magdalena Insfran, Juan Diaz

HIV and AIDS

Research conducted by the Population Council/Brazil, supported by the USAID-funded Horizons Project, documents findings from a study in Paraguay among men who have sex with men and female sex workers to estimate HIV and syphilis prevalence; examine knowledge, attitudes, and risk behaviors related to HIV and STIs; and describe the contextual and behavioral factors influencing HIV and STI transmission. Findings provide guidance to the development of HIV and STI prevention and care interventions and further operations research to test strategies and interventions to reduce the spread of HIV and STIs in these groups.

School As A Workplace In Kenya: Evaluation Of The Teachers Matter Hiv/Aids Project, Karusa Kiragu, Caroline Mackenzie, Jennifer Weiss, Murungaru Kimani, Debbie Gachuhi

HIV and AIDS

The Horizons program of the Population Council embarked on an operations research initiative in Kenya to test the feasibility of implementing a teacher-centered workplace program based in schools. The study was conducted in partnership with the Ministry of Education, the Kenya Institute of Education, the Teachers Service Commission, and UNICEF. Called Teachers Matter, the project’s main audience was primary and secondary school teachers. The purpose of the research was to assess whether such a program would improve teachers’ HIV-related knowledge, attitudes, and behaviors; increase the proportion of teachers seeking voluntary testing and counseling; and enhance their ability to cope with …

Moving Forward: Tackling Stigma In A Tanzanian Community, Laura Nyblade, Kerry Macquarrie, Gideon Kwesigabo, Aparna Jain, Lusajo Kajula, Fausta Philip, William Henerico Tibesigwa, Jessie K. Mbwambo

HIV and AIDS

The International Center for Research on Women, the Muhimbili University College of the Health Sciences, the Population Council, and Family Health International conducted an evaluation of a community-based effort to reduce stigma surrounding HIV infections in a peri-urban community in Tanzania. Results presented a mixed, but hopeful, picture for a way forward in tackling stigma at the community level. Tackling stigma requires that the individuals tasked with doing this undergo personal change. Programs can start by focusing stigma-reduction efforts on a smaller, more manageable geographical area and adding specific anti-stigma components to their portfolio of activities. Engaging community opinion leaders …

If You Build It, Will They Come? Kenya Healthy Start Pediatric Hiv Study: A Diagnostic Study Investigating Barriers To Hiv Treatment And Care Among Children, Karusa Kiragu, Katie D. Schenk, Julie Murugi, Avina Sarna

HIV and AIDS

In Kenya the proportion of eligible HIV-positive children receiving ART treatment is only 11 percent. This study explored and documented possible barriers in the community to accessing pediatric HIV testing and treatment, to guide the development of new interventions to encourage uptake. The study identified barriers such as cost, use of traditional healers, low knowledge of treatment options, attitudinal barriers, stigma, unique treatment issues, and dissatisfaction with available services. Additionally, healthcare workers missed opportunities to provide services and cited numerous service-side challenges. The study recommends prioritizing community awareness, mobile clinics, strengthening capacity of healthcare workers, supporting family-based HIV testing, and …

The Limits Of Health Care Reform, Ani B. Satz

Faculty Articles

Part I of this Article provides a context for understanding health law in 2008. It discusses the complex relationships between the various actors, at both the federal and state levels, which affect the distribution, provision, and regulation of health care, as well as the role of technological devel­opments in these relationships. Individuals familiar with health law may choose to skip this Part.

Parts II and III address the theoretical underpinnings of basic mini­mum and rationing approaches, respectively. Part II discusses the contractarian foundations of basic minimum schemes. It focuses on the distribu­tion of health care goods as primary goods (goods …

Institutionalization Of Quality Assurance Within District Health Management: Experiences From Maharashtra And Karnataka, M.E. Khan, Anurag Mishra, Vivek Sharma, Jaleel Ahmad, Jose Joseph, Venkatesh Srinivasan, K.M. Sathyanarayana, Viji Vargees, K.D. Maiti, Rashmi Sharma

Reproductive Health

The Population Council, with financial support from UNFPA, provided technical assistance to the states of Maharashtra and Karnataka, India in implementing a quality assurance (QA) program and helped its institutionalization in the district level of health management. An analysis of all the facilities covered as of December 2007 revealed substantial gaps in the infrastructure and human resources available to provide good-quality services, as well as adherence to standards for providing the services. To build the capacity to undertake QA visits, the Population Council and state authorities organized a series of events to orient and train state and district officials, facility-level …

Assessment Of Maine's Long-Term Care Needs Baseline Report: Demographics And Use Of Long Term Care Services In Maine, Stuart Bratesman Mpp, Julie T. Fralich Mba, Karen Mauney, Catherine Mcguire Bs, Louise Olsen, Jasper Ziller

Disability & Aging

In 2006, the Office of Elder Services requested the assistance of the Muskie School in developing an assessment of long term care service use in Maine. This report provides baseline information on the demographic characteristics, participant characteristics and service use trends for people accessing long term care services in this State.

For purposes of this report, we have excluded people with MR/DD. Long term care services do not include community support services for people with mental illness.

In this report, long term care services include:

• Nursing Facility Services
• Private Non-medical Institutions
• Consumer Directed Attendant Services
• Day Health Services
• Elder and …