Action research was conducted in Bangladesh to determine whether a high level of fertility control behavior can be attained in a country of very low socioeconomic status, including very low levels of literacy and women's status, and if management training help can improve the performance of service delivery systems. 20 family planning officials participated in a 14-week, non-degree, management training program conducted in Dhaka. The research found that competently executed determined effort is a far faster and more effective alternative to socioeconomic development-led contraception in a developing population. A carefully designed and executed intervention can achieve a high level of contraceptive use, and thereby control fertility, without waiting for significant improvement in a country's socioeconomic indicators. For example, in the 19 experimental thanas, the contraceptive prevalence rate increased by an average of approximately 10 percentage points within 12 months of training. These findings demonstrate how a task-focused, well-designed, and properly conducted management training, backed by well organized and managed follow-up, can effect major improvement in a system's effectiveness and productivity, even if that system is staffed by a demoralized and apathetic work force.
Best practices, policy and innovations in the administration of healthcare in developing communities and countries. For administrators, academics, researchers and policy leaders. Includes peer reviewed research papers. Edited by Dr. Judith Shamian, President Emeritus, International Council of Nurses, Professor and Co-investigator with the Nursing Health Services Research Unit, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON
Research from both developed and developing countries has shown that various indicators of socioeconomic status (SES) are inversely associated with infant and child mortality. However, findings on the association between SES and morbidity are less clear. The impact of SES upon diarrheal and respiratory morbidity among children aged 5 years or less was assessed through a survey of mothers in 2 of Kuwait's 5 major residential areas. Findings are based upon interviews conducted during January-March 1994 with the mothers of 781 children of maximum age 5 years in a sample of Kuwaiti households. Only Kuwaiti nationals were included in the study. Higher SES women used health care facilities relatively more often. However, after controlling for relevant demographic factors, the effect of SES upon morbidity varied for diarrheal and respiratory illnesses. There were no significant differences in the reported morbidity due to diarrheal illness in either the 2 areas or the various SES groups. An inverse association was identified between SES level and morbidity due to respiratory illness, with children in the low and medium SES groups having higher respiratory morbidity than those in the high SES group.
Best practices, policy and innovations in the administration of healthcare in developing communities and countries. For administrators, academics, researchers and policy leaders. Includes peer reviewed research papers. Edited by Dr. Judith Shamian, President Emeritus, International Council of Nurses, Professor and Co-investigator with the Nursing Health Services Research Unit, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON
Bangladesh has considerable national experience promoting and providing family planning services through home visits to reproductive-age married women by paid female community workers. Since 1978, the government has trained and employed 24,000 such workers, known as Family Welfare Assistants (FWA), while nongovernmental organizations (NGO) have trained and employed an additional 7000 field workers to carry out similar activities. NGO field workers are considered to be part of the national family planning program. Findings are presented from an assessment of the quality of family planning services provided by community-based field workers in zone 3 of Dhaka City, Bangladesh, and are based upon a large household survey of a representative sample of clients, direct field worker observation, and interviews with field workers and clients. Areas in greatest need of improvement include the frequency of contact with clients who are nonusers or who have special needs, client education about family planning methods, and counseling about side effects and warning signs.
Over the past decade, there has been a sharp increase in the reported and estimated numbers of HIV/AIDS cases in India. The UNAIDS estimates that up to 3 million people in India may be infected with HIV, of which 70-80% were infected through unprotected heterosexual activity. Findings are presented from an assessment of HIV/AIDS-related knowledge and awareness among slum dwellers in Delhi, India, and which factors affect that knowledge. To explore the links between socioeconomic, health, and migrant status generally, a survey was conducted in 1996 among 150 slum households from different parts of the city. The slum dwellers were all migrants from other states, living for at most 15 years in Delhi. All 361 adults in the selected households were interviewed. Despite significant investment in IEC activities by the State AIDS Cell over the past decade, respondents were found to be poorly informed about HIV/AIDS and how it is spread. The probability of having better knowledge about HIV/AIDS was higher among younger, more educated individuals, as well as among those who owned televisions and lived in certain zones.
Best practices, policy and innovations in the administration of healthcare in developing communities and countries. For administrators, academics, researchers and policy leaders. Includes peer reviewed research papers. Edited by Dr. Judith Shamian, President Emeritus, International Council of Nurses, Professor and Co-investigator with the Nursing Health Services Research Unit, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON
This paper attempts to gain insights into the health care system of Bangladesh from the perspectives of hospital patients. The study is based on survey data obtained from 207 recipients of health care services from 57 hospitals in Dhaka City. Patients' choice of hospital is influenced by referrals of doctors (28.7%), reputation of the hospital (23.7%), referral by family and friends (17.4%), closeness to home (14.9%), cost (7.4%) and other miscellaneous factors (7.9%). The major reason for selecting a particular hospital is for treatment (86%). Only few choose preventive or health maintenance services. Demographic trends indicate that better educated and more affluent people are more likely to seek private hospital care, while those who are less educated and less affluent are more inclined to seek public hospital care. The average length of hospital stay, both for private and public hospitals, was 9.9 days. Longer hospital stays are positively associated with nonavailability of needed medicines, poor upkeep of facilities, need to provide "tips" for services, lack of prompt services, a suffocating environment, and unexplained hospital costs. Average satisfaction rate was 4.85, with private hospitals earning higher average ratings than public facilities. The highest income groups gave the highest quality ratings (5.26) compared to other income groups. Implications of findings for health policy are outlined.
Best practices, policy and innovations in the administration of healthcare in developing communities and countries. For administrators, academics, researchers and policy leaders. Includes peer reviewed research papers. Edited by Dr. Judith Shamian, President Emeritus, International Council of Nurses, Professor and Co-investigator with the Nursing Health Services Research Unit, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON
Drawing experiences from two case studies at two districts in India, this paper highlights several lessons for effective implementation of a district health planning policy. District plans for both groups are discussed. Though these district plans both aimed to improve maternal health care, they were different in various aspects: in their content, in the roles played by the state, how they utilized data, and the attention given to their implementation. Most items in the District A plan did not directly relate to the concern chosen for planning; decentralized planning allowed functionaries at each level to decide their own plans; used data to assess the performance on "Health for All" goals of the district, but not to identify reasons for low performance; and gave minimal attention to the implementation. On the other hand, the District B plan was more focused in its attempt to improve service delivery. The state took an active role in developing a district planning policy and used modular approach to planning and utilized data to determine factors associated with access and quality of services. District officers were directly involved in removing all implementation obstacles, gave large attention on solving implementation problems while encouraging nongovernmental organizations to play a supportive role. The contrasting experiences of these two plans indicate that the success of decentralized planning relies on the degree of administrative and implementation support provided by the state, nongovernmental organizations, the community, and stakeholders. Conclusions and policy recommendations were given.
Best practices, policy and innovations in the administration of healthcare in developing communities and countries. For administrators, academics, researchers and policy leaders. Includes peer reviewed research papers. Edited by Dr. Judith Shamian, President Emeritus, International Council of Nurses, Professor and Co-investigator with the Nursing Health Services Research Unit, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON
Best practices, policy and innovations in the administration of healthcare in developing communities and countries. For administrators, academics, researchers and policy leaders. Includes peer reviewed research papers. Edited by Dr. Judith Shamian, President Emeritus, International Council of Nurses, Professor and Co-investigator with the Nursing Health Services Research Unit, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON
This article defines unmet reproductive and sexual health needs in South Asia, which is inhabited by 40% of the world's absolute poor and is now the poorest region in the world. The magnitude of unmet reproductive and sexual needs in the region is daunting, and its problems are many. However, a changing policy environment provides an opportunity to address unmet needs. Several of the countries in South Asia are making a paradigm shift and are restructuring their national programs to implement the International Conference on Population and Development Plan of Action. Nations are beginning to implement comprehensive sexual and reproductive health services. Translating reproductive rhetoric into reality in South Asia offers a challenge that necessitates concerted efforts of governments, donors, nongovernmental organizations, the private sector, and the largely civil community. Addressing unmet needs in the region calls for strategies targeted at neglected client groups such as women, men and adolescents, as well as implementing services to meet their priority reproductive and sexual health needs. The paper emphasizes interlinked gender, sexuality and rights issues within which these problems are embedded.
Exclusive and extended breast feeding is responsible for much of the fertility limitation and child spacing throughout the world. In many developing countries, where breast feeding is almost universal and of long duration, postpartum amenorrhea protects women from closely spaced subsequent pregnancies. However, at the same time, increased pressures toward modernization, rapid rural-to-urban migration, frequent advertisements of powdered milk substitutes, and the increased employment of women outside of the home are adversely affecting traditional breast feeding practices. In Bolivia, almost all women breast feed their newborn infants, for periods up to 2 years. This paper reports findings which describe and compare patterns of women's differential knowledge of breast feeding and lactational amenorrhea resulting from data collection using a survey instrument and a focus group guide. The findings are part of a larger study on infant feeding and child spacing conducted in periurban communities in Bolivia. Current and historical trends with regard to paradigm and methodology in social science research are reviewed and the survey/focus group research method is described.
Amid persistently high population growth rates in developing countries, people have questioned whether the recent change from a fertility-reduction oriented family planning program strategy to a reproductive health-oriented and meeting-unmet-needs based program of contraceptive services will slow the pace of fertility decline, exacerbating population problems and developmental issues in developing countries. The authors consider the question and suggest reorienting program strategy such that both the microlevel needs of couples and the macrolevel objective of fertility reduction are simultaneously and efficiently met. A birth-based approach to family planning program is proposed in which efforts will be made to identify all pregnant women and recently delivered mothers and provide services to them. This approach would comprise a key component of a reproductive health program. The authors empirically test the hypotheses that the unmet needs of contraception for birth spacing and limiting are relatively higher among recently delivered mothers than among all women of comparable age and parity, and that recently delivered mothers are self-selected for their higher fertility.
Best practices, policy and innovations in the administration of healthcare in developing communities and countries. For administrators, academics, researchers and policy leaders. Includes peer reviewed research papers. Edited by Dr. Judith Shamian, President Emeritus, International Council of Nurses, Professor and Co-investigator with the Nursing Health Services Research Unit, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON
Women in Bangladesh have a life-time risk of dying from pregnancy and child-related causes which is estimated to be about 500 times higher than that in the developed countries. More than 100 mothers die daily in Bangladesh due to maternity-related causes. Studies show that 5% of about 600,000 patients in Bangladesh with obstetric complications attend medical facilities, 27.5% of pregnant women receive some prenatal care, 3.5% of women deliver in institutions, and practically no women go for postnatal care. The provision of emergency obstetric care is an extremely important element in the prevention of maternal mortality. While there are inadequate emergency obstetric care services in Bangladesh, those which are available are underutilized because of the medical, social, cultural, economic, geographic, and community barriers women with obstetric complications encounter. The "three-delays" model proposed by Maine in 1993 depicts the roles of communities and the health system in the use status of emergency obstetric care. The model suggests that the outcome of an obstetric emergency is influenced by factors which govern the decision to seek care, reaching the medical facility, and receiving adequate treatment. These three delays impede the use of emergency obstetric care facilities. Using an econometric choice model, the authors identify the relative importance of the factors which affect the first two delays.
Best practices, policy and innovations in the administration of healthcare in developing communities and countries. For administrators, academics, researchers and policy leaders. Includes peer reviewed research papers. Edited by Dr. Judith Shamian, President Emeritus, International Council of Nurses, Professor and Co-investigator with the Nursing Health Services Research Unit, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON
