Local implementation of the Family Health Program in Brazil

This article discusses the implementation of the Family Health Program in the municipalities of Camaragibe, Aracaju, S?o Gon?alo, and the Federal District of Brazil, aiming to identify possible interfaces between the program's shaping and different incentives structures, the local health system's case-resolving capacity, experiences with social participation, and accountability mechanisms. The article shows that aspects related to the constitution of local health systems in terms of the quantitative and qualitative supply of services, technical and management training within the Municipal Health Department, investment in other levels of care, and local political traditions are crucial variables for understanding the diversity of experiences in the implementation of the Family Health Program.     

Impact of an Integrated Adolescent Reproductive Health Program in Brazil

An impact evaluation of an integrated school- and health-clinic-based adolescent reproductive health initiative was undertaken by the State Secretariats of Health and Education in Bahia, Brazil during 1997-99. The project was initiated in response to continued high pregnancy rates among adolescents and growing numbers of new HIV infections among young adults. It sought to promote responsible sexual and health-seeking behaviors among public secondary-school students, including the use of public health clinics. The study design included a matched control group used to measure project impact. The findings indicate that the project was successful in increasing the flow of sexual and reproductive health information to secondary-school students and that it had an impact on adolescents' intentions to use public health clinics in the future. No effects on sexual or contraceptive-use behaviors or on use of public clinics were observed, however. Client exit-interview data from a subset of project clinics indicate that adolescents who use clinic-based services are overwhelmingly female and considerably older on average and much more likely ever to have been pregnant than are adolescents in the target population for the project.     

A Cost Analysis of a Community Health Worker Program in Rural Vermont

Studies have shown that community health workers (CHWs) can improve the effectiveness of health care systems; however, little has been reported about CHW program costs. We examined the costs of a program staffed by three CHWs associated with a small, rural hospital in Vermont. We used a standardized data collection tool to compile cost information from administrative data and personal interviews. We analyzed personnel and operational costs from October 2010 to September 2011. The estimated total program cost was $420,348, a figure comprised of $281,063 (67 %) for personnel and $139,285 (33 %) for operations. CHW salaries and office space were the major cost components. Our cost analysis approach may be adapted by others to conduct cost analyses of their CHW program. Our cost estimates can help inform future economic studies of CHW programs and resource allocation decisions.     

Evaluation of the Nigerian Urban Reproductive Health Initiative (NURHI) Program

Gaps remain in understanding whether family planning (FP) programs can change urban women's FP behaviors. Even less is known about what works among poor urban women. This article presents results of the impact evaluation of the Nigerian Urban Reproductive Health Initiative (NURHI). Findings are based on recently collected longitudinal data from women and facilities in six cities in Nigeria. Over the four‐year follow‐up period, there was an increase of about ten percentage points in modern method use. Impact evaluation analyses using fixed‐effects regression methods indicate that both demand‐ and supply‐side program activities increased modern method use. Radio, television, community events, and living near program‐enrolled health facilities all significantly increased modern method use or were related to a desire for no more children among all women and among poor women. Results are discussed with an eye toward the design and scale‐up of future family planning programs in urban Nigeria and elsewhere in sub‐Saharan Africa.     

A study on effective implementation of the Shinjuku Regional Occupational Health Center Program in Japan]

The Regional Occupational Health Center (ROHC) Program is aimed at improving occupational health services for small-scale enterprises (SSEs) with less than 50 employees. In 1993 the ROHC program began as a new policy announced by the national government, which entrusted the management to regional medical associations. The establishment of 347 ROHCs has completed in 1997. SSEs are able to use several services, such as workplace visits and health consultations at SSEs, but ROHCs have often been under-utilized. Purpose of this study was to discuss the effective implementation of ROHCs through a couple of surveys of potential and actual ROHCs users. Two surveys were conducted in the area of the Shinjuku ROHC. Survey 1: The subjects were 78 SSEs that used The Shinjuku ROHC between October 1996 and March 1999. A qualitative evaluation was carried out for 78 SSEs about users' positions, opportunities for use and kinds of consultations. Survey 2: The subjects were 50 users of the ROHC between April 1998 and March 1999. The effective response rate was 56.0%. A questionnaire survey was conducted on users' impressions before and after using the ROHC and on requests for further service. Survey 1 showed users' positions were office workers 36.5%, managers 32.0%, directors 17.0%, health nurses 9.0% and employees 3.5%, half of the users were recommend by the Labour Standards Inspection Office. The kind of consultation were on Industrial physicians, 22.9%, Occupational health control systems, 19.1% and ROHC functions, 16.8%. Survey 2 showed that almost but all users had misunderstood the ROHC's function before utilizing of its services, but many users were satisfied with the services provided. First, ROHCs need to make known their existence and the content of their services available to SSEs. Second, ROHCs have to improve their availability to SSEs. Third, ROHCs have to ensure the quality of their services to make users satisfied. And cooperation with other occupational health institutions will become important as the ROHC Program continues to develop.     

Adolescent Reproductive Health in Indonesia: Contested Values and Policy Inaction

This study examines the changing social and political context of adolescent sexual and reproductive health policy in Indonesia. We describe how, in 2001, Indonesia was on the brink of implementing an adolescent reproductive health policy that was consistent with international agreements to which the Indonesian government was a party. Although the health of young Indonesians was known to be at risk, the opportunity for reform passed quickly with the emergence of a new competing force, Middle Eastern fundamentalist Islam. Faced with the risk of regional separatism and competing politico-religious influences, the Indonesian government retreated to the safety of inaction in this area of policy. In the absence of a supportive and committed political environment that reinforces policy specifically targeted to young people's reproductive health, extremist approaches that involve considerable health risk prevailed. The sexual and reproductive values and behaviors that are emerging among single young people in contemporary Indonesia are conditioned by a political context that allows the conflicting forces of traditional Indonesian values, Westernization, and the strong emerging force of fundamentalist Islam to compete for the allegiance of young people.     

Vouchers for health: A demand side output-based aid approach to reproductive health services in Kenya

Abstract

Reaching the United Nation's Millennium Development Goals has been a focus for many countries and development partners. In Kenya, as in many other countries with low levels of development, access to and equity of basic quality health services is limited, especially for the very poor. Among poor populations, maternal mortality is high as access to medical care and financial means are lacking. In 2005, the Governments of Kenya and Germany in cooperation with KfW Banking Group made funds available for the Reproductive Health OBA Voucher Programme offering vouchers for Safe Motherhood, Family Planning and Gender Violence Recovery Services. This programme, herein referred to as Vouchers for Health, was launched in June of 2006 in five Kenyan districts with the aim of providing health services for safe deliveries, long-term family planning methods and victims of gender violence. The way that the programme is being implemented in Kenya demonstrates that the voucher-based approach comprises a variety of key structural elements of a national health insurance scheme: accreditation; quality assurance; reimbursement system; claims processing; integrating the private sector; client choice; provider competition; and access to and equity of services provided.     

Reproductive Health Hazards in the Workplace: Guidelines for Policy Development and Implementation

Abstract

To provide occupational health professionals and employers with guidelines for reproductive health policy making, the authors— both of whom are obstetrician-gynecologists and occupational medicine physicians—review the history of and legal basis for U.S. policy on work and reproduction, delineate the goals and important elements of a reproductive health policy (RHP), and emphasize the need to incorporate an RHP into a comprehensive occupational injury and illness prevention program. After suggesting practical ways to achieve the goals of an RHP (maximal health protection, compliance with legal mandates, and reduction of liability), the authors propose a team-based model for RHP implementation with shared responsibility of management and workers in designing, enforcing, and evaluating the policy.     

Evaluation of a Policy,Systems, and Environmental-Focused Faith-Based Health Promotion Program

ObjectiveThis study assessed the impact and lessons learned from implementing policy, systems, and environmental (PSE) changes through Faithful Families Thriving Communities (Faithful Families), a faith-based health promotion program, in 3 southern states.MethodsFaithful Families classes and PSE changes were implemented through a coordinated effort between the Expanded Food and Nutrition Education Program (EFNEP) and Supplemental Nutrition Assistance Program–Education (SNAP-Ed). Changes were measured using a faith community assessment, site reports, and annual reporting.ResultsThirteen faith communities participated in the intervention. A total of 34 PSE changes were implemented across the 3 states, affecting 11 faith communities with 4,810 members across sites.Conclusions and ImplicationsPrograms such as Faithful Families can allow EFNEP and SNAP-Ed to coordinate to implement PSE changes in community settings. However, these types of coordinated programs to support faith communities require time for relationship building and trust, adequate training, and strong support for faith-based lay leaders as they carry out this work.     

Family Health Program implementation in municipalities in Mato Grosso State, Brazil

This article analysis some key aspects in the implementation of the Family Health Program (FHP): results; conditions; and institutional mechanisms; flow and regularity of funding; organizational structures; and human resources availability and training. The study was conducted in seven municipalities (counties) in the State of Mato Grosso, Brazil, and used secondary data as well as primary data from interviews with different stakeholders. The research design was evaluative, using a quantitative/qualitative analysis. The results showed: varying stages in the implementation process, different FHP models, and adaptation of organizational structures; high level of human resources availability, except for nurse assistants; availability of financial resources, with some difficulties in their flow; and other institutional factors that hinder or facilitate the micro-implementation process in the municipalities.     

辽宁省卫生总费用的政策分析

文章运用福利经济学的基本理论对辽宁省1990-2008年的卫生总费用进行了测算,从公平性角度对迁宁省卫生总费用占GDP比重、人均卫生费用、卫生总费用筹资构成、政府卫生投入水平和居民个人卫生投入水平进行了分析.     

大冶市某公司832例已婚妇女生殖健康状况分析

目的了解大冶市某公司女性生殖道感染状况，为此类疾病的防治提供科学依据。方法采用《中国妇产科学》的诊断标准，对该公司832名已婚妇女进行妇科疾病普查。结果所查妇女患有多种妇科疾病，患病率居前5位的是宫颈炎、阴道炎、附件炎、子宫肌瘤和卵巢囊肿，患病率分别为59．86％、30．17％、20．91％、10．46％和5．17％。宫颈炎多见于青壮年妇女．阴道炎多见于老年妇女。结论女性应进行定期体检，提高自我保健意识，促进其生殖健康，并应尽早进行治疗。     

基于卫生总费用核算结果的卫生政策分析框架

从政策分析框架的概念出发,针对卫生总费用核算结果涉及的卫生资金来源、使用、用途和产生的结果等政策分析的主要问题,提出了福利经济学的政策分析准则,并从收益分配公平、成本分配公平、配置效率和技术效率的维度,对相关政策分析问题进行了组织和梳理,建立了基于卫生总费用核算结果的卫生政策分析的基本框架。     

Health care reform in Kenya: a review of the process

The paper looks at the process of health care reform in Kenya during the past 30 years, with a focus on implementation strategies. The data are from official documents of the government. The main finding is that development plans served as the medium through which the government announced its intentions as well as its decisions to implement reforms. A decision to implement a reform was normally accompanied by an implementation budget, whereas an announcement of an intention typically lacked such support. Some of the reforms were implemented speedily and firmly, whereas others suffered delays and reversals. Reforms were implemented with speed and firmness when research provided clear guidance on key policy issues or when political will and skill existed. Donor influence on the timing of reforms might have been excessive. Policy lessons from the process are indicated.