Knowledge and attitudes of primary health care personnel concerning mental health problems in developing countries: a follow-up study

Within the context of a World Health Organization coordinated collaborative study health workers in six developing countries were assessed 18 months after their training for improvement in their knowledge and attitude towards mental health problems and their management. The approaches to training varied between study areas, but the degree of improvement following the training, was of equal magnitude in all countries. The training process has formalized the recognition by the health workers that treatment of mental health problems is an integral part of their work.     

Urbanization and mental health in developing countries

It is expected that the urban population in developing countries will double in the next 30 years. While urbanization is accompanied by health problems, population density can lower public health costs. Common mental disorders, such as anxiety, depression, insomnia, fatigue, irritability, and poor memory, account for 90% of all mental disorders, cause behavioral problems in offspring, and impede recovery from physical ailments. Those who suffer most from common mental disorders include women, those between 15 and 49 years old, and low-income populations. Strong links have been established between socioenvironmental factors and common mental disorders, and an urban environment has been associated with many possible risk factors for such disorders. Only a small percentage of people with mental disorders seek primary health care and even less receive secondary- or tertiary-level care. Common mental disorders place a large burden on primary health care services, however, but most of the patients suffering from mental disorders seek care for physical disorders that mask proper diagnosis and treatment. Thus, the World Health Organization advocates the introduction of mental health components in primary health care services in developing countries. In order to reach those who remain outside of the health care system, community-based interventions such as self-help groups or efforts to promote wider social changes or address poverty should be undertaken. Mental health in developing countries is gaining attention as the attendant loss in economic productivity of human capital has become apparent.     

Water supply and health in developing countries: selective primary health care revisited

The inclusion of water supply and sanitation programs as a component of primary health care (PHC) has been questioned on the basis of calculations of the costs of these programs per infant death averted. In this paper the procedures used in these cost-effectiveness calculations are examined and found to be wanting. The calculations are misleading since gross rather than net costs have been used, and the health impact of these programs underestimated. It is also shown that the methodology used is biased against water supply and sanitation and other programs with multiple outputs. The time constraints facing mothers in implementing PHC programs, as well as the contribution of improved water supplies in alleviating these constraints are outlined. Data are presented to show that, if poor women in developing countries were to choose the mix of activities to be included in PHC programs, improved water supplies would frequently constitute part of that mix.     

Managing the health care market in developing countries: prospects and problems

There is increasing interest in the prospects for managed market reforms in developing countries, stimulated by current reforms and policy debates in developed countries, and by perceptions of widespread public sector inefficiency in many countries. This review examines the prospects for such reforms in a developing country context, primarily by drawing on the arguments and evidence emerging from developed countries, with a specific focus on the provision of hospital services. The paper begins with a discussion of the current policy context of these reforms, and their main features. It argues that while current and proposed reforms vary in detail, most have in common the introduction of competition in the provision of health care, with the retention of a public monopoly of financing, and that this structure emerges from the dual goals of addressing current public sector inefficiencies while retaining the known equity and efficiency advantages of public health systems. The paper then explores the theoretical arguments and empirical evidence for and against these reforms, and examines their relevance for developing countries. Managed markets are argued to enhance both efficiency and equity. These arguments are analysed in terms of three distinct claims made by their proponents: that managed markets will promote increased provider competition, and hence, provider efficiency; that contractual relationships are more efficient than direct management; and that the benefits of managed markets will outweigh their costs. The analysis suggests that on all three issues, the theoretical arguments and empirical evidence remain ambiguous, and that this ambiguity is attributable in part to poor understanding of the behaviour of health sector agents within the market, and to the limited experience with these reforms. In the context of developing countries, the paper argues that most of the conditions required for successful implementation of these reforms are absent in all but a few, richer developing countries, and that the costs of these reforms, particularly in equity terms, are likely to pose substantial problems. Extensive managed market reforms are therefore unlikely to succeed, although limited introduction of particular elements of these reforms may be more successful. Developed country experience is useful in defining the conditions under which such limited reforms may succeed. There is an urgent need to evaluate the existing experience of different forms of contracting in developing countries, as well as to interpret emerging evidence from developed country reforms in the light of conditions in developing countries.     

Problem-based learning for training primary health care managers in developing countries

Summary. The ‘International Course for Primary Health Care Managers at District Level In Developing Countries’ (ICHM) came into being in 1988. Its creation was the direct result of an Italian Government initiative to improve the managerial skills of health care personnel at intermediate level. Problem-based learning (PBL) was selected as the most promising educational approach and the method became associated with primary health care (PHC) management. At the end of three experimental years (1988–1990) a basic course structure that would be open to continual improvement was defined. This paper describes how PBL was implemented practically in 1991, the main problems identified with the method and the corrective action taken for the year 1992.     

Knowledge and attitudes in multicultural health care

Health professionals' knowledge of ethnic minority cultures and lifestyles was assessed to determine whether the respondents' cultural background and experience of working with ethnic minorities affected the health care delivered by them and to assess the need for training. Improving access to health services for ethnic minorities requires continuing education and training of all health professionals.     

Women's access to health care in developing countries.

Women in developing countries are frequently confronted with a myriad of socio-cultural factors which negatively impinge upon physical well-being and accessibility to appropriate health care services. Institutional, economic, and educational barriers effect and lowers their standard of living when compared to their male counterparts. Women must become agents of change to improve their situation. Factors such as access to income, legal rights, social status, and education may prove far more important in determining women's access to health care than technology distribution and governmental strategies.     

Elderly self care education: a low technology primary health care option for developing countries.

This article presents a number of perspectives on the curriculum building processes as well as the methodology and content of a self care training curriculum and information packet that were prepared and field for the development of a model self care education program for older persons. Course content and topical areas are outlined, and various training agenda and educational materials are described. Although this program was undertaken as part of the national goal to develop a health promotion and disease prevention strategy for older people in the United States, a number of insights, principles and implications drawn from the curriculum development activities and field testing experiences are applicable to other countries, especially developing nations where the problems and needs of the aged are becoming increasingly apparent in the face of ever shrinking resources.     

发展中国家的医疗卫生服务体系

考察了发展中国家的卫生筹资和服务提供体系,并认为发展中国家需要扩大医疗保障覆盖面,需要重新关注初级卫生保健和公共卫生,只有这样才能不断完善其卫生体系。     

The viability of the concept of a primary health care team in developing countries

The concept of a team approach in primary health care (PHC) is an integral part of the overall PHC strategy and is advocated at many occasions. Its theoretical advantages are multiple, even though very few sound studies exist on the effectiveness of PHC team. The viability of the concept of PHC teams is affected by two groups of factors. The first group is related to (health) manpower problems in developing countries with its underlying economic causes. The second group of factors is associated with the viability of the PHC concept in general. This pertains to decentralization, intersectoral collaboration and community participation which all affect the viability of the concept of PHC teams.     

Innovations in health care financing in developing countries

The severe health care crisis in developing countries calls for a new health care financing system based on tailor-made health insurance schemes. Although there are manifold attempts of installing new risk sharing pools in developing countries, most of them are suffering from poor acceptance by the local population. In order to avoid that a nation-wide insurance system will prove unsustainable, the Ministry of Health of Uganda asked a team of consultants to tailor such a scheme for this East-African country. This paper presents the basic findings of the consultancy report, stressing the fact that a single insurance won’t work in Uganda. There must be a well-balanced public-private mix and a strong distinction between locations, e.g. ÁMutual Health Funds Ñ in urban and ÁLocal Health Care Plans Ñ in rural areas     

新一轮医改以来我国基层卫生人力资源现状及问题分析

目的:分析新一轮医改以来我国基层卫生人才资源现状和问题,为稳定基层卫生人才队伍提供参考。方法:运用描述性统计分析和公平性分析方法,分析我国基层医疗卫生人员的数量、结构和分布公平性。结果:基层卫生人员数量显著增加,人员素质有所提升;以省为单位的东中西部地区基层卫生人员Gini系数和泰尔指数均不断减小;东部地区内部的差异是影响总体差异的主要因素。结论:我国基层卫生人才队伍仍存在人员数量不足和流失并存、职称结构失衡以及城乡、地区差距较大等问题;主要原因有激励机制不合理、人员配置行政化、医改部分措施的协同作用有待进一步发挥等;建议进一步改革收入分配制度、提高基层治理能力和加强政策协同,以吸引和稳定基层卫生人才队伍。     

Health information technology in primary health care in developing countries: a literature review

This paper explores the debate and initiatives concerning the use of information technology (IT) in primary health care in developing countries. The literature from 1992-2002 was identified from searches of the MEDLINE, Latin American and Caribbean Health Science Literature Database (LILACS), Cochrane Library and Web of Science databases. The search identified 884 references, 350 of which were classified according to the scheme described by the Pan American Health Organization (PAHO). For the analysis of advantages, problems and perspectives of IT applications and systems, 52 articles were selected according to their potential contribution to the primary health-care processes in non-developed countries. These included: 10 on electronic patient registries (EPR), 22 on process and programmatic action evaluation and management systems (PPAEM) and 20 on clinical decision-support systems (CDS). The main advantages, limitations and perspectives are discussed.