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1.
Washington; PAHO; 2012; 2012. v,223 p. (Scientific and technical publication No. 636^ien, 636).
Monografia em Inglês | MedCarib | ID: med-18196
2.
Rev. panam. salud pœblica ; 18(1): 37-44, Jun-July 2005.
Artigo em Inglês | MedCarib | ID: med-17063

RESUMO

The countries of Latin America and the Caribbean are facing the gradual phaseout of international-donor support of contraceptive commodities and technical and management assistance, as well as an increased reliance on limited public sector resources and a limited private sector role in providing contraceptives to the public. Therefore, those nations must develop multisectoral strategies to achieve contraceptive security. The countries need to consider information about the market for family planning commodities and services in order to define and promote complementary roles for the public sector, as well as to better identify which segments of the population each of those sectors should serve. While it is unable to mandate private sector participation, the poublic sector can create conditions that suport and promote a greater role for the private sector in meeting growing needs of family planning users. Taking steps to actively involve and expand the private sector's market share is a critical strategy for achieving a more equitable distribution of available resources, addressing unmet need, and creating a more sustainable future for family planning commodities and services (AU)


Assuntos
Humanos , Anticoncepção/estatística & dados numéricos , Anticoncepção/tendências , América Latina/epidemiologia , Atenção à Saúde/estatística & dados numéricos , Atenção à Saúde/tendências , Serviços de Planejamento Familiar , Acesso aos Serviços de Saúde , Marketing de Serviços de Saúde , Marketing Social , Região do Caribe/epidemiologia
3.
Rev. panam. salud publica ; 11(5/6): 418-424, May/June 2002. ilus, tab
Artigo em Inglês | MedCarib | ID: med-16976

RESUMO

This paper reviews policy tools or instruments for achieving more equitable financing of and access to health care services. The paper summarizes the economic rationale for public policies and the types of tools that governments can use in addressing resource allocation efficiency issues and equity objectives in order to reduce inequalities in the financing of national health systems and to improve equity in the access to health care services. Estimates are presented on the patterns of government expenditures and financing in countries of Latin America and the Caribbean. Estimates are also included on the level of government expenditures, the composition of revenues, the importance of government social and health expenditures, and the distribution of the benefits of government expenditures on health for different income groups. The last section of the paper presents policy challenges faced by the governments of Latin America and the Caribbean as they try to achieve more equitable financing of and access to health care services (AU)


Assuntos
Humanos , Acesso aos Serviços de Saúde/tendências , América Latina , Economia/tendências , Região do Caribe , Gastos em Saúde , Política Pública
4.
Mona; s.n; Nov. 2001. i,36 p. ilus, tab, gra.
Tese em Inglês | MedCarib | ID: med-17167

RESUMO

Reducing health inequities associated with poverty is an important public health concern. Most countries in expressing their commitment to primary health care and the reduction in inequity have embarked on a health reform process. This process involves the re-orientation of the health services to fit the primary health care model and bringing decision-making, planning of health policies and delivery systems closer to the people who are served by it. However developing the capability to establish reliable information systems and to analyze health status measures is a necessary adjunct to facilitate a more precise definition of sectoral priorities, improved programming, monitoring and evaluation of health programs in order to ensure a smooth transition and minimal displacement of those being served by the system. Community hospitals ... A retrospective study was carried out examining the records of women delivered at the community hospitals of the Northeast region during the period January to December 1999. A cross sectional survey of the women attending antenatal clinic at the facilities was also carried out using the hospital records and a questionnaire designed for the purpose. One third of the deliveries occuring in these facilities were found to be high risk and one of the two facilities was found to be having complication rate that is significantly higher than that of the general population. A fifth of the women are teenagers and the majority genrally of low socio economic status with very little earning potential. The majority however lived ... Which may explain their preference for using these facilities in spite of their risk status. Stricter attention should be paid to the women being admitted for delivery at community hospitals and a more liberal referral policy be adopted though it is noted that a significant number of high risk cases present to community hospital at a point in labour where time might not afford effective transfer. The community hospitals should therefore be equipped with basic resuscitation equipment inclusive of even one incubator for use while the compromised baby awaits transfer, and the nursing sraff and midwives under go frequent refresher courses re the management of common obstetric complications. A doctor should also be available on call on a twenty-four hour basis (AU)


Assuntos
Feminino , Gravidez , Acesso aos Serviços de Saúde , Política de Saúde , Gravidez , Parto , Jamaica , Região do Caribe
5.
Rev. panam. salud publica ; 10(3): 188-201, Sept. 2001. maps, tab
Artigo em Espanhol | MedCarib | ID: med-16963

RESUMO

In this day and age, public policies that aim to improve equity cannot limit themselves to seeking greater access for all to the job market; the lack of equity is also reflected in unequal access to health services, to education, and to political representation. In order to understand and attempt to correct this unequal access, an approach is needed that takes into account all the sociodemographic factors that shape inequality in the Region of the Americas, most notably sex, ethnic origin, and race. This paper is the product of a request by the Member States of the Pan American Health Organization for PAHO to make known the influence that race, ethnic origin, and sex have on the state of health and on access to health care services. The paper examines how racial discrimination and other forms of intolerance, the low socioeconomic and educational level of certain ethnic and racial groups, and cultural beliefs exert a decisive influence on individuals' search for health care and their possibilities of enjoying good health. This subject is particularly important this year, when the United Nations is holding its World Conference against Racism, Racial Discrimination, Xenophobia and Related Intolerance (AU)


Assuntos
Humanos , Saúde , Etnicidade , América , Grupos Raciais , Acesso aos Serviços de Saúde
6.
JAMA ; 286(7): 853-60, Aug. 2001. maps, tab
Artigo em Inglês | MedCarib | ID: med-110

RESUMO

Central America is an area with a growing human immunodeficiency virus (HIV) epidemic, but with marked limitations in its health care infrastructure. Estimated adult HIV infection rates range from 0.20 percent in Nicaragua to 2.01 percent in Belize. Hospitals and clinicans with experience in HIV care exist mainly, if not only, in capital cities and principal economic centers. Nationally sponsored social security systems in each country consistently offer a wider range of services than do ministry of health systems. Estimated access to the social security system ranges from 0 percent in Belize and 10 percent of the population in Honduras to 95 percent in Costa Rica. Combination antiretroviral therapy is not available through the ministries of health and zidovudine is only sporadically available for prevention of perinatal transmission. Combination therapy is available through the social security system in the countries of Guatemala, Panama and Costa Rica only. A wide variety of antiretroviral agents are available through private pharmacies in all countries except Belize. With the exception of Costa Ricans, most people with HIV infection in Central America have limited access to HIV-specific health services and limited or no access to antiretroviral agents. (AU)


Assuntos
Humanos , Infecções por HIV/terapia , Acesso aos Serviços de Saúde , Belize/epidemiologia , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle
7.
Optom Vis Sci ; 77(1): 51-7, Jan. 2000. tab
Artigo em Inglês | MedCarib | ID: med-127

RESUMO

PURPOSE: To test the hypothesis that access to and amount of eye care services in Jamaica are inadequate and that this is related to insufficient eye care personnel and legal limitations on optometric practice in Jamaica. METHODS: An eye care provider survey, a consumer survey, and a literature search were used for data collection. The consumer sample consisted of 500 subjects (aged 16 to 84 years or older) recruited from a stratified random sample of food markets in Jamaica. The provider sample consisted of 10 opthalmologists and 10 optometrists, randomly selected from licensing rosters. Adequacy of amount of eye care services was measured by comparing the frequency of eye examinations in Jamaica with professinal practice guidelines. Access was measured by the eye provider to population ratio compared with calculated need for adequate care. RESULTS: Only 38.6 percent of the study population had received an eye examination within 3 years and only 23.4 percent reported having eye examinations at least once every 3 years. Over 43 percent had never received an eye examination. The total eye care provider/population ratio was only 2.04/100,000 and only 1.32/100,000 when optometrists are excluded. CONCLUSION: Access to and amount of eye care professionals services are severely inadequate in Jamaica. Outdated optometric laws governing the activities of eye care professionals compound the problem. (AU)


Assuntos
Feminino , Humanos , Masculino , Adolescente , Adulto , Idoso , Estudo Comparativo , Pessoa de Meia-Idade , Política de Saúde , Mão de Obra em Saúde/normas , Acesso aos Serviços de Saúde/normas , Optometria , Idoso de 80 Anos ou mais , Oftalmopatias/diagnóstico , Oftalmopatias/terapia , Acesso aos Serviços de Saúde/organização & administração , Jamaica , Optometria/economia , Optometria , Inquéritos e Questionários , Estudos Retrospectivos
8.
Kingston; s.n; 2000. 59 p. tab, gra.
Tese em Inglês | MedCarib | ID: med-485

RESUMO

In this study adolescents' access to health care is analyzed, based on a survey done in two secondary schools. Two hundred adolescents 14 -19 years old were selected. A pretest and a focus group were used in the formulation of a quantitative and qualitative questionnaire. Questions were identified by number in order to maintain confidentiality. Data were collected over a 2 week period, and analyzed manually by a prepared coding system and by using the computer program SPSS. Results showed that adolescents' main health problems were preventable, mostly stress and tension related. The health services available were utilized. Seventy eight point five percent of respondents accessed the private services, and 61.0 percent of the sample had health insurance. Access to contraceptive source was over the counter (65.0 percent), from pharmacies (53.0 percent), from medical sources and 12.0 percent from supermarkets. Adolescents utilized health services for general health problems, but accessed services for sensitive areas such as contraceptives from an additional source. The study has demonstrated that adolescents' access is constrained when relating to reproductive health.(Au)


Assuntos
Adolescente , Feminino , Humanos , Masculino , Acesso aos Serviços de Saúde , Serviços de Saúde do Adolescente/estatística & dados numéricos , Jamaica , Inquéritos Epidemiológicos , Estresse Fisiológico/prevenção & controle , Serviços de Planejamento Familiar/educação
9.
In. Howe, Glenford D; Cobley, Alan G. The Caribbean AIDS epidemic. Kingston, University of the West Indies Press, 2000. p.186-201.
Monografia em Inglês | MedCarib | ID: med-622
10.
Public Health ; 113(6): 307-9, Nov., 1999.
Artigo em Inglês | MedCarib | ID: med-740

RESUMO

This study seeks to identify background characteristics of the people who utilize health care services in Trinidad and Tobago and to investigate their perceptions of the services offered. Data were collected through a survey of health care users distributed throughout Trinidad and Tobago. Multi-stage sampling was used to select 1500 health care users and structured interviews were conducted on regular clinic days by trained personnel. Results indicate that there are fairly high levels of patient satisfaction with health care centres in Trinidad and Tobago and that the more disadvantaged groups (the elderly, women and the unemployed) utilize these services more frequently. Results also show variations with respect to pay, services that need improving and doctor's willingness to listen to problems. (AU)


Assuntos
Feminino , Humanos , Masculino , Satisfação do Paciente/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Eficiência Organizacional , Acesso aos Serviços de Saúde , Pesquisa sobre Serviços de Saúde , Amostragem , Classe Social , Trinidad e Tobago
11.
Rev. panam. salud publica ; 4(5): 305-10, Nov.1998. tab
Artigo em Espanhol | MedCarib | ID: med-16910

RESUMO

Since the 1970s the Member States of the World Health Organization have pledged themselves to the goal of "health for all" and to broadening the coverage, quality, and efficiency of the health care services they provide. In spite of that commitment, there has been little progress in the conceptual understanding and development of indicators to help evaluate the characteristics of the populations with and without coverage, as well as in knowing the relationship between coverage and the characteristics of health care services. Most of the countries of Latin America and the Caribbean are in the process of reforming their health care sectors, and they could benefit from new insight in these areas. To help build that knowledge, this study looked at the population without health care services in the countries of Latin America and the Caribbean, using four indicators: vaccination for poliomyelitis, tuberculosis (BCG) vaccination, prenatal care for pregnant women, and childbirths attended by a health professional. In 1995, out of a total population of 474 million in Latin America and the Caribbean, the number without coverage was a minimum of 40 million, calculated using the indicator of BCG vaccination coverage. Using the indicator for prenatal care, the number of persons without health care coverage was 137 million. By analyzing these four indicators in each country, it is possible to develop health services profiles that would suggest different health sector reform policies. The study also analyzed some characteristics of the structure and coverage of the health systems in 46 countries and territories and their correlation with indicators of result or impact. Five indicators of health care resources were used, along with ten indicators of coverage and seven indicators of result or level of health achieved. A statistically significant association (P=0.05) was found between the coverage of prenatal care and professionally attended childbirths and the results as measured by rates of infant mortality and maternal mortality (AU)


Assuntos
Lactente , Humanos , Recém-Nascido , Serviços de Saúde , América Latina , Acesso aos Serviços de Saúde/estatística & dados numéricos , Região do Caribe , Cuidado Pré-Natal , Mortalidade Infantil
12.
West Indian med. j ; 47(Suppl. 3): 36, July 1998.
Artigo em Inglês | MedCarib | ID: med-1700

RESUMO

The aim of this study was to determine the extent of services for persons with disabilities in Jamaica and the progress made in the past 10 years. A questionnaire was sent to 23 agencies; 22 responded. The main constraints were poor data collection and lack of current prevalence data. 14 agencies provide for all types of disability; the rest cater for single disability groups. Eight provide mainly special education programmes, three mainly assessment services, three provide community base rehabilitation (one, early intervention; two, medical rehabilitation), three provide residential care and nine vocational services. Coverage varies considerably and there is inequitable distribution of services for adults compared with children. The majority of clients are in the rural areas and there is marked inequity among the parishes. The largest disability group is those with intellectual disabilities, followed by physical, hearing and visual disabilities. Intellectual disability is under-served in relation to its prevalence. The school age groups is the main beneficiary. In all categories for disability and in most age groups more males receive services than females. There had been an increased demand for services over the past 10 years, but only a small increase in provision. The main expansion has been in community based rehabilitation, moving from 750 clients in 1988 to 2 365 now; and special education, with doubling of the number of school places. The great need for psychological services identified in 1988 has not been met. There have been increase in budgetary provision to offset rapidly increasing costs but very little investment in new programmes.(AU)


Assuntos
Adulto , Criança , Pessoa de Meia-Idade , Idoso , Feminino , Humanos , Masculino , /reabilitação , Acesso aos Serviços de Saúde/normas , Estudos Prospectivos , Jamaica
13.
Kingston; s.n; Aug. 20, 1998. 72 p.
Tese em Inglês | MedCarib | ID: med-1673

RESUMO

Equity in health care is basic concept in primary health care. To be equitable it must be available, accessible, acceptable and affordable. This include the provision of essential drugs. This study was undertaken to examine the level of pharmaceutical care available to the people of St. Ann through the government public health system and the attitude of the people to the service. To do this, direct observation of the facilities, a self administered questionnaire for pharmacists and exit interviews of 75 persons, were conducted in three of the five facilities which are required, by their classification, to offer pharmaceutical services in the parish. Results indicate that the patients have a generally fair attitude towards the service with the main agent of discontent being the long waiting time for the service and the unavailability of essential drugs. The distance travelled, more than ten miles, by a significant number of persons was greater than that desired by primary care advocates. The lack of adequate facilities and tools with which to work, were noted by the pharmacists as a hindrance to the performance of their duties. A study of the level of patient drug compliance/non-compliance and the level of admission to hospital due to drug misadventure would be useful, to determine the effect of the level of service on other aspects of health care.(AU)


Assuntos
Serviço de Farmácia Hospitalar , Serviços Comunitários de Farmácia , Jamaica , Acesso aos Serviços de Saúde , Farmacoeconomia
14.
WEST INDIAN MED. J ; 46(Suppl 2): 27, Apr. 1997.
Artigo em Inglês | MedCarib | ID: med-2299

RESUMO

This study examines whether there is socioeconomic equity in health care utilization in Curacao. We explore how education level is related to utilization of various health services, taking into account the effects of sex, age, and inequalities in health. The study also examines whether these relationships vary according to the unit of analysis; probability (or incidence) of services use versus overall volume contacts. The data was derived from the "Curacao health study", a health interview survey among a random sample (n=2248) of the non-institutionalized population 18 years and over. The results indiacte that there is socio-economic inequalities in health (need for care) is taken into account. In other words: greater need for services are not met by greater use (vertical equity) and similar needs for care are not met by similar levels of service use (horizontal inequity). The volume of use (i.e. the number of consultations with a care provider, once a person has entered the health care system) appears to be fairly equitable. The observed inequalities in probability of specialist and health utilization contrast with findings from international research. The outcomes of this study underline the importance of health care reforms in order to attain more equitatble access to health care. (AU)


Assuntos
Humanos , Serviços de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde , Fatores Socioeconômicos
15.
WEST INDIAN MED. J ; 45(1): 18-21, Mar. 1996.
Artigo em Inglês | MedCarib | ID: med-4689

RESUMO

In order to improve the effectiveness and subtainability of the family planning programme, the National Family Planning Board has devised a strategy to shift users to longer-acting methods and increase the role of the private sector. To design interventions, a better understanding of existing services was thought to be necessary. This study examines the distribution of family planning service delivery points in Jamaica and the services offered by the public and private sectors through an examination of records and questionnaire interviews. The study found that, because of the concentration of private sector providers - the main outlets for longer-acting methods - in urban areas, rural areas had poor access to these methods. Because rural areas are not attractive to private sector providers, the public sector should recognize the need to continue to serve these areas (AU)


Assuntos
Humanos , Acesso aos Serviços de Saúde , Serviços de Planejamento Familiar/provisão & distribuição , Serviços de Planejamento Familiar , População Urbana , População Rural , Serviços de Planejamento Familiar/economia , Área Carente de Assistência Médica , Jamaica , Anticoncepção
17.
World Health Stat Q ; 49(3-4): 200-3, 1996.
Artigo em Inglês | MedCarib | ID: med-1960

RESUMO

Antigua and Barbuda, located in the Caribbean, was one of the countries most affected by Hurricane Luis in 1995. Electricity, water supply and health facilities were disrupted for several weeks. Inadequate criteria at the design stages, unsound structual design, and lack of maintenance of building components, are some of the reasons that damage was so severe. The main hospitals and 6 health facilities were destroyed and flooded and most of the medical staff had to cope with their own damaged houses. Although the knowledge and materials are available to reduce the losses caused by hurricanes, building codes are not reinforced by laws and preventive maintenance to protect health care facilities from natural hazard damage is not usually budgeted for. The additional cost of making a single or two-storey health facility almost invulnerable to future catastrophe in a hurricane is only 2 percent in initial capital cost and becomes negligible when spread over the life of a building. The effort of UN International Decades for Natural Disasters (IDNDR) directed towards disaster mitigation should be increased over the remainder of the decade to ensure that standards are respected and building codes are mandatory.(AU)


Assuntos
Humanos , Serviços de Saúde , Desastres Naturais , Antígua e Barbuda , Atenção à Saúde , Instalações de Saúde/normas , Acesso aos Serviços de Saúde , Manutenção
19.
Kingston; s.n; 1996. vi,51 p.
Tese em Inglês | MedCarib | ID: med-2940

RESUMO

The health care services in Jamaica are provided free or at a nominal charge to all citizens. Services range form a broad primary health care network to sophisticated tertiary care, and most Jamaicans have relatively easy access to all levels of health care service. A survey was conducted by means of a questionaire on a sample of 130 clients selected from the primary (Department of Social Preventive Medicine) and tertiary health care facilities (A/E UHWI) during February and March, 1996. Factors influencing client's choice were analyzed to determine reasons for bypassing the primary care facility resulting in the inefficient use of more specialized resources at the tertiary level. The results revealed that clients visiting the primary care facility (DSPM) resided within an estimated mean distance of 1.7 miles from the clinic and 4.3 miles from the tertiary care facility (A/E - UHWI). With respect to the distance travelled, transportation costs and time, the tertiary care facility (A/E -UHWI) was less accessible. The majority (94 percent) of clients visiting the primary facility, were able to commute within less than half an hour to access care at this facility. Also, those commuting paid less in transportation cost than those who visited the tertiary facility. Females were significantly (p<0.01) more likely to visit both health facilities than males. However in the 5 pm - 8 am and weekend time frames at the tertiary level, males out numbered the females 60 to 40 per cent. The majority of clients visiting both health facilities were in the under 20 and 20 - 39 age group. In terms of the clients' health seeking behaviour, 71 and 51 per cent utilized the primary and tertiary health care facilities respectively, as a first option for health care. Self referrals accounted for the highest percentage (60 percent) of all sources to the tertiary facility (A/E - UHWI). Of this total, 68 per cent was during the 5 pm - 8 am and weekend time frames. It was the finding also that the estimated waiting time for a doctors' consult was 55 minutes on average at the primary facility (DSPM) than the tertiary (A/E - UHWI). There were no significant differences in the level of satisfaction of the services received by clients visiting facilities. However 62 per cent were dissatisfied with the opening hours of the primary care facility. (AU)


Assuntos
Humanos , Adulto , Feminino , Masculino , Adolescente , Idoso , Lactente , Pessoa de Meia-Idade , Atenção Primária à Saúde/estatística & dados numéricos , Atenção Terciária à Saúde , Serviços de Saúde/estatística & dados numéricos , Jamaica , Serviço Hospitalar de Emergência/estatística & dados numéricos , Acesso aos Serviços de Saúde
20.
Kingston; s.n; 1995. xix,274 p.
Tese em Inglês | MedCarib | ID: med-3395

RESUMO

This dissertation examines the relationship between health status and socioeconomic status in St. Lucia. Data for the study were collected during a nationwide survey carried out in St Lucia in 1990. Using bivarite and multivariate analyses, the pattern of relationship between health and socioeconomic status was examined and defined. The analyses showed that there was a persistent pattern in the relationship between health and socioeconomic status generally, the higher the socioeconomic status of an individual, the better the health status. Recognizing that the link between health and socioeconomic status is the access to health facilities, the accessibility and utilization of the private and public health facilities by the various socioeconomic groups are also examined. The study reveals that the disadvantaged socioeconomic groups generally have more diabilities, possess less access to better quality care and utilize the public health care facilities more than the other socioeconomic groups. The study ends with some guidelines for future research in the Caribbean. (AU)


Assuntos
Humanos , Adulto , Feminino , Masculino , Criança , Idoso , Pessoa de Meia-Idade , Nível de Saúde , Classe Social , Qualidade de Vida , Atenção à Saúde , Análise Multivariada , Fatores Socioeconômicos , Atenção à Saúde , Instalações de Saúde , Pobreza , Estudos Transversais , Acesso aos Serviços de Saúde , Escolaridade
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