The kingdom of Bhutan health system review

The predominantly public financed and managed health system in Bhutan has evolved and grown remarkably in the past five and a half decades. Health services are available through a three-tier structure, i.e. primary, secondary and tertiary levels. Traditional and allopathic medicine services are integrated and delivered under one roof. Village health workers play an important role as a bridge between health services and the community to promote health. Programmes are in place to address the public health challenges facing the country. Health services are free as enshrined in the Constitution of Bhutan. Therefore, government revenue is the predominant source of health financing. In 2014, the total health expenditure (THE) was 3.6% of the gross domestic product (GDP). Despite the difficult geographical terrain and dispersed population settlements, access to health services has improved remarkably. Bhutan is among the top global performers in gains in life expectancy in the past 40 years. The targets of MDGs 4 and 5 have been achieved and since 2010, immunization levels have been maintained over 95%. However, the country faces multiple burden of health challenges. While communicable diseases remain a substantial burden, noncommunicable diseases (NCDs) are increasing. A few other emerging, challenging issues are crime, substance dependence and suicide/other mental health problems. Health equity requires attention as disparities exist in access to and utilization of health services as well as in health outcomes between urban and rural areas, income levels, districts and between western, central and eastern regions. Variations in efficiency levels among different districts and health facilities highlight the potential for improvement in overall efficiency. Though there is good evidence of intersectoral action, it needs to be fostered further to close the existing equity gaps and achieve the Sustainable Development Goals (SDGs).

Predictors of transition in smoking stages in Iranian adolescents: latent transition analysis

يحدد الباحثون في هذه الدراسة معدل انتشار مراحل التدخين لدى المراهقين، واحتال التحول من مرحلة إلى أخرى، والعوامل الشخصية والبيئية المنبئة بالتحول. وقد أجرى الباحثون دراسة في المدارس في عامي 2010 - 2011 واستخدموا عينة تتألف من 5197 تلميذا [العمر الوسطي 15.7 عاما]في مدينة تبريز. وقيم الباحثون التلاميذ مرتين يفصل بينها 12 شهرا. وقد أظهر نموذج تحليل التحول الخافي تسع حالات يمكن تفسرها لقياس مراحل التدخين. كما أوضحت بيانات معدلات الانتشار أن نسبة الطلاب الذين كانوا في مرحلة الملتزمين بلغت في التقييم الأول 75.1 % وفي التقييم الثاني 66.8 %، وأن نسبة المدخنين يوميا في التقييم الأول 4.8 % وفي التقييم الثاني 7.1 %.وعلى مدى الأشهر الاثني عشر كان 10.1 % من التلاميذ الذين لم يسبق لهم التدخين قد أصبحوا من المجربين، كما أصبح 1.7 % منهم من المدخنين الاعتيادين، في حين أصبح 17 % من المجربين مدخنين اعتيادين. كما أوضح التحليل العوامل التي رافقت التحولات في مراحل تدخين السجائر، فرغم أن معدل انتشار التدخين كان منخفضا لدى هؤلاء المراهقين، فإن معدل التحول إلى المدخنين على مدى سنة كان معدلا مرتفعا

ABSTRACT This study determined the prevalence of smoking stages in adolescents, the probability of transition across stages and the personal and environmental predictors of transition. A school-based study was conducted in 2010–11 using a random sample of 5197 students (mean age 15.7 years) in Tabriz city. The students were evaluated twice, 12-months apart. The latent transition analysis model revealed 9 interpretable statuses for the measurement of smoking stages. Prevalence data showed that at the first and second assessments 75.1% and 66.8% of students respectively were in the committer stage, while 4.8% and 7.1% respectively were daily smokers. Over 12 months, 10.1% of the never smokers became experimenters and 1.7% became regular smokers, while 17.0% of experimenters became regular smokers. The analysis also showed factors associated with transitions in cigarette smoking stages. Although the prevalence of smoking was low in our adolescents, the rate of becoming a smoker over 1 year was high.

RÉSUMÉ La présente étude a déterminé la prévalence des stades de consommation du tabac chez des adolescents, la probabilité de transition entre les différents stades et les facteurs prédictifs de transition personnels et environnementaux. Une étude a été menée en milieu scolaire en 2010 et 2011 à partir d'un échantillon aléatoire de 5197 élèves (âge moyen : 15,7 ans) dans la ville de Tabriz. Les élèves ont été évalués à deux reprises, à 12 mois d'intervalle. Le modèle d'analyse des transitions latentes a permis de dégager neuf statuts interprétables afin de mesurer les stades de consommation de tabac. Les données sur la prévalence ont révélé que lors de la première et de la deuxième évaluation, 75,1 % et 66,8 % des élèves respectivement étaient des non-fumeurs décidée à ne pas commencer, tandis que 4,8 % et 7,1 % respectivement étaient des fumeurs quotidiens. Sur une période de 12 mois, 10,1 % des personnes n'ayant jamais fumé ont expérimenté le tabac et 1,7 % sont devenus des fumeurs réguliers, tandis que 17,0 % des personnes ayant expérimenté le tabac sont devenus des fumeurs réguliers. L'analyse a mis en évidence des facteurs associés aux transitions entre les stades de consommation de tabac. Si la prévalence du tabagisme était faible chez nos adolescents, le taux de transition vers le statut de fumeur sur une période d'un an était en revanche élevé.

Health systems in transition: learning from experience

The period following the break-up of the Soviet Union has brought enormous political and socioeconomic change to the WHO European Region. The health sector has not been spared the effects of transition, and the countries emerging from the process have each engaged to varying degrees in health system reform. It is at last possible to reach some judgement about how this process has unfolded, to identify successes and failures, and to understand better the scale and nature of the remaining challenges. This book draws on the experience and lessons learned in the Region over the past 10 years of transition in key health systems areas, such as health care financing, the restructuring of hospitals, public health and gains in health system quality.