Determinants of the evolution of the health situation of the population.

ABSTRACT

The objective of the present project is to evaluate the relative importance of different governmental social programmes for health development during the 1970's. National statistics available for the whole period and disaggregated to district level were analyzed with particular regard to three indicators of infant health status when the infant mortality rate was used, increased access to secondary care and improved socio-economic status were related to improvement in infant health status. When the percentage of neonatal deaths or the percentage of deceased live births per woman was used, neither the socio-economic improvement nor the assess to secondary did explain the improvement. Moreover, the primary health programme did not seem to be of importance in explaining the changes in the three indicators of infant health status. A second phase of the project, currently ongoing, is aimed at the evaluation of other factors such as the degree of efficiency of some of the health programmes. This study is based on directly collected information, quantitative as well as qualitative. Structured interviews have been used together with anthropological information from in-depth interviews with individuals and groups. The preliminary results of this second phase indicate that the contradictions observed in the first phase might be due to shortcomings in the national registers. In one of the study areas the coverage of PHC developed earlier than indicated by the official information. In other areas it was found that different obstacles as access problems, lack of health centers, socio-economical problems and lack of cultural knowledge reduced the effectiveness and impact of the primary health programmes.

ABSTRACT

PIP Costa rica has achieved considerable success in social development and attention to the marginalized poor. The aim of this study is to assess the impact of health and nutrition from social interventions of the 1970s and to provide an explanation. Archival data on vital statistics from 1970 to 1984 and coverage of the Rural Health and Community Health Programs were used. In general, data were analyzed on the district level and in zones where population was sparse. Dependent variables were infant mortality under 1 year/live births, neonatal deaths 1-11 months/infant mortality, and mortality of live births/live births of women 20-24 years. Independent variables were health coverage, access to medical assistance, environmental conditions, educational status, rural residence, and the presence of modern living conditions. The results showed that major changes occurred in access to different health programs in rural and backward regions. National coverage was 60% in 1978. In 1980, 70% were covered by social security and 95% of all deliveries were medically assisted by trained health personnel. Electricity, water, and sanitation also improved. Independent variables were closely and inversely related to infant mortality around 1974 and declined in effect about 1983. Socioeconomic factors and access to health care became else important. There was less geographic variation in infant mortality. The percentage of postneonatal mortality and the percentage of live birth deaths continued to be strongly associated by the end of the period (1983). Correlation coefficients were generated for the absolute changes in the 2 measures of infant mortality for the time periods 1973-75, 1976-78, and 1979-81. The results were all highly significant. Regions with low socioeconomic development and low access to health care and regions with high primary health care (PHC) had greater reductions in infant mortality. When the analysis was repeated with changes in independent variables, infant, mortality was reduced in regions with increases in secondary health programs, larger PHC coverage, and greater increases in standard of living measures. In a socioanthropological approach in 1988, preliminary results continued to show inconsistencies in the 3 infant mortality measures. Data deficiencies are suspected to be the cause and analysis is ongoing to correct for doubtful figures.