Perceptions of "Male Sensitive" Health Services Among Men in Trinidad and Tobago

Introduction: While Caribbean researchers have explored masculinity, socialization, and behavior, the literature has been silent on masculinity and "male sensitive" health services. This study explored masculinity and perceptions of "male sensitive" health services. Method: An interpretative, phenomenological, qualitative design that used 14 focus groups and 12 semistructured interviews among men between the ages 18 and 65 years. Results: The notion of "male sensitive" services were more of preferences like having more females, timeliness, and privacy of services rather than a specific set of services unique to men. Services were expected to be professional, offered in private spaces, timely, and as an "all in one" service with more male service providers. Discussion: Male utilization of health services may be a problem if they are not considered "sensitive" to their needs. This has implications for the reorientation of services, as well as, personnel, including increased involvement of males as health care providers.

Estimated cost analysis for demand-driven family health outreaches in Guyana in 2014

OBJECTIVE: To review the cost implications of demand driven health outreaches made in 2014 in terms of need, saliency and benefits. SUBJECTS AND METHODS: In 2014, there were 85 medical outreach visits to seven of the 10 administrative regions provided by five entities including the government. The costing methodology was to randomly select two outreaches by each entity and then quantify the direct cost, vis-à-vis drugs and medical supplies, voluntary counseling and testing (VCT), visual inspection of cervix using acetic acid (VIA), dental, blood banking and optical services, and the cost of indirect services such as transportation, meals and stipend. RESULTS: The direct cost was GY $101 755 075 while the indirect costs amounted to GY $3 464 925 (US $17026.66) in total. Therefore, the total estimated aggregate cost for the demand-driven medical outreaches in 2014 in Guyana amounted to GY $105 220 000 (US $517 051.58). CONCLUSIONS: The cost involved in the provision of the demand-driven medical outreach service could have provided support for nine health centres or 36 health posts for one full year. Coupled with the fact that the service is mainly along the coastal areas, where the need for such services is less, it is suggested that government either suspend these activities pending a full review or have limited outreach visits to the interior in the interim.

Are country reputations for good and bad leadership on AIDS deserved? An exploratory quantitative analysis.

Some countries (e.g. Brazil) have good reputations on AIDS policy, whereas others, (notably South Africa) have been criticized for inadequate leadership. Cross-country regression analysis reveals that these 'poster children' for AIDS leadership have indeed performed better or worse than expected given their economic and institutional constraints and the demographic and health challenges facing them. Regressions were run on HAART coverage (number on highly active antiretroviral therapy as percentage of total need) and MTCTP coverage (pregnant HIV+ women accessing mother-to-child-transmission prevention services as percentage of total need). Brazil, Cambodia, Thailand and Uganda (all of whom have established reputations for good leadership on AIDS performed consistently better than expected-as did Burkina-Faso, Suriname, Paraguay Costa Rica, Mali and Namibia. South Africa, which has the worst reputation for AIDS leadership, performed significantly below expectations-as did Uruguay and Trinidad and Tobago. The paper thus confirms much of the conventional wisdom on AIDS leadership at country level and suggests new areas for research.

Men's Perspectives on 'Male Sensitive' Health Services

Men, in general, are more likely to hold negative views and be unwilling to access health services (Hawkes and Buse, 2013) except in circumstances when they view their lives qas being imperilled (Novak, et al., 2019). However, this is associated with the social constructionof masculinity an the expectations of how masculinity should be performed (Novak, et al 2019.) Being concerned about one's health is perceived as a female concern and creates cognitive dissonance for men in deciding whether they should behave as though they don't care or should care for their health (Robertson and Williams, 2010, Elliott. 2015, Bonhomme, Brott and Fadich, 2017, Novak, et al., 2019). In spite of the growing body of literature on masculinity and health; addressing issues of men's health is challening since there is an absence of agreement on what constitutes 'men's health', in spite of attempts to do so (Bardehle, Dinges and Whitw, 2016). Although a number of studies have been conducted on men in the Caribbean, there is a dearth of literature on men and their perceptions of 'male sensitive' health services among men between the ages of 18 yeas to 65 years in Trinidad and Tobago. The research questions was: What are men's perceptions about masculinity and its implications for 'male sensitive' health services?

Health @ 50 in Guyana: Progress health report 1966-2016

The document highlights the achievements made in the public health system in Guyana as well as the challenges faced during the past fifty years. It provides an analysis of the country context, the health systems and services, the epidemiological profile, the achievements and challenges, and the health targets for the next fifty years. The Epidemiological profile addresses diseases surveillance and disease profile, including measles, malaria, tuberculosis, HIV/AIDS, dengue, cardiovascular, hypertension, diabetes and cancer.

Health sector challlenges and responses beyond the Alma-Ata declaration: a Caribbean perspective

Primary health care (PHC) is defined as "essential health care based on practical, scientifically sound, and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination." For the effective delivery of PHC to occur, it must be undergirded by a national health system infrastructure that has five key components: (1) development of health resources, such as manpower, facilities, equipment and supplies; (2) organized arrangement of health resources through the establishment of national health authorities, the provision of national health insurance, and the integration of public and private health services; (3) delivery of health care through the media of primary, secondary and tertiary health services; (4) economic support through sources, such as public financing and foreign aid; and (5) management through strong leadership, policy formulation, regulation and monitoring and evaluation (AU)

Does the Chronic Disease Assistance Program promote equity or increases the socioeconomic divide?

Objectives: The objective of the study was to assess the extent to which the Chronic Disease Assistance Programme (CDAP)was able to meet the needs of different risk groups within the Trinidad and Tobago population. The study sought to answer the research question how does the healthcare strategy of risk group segmentation (RGS) interact with the country context to create legitimacy for CDAP. It was hypothesised that the implementation of a RGS strategy improves CDAP's legitimacy to allocate and manage resources. Design and Methodology: A sample of 161 pharmacists were surveyed via face to face interviews and telephone calls using a convenient sampling method. The instrument determined the extent to which the six dimensions of RGS were utilized in CDAP and three performance construct were assessed. Two pharmacists from each pharmacy were interviewed to reduce common method bias. Descriptive measures such as mean, standard deviation and Pearson bivariate correlations for the purpose of simple summaries of the dominant views and relationships were done and hypothesis testing was conducted using three-stage hierarchical regression analysis. Results: RSG was seen as an empowering tool for the patients and was needed, but not addressed. It was found to be desirable but not implemented. Its non implementation reduced the socio-political legitimacy of the program. Conclusions: CDAP in its current form does not address the risk faced by various groups in Trinidad and Tobago. This has led to the socio-political legitimacy of the program being reduced. It may be inferred its ability to create true health equality is compromised.

An overview of the present state of medical technology in the Winward and Leeward Islands of the English-Speaking Caribbean

This article is an assessment of the present state of medical technology in the Winward and Leeward Islands of the English-Speaking Caribbean. It includes a review of manpower, equipment, materials and service to the public; it outlines major problems in each of these areas and proposes solutions

Good managers for good health services

This article outlines progress in the preparation of nurses, doctors and other professionals for managerial roles in the health services of several Caribbean countries. It is expected that there will be solid gains in effectiveness and efficiency during the next few years as the new managers' influence is felt and that the prospects for primary care and health for all will consequently be enhanced. (AU)

Pre-hospital care in Barbados - abstract

Pre-hospital care in Barbados was completely re-organised in 1984 with international assistance. Training included a three-month course for 45 emergency medical technicians (EMTs) to the basic EMT level. The aim of this study was to review the operations of the Emergency Ambulance Service (EAS), now in its seventh year of operation. During the three-month period July - September 1991, the following information was taken from each call: time and allocation, time of arrival at the scene and the chief complaint. The EAS responded monthly to 1,142 calls from the various parishes. Distribution of calls closely followed that of the population. The majority of calls (66.4 percent) were genuine emergencies, with only 1.2 percent being crank calls. Emergency included asthmatics (12.5 percent), accidents (9.3 percent), violent injuries (6.1 percent), comatose patients (7.3 percent), seizures (5.1 percent) and 14 (0.4 percent) patients with cardiac arrest. The average response time for all calls was 20 minutes. This ranged from 13 minutes in the central parish of St. Michael, to 39 minutes in the northern district of St. Lucy, and 30 minutes in the eastern area of St. Philip. These findings highlight the need for satellite stations in the northern and eastern sides of the island. The wide range of emergencies identified also provides a useful base for reviewing the curriculum and introducing new protocols for pre-hospital care (AU)

Cooperation in health in the Commonwealth Caribbean

Reviews past and present efforts regarding cooperation in health and proposes that the existence of a strong institutional framework is essential for the development and success of any cooperative initiatives. The existing institutional frameworks are described, viz., the University of the West Indies and the Pan American Health Organization/World Health Organization (PAHO/WHO). The priority areas of health care are outlined including environmental protection, human resources development, food and nutrition and maternal and child health. The future of health co-operation, particularly in public health, is the final area of discussions, which includes a discourse on the Commonwealth Caribbean Medical Research Council. (AU)

Utilization and morbidity patterns at a district casualty department in Dominica - abstract

The registers of the Casualty Department at the Marigot District Hospital, a 26-bed primary care facility, were analyzed for morbidity and utilization patterns, using the International Classification of Primary Care. From 1st October, 1991 to 30th September, 1992, a total of 9,504 encounters was recorded with a daily average attendance of 26 patients. A random 1 in 4 sample of records was analysed. Most patients came from Marigot village. The bulk of encounters (40.3 per cent) was for skin conditions. Of these, a third required only routine wound care. Other major reasons for encounter (REF) were abdominal pain, daily insulin treatment, musculoskeletal complaints, fever, cough and common cold and gastroenteritis. Circulatory, gynaecological and obstetrical conditions were relatively rare, the latter being attributed to the effective linkage of midwives with the obstetrical wards of the central referral hospital. Twenty to 25 per cent of all encounters were for strictly primary care activities such as routine wound care and administering of medication. A significant proportion of (19 per cent) was made up of children aged 0 - 4 years, mainly for cough and the common cold, gastroenteritis and skin conditions. A quarter of the patients seen were referred to the medical officer or family nurse practitioner, 4.3 per cent were admitted to the district hospital and 2.1 per cent referred to the central referral hospital (AU)

District medical officers encounters in the Marigot Health District, Dominica

As part of a series of studies on Primary Health Care Services in the Marigot Health District, the encounters of District Medical Officers (DMOs) and the Family Nurse Practitioners (FNPs) were studied during the one-year period October 1991 - September 1992. For this purpose, the International Classification of Primary Care (ICPC) was used. During the study period 3 518 patients (40 percent of the district's population) were seen at 7 267 encounters with 11 835 RFE'S leading to 10 914 diagnoses. There were 7 176 episodes, 1 302 originating from the period before the study and 5 874 new episodes. More women than men attended the clinics and the youngest and the oldest age groups were seen more frequently than the other age-groups. Of all encounters, 60 percent were at regular clinics, whereas 40 percent were emergency after hours encounters at the Casualty of the Marigot Hospital. The most frequent episodes of chronic conditions were hypertension (5 percent of all episodes), diabetes mellitus (3 percent) and osteoarthrosis (1 percent). Most acute conditions were due to accidents (5 percent) and infectious conditions of skin (4 percent), respiratory (6 percent) and digestive system (2 percent). "No disease" accounted for 3 percent of the episodes; in general, the results of this study are similar to previous studies conducted on primary care in Barbados and Saba. Most of the differences between the studies can be attributed to differences in the structure of the health care delivery systems, with the exception of gastritis (4 percent) and helminthiasis (2 percent) which are health problems commonly seen at the DMO clinics in Dominica (AU)

Most successful practice building pearls [abstract]

Buying into a practice does not assure one's success. A successful practice is built and the investment in your training demands your best effort at "Brand Name" development. THE PHYSICIAN: -introduce and present your self to sources of referral; -be responsive; -communicate; -what's your gimmick? THE AMBIENCE: -Location; -A plesant purpose-built office layout; -Facilitate patient flow; -Image is important; -Use technology (Computerized system) THE STAFF: -You get what you pay for; -Inferior staff never leave; THE SERVICES -Control appointment system; -Plan 6 to 12 months ahead; -Information brochures; MARKETING: -Brand Name development; - Use the subtle media; -Develop own strategies; -Niche markets; -Feed back to sources; -Use of the Internet. (AU)

Reported versus recorded health service utilization in Grenada, West Indies

Calls for household surveys to provide information on service utilization in less developed countries raise questions regarding the accuracy and reliability of reporting. This paper compares reported to recorded health service utilization for diarrhoea and any other morbidity over a 2-week and 3-month period for information obtained from a household survey in Grenada, West Indies. A sensitivity analysis is used to derive minimum and maximum estimates of the accuracy of reported utilization. Over-reporting utilization was found to be between 33 and 62 percent for diarrhoea and 49 and 81 percent for any other morbidity. Under-reporting of all utilization was estimated to be between 47 and 65 percent. These results cast doubt on the utility of household surveys as a reliable source of information regarding service utilization. (AU)

Sixth decade obesity in a Barbadian community - abstract

This study was designed to determine the prevalence of obesity and its association with morbidity and increased use of the health services in a defined Barbadian community. Households in the Wildey Polyclinic catchment area of central Barbados were visited after sytematic sampling from census maps. Residents aged 50 - 59 years were invited to respond to a questionnaire seeking information on their out-patient attendances at health care facilities, diagnostic tests, hospitalizations and specific chronic diseases. Each respondent was weighed and the height and mid-triceps skin fold measured. One hundred and twenty-two (122) respondents were obtained from 1,889 household. 76.3 percent were obese (Body mass index (BMI) 22 percent or more above normal values) and 41 percent very obese (BMI greater than 35 percent above normal). Females out numbered males by 3:1, they had significantly higher B.M.I. (p<.05) and markedly different skin fold distributions to the males. Comparison of obese and non-obese respondents did not reveal statistical differences in the use of health care facilities. In the group of obese respondents there were more diabetics (6.5 percent) than in the non-obese (3.5 percent), and similarly there were more hypertensives in the obese group (22.6 percent) than in the non-obese (10.3 percent). These results are from a study in which the sample of respondents is too small for firm conclusions, but they indicate a greater occurrence of obesity among females and suggest an association of diabetes mellitus and hypertension with obesity in the 6th decade. Further investigation is needed into obesity related morbidity and the use of the health sevices (AU)

Impact of Hurricane Luis on the health services of Antigua and Barbuda

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)

Whatever happened to public health?

In many rich and poor countries, recent health service developments have led to neglect of the traditional public health functions. For various reasons, however, the need for these functions is increasing rather than diminishing. Developing countries should devote more resources to them, but they should not necessarily folow proposals from developed countries such as those in the Acheson Report, when locating public health in their organizational structure (AU)

Quality assessment of medical care in Jamaica

With the extension of primary health care it is important that attention be directed to ensuring that its quality is acceptable, particularly where resources are limited. In Jamaica, care was assessed in respect of 12 tracer conditions and a confidential inquiry into maternal deaths provided additional information. The tracer conditions were chosen to reflect important health problems and represent age and sex groups and aspects of medical care. The tracer conditions selected for study were acute gastroenteritis in children under 5 years, measles, appendicitis, diabetes mellitus plus keto-acidosis and peripheral gangrene, hypertension, stroke, abortions and maternity care, pelvic inflammatory disease, and inguinal hernia. While death registration data suggested that maternal mortality was at a relatively low level, obstetricians felt that many maternal deaths were avoidable. The results of this study indicate that before quality assurance programs can be routinely implemented, the following requirements should be fulfilled: (1) concern at the political level, health manager and health worker levels about not only quantitative equity but also the optimal affordable quality of promotive, preventive and clinical care, (2) agreement on the objectives of health care services, (3) clearly defined responsibility for undertaking the collection, analysis and presentation of the data on which the interpretation of quality assessment depends, and (4) inclusion in the assessment of decisions on the specific aspects of service evaluation. (AU)

Reproductive Health Policies and Programs in eight countries: Progress since Cairo

Looks at reproductive health policies and programs in eight countries. In-depth interviews in 1997 with stakeholders in Bangladesh, India, Nepal, Jordan, Ghana, Senegal, Jamaica and Peru; Adoption of the 1994 International Conference on Population and Development in six of the eight countries studied; Discussion of implementation problems.(AU)