Finding the gap: revealing local disparities in coverage of maternal, newborn and child health services in South Sudan using lot quality assurance sampling.

OBJECTIVES: We adapted a rapid monitoring method to South Sudan, a new nation with one of the world's highest maternal and child mortality rates, aiming to assess coverage of maternal, neonatal and child health (MNCH) services at the time of independence, and introducing a monitoring and evaluation system (M&E) for equity-sensitive tracking of progress related to Millennium Development Goals (MDG) 4 and 5 at national, state and county levels to detect local variability. METHODS: We conducted a national cross-sectional household survey among women from six client populations in all, but six of South Sudan's 79 counties. We used lot quality assurance sampling (LQAS) to measure coverage with diverse MNCH indicators to obtain information for national-, state- and county-level health system management decision-making. RESULTS: National coverage of MNCH services was low for all maternal and neonatal care, child immunisation, and child care indicators. However, results varied across states and counties. Central Equatoria State (CES), where the capital is located, showed the highest coverage for most indicators (e.g. ≥4 antenatal care visits range: 4.5% in Jonglei to 40.1% in CES). Urban counties often outperformed rural ones. CONCLUSIONS: This adaptation of LQAS to South Sudan demonstrates how it can be used in the future as an M&E system to track progress of MDGs at national, state and county levels to detect local disparities. Overall, our data reveal a desperate need for improving MNCH service coverage in all states.

'He'll not talk to anyone': researching men on low incomes.

This paper explores the difficulties of undertaking research with men living on low incomes. The literature shows that most social research undertaken with men has been based on groups of men from higher socioeconomic groups--predominantly from those in work, where access is less problematic than with those who are unemployed.A research project is used as an example to demonstrate the difficulties of accessing men from low socio-economic groups. It is more difficult to make contact with men in the privacy of the home, which is often perceived as the woman's domain. Women may consequently act as gatekeepers to men. A community development approach can overcome these difficulties, because the researcher is known within the community. Despite this, a female researcher working within the private domain of the home can still face problems in engaging men in discussion.

The costs of non-insurance in Maryland.

OBJECTIVES: This study calculates expenditures and costs related to a lack of health insurance coverage in the State of Maryland. RESEARCH METHODS: The study is based on detailed primary and secondary data collection on the following sources of payment and care related to non-insurance: (1) uncompensated hospital care; (2) other public subsidies; (3) ambulatory services; (4) philanthropic spending; and (5) uninsured individuals' costs. RESULTS: Expenditures by and for the uninsured in Maryland total $1.47 billion dollars. On a per-capita basis, this is equivalent to $2,371 per full-year uninsured person in the state. Twenty-seven percent of this total, or $633 per uninsured person, is paid directly by the uninsured themselves in out-of-pocket medical expenditures. The state and local governments spent $497 per uninsured person (21% of the total), and the federal government spent an additional $401 (17%). Private payers (including insurance, physicians, and philanthropy) accounted for $460 (19%). CONCLUSIONS: The sources and flows of spending on the uninsured are complex, and these expenditure levels should not be interpreted as savings that would directly result from an expansion of insurance coverage. Our results are consistent with earlier studies completed at the national level, and add considerable detail.

The consequences of official labels: an examination of the rights lost by the mentally ill and mentally incompetent ten years later.

This study presents a survey of state statutes which restrict the civil rights of persons with a mental illness or who have been declared mentally incompetent. Five civil rights (jury service, voting, holding public office, marriage, and parenting) are examined. The results of the 1999 study are compared with the results of a 1989 study, to reveal any trends in the restriction of the civil rights of those suffering from mental problems. This comparison reveals that states continue to restrict the rights of the mentally ill and incompetent, and that there is a trend toward increased restriction of the familial rights of marriage and parenting.