Those who are against privatisation of public services are often confronted with the objection that there is no alternative. This book takes up that challenge by establishing theoretical models for what does (and does not) constitute an alternative to privatisation, and what might make them ‘successful’, backed up by a comprehensive set of empirical data on public services initiatives in over 40 countries. This is the first such global survey of its kind, providing a rigorous and robust platform for evaluating different alternatives and allowing for comparisons across regions and sectors. The book helps to conceptualise and evaluate what has become an important and widespread movement for better public services in the global South. The contributors explore historical, existing and proposed non-commercialised alternatives for primary health, water/sanitation and electricity. The objectives of the research have been to develop conceptual and methodological frameworks for identifying and analysing alternatives to privatisation, and testing these models against actually existing alternatives on the ground in Asia, Africa and Latin America. Information of this type is urgently required for practitioners and analysts, both of whom are seeking reliable knowledge on what kind of public models work, how transferable they are from one place to another and what their main strengths and weaknesses are.
Equitable health services
This study aimed to assess the health care waste generation rate and its management system in some selected hospitals located in Addis Ababa, Ethiopia. Researchers randomly selected six hospitals in Addis Ababa, three private and three public. Data was recorded by using an appropriately designed questionnaire. Results revealed that the management of health care waste at hospitals in Addis Ababa city was poor. The median waste generation rate was found to be varied from 0.361- 0.669 kg/patient/day, consisting of 58.69% non-hazardous and 41.31% hazardous wastes. The amount of waste generated was increased as the number of patients flow increased, and it was positively correlated with the number of patients. Public hospitals generated high proportion of total health care wastes (59.22%) in comparison with private hospitals (40.48%). The waste separation and treatment practices were very poor. The authors recommend that other alternatives for waste treatment rather than incineration such as a locally made autoclave should be evaluated and implemented.
The main objective of this study was to decompose wealth-related inequalities in skilled birth attendance (SBA) and measles immunisation into their contributing factors. Researchers used data from the Kenyan Demographic and Health Survey 2008/09 to investigate the effects of socio-economic determinants on coverage and wealth-related inequalities of the two health services. Results indicated that SBA utilisation and measles immunisation coverage differed according to household wealth, parent’s education, skilled antenatal care visits, birth order and father’s occupation. SBA utilisation further differed across provinces and ethnic groups. The overall C for SBA was 0.14 and was mostly explained by wealth (40%), parent’s education (28%), antenatal care (9%), and province (6%). The overall C for measles immunisation was 0.08 and was mostly explained by wealth (60%), birth order (33%), and parent’s education (28%). Rural residence (−19%) reduced this inequality. The authors conclude that both health care indicators require a broad strengthening of health systems with a special focus on disadvantaged sub-groups.
Although cervical cancer is a leading cause of cancer related morbidity and mortality among women in Ethiopia, there is lack of information regarding the perception of the community about the disease. In this study, researchers conducted focus group discussions with men, women and community leaders in the rural settings of Jimma Zone southwest Ethiopia and in the capital city, Addis Ababa. Participants had very low awareness of cervical cancer. The perceived benefits of modern treatment were also very low, and various barriers to seeking any type of treatment were identified, including limited awareness and access to appropriate health services. Women with cervical cancer were excluded from society and received poor emotional support. Moreover, the aforementioned factors all caused delays in seeking any health care. Traditional remedies were the most preferred treatment option for early stage of the disease. However, as most cases presented late, treatment options were ineffective, resulting in an iterative pattern of health seeking behaviour and alternated between traditional remedies and modern treatment methods. Prior to the introduction or scale up of cervical cancer prevention programmes, socio-cultural barriers and health service related factors that influence health seeking behaviour must be addressed through appropriate community level behaviour change communications.
In this study, researchers analysed first admissions of adult medical inpatients to Groote Schuur Hospital, Cape Town, from January 2002 to July 2009, disaggregating data according to age, sex, medical specialty, date of admission and discharge, and socio-economic status (SES). There were 42,582 first admissions. Patient demographics shifted towards a lower SES. Median age decreased from 52 years in 2002 to 49 years in 2009, while patients aged 20-39 years increased in proportion from 26% to 31%. The unadjusted proportion of admissions which resulted in in-hospital deaths increased from 12% in 2002 to 17% in 2009. Corresponding mortality rates per 1,000 patient days were 17 and 23.4, respectively. Annual increases in mortality rates were highest during the first two days following admission (increasing from 30.1 to 50.3 deaths per 1,000), and were associated with increasing age, non-paying patient status, black population group and male sex, and were greatest in the emergency ward.
This paper reports on the strategies, achievements and challenges of the past and contemporary malaria vector control efforts in Zambia. Researchers reviewed all available information and accessible archived documentary records on malaria vector control in Zambia. They also conducted a retrospective analysis of routine surveillance data from the Health Management Information System (HMIS), data from population-based household surveys and various operations research reports on implementing policies and strategies. Results suggested that Zambia has made great progress in implementing the World Health Organisation’s integrated vector management (IVM) strategy within the context of the IVM Global Strategic framework with strong adherence to its five key attributes. In conclusion, the country has solid, consistent and coordinated policies, strategies and guidelines for malaria vector control. The authors highlight the Zambian experience as a successful example of a coordinated multi-pronged IVM approach effectively operationalised within the context of a national health system.
In 2000 Uganda adopted the Integrated Disease Surveillance and Response (IDSR) strategy, which aims to create a co-ordinated approach to the collection, analysis, interpretation, use and dissemination of surveillance data for guiding decision making on public health actions. In this study, researchers used a monitoring framework recommended by World Health Organisation and the United States’ Centres for Disease Control and Prevention to evaluate performance of the IDSR core indicators at the national level from 2001 to 2007. Findings showed improvements in the performance of IDSR, including: improved reporting at the district level (49% in 2001; 85% in 2007); an increase and then decrease in timeliness of reporting from districts to central level; and an increase in analysed data at the local level. The case fatality rate for two target priority diseases (cholera and meningococcal meningitis) decreased during IDSR implementation (cholera: from 7% to 2%; meningitis: from 16% to 4%), most likely due to improved outbreak response. However, decreased budgetary support from the government may be eroding these gains. Renewed efforts from government and other stakeholders are necessary to sustain and expand progress achieved through implementation of IDSR.
Those who are against privatisation of public services are often confronted with the objection that there is no alternative. This book takes up that challenge by establishing theoretical models for what does (and does not) constitute an alternative to privatisation, and what might make them ‘successful’, backed up by a comprehensive set of empirical data on public services initiatives in over 40 countries. This is the first such global survey of its kind, providing a rigorous and robust platform for evaluating different alternatives and allowing for comparisons across regions and sectors. The book helps to conceptualise and evaluate what has become an important and widespread movement for better public services in the global South. The contributors explore historical, existing and proposed non-commercialised alternatives for primary health, water/sanitation and electricity. The objectives of the research have been to develop conceptual and methodological frameworks for identifying and analysing alternatives to privatisation, and testing these models against actually existing alternatives on the ground in Asia, Africa and Latin America. Information of this type is urgently required for practitioners and analysts, both of whom are seeking reliable knowledge on what kind of public models work, how transferable they are from one place to another and what their main strengths and weaknesses are.
Despite extensive scientific and policy innovations in quality of care, the authors raise a gap in quality in resource-limited areas that undermine effective access to healthcare for poor people. In this perspective piece, the authors propose six actions to address this: revise global health investment mechanisms to value quality; enhance investment in the role of health persinnel for improving quality; scale up data capacity; deepen community accountability and engagement initiatives; implement evidence-based quality improvement programmes; and develop an implementation science research agenda.
In this presentation given at the Second Global Symposium on Health Systems Research in November 2012, researchers presented the results of a study in which they evaluated the effectiveness of daily observation of drug consumption at tuberculosis (TB) clinics in South Africa. They conducted 1,200 patient exit interviews with patients in 30 different TB facilities, as well as 17 in-depth interviews to understand patient access barriers. Findings indicated that the requirement for daily observation of drug consumption at clinics imposes substantial costs on patients, and this may impact adversely on adherence. In multivariate regressions, patients that visited the facility on a daily basis (versus other) were more than twice as likely to report missing their TB medication (after controlling for other factors). Qualitative findings suggest that long travel distances to facilities, the cost of transport, and the opportunity cost of clinic attendance were some of the factors influencing adherence. Less frequent clinic visits may be a win-win for TB treatment because of: improved efficiency through reduced provider costs; higher adherence; and lower patient access barriers to care.