Inclusion of vulnerable groups in health policies: regional policies on health priorities in Africa

Background: If access to equitable health care is to be achieved for all, policy documents must mention and address in some detail different needs of groups vulnerable to not accessing such health care. If these needs are not addressed in the policy documents, there is little chance that they will be addressed at the stage of implementation. Objectives: This paper reports on an analysis of 11 African Union policy documents to ascertain the frequency and the extent of mention of 13 core concepts in relation to 12 vulnerable groups, with a specific focus on people with disabilities. Method: The paper applied the EquiFrame analytical framework to the 11 AU policy documents. The 11 documents were analysed in terms of how many times a core concept was mentioned and the extent of information on how the core concept should be addressed at the implementation level. Each core concept mention was further analysed in terms of the vulnerable group in referred to. Results: The analysis of regional AU policies highlighted the broad nature of the reference made to vulnerable groups, with a lack of detailed specifications of different needs of different groups. This is confirmed in the highest vulnerable group mention being for 'universal'. The reading of the documents suggests that vulnerable groups are homogeneous in their needs, which is not the case. There is a lack of recognition of different needs of different vulnerable groups in accessing health care. Conclusion: The need for more information and knowledge on the needs of all vulnerable groups is evident. The current lack of mention and of any detail on how to address needs of vulnerable groups will significantly impair the access to equitable health care for all

Perceptions of caring for children with disabilities: experiences from Moshi, Tanzania

Background: Although there exist laws; policies and standards in Tanzania that serve to protect and improve the lives of children with disabilities; the individual human experiences and feelings of the carers and parents still remain the realities of caring for children with disabilities. There is a lack of qualitative studies examining experiences in a developing context. This research aimed to fill that gap. Objectives: The objective of this research was to gain an insight into how having a child with a disability impacts upon participants lives and to examine both negative and positive experiences of care through the use of qualitative methods. Method: This was a qualitative; exploratory study and followed a phenomenological method. Purposive convenience sampling methods were used to recruit 14 carers in Moshi; Tanzania. Qualitative; semi-structured interviews were undertaken with all 14 participants. Results: Five main themes emerged from the data which shed light on the carers experiences; namely; objective challenges in terms of financial challenges; employment issues and demands of care; subjective challenges in the form of stigma; isolation and pity; positive experiences such as the child's progress; respect and happiness; material and financial needs; and coping mechanisms which included beliefs; support and attitudes. Conclusion: The findings of this research were that objective challenges are common and more significant than subjective challenges. Positive experiences were not as easily identified by the participants as the challenges faced. However; having analysed the data; carers do not experience their roles as entirely negative. They simply need the resources to deal with objective challenges which in a developing context are not easily attainable

La rationalisation du systeme de soins grace a un dialogue renouvele entre Structures sanitaires; entreprises; organismes d'assurances : actes du seminaire sur l'economie de la sante; 12 et 13 aout 1993; Douala

Face a la dure crise economique qui secoue l'Afrique en general et le Cameroun en particulier; face aux poids ecrasant des budgets de sante que consentent encore quelques entreprises; et face enfin aux limites economiques du financement assignables aux travailleurs; il apparait imperatif de limiter la croissance des depenses de sante; et dans leurs composantes; celles des depenses hospitalieres qui equivalent a plus de la moitie de l'ensemble. Le poids des couts de sante pese lourdement sur ceux censes les supporter. Mais en limitant les couts; la finalite hospitaliere devra demeurer identique; a la seule difference que desormais; le meilleur soin devrait etre acquitte a mointre cout