Indications for Gynaecological Consultation by Women at a Rural Outreach Centre in North-Central Nigeria.

Aims: To identify the reasons for consultations, the common clinical diagnosis and disease pattern at a rural gynaecologic outreach clinic. Study Design: Descriptive Retrospective Study. Place and Duration of Study: NKST Hospital Mkar-Gboko, Benue state, North-central Nigeria, in seven years (1st April 2005 to 31st July 2012). Methodology: Information from the case notes of patients who attended the outreach clinic over the study period were retrieved and analysed. Majority of the patients came by self-referral. Results: Of the 1,733 women that attended the clinic during the study period, 1,605 (92.6%) women made the inclusion criteria and formed the study population. The age range was 15 to 78 years; mean value of 33.6 +/- 9.5 year; 78% of the women were ages 21 – 40 years. The mean parity was 2.1 +/- 2.7and ranged between 0 to 13 children. 68% of the women were para 0 – 2 whilst 18% had parity of 5 and above. The women had 73 reasons and 2,390 presenting complaints, 49.6% of them had multiple presenting complaints (average 1.5 complaints per woman).Most common complaints were inability to conceive, lower abdominal pain and leaking of urine and /or faeces amongst 38%, 11% and 10% of the women respectively. There were 63 disease conditions with 1,793 clinical diagnoses. About 12% of the women had multiple clinical diagnoses. The three leading clinical diagnoses were infertility, genital fistulae and uterine myoma, in 46%, 12% and 10% of the women respectively; followed by sundry other gynaecological disorders (9%) and medical disease conditions (5%) in which hypertension, diabetes mellitus and retroviral diseases were more frequent in that order. Some women (n = 21; 1%) came for second opinion. Conclusion: Gynaecological diseases are diverse and common among women in rural central Nigeria. Inability to conceive, lower abdominal pain and incontinence of urine and or faeces were the three main reasons women sought consultation with the gynaecologist at Mkar. Infertility, genital fistulae, uterine myoma, non-communicable medical disorders and retroviral diseases were leading clinical diagnoses. Extending the services of Gynaecologist to the rural areas in the region may reduce the access gap to women’s health and enhance national development.

Separación de funciones en el Sistema de Protección Social en Salud, México 2009: avances y retos / Separation of functions in the System of Social Protection in Health, Mexico 2009: progress and challenges

OBJETIVO. Analizar los avances y retos de la separación de funciones en el Sistema de Protección Social en Salud en México. MATERIAL Y MÉTODOS. Investigación evaluativa realizada en 2009. Se incorporaron nueve entidades federativas y la Comisión Nacional de Protección Social en Salud. Se realizaron entrevistas semiestructuradas a informantes clave y análisis documental. RESULTADOS. El principal avance es la creación de los Regímenes Estatales de Protección Social en Salud (REPSS), con una función de intermediación entre los usuarios y los prestadores de servicios de salud. Éstos se constituyen como instancias del nivel estatal encargadas de administrar los recursos financieros y conformar y coordinar la red de prestación de servicios de atención médica. No obstante, la mayoría de los REPSS estudiados se encuentran en un estado de inercia que les impide cumplir adecuadamente con las funciones marcadas por la ley. CONCLUSIÓN. Persisten obstáculos normativos, técnicos, políticos y gerenciales para cumplir con la separación de funciones.

OBJECTIVE. To evaluate advancements and challenges in the separation of functions within Mexico's System of Social Protection in Health. MATERIAL AND METHODS. A 2009 evaluation study involving nine states and the National Commission for Social Protection in Health was carried out via semi-structured interviews with key actors and literature analysis. RESULTS. The main advancement has been the creation of the State Regimens for Social Protection in Health (REPSS in Spanish) which act as intermediaries between users and health service providers, making these state-level entities responsible for both managing financial resources and shaping and coordinating the health care delivery network. However, most of the REPSS studied were found to be in a state of inertia, leading to inadequate compliance with legally mandated functions. CONCLUSION. Normative, technical, political and managerial obstacles persist, impeding the successful separation of functions.

Medicines in Mexico, 1990-2004: systematic review of research on access and use: [review] / Medicamentos en México, 1990-2004: revisión de investigación sobre acceso y uso: [revisión]

OBJECTIVE: To review original research studies published between 1990 and 2004 on the access and use of medicines in Mexico to assess the knowledge base for reforming Mexico's pharmaceutical policy. MATERIAL AND METHODS: A literature review using electronic databases was conducted of original studies published in the last 15 years about access and use of medicines in Mexico. In addition, a manual search of six relevant journals was performed. Excluded were publications on herbal, complementary and alternative medicines. RESULTS: Were identified 108 original articles as being relevant, out of 2289 titles reviewed, highlighting four policy-related problems: irrational prescribing, harmful self-medication, inequitable access, and frequent drug stock shortage in public health centers. CONCLUSIONS: This review identified two priorities for Mexico's pharmaceutical policy and strategies: tackling the irrational use of medicines and the inadequate access of medicines. These are critical priorities for a new national pharmaceutical policy.

OBJETIVO: Revisar estudios de investigaciones originales publicados sobre el acceso y uso de los medicamentos en México de 1990 a 2004, con el fin de evaluar el conocimiento que existe para reformar la política farmacéutica nacional. MATERIAL Y MÉTODOS: Se condujo una revisión de la literatura sobre estudios originales publicados entre 1990 y 2004 sobre el acceso y uso de medicamentos en México. Además, se revisaron manualmente seis revistas relevantes. Se excluyeron publicaciones sobre herbolaria, medicamentos tradicionales y alternativos. RESULTADOS: Se revisaron 2 289 artículos e identificaron 108 como relevantes que destacan cuatro problemas importantes relacionados con las políticas farmacéuticas: prescripción inadecuada, automedicación dañina, acceso inequitativo y desabasto de medicamentos en servicios públicos de salud. CONCLUSIONES: Esta revisión identificó dos prioridades críticas para el desarrollo de una nueva política farmacéutica en México: actuar sobre el uso irracional de medicamentos y sobre el acceso inadecuado a medicamentos.

El concepto y la práctica de la salud internacional en el Programa Takemi / The concept and practice of International healtah in the Takemi Program

El Programa Takemi en Salud Internacional se fundó en la Escuela de Salud Pública de Harvard en 1983 como un programa de investigación y capacitación al más alto nivel, dirigido a profesionales de la salud a mitad de su carrera e interesados en la distribución de recursos para la salud, particularmente en los países en desarrollo. Este ensayo describe los orígenes del Programa Takemi y presenta siete principios que subyacen en el concepto y la práctica de la salud internacional en él. Los principios son: énfasis en la investigación, orientación de las políticas, perspectiva interdisciplinaria, respeto mutuo, libertad individual, espíritu comunitario y desarrollo de la capacidad individual. Las implicaciones más generales de estos principios se proponen para los actuales esfuerzos por redefinir el concepto de salud internacional

The Takemi Program in International Health was established at the Harvard School of Public Health in 1983 as a research and advanced training program for mid-career health professionals concerned with the allocation of resources for health, especially in developing countries. This essay describes the origins of the Takemi Program and presents seven principles that underlie the concept and practice of international health in the Takemi Program. The principles are: research emphasis, policy orientation, interdisciplinary perspective; mutual respect, individual freedom, community spirit, and individual capacity building. The broader implications of these principles are suggested for current efforts to redefine the concept of international health.