Information, communication and equitable access to health care: a conceptual note

This conceptual paper addresses the health policy goal of equitable access to health care from a perspective that highlights the role of choice. It sketches a framework around the three access dimensions availability, affordability, and acceptability. The degree of fit with respect to each of these dimensions between the health system and individuals or communities plays a role in determining the level of access to health services by outlining the existing choice set. Yet it is the degree of informedness about the choices that ultimately determines access to health services. Access is therefore defined as the freedom to utilize. The paper focuses on information and its properties, which cut across the dimensions of access. It is argued that equity-oriented health policy should stimulate communicative action in order to empower individuals and communities by expanding their subjective choice sets.

Este artigo conceitual discute a meta política do acesso eqüitativo à assistência em saúde, com um foco especial no papel da escolha. Estabelece um arcabouço teórico baseado nas três dimensões do acesso: disponibilidade, acessibilidade financeira e aceitabilidade. No que diz respeito a cada uma dessas dimensões, o grau de ajuste entre o sistema de saúde e os indivíduos ou comunidades tem um papel determinante no nível de acesso aos serviços de saúde, na medida em que define o conjunto de escolhas. No entanto, em última análise, é o grau de informação sobre as escolhas que determina o acesso aos serviços de saúde. Portanto, acesso é definido como liberdade de utilização. O artigo analisa a informação e suas características (que atravessam as diversas dimensões do acesso), argumentando que uma política de saúde eqüitativa deve estimular a ação comunicativa para fortalecer os indivíduos e as comunidades na expansão dos seus conjuntos de escolhas subjetivas.

Rethinking the economic costs of malaria at the household level: Evidence from applying a new analytical framework in rural Kenya

Background Malaria imposes significant costs on households and the poor are disproportionately affected. However; cost data are often from quantitative surveys with a fixed recall period. They do not capture costs that unfold slowly over time; or seasonal variations. Few studies investigate the different pathways through which malaria contributes towards poverty. In this paper; a framework indicating the complex links between malaria; poverty and vulnerability at the household level is developed and applied using data from rural Kenya. Methods Cross-sectional surveys in a wet and dry season provide data on treatment-seeking; cost-burdens and coping strategies (n=294 and n=285 households respectively). 15 case study households purposively selected from the survey and followed for one year provide in-depth qualitative information on the links between malaria; vulnerability and poverty. Results Mean direct cost burdens were 7.1and 5.9of total household expenditure in the wet and dry seasons respectively. Case study data revealed no clear relationship between cost burdens and vulnerability status at the end of the year. Most important was household vulnerability status at the outset. Households reporting major malaria episodes and other shocks prior to the study descended further into poverty over the year. Wealthier households were better able to cope. Conclusion The impacts of malaria on household economic status unfold slowly over time. Coping strategies adopted can have negative implications; influencing household ability to withstand malaria and other contingencies in future. To protect the poor and vulnerable; malaria control policies need to be integrated into development and poverty reduction programmes