Home-based newborn care voucher initiative in Assam: An evaluation

Background: An innovative home-based newborn care (HBNC) voucher system has been introduced in Assam to improve home visits of accredited social health activists (ASHAs), make them more accountable, and empower the community. Objective: This study aimed to evaluate the effectiveness of HBNC voucher initiative in Assam. Methods: A mixed methodology study was conducted in 2018 including 4 districts of Assam. A quantitative study was done among a sample of 836 lactating mothers by interviewing them through house-to-house visits. A qualitative study was done by in-depth interview of various health-care service providers. Results: Of 836 lactating mothers, 65% received HBNC voucher; 45.6% received at the time of discharge, and 5.3% during antenatal care. The purpose of HBNC vouchers as a tool of validating ASHAs' home visits was explained to only 14.5% of lactating mothers. Examination of newborn (44.6%), counseling on breastfeeding (57.1%), counseling on care of baby (39.2%), and counseling on immunization (49.2%) were the services commonly provided by ASHA during HBNC visits. Voucher system improved incentive payment system, but uninterrupted supply was a problem area as stated by ASHAs. Auxiliary nurse midwives and ASHA supervisors told that voucher system had improved ASHA home visits, payment system, and increased identification of danger signs of newborns. Conclusions: HBNC voucher system as an innovative approach was found to be effective. Coverage of services varied among different districts. Uninterrupted supply of the vouchers, periodic resensitization of health workers on its use, and increasing awareness among the community is needed to be sustained.

Analysing ambiguities in trypanosomatids taxonomy by barcoding

BACKGROUND Biodiversity screens and phylogenetic studies are dependent on reliable DNA sequences in public databases. Biological collections possess vouchered specimens with a traceable history. Therefore, DNA sequencing of samples available at institutional collections can greatly contribute to taxonomy, and studies on evolution and biodiversity. METHODS We sequenced part of the glycosomal glyceraldehyde phosphate dehydrogenase (gGAPDH) and the SSU rRNA (V7/V8) genes from 102 trypanosomatid cultures, which are available on request at www.colprot.fiocruz.br. OBJECTIVE The main objective of this work was to use phylogenetic inferences, using the obtained DNA sequences and those from representatives of all Trypanosomatidae genera, to generate phylogenetic trees that can simplify new isolates screenings. FINDINGS A DNA sequence is provided for the first time for several isolates, the phylogenetic analysis allowed the classification or reclassification of several specimens, identification of candidates for new genera and species, as well as the taxonomic validation of several deposits. MAIN CONCLUSIONS This survey aimed at presenting a list of validated species and their associated DNA sequences combined with a short historical overview of each isolate, which can support taxonomic and biodiversity research and promote culture collections.

Medical voucher system in Hong Kong and Macao and its implications to mainland China / 中国卫生政策研究

It is important and difficult to establish the market competition mechanism in the health care re-form. Medical voucher system in Hong Kong and Macao can provide policy guidelines for Mainland China to promote institutional innovation, force public hospital reform and the rational allocation of medical and health resources. This paper introduced the origin and development of medical voucher system. Based on the description of the implementa-tion background, similarities and differences and effects of medical voucher system in Hong Kong and Macao, the pa-per found that medical voucher system could help encourage the demander to make more frequent use of medical serv-ices, improve their consciousness of prevention and health care and promote family doctor system. Through analyzing the applicability of medical voucher system in mainland China, the paper pointed out it was consistent with the reform orientation and could be served as a useful supplement to the health care system to improve medical insurance, medi-cal assisstance system as well as an effective measure to develop private medical institutions.

Evidence-informed policy formulation: the case of the voucher scheme for maternal and child health in Myanmar.

Introduction: In 2010, with financial support from the Global Alliance for Vaccine and Immunization’s Health System Strengthening programme, the Government of Myanmar established a scheme to improve coverage of maternal and child health (MCH) services. Employing qualitative approaches, this article reviews the processes through which this scheme was devised, focusing on evidence generation and the use of such evidence to inform policy formulation. To address the problem of high mortality rates among mothers and infants, collaborative research was conducted by Myanmar’s Ministry of Health, the World Health Organization, and a research arm of Thailand’s Ministry of Public Health, between March 2010 and September 2011. In the early phase of this study, key barriers to governmentprovided MCH services were identified. Based on a comprehensive review of the literature, the introduction of a voucher scheme was raised for consideration by ministry of health decision-makers and respective stakeholders. Despite the successful experience of this financing strategy in low-income countries, a series of surveys, an economic evaluation, and focus group discussions were carried out to assess the feasibility and potential health and economic implications of this scheme in the Myanmar context. The research findings were then used to guide the design and adoption of the newly established initiative.

Access to and utilization of voucher scheme for referral transport: a qualitative study in a district of West Bengal, India.

Background: Lack of motorized transport in remote areas and cash in resourceconstrained settings are major obstacles to women accessing skilled care when giving birth. To address these issues, a cashless voucher transport scheme to enable women to give birth in a health-care institution, covering poor and marginalized women, was initiated by the National Rural Health Mission in selected districts of India in 2009. Methods: The access to and utilization of the voucher scheme were assessed between December 2010 and February 2011 through a qualitative study in the district of Purulia, West Bengal, India. Data were collected from in-depth interviews and focus group discussions with women, front-line health-care workers, programme managers and service providers. Results: The main factors influencing coverage and utilization of the scheme were: reliance on ill-prepared gram panchayats (village councils) for identification of eligible women; poor birth preparedness initiatives by health-care workers; overreliance on telephone communication; restricted availability of vehicles, especially at night and in remote areas; no routine monitoring; drivers’ demand for extra money in certain situations; and low reimbursement for drivers for long-distance travel. Conclusion: Departure from guidelines, ritualistic implementation and little stress on preparedness of both the community and the health system were major obstacles. Increased enthusiasm among stakeholders and involvement of the community would provide opportunities for strengthening the scheme.