Access to prenatal care: inequalities in a region with high maternal mortality in southeastern Brazil / Acesso ao pré-natal: desigualdades em região de alta mortalidade materna do sudeste brasileiro

Abstract Aim This article aims to evaluate access to prenatal care according to the dimensions of availability, affordability and acceptability in the SUS microregion of southeastern Brazil. Methods A cross-sectional study conducted in 2012-2013 that selected 742 postpartum women in seven hospitals in the region chosen for the research. The information was collected, processed and submitted to the chi-square test and the nonparametric Spearman’s test, with p-values less than 5% (p < 0.05). Results Although the SUS constitutionally guarantees universal access to health care, there are still inequalities between pregnant women from rural and urban areas in terms of the availability of health care and among families earning up to minimum wage and more than one minimum wage per month in terms of affordability; however, the acceptability of health care was equal, regardless of the modality of the health services. Conclusion The location, transport resources and financing of health services should be reorganised, and the training of health professionals should be enhanced to provide more equitable health care access to pregnant women.

Resumo Este artigo tem por objetivo avaliar o acesso à assistência pré-natal segundo as dimensões de disponibilidade, capacidade de pagar e aceitabilidade, no SUS de uma microrregião do sudeste brasileiro. Trata-se de um estudo seccional, realizado em 2012-2013, que selecionou 742 puérperas em sete maternidades da região escolhida para a pesquisa. As informações foram coletadas, processadas e submetidas ao teste Qui-quadrado e ao teste não paramétrico de Spearman, com p-valor menor que 5% (p < 0,05). Apesar de o SUS garantir constitucionalmente o acesso universal ao sistema de saúde, nota-se que ainda existem iniquidades entre as puérperas da zona rural e urbana quanto à disponibilidade e, entre as famílias que ganham até um salário mínimo e mais de um salário mínimo por mês, quando se relaciona à capacidade de pagar, porém a aceitabilidade revelou-se igual, independentemente da modalidade dos serviços de saúde. O local de moradia, os recursos de transporte e o financiamento dos serviços de saúde devem ser reorganizados, e a formação dos profissionais de saúde aprimorada, a fim de oferecer um acesso mais justo às gestantes.

Effectiveness of depot-holders introduced in urban areas: evidence from a pilot in Bangladesh.

Depot-holders are women from the community who promote good health practice and use of clinics. They keep a stock of contraceptives and oral rehydration salts to supply other women and are paid some incentives. In 2003, the NGO Service Delivery Program (NSDP) introduced depot-holders in three types of urban area in Bangladesh as a pilot. This evaluation study was carried out to: (a) establish a baseline for measuring the impact of activities of depot-holders on a comprehensive range of indicators in the long-term, (b) make a preliminary assessment of the impact on the use of selected services of the essen-tial services package (ESP) and other indicators at the end of the pilot phase, and (c) assess the cost of introducing depot-holders and running their activities for a year. Data from the baseline and end of pilot household surveys, together with service statistics from the intervention and comparison areas, were used for assessing the changes in clinic use and commodity distribution. The study found evidence that the depot-holders transferred knowledge to women in the community, provided services, and referred women to clinics run by non-governmental organizations (NGOs). There was a large increase in the number of client contacts at the NGO clinics and in the quantity of oral contraceptive pills and oral re-hydration salts distributed by the NGOs, mostly attributable to the activities of the depot-holders. The estimated cost per depot-holder per year was Tk 15,241 (U.S. dollars 262). Overall, the performance of the depot-holders in the pilot phase suggests that they can be introduced in different types of urban area and can be effective in their dual role as providers and promoters of services.

Patterns, appropriateness, and predictors of antimicrobial prescribing for adults with upper respiratory infections in urban slum communities of Bangkok.

Upper respiratory tract infections (URIs) are the most common infections worldwide. Their frequent inappropriate treatment with antibiotics is likely to increase antibiotic resistance, contribute to morbidity and mortality, and waste scarce resources. Using data from registration books and prescriptions, we measured patterns and assessed appropriateness and predictors of antibiotic prescribing for viral and bacterial URIs treated in health centers located in two slum communities in Bangkok, Thailand. Based on recorded diagnoses and symptoms, 91% of the patients probably had viral URIs; 60% of viral and 89% of bacterial URI patients were prescribed an antibiotic. Compliance with the national treatment guideline was 36.4% for treatment of viral URIs and only 1.7% for treatment of bacterial URIs. Amoxicillin was the most frequently prescribed antibiotic regardless of diagnosis. Among viral URI patients, those who were young, male, and self-paying were more likely to receive antibiotics; part-time physicians were more likely to prescribe antibiotics for these patients. Among patients with bacterial URIs, those who paid for drugs by themselves were more likely to receive antibiotics compared to patients covered by the national health insurance plan. We used these formative results as input to the design of health center and community interventions to encourage more appropriate prescribing for URI among adults.

Estimating the Cost of Visiting Nursing Service by Visiting Nursing Model for Urban Public Health Center in Korea / 간호학회지

PURPOSE: This study focused on analysing costs per visiting nursing care based on nursing activities in a public health center. METHOD: The Easley-Storfjell Instrument(1997) was used for a prospective descriptive analysis of self-records for workload data from 10 visiting nurses during 4 weeks on all nursing activities. In addition, analysis of the 478 visiting nursing records and cost data from 5 home visiting departments in public health centers during one year of 2003 was done. RESULT: The workload of visiting nurses by the type of model was identified as follows: Type I showed that caseloads made up 32.9 % of all nurse activities, and type II showed that the caseloads made up 45.8 %. Second, The cost per visit in type I was 33,088 won and 31,323 won in type II. Third, the estimated budgets were 1,902,436 won to 12,057,696 won for the type I model. and 4,151,316 won to 17,432,712 won for the type II model for one year. CONCLUSION: This study's results will contribute to baseline data used to establish on infrastructure for visiting nursing program and visiting nursing agencies based on the budget of visiting nursing services.

Expenses of health facilities in rural and urban health care centers in Zanjan

Expenses of health facilities have a great impact on their quality. The present study was conducted to determine the expenses of each health facility in rural and urban health care centers in Zanjan province in 2001.For this descriptive study, 26 minor health care centers in small villages, 6 rural and 5 urban health care centers were selected through randomized sampling. Expenses were determined according to the type of facility, the exact center, and also type of expense. Thus, expenses of usable materials and equipment, specific equipment, drugs, building repairs, vehicles, personnel, and other equipment were all determined in accordance to the population.Expenses of minor health care centers in small villages, rural and urban health care centers were 49, 330, and 44 million Rials, respectively. Personnel expenses were by far the most common type of expenses that comprised 25.7, 21.5, and 31.3% of the aforementioned centers' expenses, respectively. Unfortunately, government has not allocated enough budgets for these health care centers. Meanwhile, paying further attention to the managing aspects of such centers could be helpful to control their expenses. Similar studies are highly recommended in other centers

Costs-effectiveness of the urban health center in Nakhon Ratchasima: a case study on diabetes and hypertension.

Health care reforms in Thailand are looking for a better health infrastructure within the urban setting. The urban health center is one of the models tried in many provinces. This study compared the costs--effectiveness of the urban health center in Nakhon Ratchsima with the Maharaj Nakhon Ratchasima Hospital, using diabetes and hypertension as tracer conditions. The point estimates by a retrospective review and cross-sectional study revealed that the overall costs (provider plus patient costs) of the urban health center for these tracers were lower than the costs of the Maharaj Hospital. The effectiveness of treatment at the urban health center was also better. It was concluded that the urban health center should be considered as a better alternative of primary care institution within the urban area.