Health interventions for the metal working industry: which is the most cost-effective? A study from a developing country.

This study ranked the cost-effectiveness of health interventions in the metal working industry in a developing country. Data were based on 82 034 workers of the Northern region of Mexico. Effectiveness was measured through 'healthy life years' (HeaLYs) gained. Costs were estimated per worker according to type and appropriate inputs from selected health interventions. 'Hand' was the anatomical region that yielded the most gain of HeaLYs and amputation was the injury that yielded the most gain of HeaLYs. The most effective health intervention corresponded to training, followed by medical care, education, helmets, safety shoes, lumbar supports, safety goggles, gloves and safety aprons. In dollar terms, education presented the best cost-effectiveness ratio (US$637) and safety aprons presented the worst cost-effectiveness ratio (US$1 147 770). Training proved to be a very expensive intervention, but presented the best effectiveness outcome and the second best cost-effectiveness ratio (US$2084). Cost-effectiveness analyses in developing countries are critical. Corporations might not have the same funds and technology as those in developed countries or multinational companies.

Quality differences between rural and urban primary care: the case of a cervical cancer screening programme.

OBJECTIVE: To measure the difference between rural and urban primary care quality in terms of an early cervical cancer detection programme. LOCATIONS: Seven hundred and fifty smear reports from rural primary care units and 750 from urban primary care units were selected at random from three institutions: the Ministry of Health, the largest Mexican social security institution, and one University Hospital, during August 1995-March 1996. Excluded were reports from women who were pregnant, menopausal or those who had undergone hysterectomy, as well as those tested positive for dysplasia and cancer. ACTIVITIES: Quality was measured through indicators and standards set by consensus of recognized field experts, based mainly on recommended national and international parameters. RESULTS: There was no difference between the overall quality of the urban and rural units. Both registered fairly satisfactory levels (achievement: 76.2%; 95% CI: 72.7-77.0%, versus 75.2; 95% CI: 69.8-78.9%, respectively). The quality of the smear sampling was highly unsatisfactory in rural units and unsatisfactory in urban units (achievement: 64.2%; 95% CI: 58.2-70.0%, versus 47.3%, 95% CI: 42-52.7%; P < 0.00001). Quality of coverage was unsatisfactory for both regions. Quality of smear processing and timeliness were highly satisfactory for both rural and urban units. RECOMMENDATIONS: Efforts should be directed toward smear quality improvement, especially in rural units. Health care workers who take smears need training programmes and better instruments. They should receive feedback on smear adequacy from the laboratory. Health education is necessary to improve utilization and programme coverage quality.