Assessment of Community Based Health Insurance in Sunsari District.

Background Community Based Health Insurance (CBHI) Schemes are promising alternatives for a cost sharing health care system which hopefully leads to better utilization of health care services, reduce illness related income shocks and eventually lead to a sustainable and fully functioning universal health coverage. Objective This study focused on factors influencing the people's enrolment and hindrances for enrollment of CBHI program. Method Altogether 316 households were taken according to population proportionate sampling method.Community based cross-sectional analytical study was carried out with preformed questionnaire among members and non- member in four villages. Sample unit for enrollee were selected by using population proportionate systematic random sampling method using enrolled register and for non-enroll systematic random sampling technique was used using household list from VDC. Result For non- members 28.3% small benefit package was main reason for non membership. Provision of partial payment would be a motivating factor for 26.4% of the respondents. Non-members (30.5%) felt disparities in treatment while providing good medicines (11.9%). Financial help for the treatment was good part of the program for 43.0% of the respondents. Among 9.3% of members who would not renew reported of tedious process of taking service as the main reason. The educational status of the respondents is directly related to the enrolment in the CBHI scheme (<0.001). Conclusion The study gave some insight about factors influencing the utilization of health insurance schemes in low resourced countries. Properly implemented CBHI schemes would add on better health financing and better utilization of health care in developing countries.

Use of amphotericin B in drug-resistant cases of visceral leishmaniasis in north Bihar, India.

Thirty-four multidrug-resistant cases of Indian visceral leishmaniasis (kala-azar) were treated with amphotericin B. A complete hemogram, liver and renal function tests, determination of serum electrolyte levels, a chest radiograph, and an electrocardiogram were done before, during, and after completion of therapy. Assessment for clinical and parasitologic cure was done weekly. Thirty-one patients who completed treatment had full cure after receiving 10-15 injections at six-months follow up. One patient died of myocarditis. A febrile reaction was observed in all cases, while thrombophlebitis was found in six cases (18.75%). Anorexia, nausea, and vomiting were found in seven cases (21.88%). No significant nephrotoxicity or electrolyte disturbances were observed. It is concluded that amphotericin B is an effective second-line drug for Indian visceral leishmaniasis, but unpredictable drug-induced myocarditis remains a problem.