Journal of Health Management recent issues

Editorial

Kumar, M., Burman, E. — 2009-09-18

We welcome readers to the second special issue (11.2) of the Journal of Health Management in 2009. We hope the readers find the articles and various reviews enriching and provocative, both in terms of the range of ideas and critical approaches addressed. The key theme of this double issue concerns the political limits of mega-development projects such as the Millennium Development Goals (MDGs). The primary focus of the articles collected here is to provide an insightful, constructive and in-depth critique of the United Nations (UN) MDGs along with critical deliberations on their short- and long-term implications not only for health management but also for a wide range of issues around development and social change.

Disability and the Millennium Development Goals: A Missing Link

Ghai, A. — 2009-09-18

The objective of this article is to locate disability issues within the discourse of the Millennium Development Goals (MDGs). The idea is to question the failure of the goals addressing disability. MDGs cannot work as a universal remedy. It is critical to foreground the meaning of disability and underscore the reasons for the disabled people's absence from the agenda of the MDGs. Further, I discuss the ways in which state policy has addressed ‘disability’ in a globalising context. Finally, I outline the paradox of identity politics and its nuances based upon an understanding of the issues and related questions from my own experiences as a disabled Indian woman, having to contend with the existential realities of a visible physical disability. The plea is to expand the democratic space to ensure that the rights and needs of disabled people within the MDGs discourse are given due consideration.

Bottlenecks and Benevolence: How the World Bank is Helping Communities to 'Cope' with HIV/AIDS

Harman, S. — 2009-09-18

This article looks at how Goal 6 of the United Nations (UN) Millennium Development Goals (MDGs) impacts on the well-being of the people affected by Human Immunodeficiency Virus/ Acquired Immune Deficiency Syndrome (HIV/AIDS). The focus is on a specific aspect : how the aid emphasised by Goal 6 is channelled towards community groups responding to the HIV/AIDS crisis. It does so by exploring the institutional mechanisms used by one of the key international organisations involved in the realisation of the MDGs—the World Bank and its Multi-Country HIV/AIDS Programme (MAP) in Kenya, Tanzania and Uganda. The article explores the role of local government, rivalry between different forms of civil society organisations, the problems associated with effective delivery and community feedback, donor responses to these problems and how these factors impact upon the immediate and long-term realisation of Goal 6, and the position of communities within it. Key to which are themes of conditionality and divisions between implementation and decision-making. The article is based upon extensive qualitative research into MAP in East Africa.

Frustrated Potential, False Promise or Complicated Possibilities? Empowerment and Participation Amongst Female Health Volunteers in South Africa

Campbell, C., Gibbs, A., Nair, Y., Maimane, S. — 2009-09-18

We present a longitudinal case study of lay women's participation in a project seeking to facilitate home-based care of people dying of AIDS in a rural community in South Africa, drawing on four sets of interviews conducted with volunteers over a five-year period. We link participation in the project to three dimensions of women's agency: their knowledge and skills, their confidence; and their personal experiences of efficacy. We show that whilst the experience of participation enhanced each of these dimensions of volunteers’ agency at various stages of the project, the empowerment that did take place appeared to be limited to women's project-related roles, rather than generalising to other areas of their lives beyond the project. The project had limited impact on women's ability to negotiate condom use with husbands, to assert themselves in relation to male project leaders and to become more involved in wider community decision-making and leadership. We discuss three possible interpretations of our findings: (i) that greater empowerment might have occurred had the project run for a longer time period; (ii) that whilst such projects play a vital role in providing services, the more general ‘empowerment via participation’ agenda is a false promise in highly marginalised communities; or (iii) that whilst generalised positive impacts of such projects on volunteers are hard to track, such projects do open up glimpses of increased agency for many women. These might have positive but unpredictable results in ways that defy formulation in linear conceptualisations of social transformation and development, understood in terms of clearly observable and measurable inputs and outputs.

Is it Possible to Eradicate Poverty without Attending to Mental Health? Listening to Migrant Workers in Chile through their Idioms of Distress

C., L. N. — 2009-09-18

Departing from the existing critique of the Millennium Development Goals (MDGs), regarding the absence of mental health dimensions in the formulation of its poverty related goal, this article explores the interrelation between poverty and mental health by examining experiences of emotional distress of Peruvian migrant workers in Chile. Through an analysis of the idioms that Peruvian migrants use to communicate their distress, this article proposes an understanding of Peruvian migrant's emotional suffering that attends to the broader unequal relations that migrant workers are subjected to in the host society. The analysis enables an understanding of their experiences of social exclusion and personal uprootedness, making visible the agency that the migrants display in giving meanings and coping with their emotional distress, most often outside the medical system. This article argues for the need to develop alternative and culturally sensitive approaches to mental health, in order to support the everyday struggles of the poor.

Listening to Oral Traditions in a Re-searching for Praxis in a Non-western Context

Eskell-Blokland, L. M. — 2009-09-18

The relevance and appropriateness of western oriented psychology in practice and research is a concern in developing and non-western contexts. It is difficult to address this problem from any alternative position other than the western academic frame if one is situated in a tertiary educational institution in South Africa. In acknowledgement, this article explores the academic context including some local voices from the field in a search for possible congruent research methodologies, which may echo knowledge systems of the traditions of the local context in South Africa and its broader context in the continent. Constraining factors to the development of an appropriate praxis have been suggested to include epistemological issues, western academic hegemony and the perceived elitism of psychology as a discipline. In particular, this article explores the adoption of a narrative literary stance for research in psychology. Literary theory and discussions of the narrative from Bakhtin's writings are drawn on in an attempt to bridge a perceived epistemological divide between local traditional knowledge systems and western academia. From this perspective the oral tradition of Africa is considered at the interface of local and western knowledge around healing /helping traditions.

Danger and Disease in Sex Education: The Saturation of 'Adolescence' with Colonialist Assumptions

Macleod, C. — 2009-09-18

The United Nations Development Programme's (UNDP) Millennium project argues for the importance of sexual and reproductive health in the achievement of all Millennium Development Goals (MDGs). Sex education programmes, aimed principally at the youth, are thus emphasised and are in line with the specific MDGs of reducing the incidence of HIV and improving maternal health. In this article, I analyse recent South African sex education and Life Orientation (a learning area containing sex education) manuals. Danger and disease feature as guiding metaphors for these manuals, with early reproduction and abortion being depicted as wholly deleterious and non-normative relationships leading to disease. I argue, first, that these renditions ignore well-designed comparative research that calls into question the easy assumption of negative consequences accompanying ‘teenage pregnancy’ and abortion, and, second, that the persistence of danger and disease in sex education programmes is premised on a discourse of ‘adolescence’. ‘Adolescence’ as a concept is already saturated with the colonialist foundation of phylogeny re-capitulating ontogeny. Individual development is interwoven with collective development with the threat of degeneration implied in both. This interweaving allows for the instrumentalist goal of sex education in which social changes are sought through changing individuals’ sexual attitudes and behaviour.

The Millennium Development Goalposts: Researching the Score on and off the Field

Bradbury, J., Clark, J. — 2009-09-18

The United Nations’ Millenium Development Goals (MDGs) work in pervasive and powerful ways in the international imagination, by naturalising a strategic set of goals, indicators and targets, and in doing so, either opening up, or precluding and prescribing particular possibilities for understanding the state of the world and people's experiences. Our departure point for exploring the need for alternative research routes is therefore an engagement with the conceptualisation of ‘development’, the hopeful product of the 2015 target. This conceptual critique is three-fold: 1. There is a slippage in the discourse of the MDGs between ‘poverty’, ‘health’ and ‘development’ and consequently, the relations between different goals are poorly theorised. 2. There is an absence (or extreme paucity) of structural analysis. 3. While people are surely the centre of the developmental goals, in their formulation there is a remarkable absence both of specific groups of people and any conceptualisation of personhood in a more universal human sense. An alternative framework for understanding development and the relations between structure and agency is explored by theorising the themes of gender, national identity and childhood/youth. We then suggest that narrative methodologies may offer a productive research trajectory.

Universal Primary Education for All Towards Millennium Development Goal 2: Bangladesh Perspective

Rahman, Md. O., Islam, M. T. — 2009-09-18

Bangladesh, in theory and law, advocates equity of access to largely uniform, mass-oriented and universal system of education. This objective remains unfulfilled owing to the lack of commitment of all concerned to reach the goal of Education for All. Although the aggregate performance indicators (e.g. gross enrollment rate) for the primary education sub-sector has been relatively satisfactory in 2000s compared to the situations in 1990s. Beset with numerous problems, the education system is at once discriminatory and inconsistent. The standard of education is on the decline. The absence of effective quality control mechanisms and non-standardisation of the core content of basic learning materials make the education scenario even less satisfactory. More then half of the population in Bangladesh is denied the right to education. In this backdrop, this article critically examines government commitments for universal primary education for all by 2015 and the present situation of primary education sub sector. This article focused on the problem, challenges and policy issues to achieve the second goal of MDGs.

This Benevolent Hand Gives You Soap: Reflections on Global Handwashing Day from an International Development Perspective

Plyushteva, A. — 2009-09-18

In October 2008, the first Global Handwashing Day was celebrated internationally. It was promoted as the highlight of a global effort to spread the practice of washing hands with soap, reducing the incidence of diarrhoeal disease and saving hundreds of thousands of lives. However, the objectives and strategies of the public-private partnership (PPP) behind this initiative, which includes the three biggest global producers of soap, have not received sufficient scrutiny. This article offers a critical reassessment of the Global Handwashing Day, its origins and its implications, and challenges the campaign's significance for its alleged beneficiaries and benefactors.

Book Review

2009-09-18

Editorial

Kumar, M., Burman, E. — 2009-08-18

We welcome readers to the first special issue (11.1) of the Journal of Health Management. We hope the readers find the articles and various reviews enriching and provocative, both in terms of the range of ideas and critical approaches addressed. The key theme of this double issue concerns the political limits of mega-development projects such as the Millennium Development Goals (MDGs). The primary focus of the articles collected here is to provide an insightful, constructive and in-depth critique of the United Nations (UN) MDGs along with critical deliberations on their short- and long-term implications not only for health management but also for a wide range of issues around development and social change.

What's Millennial about the MDGs? Discursive Boundaries of Public Health in Southeast Asia

Thiesmeyer, L. — 2009-08-18

The Millennium Development Goals are framed within the post-war discourses of development that also gave us Basic Human Needs and Human Security. The Goals set out a consideration of the failures of earlier strategies along with an agenda for the accelerated reduction of poverty and its accompanying human insecurities. Though the more critical aspects of the MDG discourse were sorely needed, they also left space for the repetition of earlier top–down development strategies, and, more generally, for a (re)vision and wider implementation of globalised intervention by developed countries into the less-developed. In this discourse developed countries identify needs on the part of the less-developed and then supply these needs. The ‘need’ discourse focussed on here represents inferior public health that requires services, goods and equipment to be provided by developed countries; what it ignores are negative health consequences that can arise from development schemes themselves.

The Erased and MDG Implementation: The Production of a Medical Anomy in Slovenia

Jeffs, N., Cebron, U. L. — 2009-08-18

The Erased are a group of individuals who were taken off the register of permanent residents in the aftermath of Slovenia's independence in 1991. With this they faced total social exclusion. This article discusses how Erasure came to be and its consequences. The plight of those Erased who are without legal status even today is discussed with regard to issues concerning health and access to health services from which they are excluded through a combination of nationalist and neo-liberal policies. As such, they not only form a section of society that can be completely overlooked by the implementation strategies of the Millennium Development Goals (MDGs), but can also be seen as indicative of some of the conditions that may also effect other vulnerable individuals and groups such as those emerging from various conflicts, precarious workers, migrants and ethnic minorities.

MDGs in a Global World: Gender Equity and Empowerment in Service Provision for Migrant Women in Barcelona

Montenegro, M., Montenegro, K., Yufra, L., Calaz, C. — 2009-08-18

In this article we reflect upon the relationship between the Millennium Development Goals (MDGs) formulated by the United Nations (2000) and the migration phenomena that is characteristic of the present globalised society. First, we argue that the Millennium Goals have not sufficiently considered migration processes as a structural phenomenon. Development goals must take in account this emergent phenomenon in post-industrial societies in order to achieve human rights and social equity and to promote the well-being of all people in their origin and host societies.

Second, by interpreting the results of an ethnographic study carried out in social services aimed at migrant women in the city of Barcelona, while focusing on the 3rd Millennium Goal: gender equity and the empowerment of women, we reflect on the limits and possibilities of these intervention practices in advancing towards the goal in host societies. We conclude that changes in public policy and social services are necessary in order to advance towards the achievement of the gender equity goal and empowerment of women, a transformation that aims at the achievement of citizenship for all people in this global society.

The Orthodoxy of Gender Mainstreaming: Reflecting on Gender Mainstreaming as a Strategy for Accomplishing the Millennium Development Goals

Palmary, I., Nunez, L. — 2009-08-18

Gender mainstreaming has itself become something of a mainstream practice in much development work. As the theory and practice of mainstreaming has developed so too have a range of debates over what exactly gender mainstreaming can contribute to development. This article reflects on a gender mainstreaming intervention in the East African region to explore the role that gender mainstreaming can play in achieving the Millennium Development Goals. In this article we discuss how gender mainstreaming has, at times, functioned as a retreat from women's equality and is used to render feminist perspectives more palatable to those who resist them. Far from being a simple critique of gender mainstreaming this reflects the broader tensions and debates that are shaping what gender has come to mean in different contexts. This brings difficult tensions over who develops a gender mainstreaming agenda and who claims to have expertise on gender. We explore how much is at stake in claims to represent the ‘beneficiary’ groups and the ways that donor relationships with NGOs function in this regard. Gender mainstreaming has clearly offered a mechanism for legitimating attention to gender inequality that is sufficiently flexible to account for local contexts. However, this flexibility also means that gender mainstreaming can be co-opted for conservative means and the struggles over ownership of gender mainstreaming can just as easily hamper the achievement of gender equality as envisaged in the MDGs.

A Case for Intercultural Inquiry and Cognitive Justice in the Internationalisation of HIV/AIDS: A South African Example

Frizelle, K.L. — 2009-08-18

Through the globalisation of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS), policies and prevention measures related to the epidemic have become increasingly influenced by the knowledge claims of international experts and organisations. This article critically analyses the mechanisms through which international expertise has come to influence the practice of rapid testing within the South African context. Through this analysis the article aims to illustrate the unintended consequences of the process of HIV/AID globalisation and internationalisation. While the article argues that knowledge claims about the pandemic are always produced through an interaction of local and international processes, it contends that these interactions are characterised by inequalities when the experiences of local people and contextual factors are not adequately fed into the process of policy development and implementation. The article concludes by arguing that more intercultural inquiry that prioritises cognitive justice is required if we are to develop more contextually appropriate and effective HIV/AIDS related policies and interventions.

Health Inequality in Resource Poor Environments and the Pursuit of the MDGs: Traditional versus Modern Healthcare in Rural Indonesia

Assan, J. K., Assan, S. K., Assan, N., Smith, L. — 2009-08-18

The article examines health inequalities and the impact of changing healthcare provision in rural Indonesia. Traditional medicine is often the only source of medical care for a majority of the population in rural Indonesia. However, the pursuit of the Millennium Development Goals (MDGs) requires the provision and implementation of modern healthcare systems. Using case studies from four rural districts in Kaledupa, a remote island in southeast Sulawesi in Indonesia, the study shows that although modern healthcare facilities are present in the sampled island, they seem to be remote with limited access in comparison with the number of traditional practitioners. High costs, cultural beliefs, distrust and distance to modern healthcare facilities appear to be the most common reasons for people opting for traditional healthcare. However, social reconstruction in the perception and provision of care has also led to a gradual disappearance of the traditional healthcare provision. The study calls for policy intervention approaches that are geographically and culturally sensitive as the most pragmatic means towards the attainment of MDG targets for the health sector of Indonesia.

MDG 6--What about Disabled People?

Godziek, S. — 2009-08-18

The 2008 UNAIDS Global Update estimated that there were 33 million people living with HIV and that, of these, 67 per cent of adults and 90 per cent of children live in sub-Saharan Africa. There were 2.7 million new infections during 2007 and 2.1 million AIDS deaths, 76 per cent in sub-Saharan Africa. The aims of Millennium Development Goal (MDG) 6 are to arrest the spread of HIV and to promote access to treatment. However, the vulnerability to HIV of people with disabilities, their need for HIV & AIDS information and the constraints they face in accessing treatment have largely been ignored by international development academics and practitioners when disabled people may account for 10 per cent of the world's population and 80 million Africans are estimated to be disabled. Why, then, are disabled people not mentioned anywhere in descriptions of or implementation strategies for MDG 6? This article will use the case study of the relationship of disabled people in Mozambique to HIV & AIDS to draw out the reasons for disabled people being ignored throughout HIV & AIDS policy and services and then provide recommendations to bring about disabled people's inclusion.

Global Development? Monitored Object(ive)s, Omitted Subject(ivitie)s

Gulerce, A. — 2009-08-18

In this article I critically reflect on the hegemonic modernist framework of development by focusing on its reflection and application in the United Nations’ (UN) Millennium Development Goals (MDGs) and practices. Not only do I find it falling short of explaining, understanding or bringing about global development, but quite the opposite, since it feeds into and reproduces the status quo. While I plead for serious (re)definitions, and genuine global commitment towards the (re)solution, of the current micro/macro social problems, which are interdependent and need to be treated in connection and at once, I pick four urgent areas of transformation as sub-topics for the present discussion. They include the (meta)theoretical framework and discourse of development, historical and contextual analyses of diverse human socio-cultural conditions, political will and agency and psychology's contributions within a transdisciplinary participation paradigm. I also briefly hint at various issues from the ‘developing’ context of Turkish society in order to illustrate some of the arguments. It is hoped that the complexity of these issues and widespread inequity problems will no longer be ignored in favour of conventional policies and programmes that are based on the reductionist framework and that truly trans(/post)disciplinary and trans(/post)cultural dialogues will enable new connections, meanings and actions towards desired global transformations.

Policies to Eradicate Extreme Poverty in Chile: A Critical Analysis of the Puente Programme

Urrutia, B. B., Labrin, S. M. — 2009-08-18

The present article analyses the association between the way in which public policy conceptualises poverty (in discourse and practice), the conception of poverty of people who live in extreme poverty conditions and the strategies they develop to affront it, in the light of their participation in the Puente Programme in Chile. The data emanate from research work carried out from a qualitative perspective using in-depth interviews with people considered to be living in extreme poverty and including a gendered analytic.

The ‘Puente Programme’ is part of Chilean public policy aimed to reduce levels of poverty and extreme poverty, in consonance with the Millennium Development Goal (MDG) One as stated by the UNDP.

Indeed, such policies seem to have had the effect of generating a self-perception of lack of opportunities, low level of agency in the solutions of their problems and consequently, fewer possibilities of achievement of the ends that they have in mind among the users. Also, we conclude that the strategies used by the Puente Programme have neither strengthened community association, nor helped to regenerate community networks. Additionally, the interviewed people do not feel empowered or improved in their citizenship capacities. Instead, what results is a sense of dependency on institutions. Finally, we postulate that the Puente Programme has not contributed to the development of a community or in subjective welfare.

Community 'Participation', Resistance and the Water Wars

Barnes, B. — 2009-08-18

Water is essential to human life, health and development. Prepaid water metres are a popular yet controversial approach to extending water services to the poor. They operate on an upfront payment system which automatically disconnects water if households do not have enough money to replenish supplies. While prepaid water metres have been criticised on a number of levels, this article focuses on the equally problematic discourses used to promote them amongst the poor. By drawing on a case study of a poor South African community's struggle against prepaid water metres, this article highlights how prepaid metres were promoted using psycho-education campaigns under the guise of ‘participation’. It also documents community resistance to the campaigns ending in a court battle that ruled in favour of communities’ right to sufficient water.

Democratic Decentralisation and the Millennium Development Goals for Health: An Analysis of Outcomes for Women in Two South Indian States

Mohan, N. — 2009-08-18

In the context of the targets for primary health identified by the MDGs this article evaluates the link between decentralisation and positive outcomes for women and children. Using India as a case study, the article traces the changes in health attainments as a result of decentralisation reforms. The evidence presented, drawn from the experiences of two states, speaks to the relevance of such a link. Despite the heterogeneity of contexts and in implementation, in general democratic decentralisation has enhanced health outcomes for women in the selected village Panchayats. However, the article unearths significant differences in the impacts of decentralisation between the two states. The variations in outcomes between the two states are found to be linked to the architecture of decentralisation design as well as to ‘non-statutory’ provisions that can create a process of path-dependency towards achieving MDGs. The article also flags key methodological complexities inherent in the current MDG framework with respect to the actualization of the goals of equity and access to primary health.

Challenges in Developing Community Mental Health Services in Sri Lanka

Fernando, S., Weerackody, C. — 2009-08-18

There are several issues to be faced in developing mental health services in South Asia if they are to be culturally and socially appropriate to the needs of the communities in the region. The meanings of mental health relevant to culturally appropriate service development can be obtained by exploring local notions of well-being, systems of care available to people and current practices among those seeking help for mental health problems. Participatory research carried out in communities in Sri Lanka affected by prolonged armed conflict and by the 2004 tsunami clarified the nature of well-being as perceived by communities themselves. Subsequent development of mental health services for Sri Lanka can be based on community consultation, using methodologies and interventions that involve the participation of the communities and their local institutions, and adapting relevant western approaches to the Sri Lankan context.

Vulnerability Effects in the Criminal Justice System on Women Who Suffer Physical Abuse in their Couple Relationships (Spain)

Albertin, P. — 2009-08-18

This article aims to explore the psychosocial practices in one of the sites that respond to vulnerable women who suffer abuse in their couple relationships: the criminal justice system. A discursive theoretical–methodological perspective is used (Foucault 1969; Ibáñez and Iñiguez 1997; Wetherell and Potter 1993), based on the discourse analysis and their positions that can be found in the practices of professionals in the criminal justice system (judges, prosecutors, lawyers, police), as well as in some of the narratives of vulnerable women. These accounts have been gathered through participant observations in courtrooms and police stations where complaints are filed, and through in-depth interviews. The results show the influence and the effects of: (a) an ‘empiricist position’ characterised by objectivity and emotional distance, and (b) a ‘professional position’ characterised by the predominance of professional roles and pragmatic experiences over reflexive practice. Nevertheless, emerging resistant practices include elements that could be placed in a ‘feminist position’ and provide new insights for the treatment of vulnerable women.

Hitting the Target and Missing the Point: Is the United Nations Playing Games with the World's most Vulnerable?

Webb, L., Ryan, T. — 2009-08-18

This article examines the policy of using target-setting and measurement to deliver on the United Nations’ (UN) development goals. Using evidence from similar monitoring and management strategies in the United Kingdom (UK), we question the purpose of using process and outcome targets and suggest that this approach can be counter-productive. It can also lead to a situation where maintaining public relations and image is prioritised at the expense of making real impacts on key development issues. While the UN's aims are praiseworthy, we suggest that the somewhat simplistic methodology adopted is damaging to the very people that the UN is seeking to help.

How the Poor Develop (in Spite of the Rich): A Commentary

Nieuwenhuys, O. — 2009-08-18

Book Reviews

2009-08-18

Addressing RTI/STI and HIV/AIDS, and Gender Discrimination in Treatment in India

Buragohain, T. — 2009-03-27

In this article an attempt is made to demonstrate the level of awareness of Reproductive Tract Infection (RTI)/Sexually Transmitted Infections (STI) and Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) and the extent of discrimination in treatment seeking behaviour among men and women who have got symptoms of RTI/STI in India. The awareness about RTI among women is higher than that among men by 8 percentage points, but the level of awareness about STI among men is higher than that among women by 7 percentage points. The awareness about HIV/AIDS among men is higher than that among women by 18 percentage points. Among both men and women awareness about HIV/AIDS is substantially higher than that of RTI and STI. The level of education and work participation rates among men and women have a direct relationship with the level of awareness of HIV/AIDS. In India, about 30 per cent of women of age 15–44 years had symptoms of RTI/STI as against 12.3 per cent of men of age 20–54 years. However, only about 38 per cent of the women sought treatment as against 55 per cent of men.

Development of a Scale to Determine Barriers to Paediatric Eye Care

Krishnatray, P., Bisht, S. S., Guha, K., Pinto, S. — 2009-03-27

Childhood blindness has huge socio-economic costs. India's commitment to the goal of vision 2020 has put priority to elimination of preventable blindness in children. Although adult blindness has been extensively studied, the literature is seen to be generally lacking in providing in-depth understanding of childhood blindness, especially about barriers that impede access to eye care. The present study attempts to fill this gap. This article explains the procedure adopted in developing a scale to determine the barriers to paediatric eye care. A 22-item barrier to paediatric eye care scale was specifically developed. The scale, along with the full-length questionnaire, was pre-tested and later administered to 207 parent-respondents at Sadguru Netra Chikitshalaya (SNC), Chitrakoot, in the state of Madhya Pradesh (India). A fiveround factor analysis variable deletion process resulted in a three factor structure. Although this procedure reduced the number of items in the scale from 22 to 9, the variance explained by the factors increased from 61 to 78 per cent. The three factors were labelled as economic, logistic and perception of service. Regression analyses of the three factors/barriers, economic, logistic and belief, showed significant results. Further analysis showed that parents’ demographic profile and health seeking behaviour significantly explained the economic barrier. Health seeking behaviour was a significant predictor of logistic barrier.

A Status Report on the Health Care Sector in France

Lalitha, N, Guennif, S. — 2009-03-27

Nearly 10 per cent of the Gross Domestic Product (GDP) in France is spent on health care. Twenty per cent of this budget is spent on medicines, more than in many of the Organisation for Economic Co-operation and Development (OECD) countries including the US, UK and Canada. The pharmaceutical industry in France is the third largest in Europe and adopted product patents even before the TRIPS agreement. Strict regulatory measures govern the pharmaceutical industry in France. The branded drugs are costlier compared to the generics. In order to control costs and promote generic drugs in the prescription, the government has introduced several regulatory measures, which even other OECD countries have not fully implemented yet. Of the total turnover of the pharmaceutical industry, turnover from the domestic sales has been declining while the exports turnover has been increasing. The balance of trade in pharmaceuticals has been positive. The French have also been filing a large number of patents, second only to the US; and they rank higher than the US in patents granted. In order to compensate the firms for the loss of time in the patent application process, the French government grants a five-year term of exclusivity for companies satisfying certain criteria. Though this could delay the entry of generics, for pharmaceutical companies it provides an extended period of power over the product. The industry has also responded by investing in R&D to improve further. In conclusion, the government plays a significant role in providing health care and regulating the pharmaceutical industry.

A Study on Health Awareness in Chars of Assam

Barua, P., Hazarika, J. — 2009-03-27

This article studies the situation of health awareness among the inhabitants of Chars (river islands) of Nalbari, Borpeta and Jorhat districts of Assam. The health awareness is measured by health expenditure. The findings reveal that all the variables—caste-residence compound status, educational attainment, economic consideration of the family, family structure and primary occupation of the families have desirable impact on health awareness. In particular, the inhabitants of Char areas of Nalbari and Borpeta districts are seen to be least health aware. Thus on the basis of the findings of this study, it can be stated that in spite of launching several schemes for the upliftment of Chars (like forming Char area development authority, forming a separate state ministry for Char development, and so forth), the people living in these Chars are still far more backward than the people living in other parts of Assam.

Book Reviews

Nathawat, S.S, Venkataraman, H. — 2009-03-27

Abstracts

2009-03-27

When Staff Create the Organisational Culture: A Case Study in the Spanish Emergency Health Care System

Rey Pino, J. M., Gardey, G. S., Hagen, I. — 2008-12-08

Emergency units suffer from continuous overload because all types of users demand the service. The literature shows that in general, the percentage of non-urgent users varies from 20 per cent to 80 per cent, depending on the type of centre analysed, the research approach or the methodology. While some studies have analysed this phenomenon focusing on the users, the current research adopts a different perspective. In this article, we try to explain how the break-down in the emergency services affects the work that the staff do. Drawing on evidence obtained from a six-month ethnographic study in two Spanish public hospitals, we conclude that in this overloaded context, official definitions of emergencies and formal classification protocols are completely useless. Exploring the staff's perceptions about the users and the service itself we try to re-create the process by which the diverse health care workers informally re-define symbols, concepts and behaviour patterns, creating a specific internal culture that helps them cope with the complexity of the service and the excessive demand.

Patient Safety, Knowledge Creation and the Absorptive Capacity of Rural Hospitals

Godkin, L., Adcock, M., Duva, T., Verrett, D., Godkin, J. — 2008-12-08

Patient safety is a priority issue in health care and rural hospitals face unique circumstances in this arena. This article applies the concepts of organisational learning in general and absorptive capacity in particular to the efforts by rural hospitals to continuously improve patient safety performance. Strategies are discussed through which rural hospitals might better identify patient safety related information, techniques and technologies and convert them to organisational use.

Is Lifestyle Influencing Morbidity among Elderly?

Mutharayappa, R., Bhat, T.N. — 2008-12-08

The main focus of the article was to examine the type of lifestyle adopted by the elderly and its effects on their health conditions and this was based on the data available from the National Family Health Survey–2 (NFHS–2). The study found that lifestyle adversely affected health and increased morbidity conditions among the elderly. Lifestyles such as alcohol consumption, regular smoking and tobacco chewing had adverse effects on one's ability to control diseases. It was observed that asthma was higher among the elderly who smoked regularly, consumed alcohol and chewed tobacco. About 144 persons per 1,000 population who consumed alcohol were suffering from asthma. Similarly, 143 persons who smoked regularly and 97 persons who chewed tobacco were suffering from asthma. Though TB was related to the lifestyle of a person, it was less among tobacco chewers and alcohol drinkers, but it was higher among those who smoked regularly. Smoking led to higher Illness Prevalence Rate (IPR). The IPRs of smokers and non-smokers by age group showed that in every age group, smokers had higher IPR than the non-smokers. The increase in prevalence of illness among smokers was particularly high in the case of the elderly. Old people were also generally susceptible to various cardiovascular disorders and other extraneous factors such as consumption of alcohol and tobacco chewing. The elderly morbidity due to alcohol abuse was 8.6 per cent.

Making Drugs Affordable for the Poor in a Tertiary Care Hospital: A Case Study

Singh, O. P., Bapna, J. S. — 2008-12-08

The public sector health care facilities are expected to provide health care services including medicines at low costs. The costs are escalating and the poor population is unable to afford them. The most important factor for high costs is prescribing of expensive newer drugs irrationally due to the pressure of pharmaceutical companies. An attempt to promote rational prescribing through interventions, such as essential drugs lists, clinical protocols and training has not been very effective. The margin of profit manufacturer to retailers is high. Two attempts to supply medicines at low cost, one through a not-for-profit association, Rajasthan Medicare Relief Society (RMRS) and the other through a public sector undertaking, Rajasthan State Consumer Cooperative Federation (COOPS) are described. Quantitative data was collected using WHO indicators and qualitative information through interviews. The RMRS store stocks only the expensive drugs that are prescribed by the doctors. Although the cost is 30 per cent to 50 per cent below maximum retail price (MRP), only 20 per cent of the drugs are from the Rajasthan state essential drugs list (RSEDL) indicating an irrational use of expensive newer drugs. The benefit of reduction of the costs does not reach the public in the true sense. The COOPS provide medicines at 2 per cent below the MRP, where 30 per cent of the drugs are from the RSEDL. Mostly the government servants buy medicines from these stores to get the reimbursement from their employers. The study suggests that though these two types of outlets provide the medicines at low cost to the public, the actual benefits do not reach them due to irrational prescribing of expensive non-essential medicines.

Gender Responsive Budgeting

Sodani, P.R., Sharma, S. — 2008-12-08

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2008-12-08

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2008-12-08