Abstract:
:This article assesses whether social franchising of tuberculosis (TB) services in Myanmar has succeeded in providing quality treatment while ensuring equity in access and financial protection for poor patients. Newly diagnosed TB patients receiving treatment from private general practitioners (GPs) belonging to the franchise were identified. They were interviewed about social conditions, health seeking and health care costs at the time of starting treatment and again after 6 months follow-up. Routine data were used to ascertain clinical outcomes as well as to monitor trends in case notification. The franchisees contributed 2097 (21%) of the total 9951 total new sputum smear-positive pulmonary cases notified to the national TB programme in the study townships. The treatment success rate for new smear-positive cases was 84%, close to the World Health Organization target of 85% and similar to the treatment success of 81% in the national TB programme in Myanmar. People from the lower socio-economic groups represented 68% of the TB patients who access care in the franchise. Financial burden related to direct and indirect health care costs for tuberculosis was high, especially among the poor. Patients belonging to lower socio-economic groups incurred on average costs equivalent to 68% of annual per capita household income, with a median of 28%. However, 83% of all costs were incurred before starting treatment in the franchise, while 'shopping' for care. During treatment in the franchise, the cost of care was relatively low, corresponding to a median proportion of annual per capita income of 3% for people from lower socio-economic groups. This study shows that highly subsidized TB care delivered through a social franchise scheme in the private sector in Myanmar helped reach the poor with quality services, while partly protecting them from high health care expenditure. Extended outreach to others parts of the private sector may reduce diagnostic delay and patient costs further.
journal_name
Health Policy Planjournal_title
Health policy and planningauthors
Lönnroth K,Aung T,Maung W,Kluge H,Uplekar Mdoi
10.1093/heapol/czm007subject
Has Abstractpub_date
2007-05-01 00:00:00pages
156-66issue
3eissn
0268-1080issn
1460-2237pii
czm007journal_volume
22pub_type
杂志文章abstract::This paper explores the nature and type of policy transfer promoted by global health partnerships to facilitate access to medication in Cameroon and the associated implementation challenges. Using concepts from policy transfer, multi-level governance and the politics of scale, the paper conceptualizes the social space...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czq018
更新日期:2011-01-01 00:00:00
abstract:BACKGROUND:Suicide in Sri Lanka is a major public health problem and in 1995 the country had one of the highest rates of suicide worldwide. Since then reductions in overall suicide rates have been largely attributed to efforts to regulate a range of pesticides. The evolution, context, events and implementation of the k...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czt096
更新日期:2015-02-01 00:00:00
abstract::Most government health facilities in Cambodia perform poorly, due to lack of funds, inadequate management and inefficient use of resources, but mostly due to poor motivation of staff. This paper describes contracting as a possible tool for Ministries of Health to improve health service delivery more rapidly than the m...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/18.1.74
更新日期:2003-03-01 00:00:00
abstract:BACKGROUND:Health-care financing should be equitable. In many developing countries such as Kenya, changes to health-care financing systems are being implemented as a means of providing equitable access to health care with the aim of attaining universal coverage. Vertical equity means that people of dissimilar ability t...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czt073
更新日期:2014-10-01 00:00:00
abstract::Vaccination, like most other public health services, relies on a complex package of intervention components, functioning systems and committed actors to achieve universal coverage. Despite significant investment in immunization programmes, national coverage trends have slowed and equity gaps have grown. This paper des...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czaa127
更新日期:2020-11-01 00:00:00
abstract::The use of community health workers (CHWs) has been explored as a viable option to provide home health education, counselling and basic health care, notwithstanding their challenges in training and retention. In this manuscript, we review the evidence and discuss how the digitalization affects the CHWs programmes for ...
journal_title:Health policy and planning
pub_type: 杂志文章,评审
doi:10.1093/heapol/czy099
更新日期:2019-02-01 00:00:00
abstract::BACKGROUND Post-communist health care reforms and the break-up of Czechoslovakia have been studied from various perspectives, but little research has addressed the impact on health system performance. This paper investigates the quality and performance of the Slovak and Czech health systems before and after 1989, incl...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czs093
更新日期:2013-08-01 00:00:00
abstract:BACKGROUND:Integrating mental health with general medical care can increase access to mental health services, but requires helping generalists acquire a range of unfamiliar knowledge and master potentially complex diagnostic and treatment processes. METHOD:We describe a model for integrating complex specialty care wit...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czu058
更新日期:2015-07-01 00:00:00
abstract::Within the existing health financing literature, males are typically categorized as the household's decision-makers. While this view accurately reflects many local sociocultural realities, approximately a quarter of sub-Saharan African households are now headed by females. In light of various efforts to expand health ...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czx152
更新日期:2018-03-01 00:00:00
abstract::This paper reports an empirical investigation into the pattern of private health insurance coverage in South Africa before and after deregulation of the health insurance industry. More specifically, we sought to measure trends in risk-pooling over the period 1985-95, and to assess the impact of risk pooling on the cos...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/15.4.378
更新日期:2000-12-01 00:00:00
abstract::The 'Community Action for Preventing HIV/AIDS Project' was implemented in four provinces in Cambodia (2001-04) to support a comprehensive set of HIV prevention efforts. Implementation was strictly monitored in terms of inputs, outputs and outcomes. We examine changes in these variables during the project period to ass...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czn014
更新日期:2008-07-01 00:00:00
abstract::Reproduction is a dual commitment, but so often in much of the world, it is seen as wholly the woman's responsibility. She bears the burden not only of pregnancy and childbirth but also the threats from excessive child bearing, some responsibility for contraception, infertility investigation and often undiagnosed sexu...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/11.1.84
更新日期:1996-03-01 00:00:00
abstract::Stroke is a major global health problem. It is a major cause of mortality, morbidity and disability in developed and increasingly in less developed countries. Worldwide, it is the leading cause of healthy years lost in late adulthood, and evidence indicates that the burden of stroke, particularly in terms of morbidity...
journal_title:Health policy and planning
pub_type: 杂志文章,评审
doi:10.1093/heapol/10.1.1
更新日期:1995-03-01 00:00:00
abstract::When seeking to ensure financial sustainability of a health programme, existence of a line item in the Ministry of Health (MOH) budget is often seen as an essential, first step. We used immunization as a reference point for cross-country comparison of budgeting methods in Sub-Saharan African countries. Study objective...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czaa040
更新日期:2020-08-01 00:00:00
abstract::In August 2003, the Ghanaian Government made history by implementing the first National Health Insurance System (NHIS) in sub-Saharan Africa. Within 2 years, over one-third of the country had voluntarily enrolled in the NHIS. To discourage households from selectively enrolling their sickest (high-risk) members, the NH...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czr057
更新日期:2012-08-01 00:00:00
abstract::Global financing for the HIV response has reached unprecedented levels in recent years. Over US$10 billion were mobilized in 2007, an effort credited with saving the lives of millions of people living with HIV (PLHIV). A relatively unexamined aspect of the global HIV response is the role of the private sector in finan...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czr031
更新日期:2011-07-01 00:00:00
abstract::Low contract renewal rates have been identified as one of the challenges facing the development of community-based health insurance (CBHI) schemes. This article uses longitudinal household survey data gathered in 2012 and 2013 to examine dropout in the case of Ethiopia's pilot CBHI scheme. We treat dropout as a functi...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czu142
更新日期:2015-12-01 00:00:00
abstract::In 2006, in response to the high maternal mortality, driven largely by unsafe abortions, the government of Ghana, in partnership with other organizations, launched the reducing maternal mortality and morbidity (R3M) programme in seven districts in Greater Accra, Ashanti and Eastern, to improve comprehensive abortion c...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czu105
更新日期:2015-10-01 00:00:00
abstract::The private sector plays a major role in the delivery of health care in South Africa. Over the past two decades, the quality and equity of such provision has been questioned internationally. A study was conducted in Gauteng Province to explore these issues, using care for sexually transmitted disease (STD) as a case s...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/17.suppl_1.40
更新日期:2002-12-01 00:00:00
abstract:Background:The efficacy of low- and middle-income countries’ (LMIC) national drug policies in managing antiretroviral (ARV) pharmaceutical prices is not well understood. Though ARV drug prices have been declining in LMIC over the past decade, little research has been done on the role of their national drug policies. Th...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czw107
更新日期:2017-03-01 00:00:00
abstract::Recent efforts to prevent post-partum haemorrhage (PPH) in low-income countries have focused on providing women with access to oral misoprostol during home birth. The WHO recommends using lay health workers (LHWs) to administer misoprostol in settings where skilled birth attendants are not available. This review synth...
journal_title:Health policy and planning
pub_type: 杂志文章,评审
doi:10.1093/heapol/czv012
更新日期:2016-02-01 00:00:00
abstract::Drink-driving is a major cause of global road traffic fatalities, yet few countries have laws that meet international best practices. One possible reason is the alcohol industry's opposition to meaningful policies that are perceived to directly threaten sales. Our primary objectives are to document alcohol industry in...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czaa097
更新日期:2020-11-21 00:00:00
abstract:INTRODUCTION:Lack of information on the warning signs of complications during pregnancy, parturition and postpartum hampers women's ability to partake fully in safe motherhood initiatives. We assessed the extent to which women in 19 countries of sub-Saharan Africa recall receiving information about pregnancy complicati...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czp017
更新日期:2009-09-01 00:00:00
abstract::There is increasing interest in the prospects for managed market reforms in developing countries, stimulated by current reforms and policy debates in developed countries, and by perceptions of widespread public sector inefficiency in many countries. This review examines the prospects for such reforms in a developing c...
journal_title:Health policy and planning
pub_type: 杂志文章,评审
doi:10.1093/heapol/9.3.237
更新日期:1994-09-01 00:00:00
abstract::While the concept of gender mainstreaming has gained acceptance among many national and international development organizations, many obstacles are faced in translating the concept into tangible improvements in the health and well-being of women and men. This paper presents two qualitative case studies, one from Kenya...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czi017
更新日期:2005-05-01 00:00:00
abstract::National Health Accounts (NHA) are an important tool to demonstrate how a country's health resources are spent, on what services, and who pays for them. NHA are used by policy-makers for monitoring health expenditure patterns; policy instruments to re-orientate the pattern can then be further introduced. The National ...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/14.4.342
更新日期:1999-12-01 00:00:00
abstract::This article examines the role of health governance in shaping the outcomes of healthcare reforms in China. The analysis shows that the failure of reforms during the 1980s and 1990s was in part due to inadequate attention to key aspects in health governance, such as strategic interactions among government, providers a...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czs109
更新日期:2014-09-01 00:00:00
abstract::Three broad strategies for health financing reform include: 1) cost recovery through user fees to expand access and improve quality of health services along with means testing to increase equity; 2) reallocation of existing resources to improve efficiency and access; and 3) assessment of the efficiency and quality of ...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/10.3.213
更新日期:1995-09-01 00:00:00
abstract::The 2014-16 West Africa Ebola epidemic was a watershed moment for global health. The outbreak galvanized global action around strengthening infectious disease prevention, detection and response capabilities. We examined the nascent landscape of international programmes, initiatives and institutions established in the ...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czy102
更新日期:2019-02-01 00:00:00
abstract::This paper investigates the key factors associated with the demand for Urban Resident Basic Medical Insurance (URBMI), which was established in 2007 and aims to cover all Chinese urban residents. Two waves of longitudinal household survey data are used, and a three-level random-intercept logit model is used for the an...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czs014
更新日期:2012-12-01 00:00:00