Pub Date : 2020-04-05DOI: 10.5772/intechopen.91414
P. Otieno, G. Asiki
Health sector reforms not only require attention to specific components but also a supportive environment. In low- and middle-income countries (LMICs), there is still much to be done on ensuring that people receive prioritized healthcare services. Despite LIMCs spending an average of 6% of their GDP on health, there have been minimal impacts compared to high-income countries. Health sector reform is a gradual process with complex systems; hence, the need for a vision and long-term strategies to realize the desired goals. In this chapter, we present our proposal to advance universal health coverage (UHC) in LMICs. Overall, our main aim is to provide strategies for achieving actual UHC and not aspirational UHC in LMICs by strengthening health systems, improving health insurance coverage and financial protection, and reducing disparities in healthcare coverage especially on prioritized health problems, and enhancing a primary care-oriented healthcare system.
{"title":"Making Universal Health Coverage Effective in Low- and Middle-Income Countries: A Blueprint for Health Sector Reforms","authors":"P. Otieno, G. Asiki","doi":"10.5772/intechopen.91414","DOIUrl":"https://doi.org/10.5772/intechopen.91414","url":null,"abstract":"Health sector reforms not only require attention to specific components but also a supportive environment. In low- and middle-income countries (LMICs), there is still much to be done on ensuring that people receive prioritized healthcare services. Despite LIMCs spending an average of 6% of their GDP on health, there have been minimal impacts compared to high-income countries. Health sector reform is a gradual process with complex systems; hence, the need for a vision and long-term strategies to realize the desired goals. In this chapter, we present our proposal to advance universal health coverage (UHC) in LMICs. Overall, our main aim is to provide strategies for achieving actual UHC and not aspirational UHC in LMICs by strengthening health systems, improving health insurance coverage and financial protection, and reducing disparities in healthcare coverage especially on prioritized health problems, and enhancing a primary care-oriented healthcare system.","PeriodicalId":431497,"journal":{"name":"Healthcare Access - Regional Overviews [Working Title]","volume":"20 6","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121001619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-24DOI: 10.5772/intechopen.89731
Ramona Bullock-Johnson, K. Bullock
Homelessness is an issue of social justice, in the United States, because it leaves people vulnerable, unsafe, and ill, while not having their basic needs for food and shelter met. Although the United States is the wealthiest country in the world, a significant number of its residence, whether citizens or not, have experienced homelessness in their lifetime. Less than 5 years ago, the U.S. Department of Housing and Urban Development (HUD) found that 564,708 people are homeless on any given night. There is a dearth of information available that puts older adults at the forefront or at the center of homelessness epidemic. Moreover, recent HUD reports claim that homelessness has decreased, in the United States, while the National Center on Family Homelessness reported that the number of residents experiencing homelessness is steadily climbing and is expected to hit an historic high, within the next 5 years. Yet, most of the attention given to homelessness as a public health issues, tends to focus on families and children. Few studies have targeted older adults and their primary risk factors experiencing homelessness. Important to note is the fact that consistent data and accurate reporting about homeless older adults are few and far between. This chapter (1) presents a practical definition of homelessness, (2) provides a social work framework for understanding and assessing risk among homeless populations, as well as, (3) emphasizes the importance of cultural competence in health practices for addressing homelessness among older adults as a public health concern.
{"title":"Exploring Mental Health Treatment and Prevention among Homeless Older Adults","authors":"Ramona Bullock-Johnson, K. Bullock","doi":"10.5772/intechopen.89731","DOIUrl":"https://doi.org/10.5772/intechopen.89731","url":null,"abstract":"Homelessness is an issue of social justice, in the United States, because it leaves people vulnerable, unsafe, and ill, while not having their basic needs for food and shelter met. Although the United States is the wealthiest country in the world, a significant number of its residence, whether citizens or not, have experienced homelessness in their lifetime. Less than 5 years ago, the U.S. Department of Housing and Urban Development (HUD) found that 564,708 people are homeless on any given night. There is a dearth of information available that puts older adults at the forefront or at the center of homelessness epidemic. Moreover, recent HUD reports claim that homelessness has decreased, in the United States, while the National Center on Family Homelessness reported that the number of residents experiencing homelessness is steadily climbing and is expected to hit an historic high, within the next 5 years. Yet, most of the attention given to homelessness as a public health issues, tends to focus on families and children. Few studies have targeted older adults and their primary risk factors experiencing homelessness. Important to note is the fact that consistent data and accurate reporting about homeless older adults are few and far between. This chapter (1) presents a practical definition of homelessness, (2) provides a social work framework for understanding and assessing risk among homeless populations, as well as, (3) emphasizes the importance of cultural competence in health practices for addressing homelessness among older adults as a public health concern.","PeriodicalId":431497,"journal":{"name":"Healthcare Access - Regional Overviews [Working Title]","volume":"84 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124400701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-19DOI: 10.5772/intechopen.90626
T. Timiș, D. Mitrea, Ioan-Alexandru Florian
Despite its frequency, psoriasis is still a difficult pathology to manage, in no small part due to the wide number of therapeutic choices available. These range from topical medicine to systemic drugs to more targeted agents such as biological therapies. All medical personnel involved in the treatment of psoriasis patients should be aware of these methods and apply them accordingly. Even though all patients may benefit from specific treatment options, these differ in regard to posology, monitoring, interactions and contraindications. Moreover, due to the adverse effects and drug interactions of some of these agents, not all patients are suitable candidates for each of therapies discussed. Therefore, nurses, trainees, general practitioners and dermatologists must carefully select the most appropriate therapy based on the characteristics of each patient, severity of the pathology, comorbidities and coexistent medications. This review aims to offer an updated, pragmatic insight into the modern management of patients with moderate-to-severe psoriasis.
{"title":"Medical Management of Chronic Plaque Psoriasis in the Modern Age","authors":"T. Timiș, D. Mitrea, Ioan-Alexandru Florian","doi":"10.5772/intechopen.90626","DOIUrl":"https://doi.org/10.5772/intechopen.90626","url":null,"abstract":"Despite its frequency, psoriasis is still a difficult pathology to manage, in no small part due to the wide number of therapeutic choices available. These range from topical medicine to systemic drugs to more targeted agents such as biological therapies. All medical personnel involved in the treatment of psoriasis patients should be aware of these methods and apply them accordingly. Even though all patients may benefit from specific treatment options, these differ in regard to posology, monitoring, interactions and contraindications. Moreover, due to the adverse effects and drug interactions of some of these agents, not all patients are suitable candidates for each of therapies discussed. Therefore, nurses, trainees, general practitioners and dermatologists must carefully select the most appropriate therapy based on the characteristics of each patient, severity of the pathology, comorbidities and coexistent medications. This review aims to offer an updated, pragmatic insight into the modern management of patients with moderate-to-severe psoriasis.","PeriodicalId":431497,"journal":{"name":"Healthcare Access - Regional Overviews [Working Title]","volume":"295 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126882881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-17DOI: 10.5772/intechopen.89995
J. Waterkeyn, Regis Matimati, Andrew Muringaniza, Agrippa Chigono, Amans Ntakarutimana, Joseph Katabarwa, Z. Bigirimana, J. Pantoglou, A. Waterkeyn, S. Cairncross
Two similar Community Health Club (CHC) interventions to achieve hygiene behaviour change and improved family health in Africa took place--one in Zimbabwe implemented by an NGO and the other in Rwanda as part of a Randomized Control Trial. Both interventions achieved high levels of community response, although the Zimbabwe project was more cost-effective, achieving blanket coverage of all households in the area with over 90% compliance in 12 recommended practices at a cost of US$4.5 per beneficiary in 8 months. In Rwanda, the spread of the intervention reached only 58% of the households in the first year costing US$13.13 per beneficiary. By the end of three years, the spread had increased to 80% with over 80% of the 4056CHC Members adopting 10 new practices without any extra cost to the project. Although the Zimbabwe program showed better Value for Money, being more efficient, long term sustainability to prevent slippage of hygiene behaviour change depends on a strong monitoring system. Scaling up hygiene behaviour change is best achieved systematically by building the capacity of the Environmental Health Department to take responsibility for the supervision of CHCs in every village. Investing in an integrated national program, which can enable Government to coordinate NGO efforts, is a more cost-effective use of scarce resources in the long term.
{"title":"Comparative Assessment of Hygiene Behaviour Change and Cost-Effectiveness of Community Health Clubs in Rwanda and Zimbabwe","authors":"J. Waterkeyn, Regis Matimati, Andrew Muringaniza, Agrippa Chigono, Amans Ntakarutimana, Joseph Katabarwa, Z. Bigirimana, J. Pantoglou, A. Waterkeyn, S. Cairncross","doi":"10.5772/intechopen.89995","DOIUrl":"https://doi.org/10.5772/intechopen.89995","url":null,"abstract":"Two similar Community Health Club (CHC) interventions to achieve hygiene behaviour change and improved family health in Africa took place--one in Zimbabwe implemented by an NGO and the other in Rwanda as part of a Randomized Control Trial. Both interventions achieved high levels of community response, although the Zimbabwe project was more cost-effective, achieving blanket coverage of all households in the area with over 90% compliance in 12 recommended practices at a cost of US$4.5 per beneficiary in 8 months. In Rwanda, the spread of the intervention reached only 58% of the households in the first year costing US$13.13 per beneficiary. By the end of three years, the spread had increased to 80% with over 80% of the 4056CHC Members adopting 10 new practices without any extra cost to the project. Although the Zimbabwe program showed better Value for Money, being more efficient, long term sustainability to prevent slippage of hygiene behaviour change depends on a strong monitoring system. Scaling up hygiene behaviour change is best achieved systematically by building the capacity of the Environmental Health Department to take responsibility for the supervision of CHCs in every village. Investing in an integrated national program, which can enable Government to coordinate NGO efforts, is a more cost-effective use of scarce resources in the long term.","PeriodicalId":431497,"journal":{"name":"Healthcare Access - Regional Overviews [Working Title]","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131575615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-13DOI: 10.5772/intechopen.90144
S. Yannopoulos, A. Kaiafa-Saropoulou
The relation between human health, water, and hygiene facilities has been realized since during the Bronze Age, the explanations of illness and health problems were based on theocratic elements. However, the Greeks during the Classical and mainly the Hellenistic period clearly differentiated their thinking from all other civilizations by inventing philosophy and empirical science. Drains/sewers, baths and toilets, and other sanitary installations are reflecting high cultural and technological level, while they also are associated with observations and ideas about hygiene and medicine. The aim of this paper is to examine the knowledges about the influence of water on human health throughout antiquity. In other words, it focuses on the views that Greeks and Romans had on water quality and its impact on the human body.
{"title":"Hygiene Technologies, Water, and Health in the Hellenic World","authors":"S. Yannopoulos, A. Kaiafa-Saropoulou","doi":"10.5772/intechopen.90144","DOIUrl":"https://doi.org/10.5772/intechopen.90144","url":null,"abstract":"The relation between human health, water, and hygiene facilities has been realized since during the Bronze Age, the explanations of illness and health problems were based on theocratic elements. However, the Greeks during the Classical and mainly the Hellenistic period clearly differentiated their thinking from all other civilizations by inventing philosophy and empirical science. Drains/sewers, baths and toilets, and other sanitary installations are reflecting high cultural and technological level, while they also are associated with observations and ideas about hygiene and medicine. The aim of this paper is to examine the knowledges about the influence of water on human health throughout antiquity. In other words, it focuses on the views that Greeks and Romans had on water quality and its impact on the human body.","PeriodicalId":431497,"journal":{"name":"Healthcare Access - Regional Overviews [Working Title]","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132022008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-24DOI: 10.5772/intechopen.88982
I. Abdulai, Abdul-Moomin Adams
Health insurance coverage provides the spring board for pregnant women to access and utilise maternal healthcare services. Yet, studies on health insurance coverage, access and utilisation of maternal healthcare are a handful. Consequently, this study examines women's access and utilisation of maternal healthcare services under the free maternal health policy in two districts in northern Ghana. The study adopted the mixed research approach with the aid of the cross-sectional design involving 212 respondents. An interview schedule was utilised in the collection of data. Percentages, Chi-square test for independence and Mann-Whitney U test as well as thematic analysis were used to analyse the data. The study revealed that 93.9% of the respondents had enrolled unto the national health insurance scheme and 98.6% of them went for antennal care. Majority (66.5%) of them had facility-based delivery. However, 79.7% of them incur cost in seeking delivery care. In brief, health insurance coverage appears to contribute to improved access and utilisation of maternal healthcare services in the two districts. Nonetheless, the government should provide the basic items that are needed for delivery to lessen the cost burden associated with facility-based delivery.
{"title":"Access to Maternal Healthcare Services under the National Health Insurance Policy in the Upper West Region, Ghana","authors":"I. Abdulai, Abdul-Moomin Adams","doi":"10.5772/intechopen.88982","DOIUrl":"https://doi.org/10.5772/intechopen.88982","url":null,"abstract":"Health insurance coverage provides the spring board for pregnant women to access and utilise maternal healthcare services. Yet, studies on health insurance coverage, access and utilisation of maternal healthcare are a handful. Consequently, this study examines women's access and utilisation of maternal healthcare services under the free maternal health policy in two districts in northern Ghana. The study adopted the mixed research approach with the aid of the cross-sectional design involving 212 respondents. An interview schedule was utilised in the collection of data. Percentages, Chi-square test for independence and Mann-Whitney U test as well as thematic analysis were used to analyse the data. The study revealed that 93.9% of the respondents had enrolled unto the national health insurance scheme and 98.6% of them went for antennal care. Majority (66.5%) of them had facility-based delivery. However, 79.7% of them incur cost in seeking delivery care. In brief, health insurance coverage appears to contribute to improved access and utilisation of maternal healthcare services in the two districts. Nonetheless, the government should provide the basic items that are needed for delivery to lessen the cost burden associated with facility-based delivery.","PeriodicalId":431497,"journal":{"name":"Healthcare Access - Regional Overviews [Working Title]","volume":"73 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115814807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-16DOI: 10.5772/intechopen.81900
K. Lin
Loss to follow-up (LTFU) is a serious issue in the field of tuberculosis (TB) since it can lead to TB outbreaks and drug resistance. The proportion of LTFU patients differs among different countries, regions, year, and institutions. In some countries, the number of patients that were LTFU nearly reaches half of the total patients. Underlying factors such as age, gender, education, residence, financial factors, migration, and social stigma are discussed in this chapter. These factors should always be taken into consideration whenever a treatment program is designed. Suggestions have been made regarding some interventions that could potentially solve the problem of LTFU. With these points in mind, an ambitious approach should be taken to reduce the number of LTFU patients up to zero.
{"title":"Loss to Follow-Up (LTFU) during Tuberculosis Treatment","authors":"K. Lin","doi":"10.5772/intechopen.81900","DOIUrl":"https://doi.org/10.5772/intechopen.81900","url":null,"abstract":"Loss to follow-up (LTFU) is a serious issue in the field of tuberculosis (TB) since it can lead to TB outbreaks and drug resistance. The proportion of LTFU patients differs among different countries, regions, year, and institutions. In some countries, the number of patients that were LTFU nearly reaches half of the total patients. Underlying factors such as age, gender, education, residence, financial factors, migration, and social stigma are discussed in this chapter. These factors should always be taken into consideration whenever a treatment program is designed. Suggestions have been made regarding some interventions that could potentially solve the problem of LTFU. With these points in mind, an ambitious approach should be taken to reduce the number of LTFU patients up to zero.","PeriodicalId":431497,"journal":{"name":"Healthcare Access - Regional Overviews [Working Title]","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130782158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-19DOI: 10.5772/INTECHOPEN.87219
A. Taylor-Robinson
Contamination of emergency medical vehicles with pathogenic microbes poses a potential threat to public health considering the many millions of ambulance responses that are made globally each year. This risk of infection is to the patients, to their companions who may travel with them, and to the paramedic first responders whose work involves pre- or inter-hospital transfer. This applies particularly to contamination by those infectious disease-causing microbes for which the threat is heightened because of their recognized resistance to leading antimicrobial agents. Determining the risks should facilitate the advancement of best practices to enhance infection control of routine outbreaks and during a major emergency such as a disease pandemic or a bioterrorism event. This may merit the introduction of amended guidelines for ambulance cleaning and disinfection to achieve more effective pre-hospital infection control among the worldwide community of emergency service providers.
{"title":"Contamination of Emergency Medical Vehicles and Risk of Infection to Paramedic First Responders and Patients by Antibiotic-Resistant Bacteria: Risk Evaluation and Recommendations from Ambulance Case Studies","authors":"A. Taylor-Robinson","doi":"10.5772/INTECHOPEN.87219","DOIUrl":"https://doi.org/10.5772/INTECHOPEN.87219","url":null,"abstract":"Contamination of emergency medical vehicles with pathogenic microbes poses a potential threat to public health considering the many millions of ambulance responses that are made globally each year. This risk of infection is to the patients, to their companions who may travel with them, and to the paramedic first responders whose work involves pre- or inter-hospital transfer. This applies particularly to contamination by those infectious disease-causing microbes for which the threat is heightened because of their recognized resistance to leading antimicrobial agents. Determining the risks should facilitate the advancement of best practices to enhance infection control of routine outbreaks and during a major emergency such as a disease pandemic or a bioterrorism event. This may merit the introduction of amended guidelines for ambulance cleaning and disinfection to achieve more effective pre-hospital infection control among the worldwide community of emergency service providers.","PeriodicalId":431497,"journal":{"name":"Healthcare Access - Regional Overviews [Working Title]","volume":"94 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128735591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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