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Integrating oral health into primary health care - experiences in Bangladesh, Indonesia, Nepal and Tanzania

INTERNATIONAL DENTAL JOURNAL 1999年第4期49卷 240-248页

作者： Helderman, WV Mikx, F Begum, A Adyatmaka, A Bajracharya, M Kikwilu, E Rugarabamu, P Nijmegen The Netherlands Dhaka Bangladesh Jakarta Indonesia Kathmandu Nepal Dar es Salaam Tanzania [*]WHO Collaborating Centre Dentistry 117 Postbus 9101 6500 HB Nijmegen The Netherlands

When primary health care (PHC) was developed and implemented in developing countries, oral health was not included. The present consequences are marked disparities in the distribution of oral health care, since conventional dentistry can only serve relatively few people and at high costs. Oral health care is virtually non-existent in rural areas of most developing countries where more than 80 per cent of the population live. More recently, community based oral health programmes have been initiated in some countries to fill the gap. These programmes give more emphasis on oral health promotion and on the prevention of oral diseases than on treatment of its consequences, since history has shown that the latter is ineffective in preventing oral diseases. Unfortunately, most of these oral health programmes have been implemented next to the existing PHC system and hence they face enormous management, logistic and financial problems, which seriously threaten their sustainability. This paper presents a proposal to counteract the problems that many countries face in developing an adequate primary oral health care (POHC) service.

关键词：孟加拉国社区卫生服务/组织和管理卫生保健提供联合牙科医疗/分类牙科医疗/经济学牙科医疗/组织和管理牙科保健服务/组织和管理发展中国家/经济学财政支持健康教育牙科健康计划健康促进卫生资源/经济学卫生资源/组织和管理卫生服务易得程度/组织和管理印度尼西亚口腔疾病/预防和控制国家卫生规划/组织和管理尼泊尔口腔保健初级卫生保健/经济学初级卫生保健/组织和管理乡村卫生服务/组织和管理坦桑尼亚人类

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Telemedicine in Sweden -: a diffusion study

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JOURNAL OF TELEMEDICINE AND TELECARE 1999年第1-Sup期5卷 63-65页

作者： Sjögren, LH Sandberg, C Törnqvist, H SPRI Swedish Inst Hlth Serv Dev S-10726 Stockholm Sweden

A survey of telemedicine use in Sweden was carried out. The response rate by hospital management was high at almost 90%. Sixty per cent of hospitals were involved in some kind of telemedicine activity in Sweden, with a further 15% planning telemedicine implementation. In rural areas of north Sweden good links exist between primary and secondary care. In the more populated southern region good links exist between the county hospitals and specialist university hospitals. Fifty-four per cent of telemedicine applications were used for specialist consultations, 13% for consultation between paramedics and hospitals and 10% for rounds. Teleradiology was the most frequent service.

关键词：革新推广预测医院县医院大学乡村卫生服务/组织和管理乡村卫生服务/发展趋势瑞典远程医学/发展趋势远程医学/利用人类

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Household health expenditures in Nepal: implications for health care financing reform

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HEALTH POLICY AND PLANNING 1998年第4期13卷 371-383页

作者： Hotchkiss, DR Rous, JJ Karmacharya, K Sangraula, P Tulane Univ Sch Publ Hlth & Trop Med Dept Int Hlth & Dev New Orleans LA 70012 USA Univ N Texas Dept Econ Denton TX 76203 USA

His Majesty's Government of Nepal has embarked on an ambitious social welfare programme of increasing the accessibility of primary education and health care services in rural communities. The implications on the financing of health care services are substantial, as the number of health posts has increased twelve-fold from 1992 to 1996, from 200 to 2597. To strengthen health care financing, government policy-makers are considering a number of financing strategies that are likely to have a substantial impact on household health care expenditures. However, more needs to be known about the role of households in the current structure of the health economy before the government designs and implements policies that affect household welfare. This paper uses the Nepal Living Standards Survey, a rich, nationally-representative sample of households from 1996, to investigate the level and distribution of household out-of-pocket health expenditures. Utilization and expenditures for different types of providers are presented by urban/rural status and by socioeconomic status. In addition, the sources of health sector funds are analyzed by contrasting household out-of-pocket expenditures with expenditures by the government and donors. The results indicate that households spend about 5.5% of total household expenditures on health care and that households account for 74% of the total level of funds used to finance the health economy. In addition, rural households are found to spend more on health care than urban households, after controlling for income status. Distributing health care expenditures by type of care utilized indicates that the wealthy, as well as the poor, rely heavily on services provided by the public sector. The results of this analysis are used to discuss the feasibility of implementing alternative health care financing policies.

关键词：发展中国家/经济学筹资政府/方法筹资个人/统计学和数值数据卫生保健改革/经济学卫生经费支出/统计学和数值数据卫生服务易得程度卫生服务研究尼泊尔乡村卫生服务/经济学乡村卫生服务/组织和管理农村人口市区人口

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Why include men? Establishing sexual health clinics for men in rural Bangladesh

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HEALTH POLICY AND PLANNING 1998年第2期13卷 121-130页

作者： Hawkes, S Int Ctr Diarrhoeal Dis Res Div Publ Hlth Sci Dhaka 1000 Bangladesh

Subsequent to recommendations from the 1994 United Nations International Conference on Population and Development, and given recent findings outlining the links between control of sexually transmitted infections (STIs) and a reduction in HIV incidence, many countries are now seeking to establish STI control programmes. In many cases this is through a policy of providing comprehensive reproductive health care through the maternal and child health/family planning (MCH-FP) system. This involves management of all reproductive tract infections including STIs. This paper demonstrates how such an approach may miss one of the largest target groups - men. In general, men are at higher risk of initially contracting STIs, but, once infected, their clinical management is usually simpler than treating equivalent infections in women. It is argued that these two factors alone make the inclusion of men in STI control programmes critical. The paper outlines the experiences of one programme in rural Bangladesh in establishing sexual health clinics for men within the existing service structure. In response to client demand, the clinics moved beyond simple STI care towards provision of comprehensive sexual health services. Finally, the paper argues that whilst including men in sexual health programmes should never be at the expense of providing services for women, excluding them from service provision may make the objectives of STI control programmes unattainable.

关键词：孟加拉国/流行病学社区卫生中心/组织和管理社区卫生中心/发展趋势男人病人接受卫生保健的程度方案评价公共卫生管理乡村卫生服务/组织和管理乡村卫生服务/发展趋势性传播疾病/流行病学性传播疾病/预防和控制成年人人类男(雄)性

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Sickle cell disease telemedicine network for rural outreach

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JOURNAL OF TELEMEDICINE AND TELECARE 2000年第5期6卷 285-290页

作者： Woods, KF Johnson, JA Kutlar, A Daitch, L Stachura, ME Med Coll Georgia MCG Sickle Cell Ctr Dept Med Augusta GA 30912 USA Med Coll Georgia Telemed Ctr Dept Med Augusta GA 30912 USA

The Medical College of Georgia (MCG) Sickle Cell Center in Augusta, Georgia, USA, provides consultation and (in some cases) primary-care services to more than 1000 patients with sickle cell disease (SCD). Three SCD telemedicine clinic sites were established in rural areas of middle and southern Georgia, based on clinical need;a fourth site had been proposed. Over a 36-month study period, 77 telemedicine SCD clinics were held. There was a mean of 6.1 (SD 2.5) encounters per clinic and 466 total encounters among 128 SCD patients. By using telemedicine, the productivity of the MCG adult sickle cell clinic increased from 1413 to 1889 encounters a year, with an increase in rural outreach activity from 271 to 745 encounters a year. This was accomplished with the addition of a single physician assistant during the last 12 months of the study period;otherwise provider staffing was unchanged. A formal cost-benefit analysis now needs to be carried out.

关键词：贫血镰状细胞性/治疗社区卫生服务/组织和管理佐治亚门诊部医院/组织和管理病人接受卫生保健的程度病人满意度乡村卫生服务/组织和管理乡村卫生服务/标准远程医学青少年成年人女(雌)性人类男(雄)性中年人

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The uneven diffusion of telemedicine services in Australia

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JOURNAL OF TELEMEDICINE AND TELECARE 1999年第Sup1期5卷 45-47页

作者： Mitchell, JG John Mitchell & Associates Unley SA 5061 Australia

The diffusion of telemedicine services in Australia over the last four years has been uneven. Some of the major barriers to the adoption of telemedicine relate to the nature of the industry, including its immaturity, the limited telecommunications infrastructure, the lack of appropriate dialogue between vendors and buyers about solutions required, and the lack of partnerships in the industry. Remuneration is only one barrier. There are, of course, other substantial organizational, financial and attitudinal barriers to the adoption of telemedicine. Further development of telemedicine in Australia will require detailed assessment of these matters.

关键词：澳大利亚革新推广乡村卫生服务/组织和管理乡村卫生服务/发展趋势远程医学/组织和管理远程医学/发展趋势人类

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Nuclear medicine teleradiology in regional and rural centres of Western Australia

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JOURNAL OF TELEMEDICINE AND TELECARE 1999年第Sup1期5卷 47-50页

作者： Tually, P Parrish, F Walker, J Imaging South Dept Nucl Med Mandurah WA 6210 Australia

We have established a nuclear medicine teleradiology service for rural and regional areas of south-west Western Australia. This study aimed to evaluate whether existing treatment models had altered in ways which were directly related to improved medical outcomes and reduced cost. Preliminary observation into musculoskeletal injury of the ankle joint included diagnosis of 10 radio-occult talar dome lesions which in some cases had not been identified until six months after the trauma. Several cases suggest that nuclear medicine provided a more timely diagnosis and actively altered treatment. Further, the potential role of radiologists as primary-care extenders in guiding appropriate investigations and defining the nature of the illness before specialist consultation may lessen the economic burden on public health care while creating economies of scale by expanding the clinical usefulness of the nuclear physician over a large rural area.

关键词：评价研究乡村卫生服务/组织和管理距骨/损伤距骨/放射性核素显像远程放射学/方法西澳大利亚青少年成年人老年人女(雌)性人类男(雄)性中年人

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Determinants of attendance and patient satisfaction at eye clinics in south-western Uganda

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HEALTH POLICY AND PLANNING 1999年第1期14卷 77-81页

作者： Whitworth, J Pickering, H Mulwanyi, F Ruberantwari, A Dolin, P Johnson, G Uganda Virus Res Inst Med Res Council Programme AIDS Entebbe Uganda Masaka Dist Referral Hosp Masaka Uganda UCL Inst Ophthalmol London England

Purpose: To identify the reasons for subjects deciding to attend or not attend local and referral ophthalmology clinics in south-west Uganda, and to establish the levels of satisfaction of clinic attenders with the services they received. Methods: A population survey identified subjects with ocular conditions who were referred to the local clinic or the district hospital. All non-attenders and a group of attenders were interviewed at home. Results: 31% of those referred did not attend the local clinic. The most common reasons were 'too busy' (29%) or 'unwilling to buy spectacles' (17%). Less than half of attenders were satisfied, mainly because of no perceived clinical improvement or having to buy spectacles. Only 13% of those referred to the district hospital clinic attended. The main reasons for non-attendance were high transport cost and fear of the clinic. Conclusion: Attendance and satisfaction with the community ophthalmology service could be improved by more intensive motivation and explanation for patients, and assistance with spectacle and transport costs. The use of aphakic motivators should be tested in this context.

关键词：社区卫生中心/标准社区卫生中心/利用发展中国家卫生保健调查眼科学/组织和管理眼科学/标准门诊部医院/标准门诊部医院/利用病人接受卫生保健的程度/统计学和数值数据病人满意度/统计学和数值数据转诊和会诊乡村卫生服务/组织和管理乡村卫生服务/标准乡村卫生服务/利用乌干达视力普查人类

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An evaluation of a network for professional development in child and adolescent mental health in rural and remote communities

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JOURNAL OF TELEMEDICINE AND TELECARE 2000年第3期6卷 158-162页

作者： Mitchell, J Robinson, P Seiboth, C Koszegi, B Womens & Childrens Hosp N Adelaide SA 5006 Australia John Mitchell & Associates Sydney NSW Australia

In 1998 a telemedicine network was established in South Australia and the Northern Territory to deliver educational material to professionals working in child and adolescent mental health in remote areas. The network involved a wide range of health professions, from psychiatrists to psychologists and social workers. The first 12 months of network activity were evaluated by quantitative and qualitative techniques. Four sources of data were used: an activity log, questionnaires, interviews and action research. A total of 36 telemedicine sessions were held, ranging in duration from 45 to 90 min (average 56 min) and involving a total of 45 different professionals, who participated an average of four times each (range 1-15). The most common types of session were case discussions (47%), followed by specialist seminars (36%) and administrative and introductory sessions (17%). The benefits of the network included: networking and peer support;improved efficiency and reduced travel costs;and improved efficiency of health services. The problems included: costs;lack of access to technical support;and the need for staff induction and training.

关键词：青少年保健服务/组织和管理精神卫生服务/组织和管理专业能力方案评价问卷调查乡村卫生服务/组织和管理南澳大利亚人员开发/组织和管理远程医学/组织和管理青少年儿童儿童学龄前人类

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The changing landscape of health care financing and delivery: How are rural communities and providers responding?

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MILBANK QUARTERLY 1999年第4期77卷 485-+页

作者： Mueller, KJ Coburn, A Cordes, S Univ Nebraska Med Ctr Nebraska Med Ctr 984350 Coll Med Omaha NE 68198 USA Univ So Maine Portland ME 04103 USA Univ Washington Seattle WA 98195 USA Univ N Dakota Grand Forks ND 58201 USA Univ Missouri Columbia MO 65211 USA US Dept Hlth & Human Serv Washington DC 20201 USA

Rural communities have not kept pace with the recent dramatic changes in health care financing and organization. However, the Medicare provisions in the Balanced Budget Act of 1997 will require rural providers to participate in the new systems. Case studies revealed the degree of readiness for change in six rural communities and charted their progress along a continuum, as reflected in three sets of activities: the development of networking;the creation of new strategies for managing patient care;and the adoption of new methods for contracting with health insurers. Some communities had constructed highly integrated systems, whereas others were just beginning to change their billing practices;a few were signing contracts fbr capitated fare, in contrast to those that were resisting discounts in current fee structures. These six rural areas still have considerable ground to cover before their health fare organization and financing reach the levels achieved by urban communities.

关键词：社区网络/经济学社区网络/组织和管理病人医护连续性/组织和管理合同业务财务管理/组织和管理卫生保健部门卫生服务研究医院乡村/经济学医院乡村/组织和管理医院乡村/发展趋势保险健康补偿管理医疗规划/组织和管理 Medicare/组织和管理明尼苏达纽约俄克拉何马组织状况研究组织改革乡村卫生服务/经济学乡村卫生服务/组织和管理乡村卫生服务/发展趋势南卡罗来纳田纳西美国华盛顿老年人人类

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