Social science & medicine
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Social science & medicine · Dec 2014
Does more equitable governance lead to more equitable health care? A case study based on the implementation of health reform in Aboriginal health Australia.
There is growing evidence that providing increased voice to vulnerable or disenfranchised populations is important to improving health equity. In this paper we will examine the engagement of Aboriginal community members and community controlled organisations in local governance reforms associated with the Aboriginal Health National Partnership Agreements (AHNPA) in Australia and its impact on the uptake of health assessments. The sample included qualitative and quantitative responses from 188 people involved in regional governance in Aboriginal health. ⋯ Higher levels of community representation were also associated with improved uptake of health assessments in the AHNPA. The findings suggest that the incorporation of Aboriginal community and community controlled organisations in regional planning plays an important role in improving health equity. This study makes an important contribution to understanding the processes through which the incorporation of disadvantaged groups into governance might contribute to health equity.
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Social science & medicine · Dec 2014
How do dual practitioners divide their time? The cases of three African capital cities.
Health professionals dual practice has received increasing attention, particularly in the context of the universal health coverage movement. This paper explores the determinants of doctors' choices to become a dual practitioner and of dual practitioners' choices to allocate time to the private sector in the capital cities of Mozambique, Guinea Bissau and Cape Verde. The data are drawn from a survey conducted in 2012 among 329 physicians. ⋯ Level of salaries in the public sector are not associated with dual practice engagement, with important implications for attempts aimed at retaining professionals in the public sector through wage increases. As predicted by theory that recognises doctors' role in price setting, earnings rates are not significant predictors of private sector time allocation; personal characteristics of physicians appear more important, such as age, number of dependents, specialist without technology, specialist with technology, and three reasons for not working more hours in the private sector. Answers to questions about the factors that limit working hours in the private sector have significant predictive power, suggesting that type of employment in the private sector may be an underlying determinant of both dual practice engagement and time allocation decisions.
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Social science & medicine · Nov 2014
Comparative StudyEffects of comparative claims in prescription drug direct-to-consumer advertising on consumer perceptions and recall.
Although pharmaceutical companies cannot make comparative claims in direct-to-consumer (DTC) ads for prescription drugs without substantial evidence, the U. S. Food and Drug Administration permits some comparisons based on labeled attributes of the drug, such as dosing. ⋯ In video ads, participants who saw an indication comparison had greater benefit recall than participants who saw dosing or mechanism of action comparisons. In addition, visual depictions of the comparison decreased risk recall for video ads. Overall, the results suggest that comparative claims in DTC ads could mislead consumers about a drug's efficacy and risk; therefore, caution should be used when presenting comparative claims in DTC ads.
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Social science & medicine · Nov 2014
On the frontline of eastern Burma's chronic conflict--listening to the voices of local health workers.
Globally, attacks on and interferences with health workers and healthcare delivery, including targeted violence towards providers, attacks on hospitals and delays and denial of health care, represent a serious humanitarian and human rights issue. However, gaps in research about these events persist, limiting the evidence base from which to understand and address the problem. This paper focuses on experiences of local health workers in eastern Burma's chronic conflict, including their strategies for addressing security and ensuring access to vulnerable ethnic communities in the region. ⋯ Data show that innovative security strategies have emerged, including the important role of the community in ensuring securer access to health care. This study underscores health workers' concern for improved data collection to support the rights of health workers to provide health care, and the rights of community members to receive health care in conflict-affected settings. Findings will inform the development of an incident reporting form to improve systematic data collection and documentation of attacks on health in this setting.
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Social science & medicine · Nov 2014
Everyday suffering outside prison walls: a legacy of community justice in post-genocide Rwanda.
Twenty years after the 1994 genocide, Rwanda shows all indications of moving quickly towards socio-economic prosperity. Rwanda's community justice system, Gacaca, was to complement this prosperity by establishing peace and stability through justice, reconciliation and healing. Evaluations of the Gacaca courts' achievements from 2002 to 2012 have had widely differing conclusions. ⋯ Study findings suggest that large scale imprisonment of genocide suspects coupled with Gacaca court proceedings have tainted the suffering of ex-prisoners and women with imprisoned husbands in unique ways, which makes their plight unparalleled in other countries. We argue that the nature and scale of this suffering and the potentially detrimental impact on families and communities require humanitarian action. However, in Rwanda's post-genocide reality, the suffering of these two groups is overwhelmed by that of other vulnerable groups, such as genocide survivors and orphaned children; hence it is rarely acknowledged.