Meeting: International Seminar on Information and Communication Technology Statistics, Seoul, Republic of Korea, 19-21 July 2010

Ministry of Statistics and Programme Implementation

Introduction Community health insurance (CHI) is receiving increased attention as a means of health financing in low- and middle-income countries. In countries with limited ability to develop and sustain national health insurance programmes, CHI has emerged as a valuable alternative to user fees since, by pooling risks and resources at the community level, it promises to ensure better access to health services and greater financial protection against the costs of illness for traditionally excluded and disadvantaged populations. (1-3) In practice, however, CHI often falls short of achieving its potential, primarily because it fails to secure satisfactory levels of participation.(4-7) Although the inability to secure satisfactory enrolment rates among target populations remains a major concern across all low- and middle-income countries, (4,8-10) the problem assumes acute proportions in sub-Saharan Africa, where schemes rarely attain 10% coverage among target populations. (7) For this reason, they often cease to exist within a few years of their inception. (4,7,11) Although the problem of low enrolment has long dominated the policy debate, rigorous scientific evaluations of the factors affecting the decision to enrol in CHI in sub-Saharan Africa are still very scarce. (6,12) While several studies have documented voluntary health insurance experiences in Asia, (8,10,13-16) only a limited number of evaluations have explored the factors influencing the decision to enrol or not to enrol in CHI in sub-Saharan countries. (17-19) The literature on CHI in sub-Saharan Africa has long been dominated by consultancy reports, which have focused on assessing the managerial and financial capacity of existing schemes rather than systematically exploring the factors motivating or discouraging enrolment. (20-23) Understanding the reasons behind low enrolment rates is therefore a relevant research question. Our study aimed to identify factors shaping the decision to enrol in CHI in a population-based study applying a case-control methodology. We hypothesized that the decision to enrol in CHI was shaped by a combination of household head, household and community characteristics. The study was conducted in the Nouna Health District, Burkina Faso, in 2004. Methods Research setting The Nouna Health District is located in the northwest of the country, about 300 km from the capital, Ouagadougou. A CHI scheme was initiated there at the beginning of 2004. The aim is to set up a district-wide scheme by progressively offering CHI to all the villages of the district and to all sectors of the district capital, the town of Nouna. Our study is limited to those parts of the district--12 villages and 3 town sectors--in which the first enrolment campaign took place between February and May 2004. The insurance product on offer was identical across the 15 communities. The unit of enrolment was the household. The yearly premium amounted to 1500 CFA francs (US$ 3) for each adult and 500 CFA francs (US$ 1) for each child (less than 15 years of age). The benefit package included a wide range of first-line and second-line services that were available at the health facilities within the district. It excluded reimbursement for all traditional healing practices. Decisions regarding the services that should be included and those that should be excluded from the benefit package were guided by the results of a study which explored community preferences for such a package prior to the implementation of the scheme. This study and details of the benefit package are described in detail elsewhere. (24,25) Depending on their geographic location, villages and town sectors were designated to receive primary care either at one of five rural first-line facilities or at the urban first-line facility located on the premises of the district hospital. If referred, all patients were entitled to receive secondary care at the district hospital. …

Understanding Enrolment in Community Health Insurance in Sub-Saharan Africa: A Population-Based Case-Control Study in Rural Burkina Faso/Motifs De la Souscription D'une Assurance-Maladie Communautaire Par Les Habitants De l'Afrique Sub-Saharienne: Etude Cas-Temoin En Population Rurale Menee Au Burkina Faso/Analisis De la Decision De Acogerse a Un Seguro Medico Comunitario En El Africa

Finger prints, palms and soles. An introduction to dermatoglyphics

Preparing for an Aging World: The Case for Cross-National Research (Book)

Author(s): Van Schalkwyk, Susan C; Hafler, Janet; Brewer, Timothy F; Maley, Moira A; Margolis, Carmi; McNamee, Lakshini; Meyer, Ilse; Peluso, Michael J; Schmutz, Ana Ms; Spak, Judy M; Davies, David; Bellagio Global Health Education Initiative | Abstract: ContextTransformative learning (TL) has been described as learning that challenges established perspectives, leading to new ways of being in the world. As a learning theory it has resonated with educators globally, including those in the health professions. Described as a complex metatheory, TL has evolved over time, eliciting divergent interpretations of the construct. This scoping review provides a comprehensive synthesis of how TL is currently represented in the health professions education literature, including how it influences curricular activities, to inform its future application in the field.MethodsArksey and O'Malley's six-step framework was adopted to review the period from 2006 to May 2018. A total of 10 bibliographic databases were searched, generating 1532 potential studies. After several rounds of review, first of abstracts and then of full texts, 99 studies were mapped by two independent reviewers onto the internally developed data extraction sheet. Descriptive information about included studies was aggregated. Discursive data were subjected to content analysis.ResultsA mix of conceptual and empirical research papers, which used a range of qualitative methodologies, were included. Studies from the USA, the UK and Australia were most prevalent. Insights relating to how opportunities for TL were created, how it manifests and influences behaviour, as well as how it is experienced, demonstrated much congruency. Conceptions of TL were seen to be clustered around the work of key theorists.ConclusionsThe training of health professionals often takes place in unfamiliar settings where students are encouraged to be active participants in providing care. This increases the opportunity for exposure to learning experiences that are potentially transformative, allowing for a pedagogy of uncertainty that acknowledges the complexity of the world we live in and questions what we believe we know about it. TL provides educators in the health professions with a theoretical lens through which they can view such student learning.

/pdf/transformative-learning-as-pedagogy-for-the-health-5dfui4srrr.pdf

Transformative learning as pedagogy for the health professions: a scoping review.

Objectives We provide new estimates on size, composition and distribution of human resource for health in India and compare with the health workers population ratio as recommended by the WHO. We also estimate size of non-health workers engaged in health sector and the size of technically qualified health professionals who are not a part of the health workforce. Design Nationally representative cross-section household survey and review of published documents by the Central Bureau of Health Intelligence. Setting National. Participants Head of household/key informant in a sample of 101 724 households. Interventions Not applicable. Primary and secondary outcome measures The primary outcome was the number and density of health workers,and the secondary outcome was the percentage of health workers who are technically qualified and the percentage of individuals technically qualified and not in workforce. Results The total size of health workforce estimated from the National Sample Survey (NSS) data is 3.8 million as of January 2016, which is about 1.2 million less than the total number of health professionals registered with different councils and associations. The density of doctors and nurses and midwives per 10 000 population is 20.6 according to the NSS and 26.7 based on the registry data. Health workforce density in rural India and states in eastern India is lower than the WHO minimum threshold of 22.8 per 10 000 population. More than 80% of doctors and 70% of nurses and midwives are employed in the private sector. Approximately 25% of the currently working health professionals do not have the required qualifications as laid down by professional councils, while 20% of adequately qualified doctors are not in the current workforce. Conclusions Distribution and qualification of health professionals are serious problems in India when compared with the overall size of the health workers. Policy should focus on enhancing the quality of health workers and mainstreaming professionally qualified persons into the health workforce.

https://bmjopen.bmj.com/content/bmjopen/9/4/e025979.full.pdf

Size, composition and distribution of human resource for health in India: new estimates using National Sample Survey and Registry data.

Introduction: India has the highest number of medical colleges in the world and subsequently the higher number of medical teachers. There is a dire need of adopting a systematic approach to faculty development to enhance quality education to meet health challenges for 21st Century. This manuscript provides a landscape of faculty development programs in India, identifying gaps and opportunities for reforms in faculty development. Methods: Conventionally, FDPs are organized by medical colleges and universities through Basic Courses and Advanced Courses focusing on pedagogy. Medical Council of India is facilitating FDPs through 18 selected regional centers to enable medical teachers to avail modern education technology for teaching from July 2009. Foundation for Advancement of International Medical Education and Research has three Regional Institutes in India. Results: Recommendations include the need for formulating a national strategy for faculty development to not only enhance the quantity of medical teachers but also the quality of medical education; providing support for Departments of Medical Education/Regional Centers in terms of finance and staffing and incorporation of teaching skills in postgraduate training. Conclusion: Distance learning courses focusing on educational leadership and pedagogy for medical teachers can be an option to reach a wider audience. FDPs can be an asset in recruiting and retaining teachers as they offer valued professional development opportunities. Keywords: Faculty; Development; Pedagogy; Medical education

http://jamp.sums.ac.ir/article_40955_74f2436d827966c44b219109e733b145.pdf

Faculty development programs for medical teachers in India

Public health ethics has been receiving increasing attention in recent years. Frequently, public health practitioners have to confront complex decisions, with numerous and often conflicting ethical implications. The objective of this study was to obtain information on the teaching of public health ethics in India by making a detailed examination of the public health and community medicine curricula. The specific areas of interest included the content and structure of the courses and electives available to students. The results of this study indicate that ethics courses are yet to find their rightful place in the teaching of public health in India. The curricula vary across institutes in terms of the time and content devoted to the teaching of public health ethics. It is suggested that public health programmes in India develop and incorporate ethics courses so as to keep pace with the emerging challenges in the field. An interdisciplinary consortium should preferably be formed at the national level to take up this academic endeavour.

Teaching of public health ethics in India: a mapping exercise.

A competent and motivated health workforce is indispensable to achieve the best health outcomes possible through given available resources and circumstances. However, apart from the shortages and unequal distribution, the workforce has fallen short of responding to the public health challenges of 21 st century also because of primarily the traditional training of health professionals. Although, health professionals have made enormous contributions to health and development over the past century, the 20 th century educational strategies are unfit to tackle 21 st century challenges. One of the key recommendations of the Lancet Commission on Education of Health Professionals is to improve health through reforms of professional education by establishing networks and partnerships which takes advantage of information and communication linkages. The primary goal of this manuscript is to highlight the potential of networks and partnerships in advancing the agenda of educational reforms to revitalize public health education in India. It outlines the current status and expanding scope of public health education in India, existing networks of public health professionals and public health education institutions in the country, and opportunities, advantages and challenges for such networks. Although, we have networks of individuals and institutions in the country, there potential to bring about change has still not being utilized fully and effectively. Immediate collaborative efforts could be directed towards designing and adaptation of competency driven curriculum frameworks suitable of addressing public health challenges of 21 st century, shifting the current focus of curriculum to multidisciplinary public health outlook, developing accreditation mechanisms for both the programs and institutions, engaging in creating job opportunities and designing career pathways for public health professionals in public and private sector. These efforts could certainly be facilitated through existing networks.

Transforming public health education in India through networking and collaborations: opportunities and challenges.

India is currently undergoing a rapid demographic transition along with a dramatic upsurge in the number of elderly adults. Creating a cadre of specialized health care professionals in geriatric medicine is clearly vital to address the health care needs of this growing population. The authors undertook a mapping of the available academic programs in geriatric health in India and examined their content, duration, architecture, and student intake. A total of 20 programs were identified in geriatric health, thus highlighting a paucity of training options in this field. Compared to Western countries, relatively few programs are offered in clinical and public health geriatrics in India. This is further compounded by an insignificant thrust of geriatrics in undergraduate health professional curricula. Our results underscore the need for a national-level curricular initiative to strengthen and mainstream the teaching of geriatric health in the country. Alternative educational strategies such as blended learning and interprofessional education should be explored to enhance geriatric health workforce competence.

Anjali Sharma

Papers

Size, composition and distribution of human resource for health in India: new estimates using National Sample Survey and Registry data.

Faculty development programs for medical teachers in India

Teaching of public health ethics in India: a mapping exercise.

Transforming public health education in India through networking and collaborations: opportunities and challenges.

Teaching of geriatric health in India: Mapping the terrain