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Dying for change : poor people's experience of health and ill-health

DODD, Rebecca
MUNCK, Lise
2002

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Drawing on the accounts from the World banks ‘Voices of the Poor’ this booklet looks at the intimate link between health and poverty and the need for health to be central to attempts at poverty reduction. Three key lessons are: [1] People view and value their health in a holistic sense, as a balance of physical, psychological and community well-being, consistent with the WHO view of health as ‘a state of complete physical, mental and social well-being, not merely the absence of disease or infirmity. [2] People overwhelmingly link disease and ill-health to poverty, while poverty is also seen in terms of instability, worry, shame, sickness, humiliation and powerless-ness. [3] Health is valued not only in its own right, but because it is crucial to economic survival. Other lessons include: the fact that ‘poor people’ are not homogenous and in particular women and men, and the young and old, experience poverty and ill-health quite differently. Gender differences include the fact that men access and are seen as more entitled to formal health care, while women more often draw on traditional and alternative health services or defer their own treatment. Attitudes of health staff often appalling. Humiliating treatment by health personnel who treat people as ‘worse than dogs’ was a common experience and barrier to getting treatment. Access to health facilities, rarely built in poor areas, and often too costly to access are a problem. WHO concludes that "there can be no real progress on poverty reduction, or improvement in health outcomes, unless economic and social inequities are tackled"

A survey of health reform in Central Asia

KLUGMAN, Jeni G
SCHIEBER, George
et al
1996

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This paper surveys health reform in the former Soviet republics of Central Asia, in the aftermath of their independence and transition from the Soviet command economy. Socio-economic, epidomiological and institutional realities face the countries. Section 2 sets out demographic and epidemiological trends, which suggest the scope and priorities for health services. The next section analyzes recent economic performance, highlighting worsening financial constraints. The existing health systems are evaluated in Section 4, centering on their primary strengths and weaknesses. Section 5 addresses critical institutional elements of the reform process, including decentralization and staffing issues. The reform agenda facing health policymakers in Central Asia is then investigated in Section 6, focusing upon empirical and descriptive aspects, in order to provide a reliable basis for discussing future options. Section 7 concludes that the large declines in real health spending signal that each country will have to do more with less. Consequently, current public health programs like maternal and child health programs will need to be restructured; improvement incentives to induce consumers and providors to behave more efficiently will have to be issued; and modorn management and quality assurance systems will have to be introduced. Although the reform debate focuses on financial sustainability, particularly attempts to bring in additional non-budget revenues, equally important is the need to focus on basic public health activities and delivery system restructuring.

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