Curative Health Care Services Research Articles

Immunization as an entry point for primary health care and beyond healthcare interventions-process and insights from an integrated approach in Lebanon.

Integrated healthcare systems are continually pitched as major contributors towards better distribution of health outcomes and enhanced well-being. Under emergency conditions, integrated healthcare services can guarantee better access to the target population. In recent years, several crises, i.e., economic collapse, the fuel crisis, the Beirut blast, a large refugee population, and the COVID-19 pandemic, in Lebanon have led to a major shift in the health-seeking behavior of the communities, with preventive services being downprioritized despite being available and curative healthcare services being sought out as late as possible. An extensive drop in immunization coverage and an overstretched public health system presents the risk of Vaccine-Preventable Disease outbreaks and urgent intervention is needed to bridge the immunity gap. The Ministry of Public Health, Lebanon, and UNICEF Lebanon successfully demonstrated the use of an immunization platform as an entry point to reach communities for service delivery, identification and referral, screening, awareness generation, and a host of other services that can be copied for other programs including but not limited to those for Maternal and Child health, nutrition, early childhood development, COVID-19, children with disabilities, social protection, education, health emergencies like cholera, etc., and these can provide bi-directional support to each other. UNICEF along with the MoPH (Ministry of Public Health) has been working towards reaching the most vulnerable population with a bouquet of services through existing immunization touchpoints for favorable healthcare outcomes.

Nurses’ Involvement in the Care of Orphans and Vulnerable Children in a Southwestern City in Nigeria: A Qualitative Study from Nurses and Caregivers’ Perspectives

ABSTRACT This study explored nurses’ involvement in the care of Orphans and Vulnerable Children (OVC) in orphanages using the exploratory qualitative method. Data were collected from fifteen nurses and fourteen caregivers of OVC using in-depth interviews. Nurses’ involvement was operationalized as nurses’ current and nurses’ expected roles in providing health care services for OVC. Health promotion and disease prevention, diagnosis and management of common illnesses and advocacy emerged as themes for nurses’ current roles, while health promotion and disease prevention, provision of basic health care services, advocacy, referrals for specialized care & services, and counseling services emerged as nurses’ expected roles. This study showed that curative health care services were the major focus of nurses’ involvement in the care of OVC and these care were provided mainly in the hospital. The study concludes that health care services provision for OVC by nurses should not be hospital-based only. It should be extended to the orphanages where these OVC live through regular visits by nurses to the orphanages. This visitation to the orphanages will give room for early detection and prevention of illnesses before they aggravate.

Impact of community-based health insurance on health services utilisation among vulnerable households in Amhara region, Ethiopia

BackgroundEthiopia piloted community-based health insurance in 2011, and as of 2019, the programme was operating in 770 districts nationwide, covering approximately 7 million households. Enrolment in participating districts reached 50%, holding promise to achieve the goal of Universal Health Coverage in the country. Despite the government’s efforts to expand community-based health insurance to all districts, evidence is lacking on how enrolment in the programme nudges health seeking behaviour among the most vulnerable rural households. This study aims to examine the effect of community-based health insurance enrolment among the most vulnerable and extremely poor households participating in Ethiopia’s Productive Safety Net Programme on the utilisation of healthcare services in the Amhara region.MethodsData for this study came from Amhara pilot integrated safety net programme baseline survey in Ethiopia and were collected between December 2018 and February 2019 from 5,398 households. We used propensity score matching method to estimate the impacts of enrolment in community-based health insurance on outpatient, maternal, and child preventive and curative healthcare services utilisation.ResultsResults show that membership in community-based health insurance increases the probabilities of visiting health facilities for curative care in the past month by 8.2 percentage points (95% CI 5.3 to 11.1), seeking care from a health professional by 8.4 percentage points (95% CI 5.5 to 11.3), and visiting a health facility to seek any medical assistance for illness and check-ups in the past 12 months by 13.9 percentage points (95% CI 10.5 to 17.4). Insurance also increases the annual household per capita health facility visits by 0.84 (95% CI 0.64 to 1.04). However, we find no significant effects of community-based health insurance membership on utilisation of maternal and child healthcare services.ConclusionsFindings that community-based health insurance increased outpatient services utilisation implies that it could also contribute towards universal health coverage and health equity in rural and informal sectors. The absence of significant effects on maternal and child healthcare services may be due to the free availability of such services for everyone at the public health facilities, regardless of insurance membership. Outpatient services use among insured households is still not universal, and understanding of the barriers to use, including supply-side constraints, will help improve universal health coverage.

A pattern of skin diseases in a tertiary hospital in Djibouti: a retrospective study between January 2018 and December 2021

<p><strong>Background: </strong>Skin diseases differ in various countries and social, hygiene, and weather conditions are contributing factors as well. We aim to describe, for the first time, the frequency of the skin disease spectrum in the Djiboutian population. The aim was to find out the spectrum of cutaneous diseases in relation to age, sex, origin, and season variation.</p><p><strong>Methods:</strong> This was a single-center, retrospective study on new patients attending a dermatology tertiary hospital in Djibouti between January 2018 and December 2021. Disease frequencies and prevalence by sex, seasons, and age group were recorded.</p><p><strong>Results:</strong> There were 9114 new patients. The male/female ratio was 0.55, with 5897 females (64.70%) and 3217 males (32.45%). The mean age was 23.1 years, ranging from 3 weeks old to 97 years old. The most common diagnoses were scabies 12.83% (n=1169), contact dermatitis 10.97% (n=1000) and dermatophytosis 7.93% (n=723). Skin infections were the commonest diagnostic group and amounted to 43.65% (n=3978).</p><p><strong>Conclusions: </strong>We found a higher prevalence of infectious dermatoses, with scabies dominating. In order to design both preventive and curative healthcare services, appropriate public health policy necessitates an understanding of skin disease epidemiology.</p>

Universal Health Coverage for Non-communicable Diseases and Health Equity: Reflections on the Role of Ideas and Democratic Decision-Making; Comment on "Universal Health Coverage for Non-Communicable Diseases and Health Equity: Lessons from Australian Primary Healthcare".

Fisher et al have published a thought-provoking article exploring the complex relationship between universal health coverage (UHC) and equity. This commentary builds on two of the lessons they highlight: the importance of ideas in determining how exactly UHC advances equity, and the political difficulties of addressing the commercial determinants of health. I argue that equity in UHC can be advanced through interventions that address popular prejudices against public health systems, greater emphasis on structural and commercial drivers of ill-health in health professionals’ training, and by ensuring meaningful public participation in decision-making about the institutionalisation and management of UHC. These strategies are important for ensuring that the political, power-laden nature of concepts such as "universality", "health" and "care" are explicitly acknowledged and publicly debated – rather than continuing the current trend of allowing technocrats to reduce UHC to a matter of efficiently and expeditiously financing curative healthcare services.

Determinants of healthcare seeking and out-of-pocket expenditures in a \u201cfree\u201d healthcare system: evidence from rural Malawi

BackgroundMonitoring financial protection is a key component in achieving Universal Health Coverage, even for health systems that grant their citizens access to care free-of-charge. Our study investigated out-of-pocket expenditure (OOPE) on curative healthcare services and their determinants in rural Malawi, a country that has consistently aimed at providing free healthcare services.MethodsOur study used data from two consecutive rounds of a household survey conducted in 2012 and 2013 among 1639 households in three districts in rural Malawi. Given our explicit focus on OOPE for curative healthcare services, we relied on a Heckman selection model to account for the fact that relevant OOPE could only be observed for those who had sought care in the first place.ResultsOur sample included a total of 2740 illness episodes. Among the 1884 (68.75%) that had made use of curative healthcare services, 494 (26.22%) had incurred a positive healthcare expenditure, whose mean amounted to 678.45 MWK (equivalent to 2.72 USD). Our analysis revealed a significant positive association between the magnitude of OOPE and age 15–39 years (p = 0.022), household head (p = 0.037), suffering from a chronic illness (p = 0.019), illness duration (p = 0.014), hospitalization (p = 0.002), number of accompanying persons (p = 0.019), wealth quartiles (p2 = 0.018; p3 = 0.001; p4 = 0.002), and urban residency (p = 0.001).ConclusionOur findings indicate that a formal policy commitment to providing free healthcare services is not sufficient to guarantee widespread financial protection and that additional measures are needed to protect particularly vulnerable population groups.

Family Planning Utilization Among Model and Non Model Family Women Enrolled in Urban Health Extension Program in Addis Ababa, Ethiopia, 2015

Background : In 2003, the Ethiopian Federal Ministry of Health (FMOH) launched a new health care plan, the “Accelerated Expansion of Primary Health Care Coverage,” through a comprehensive Health Extension Program (HEP).Recognizing the huge gap between need and health care services available, the FMOH has focused on “providing quality promotive, preventive, and selected curative health care services in an accessible and equitable manner to reach all segments of the population, with special attention to mothers and children. Objective: To assess on family planning service utilization among model and non-model family women enrolled in urban health extension program of kirkos sub-city administration. Method: A cross sectional study design using a quantitative method was used .A total of 424 (212 model families and 212 non-model families) participated the study. Adjusted ORs that controls the confounding effects of other covariates were calculated using the multiple logistic regression models of SPSS version 16 statistical programs. Statistical significance was considered at P-value less than 0.05. Result: Large proportion study population 210(81.08%) [109(78.4%)) and 101 (84.1%),) model and non-model respectively] were they prefer to be informed by health professional and followed by other (like friend husband...) were 27(10.42%) [18(12.9%) and 9(7.5%) for model and non-model families respectively], media (radio and TV) were 15(5.79%) [5(3.59) and10 (8.33%) for model and non-model families respectively] with X2 =4.21, p value =0.000021. Conclusion : By this measurement the UHEP programs lacks the aspects expected to be done. FMOH should see the implementation strategies of UHEP on providing and upgrading family planning service. Keywords: Family planning, Urban Health Extension Program (UHEP), Model /Non-model Family DOI : 10.7176/JMPB/59-04 Publication date :September 30 th 2019

Social acceptance and job satisfaction of ASHA workers in the Garo Hills Division of Meghalaya: a cross-sectional study

Background: ASHAs were appointed by NRHM to provide preventive, promotive and curative healthcare services in the rural including tribal villages in Meghalaya. However, their social acceptance and job satisfaction remain less studied. Hence our study aimed at it.Methods: A cross-sectional study was conducted among 140 ASHAs from randomly sampled 142 villages across 15 PHCs in five districts. To collect data, we used a semi-structured back-translated and validated questionnaire consisting socio-demographic profile of ASHAs, level of perceived social acceptance and job satisfaction. Data were analysed using SPSS version 22.0.Results: Mean and median age of ASHAs were 33.29 and 32.00 years respectively. Over 63% belonged to Garo tribes, 67% studied high school, and 91% married. Village elders selected 76% of ASHAs, and 81% were as ASHAs for at least eight years. About 86% were trained in a minimum of three modules and all found their training effective. While 92% had the medical kit always filled, 100% had registers updated, and 94.3% facilitated VHND and FHD meetings. About 97% accompanied the pregnant women, 96.4% attended PHC meetings regularly and 83.6% organized VHSNC meeting. Though 93.5% reported a high acceptance of ASHAs' services, social acceptance of ASHAs was rather to some extent for 36.4%. Almost 52% of ASHAs were dissatisfied with job and 61% were unhappy with their performance-based remuneration.Conclusions: Community must be aware of ASHAs’ role, and their job satisfaction has to be increased with a corresponding increase in incentives while developing strategies to ease the process of payments.

Integrating promotive, preventive, and curative health care services at hospitals and health centers in Addis Ababa, Ethiopia.

BackgroundThe current trend in patients’ disease management is mostly aimed at addressing their present health complaints; the focus is thus purely curative. As the limits of curative medicine become apparent and the cost of medical care escalates, disease prevention is gaining prominence. Factors that contribute to unreliable delivery of an integrated health care service are worth investigation. This study explores the extent to which health promotion and disease prevention services are integrated to curative health care and identifies the factors associated with not reliably providing the services.MethodsA cross-sectional quantitative study using an exploratory and descriptive design was used to explore and describe the extent of health promotion, preventive, and curative health care services provision, and investigated factors related to low performance. Phase I of the study examined the degree of promotive and preventive health care provision at hospitals and health centers while investigating the staffing and equipment and supply status of the facilities. Phase II, using the Delphi consensus-seeking process, focused on the validation of the findings from Phase I.ResultsOf all patients who attended health facilities, only 2.4% (n=20) received optimal health promotion services. Disease prevention services were optimally provided to only 3.6% (n=30) patients. Integrated health promotion and disease prevention services were provided to only 0.8% (n=7) patients. The main reasons for not providing an integrated health care service were shortage of skilled health staff, equipment, medication, protocols, and guidelines, and high service cost, poor patient awareness, and health professionals’ focus on curative health care.ConclusionHealth service providers were not routinely conducting patient-specific health promotion, disease prevention, and integrated health care services, losing the opportunities of patient’s presence for health promotion and diseases prevention purposes. Addressing barriers can help with integrating health promotion and disease prevention services to the curative health care services.

Cultural Trade: Promoting Entrepreneurial Women Cultural Herbs Traders in Nigeria

Cultural Trade/Industry is a new concept for the activities of traditional industries including herbal medicinal dealers and largely remains a small family business dominated by women. However, despite their pivotal roles in Nigeria Health Care Delivery System, they continue to suffer neglect from government. This paper attempts to investigate the activities of this cultural trade with a view to foreground its contribution to the society. Multistage sampling procedures were used in the study. 72 Traders were randomly selected in 6 Local Government Development Areas of Ondo state, Nigeria. In addition, 504 clients were interviewed but 21 respondents, not well captured were rejected, remaining 483 clients. The questionnaires were analyzed using chi square analysis. Descriptive statistical techniques (frequency and percentages) were used to summarize the data collected. Secondary data were extracted from books, journals and other relevant publications. The study revealed that Cultural Herb Trade is predominantly dominated by women. The Traders have low entrepreneurship orientation, displaying their wares under sheds in the public markets; earning less than US$1000 as profit yearly. They claimed inability to access loan from support institutions due to their poor financial literacy and abandonment. The findings showed that socio-economic attributes of Cultural Herbs Traders had significant effect on their performance (x² = 6.162877, df = 2, pr = 0.029). The findings also showed significant relationship between the treatment modalities of Cultural Herb Traders and their performance (Person x² = 50.18154 Pr = 0.000). Moreover, there existed significant relationship between the networking strategies of Cultural Herb Traders and performance (x²=44.63424, df = 2, pr=0.0009). It was found that Cultural Herb Traders provided both preventive and curative health care services with significant association between performance and patronage by clients (x²=254.8922, df = 6, pr=0..000), especially in the areas of malaria, infertility and small pox diseases to mention a few. 94% of the Clients indicated their continuous support to patronize the Traders because their medicines were efficacious. 89% of the clients/customers/buyers signified their intention to increase their patronage because of the good performance of their treatment. The study concluded that in spite of the prominence of these cultural herb traders, there is inadequate financial and research assistance from academia and corrupt government. Thus, Local Government may want to increase their research budgets to embrace modernization of cultural herbs trade sector.

Households’ choices of healthcare services in the north west region of Cameroon

Efficient healthcare systems in developing economies are significant indicators of development. Health can either be optimised households’ choices between preventive and curative healthcare services. In Cameroon like other developing countries, domestic healthcare service is either considered to be a normal or luxury good to households with competing alternative providers such as the public and private providers. To examine the healthcare preferences of households in the North West Region of Cameroon, a purposive sample of 300 households were collected and analysed using a multinomial logistic model. Households’ characteristics such as sex and age of household heads, marital status of household heads and monthly income as well as providers’ specific characteristics such as the reputation of the healthcare providers are significant determinants households ‘healthcare choices. Implicitly the reputation of the healthcare provider serves as a signal for households to overcome information asymmetry on the quality of healthcare services offered. This study suggests that standardizing the measure of reputation of healthcare providers would be an efficient signal of quality to healthcare clients. Also, household access to quality healthcare can be improved with efficient healthcare support programs and deferred payment options.Keywords: Healthcare Services; Healthcare Providers; Multinomial Logistic Model; Healthcare Systems; Primary Healthcare

Identifying gaps in the practices of rural health extension workers in Ethiopia: a task analysis study

BackgroundHealth extension workers (HEWs) are the frontline health workers for Ethiopia’s primary health care system. The Federal Ministry of Health is seeking to upgrade and increase the number of HEWs, particularly in remote areas, and address concerns about HEWs’ pre-service education and practices. The aim of this study was to identify gaps in HEWs’ practices and recommend changes in their training and scope of practice.MethodsA cross-sectional descriptive task analysis was conducted to assess the work of rural HEWs who had been in practice for six months to five years. One hundred participants were invited from 100 health posts in five regions of Ethiopia. HEWs self-reported on 62 tasks on: frequency, criticality (importance), where the task was learned, and ability to perform the task. Descriptive statistics, including frequencies and percentages, were computed for each variable. Task combinations were examined to identify tasks performed infrequently or for which HEWs are inadequately prepared.ResultsA total of 82 rural HEWs participated in the study. Nearly all HEWs rated every task as highly critical to individual and public health outcomes. On average, most HEWs (51.5%–57.4%) reported learning hygiene and environmental sanitation tasks, disease prevention and control tasks, family health tasks, and health education and communication tasks outside of their pre-service education, primarily through in-service and on-the-job training. Over half of HEWs reported performing certain critical tasks infrequently, including management of supplies, stocks and maintenance at the facility and management of the cold chain system. Almost all HEWs (95.7–97.2%) perceived themselves as competent and proficient in performing tasks in all program areas.ConclusionHEWs were insufficiently prepared during pre-service education for all tasks that fall within their scope of practice. Many learned tasks through in-service or on-the-job training, and some tasks were not learned at all. Some tasks that are part of expected HEW practice were performed infrequently, potentially reducing the effectiveness of the Health Extension Program to provide preventive and basic curative health care services to communities. Findings should alert policy makers to the need to review HEWs’ scope of practice, update pre-service education curricula and prioritize in-service training modules.

Screening program for cervical cancer: public policies and experiences of actors who implement the program in the state of Veracruz, Mexico

The aim of this article is to analyze the way in which the Screening Program for Cervical Cancer is carried out in a dysplasia clinic and related health centers in the state of Veracruz, through the representations and practices of the social actors who implement the program. In order to do so, in-depth interviews and observations of the practices of health service providers were carried out during different periods over the course of three years, from 2009 to 2011. Through the information obtained, the article explores the difficulties, achievements and results of this program as part of a public policy. Although a priority of public health policy is to see the whole population benefit from preventive and curative health care services, evidence shows that marginalized populations are not benefitted by such programs; such information does not however seem to permeate popular and medical knowledge.

Free health care for under-fives, expectant and recent mothers? Evaluating the impact of Sierra Leone's free health care initiative.

This study evaluates the impact of Sierra Leone’s 2010 Free Health Care Initiative (FHCI). It uses two nationally representative surveys to identify the impact of the policy on utilisation of maternal care services by pregnant women and recent mothers as well as the impact on curative health care services and out-of-pocket payments for consultation and prescription in children under the age of 5 years. A Regression Discontinuity Design (RDD) is applied in the case of young children and a before-after estimation approach, adjusted for time trends in the case of expectant and recent mothers. Our results suggest that children affected by the FHCI have a lower probability of incurring any health expenditure in public, non-governmental and missionary health facilities. However, a proportion of eligible children are observed to incur some health expenditure in participating facilities with no impact of the policy on the level of out-of-pocket health expenditure. Similarly, no impact is observed with the utilisation of services in these facilities. Utilisation of informal care is observed to be higher among non-eligible children while in expectant and recent mothers, we find substantial but possibly transient increases in the use of key maternal health care services in public facilities following the implementation of the FHCI. The diminishing impact on utilisation mirrors experience in other countries that have implemented free health care initiatives and demonstrates the need for greater domestic and international efforts to ensure that resources are sufficient to meet increasing demand and monitor the long run impact of these policies.

A Prospective Drug Utilization Study in Geriatric Hypertensive Patients in a Tertiary Care Hospital, Mumbai

Introduction: The geriatric population assumes great significance in terms of both preventive and curative health care services utilized. The patho-physio-psychological changes associated with ageing make their problems unique. In the geriatric population, hypertension accounts for a huge proportion of cardiovascular and all cause mortality and morbidity. We conducted a study to describe the patterns of antihypertensive drug use in the geriatric population, compare it to the current recommendations and conduct an analysis using the WHO-INRUD drug use indicators. Methods: A prospective cross sectional drug utilization study of 100 prescriptions of hypertensive patients (as per JNC 7) of either sex and ≥60 years was undertaken as per the WHO – DUS and the STROBE guidelines. Results: Statistically significant relation was found between BP control, and addictions and CIRSG score. The 100 prescriptions contained 344 drugs, out of which, 171 were antihypertensive drugs. Three percent of antihypertensive drugs were prescribed by generic names. Seventy nine

Role of health economics in developing efficient universal health care system

Application of economic principles can bring about a significant change in the performance of health system. An in-depth understanding of how to generate resources, how to pool funds, how to purchase health services and pay providers of health care, will affect how the health system delivers on its two important objectives, i.e. efficiency and equity. The economic underpinnings of health system are important structural and functional factors to aid in planning and delivery of health care services. Health economics can help in making informed decisions by explaining the factors that affect consumption and utilization of health services both from the demand and supply side using the principles of microeconomics. This is vital for improving the ‘coverage’ of all desired preventive and curative health care services. Most of the recent health system interventions such as increased public health subsidy, creating demand side financing mechanisms like conditional cash transfers schemes such as Janani Suraksha Yojana, performance based payments to Accredited Social Health Activist (ASHAs), incentivizing health workforce in rural and difficult areas, are all grounded in economic theories. Despite years of advocacy, resources have been and will continue to be scarce in health sector. On the contrary, demands for increasing the coverage of existing programs and introduction of newer interventions and technology are increasing. As a result hard choices need to be made for rational allocation of resources for maximizing the value of money spent. Despite a strong felt need among policy makers and program managers for health economists, there is an acute shortage of professionals who have requisite knowledge of health economics. This calls for introduction of health economics in the curriculum of medical and public health courses. Health professionals should also be encouraged to undertake research in this field of health economics and health financing.

Migration, remittances, and health care utilization in Ecuador

To examine the relationship between migration and migrant remittances and health care utilization in Ecuador, and to identify any potential equalizing effects. Using data from the 2004 National Demographic and Maternal & Child Health Survey (ENDEMAIN), a multilevel multivariate analysis was conducted to assess the relationship of two migrant predictors (households with an international migrant; use of migrant remittances) with use of preventive care, number of curative visits, hospitalization, and use of antiparasitic medicines. Relevant predisposing, enabling, and need factors were included following Andersen's Model of Health Care Utilization Behavior. Interaction terms were included to assess the potential equalizing effects of migration and remittances by ethnicity, area of residence, and economic status. Migrant predictors were strongly associated with use of antiparasitic medicines, and to a lesser extent, with curative visits, even after adjusting for various predisposing, enabling, and need factors. Interaction models showed that having an international migrant increased use of these services among low-income Ecuadorians (quintiles 1 and 2). No significant relationship was found between migrant predictors and use of preventive services. Migration and remittances seem to have an equalizing effect on access to antiparasitic medicines, and to a lesser extent, curative health care services. Health care reform efforts should take into account the scope of this effect when developing public policy.

Implementing a comprehensive cost information system in rural health facilities: the case of Nouna health district, Burkina Faso

To present first findings of a cost-of-illness (COI) information system implemented in Nouna health district, Burkina Faso. The entire project will include household and provider tangible COI, whereas this article concentrates on the development of a provider cost information system in rural first-line health facilities. Special forms and reports are prepared to routinely collect capital and recurrent costs of first-line facilities. Inventory lists are designed, and buildings and equipment are assessed by engineers. Total, fixed, variable and average costs are calculated for 15 rural health centres with five cost centres: general outpatient consultation, ambulatory nursing care, deliveries, immunization and other services (neonatal consultation, child care and family planning). In 2003, the average costs per service unit were 1.34 US$ for a general consultation, 0.51 US$ for ambulatory nursing care, 6.73 US$ per delivery, 3.64 US$ per vaccination and 1.11 US$ per service unit of other care. On average, a health centre consumes 29,900 US$ per year for a catchment population of 10,000 inhabitants. The major share of costs is fixed and does not depend on the workload of the health centre. Consequently, the costs of first-line facilities will hardly increase if the demand for health services rises. These findings can be used to improve the health financing in Nouna health district, Burkina Faso.

Use of some important medicinal plants and herbs for treating common diseases at home in Uttaranchal

The present study reports prevalent diseases among the communities living in Himalayan region and efforts for low cost preventive and curative healthcare services. The main emphasis is to promote awareness about the sustainable use of local easily available surrounding medicinal plants and to protect and conserve them in nature through cultivation. Since these plants are not found to occur in all climatic zones, some are procured from the raw drug market. This communication includes a brief general classification of women, children and general diseases of old persons (Male & Female) and brief contents including plant parts use in formulations, their approximate proportion, fixed dose and period of taking. These formulations are prepared in the presence of Vaidyas and experts of plant identification according to public need and positive health of an individual. The method of preparing medicines is very simple - churn powder.

Priority-setting and rationing in German health care

While the framework for the German statutory health insurance system is determined at the national level and the states have a significant influence on the provision of hospital care and public health services, most decisions on the actual delivery of curative health care services are made through joint negotiations between the associations of the physicians and the sickness funds at various levels. Decisions with effects on priority-setting include the determination of the benefit package and financial regulations. The actual provision of care is further regulated through guidelines, e.g. about the prescription of pharmaceuticals. Financial regulations include both the setting of budget limits and the determination of relative point values which affect remuneration and serve as incentives to provide certain services (or not). A survey of 2000 citizens reveals, however, that the majority of the public favours unlimited funding for health services and that treatment decisions should be made by doctors. Limiting the benefits catalogue to a core of essential services is rejected as well as priorities based on age. Separately interviewed experts expect further limitations of therapeutic freedom, however. Germany seems to be just at the beginning of a public debate on priority-setting and rationing in health care.