Free Health Care Services Research Articles

Using Three Delay Model to Understand the Social Factors Responsible for Neonatal Deaths Among Displaced Tribal Communities in India.

In the tribal region, risk of death among neonates is influenced to a great extent by factors related to the mother such as situation of the mother prior to and post pregnancy, care received before, during and after pregnancy, birth order, and care received by the child during the first few years of his/her life. There is paucity of basic epidemiological data on reproductive health outcomes of displaced people (Hynes et al. in JAMA 288(5):595-603, 2002). Therefore, this study aims to examine the social factors responsible for neonatal deaths among displaced tribal communities in India. Sequential exploratory study design was used to collect data from displaced tribal communities in the state of Odisha and Chhattisgarh during 2016-2017. A purposive sampling method was used to select the sample from the definite population. Results indicate that in total 115 (59.3%) women had experienced at least one child deaths. Analysis of neonatal deaths suggests that about 39.2% women experienced at least one or more neonatal death during the last 5 years. Women who chose to deliver at home experience higher neonatal deaths (47.1%) in comparison to the women who delivered at the health facility (26.0%). The logistic regression analysis indicate that mothers education, place of delivery, utilization of the services, possession of Below Poverty Line (BPL) card and Particularly Vulnerable Tribal Group (PVTG) status are significant predictors of neonatal mortality. The probability of occurrence of neonatal mortality is 60% lower for literate women as compared to the illiterate women. Findings of the study identified three phases of delay that affect displaced tribal women in accessing and receiving health care services. Displaced tribal women are late in recognizing health problems of neonates and delay in seeking medical care due to rooted cultural barriers. Women who participated in this study had low levels of risk perception about delivering children at home and visiting traditional healer for the treatment. This is mainly due to their personal experiences of uneventful deliveries conducted by mothers-in-law or Traditional Birth Attendants (TBA) and sociocultural beliefs. There is need for provision of culturally sensitive instruction to service providers. This would further motivate service providers to sensitize the displaced tribal communities on various free healthcare services available to them.

An overview of oral health status, socio-economic and behavioral risk factors, and the pattern of tooth loss in a sample of Egyptian rural population

BackgroundThe lack of adequate data on the oral health status among the Egyptians is a challenging barrier for the assessment and improvement of oral health needs.ObjectivesThe aim of this study was to collect data on oral health status among a sample of Egyptian rural population and to assess the possible role of the socio-demographic, socio-economic, and behavioral risk factors on the status of the present dentition (the pattern of tooth loss and edentulism).Materials and methodsData was collected from 530 patients with age ranged from 20 to 70 years using a modified World Health Organization (WHO) questionnaire. The questionnaire included information about oral health status, socio-demographic (age and sex), socio-economic (educational levels and income), and behavioral factors (smoking and oral hygiene measures). A complete intra- and extraoral examination and free dental health care services were provided by a team of qualified dental specialists from National Research Centre (NRC). Data was analyzed using chi-square and Spearman’s correlation tests, and the significance level was validated at p < 0.05.ResultsFemales comprised 79% while males were 21% of the surveyed rural sample. Concerning socio-economic aspects including the level of education and income, it was found that 50% of the individuals completed their secondary educational levels, followed by illiterates 35.5% and preparatory levels, while college graduates were minority 4.7%. On the other hand, only 27.5% of rural had income while 72.5% of them had no income. Assessment of behavioral risk factors (oral hygiene procedures and smoking) showed that only 34.3% of the individuals claimed to brush their teeth and only a minority were male smokers (13.8%). The results demonstrated poor oral health status and increased incidence of partial edentulism (45%), where Kennedy class III was the most common type (34.6%).ConclusionsLack of oral hygiene measures specifically tooth brushing is the most significant behavioral risk factor for the poor oral health status and tooth loss in this survey.Sociodemographic and socio-economic factors are influential risk factors for tooth loss.Cigarette smoking was not a main behavioral risk factor that impacts the oral health status in the present survey

Knowledge, attitude and antibiotic prescribing patterns of medical doctors providing free healthcare in the outpatient departments of public hospitals in Sierra Leone: a national cross-sectional study.

Antibiotic resistance is a global health crisis and irrational prescribing behaviour has been identified as a contributing factor. The current study aimed to assess the knowledge of, attitudes towards and practices regarding antibiotic prescribing of medical doctors providing free healthcare services in the outpatient departments of public hospitals in Sierra Leone. In addition, we evaluated prescribing patterns of antibiotics. The study has two parts. First, we conducted a cross-sectional survey using a self-administered questionnaire to assess doctor's knowledge of, attitudes towards and practices regarding prescribing antibiotics. Second, using patient medical records, we used the World Health Organization methodology on how to assess drug use in health facilities to evaluate prescribing patterns of antibiotics in four selected public hospitals in Sierra Leone. Of 130 administered questionnaires, 119 were returned, for a response rate of 91.5%. The majority of doctors (n=83 [69.7%]) agreed that amoxicillin is safe in the first 3weeks of pregnancy and considered antibiotic resistance a global (n=108 [90.7%]) and national (n=97 [81.5%]) public health crisis. Less than a quarter of medical doctors agreed that antibiotics may speed up the recovery when added to malaria (n=25 [21%]) or cold and cough (n=81 [68%]) therapies. Prescribing pattern results show that children <5y of age (adjusted odds ratio 5.199 [confidence interval 2.743 to 9.855], p<0.0001) were more likely to be prescribed an antibiotic than pregnant women/lactating mothers. Penicillins were the most commonly prescribed pharmacological class of antibiotics, with amoxicillin being the most commonly prescribed penicillin. Doctors demonstrated a sound knowledge of antibiotics and antibiotics resistance, with a positive attitude towards prescribing antibiotics. However, the prescribing pattern of antibiotics was irrational, necessitating the need for the establishment of audit and feedback programmes such as antimicrobial stewardship programmes.

A strategy to improve resource utilization: Case study of generic drug distribution in Rajasthan

The establishment of standard, universal and quality healthcare service is essential for developing countries such as India to enhance the quality of life. Various healthcare schemes such as Jan Aushadhi Scheme, Mukhyamantri Nishulk Dava Yojna etc are operating in India which provides free healthcare services including free distribution of medicines. The medicines provided in these schemes are mostly generic drugs and the supply chain has already been established for it. The variety of generic drugs varies in quantity across different storage points and consumption points, and also having different self-lives, costs and logistics requirements. It was observed that the performance of these supply chain needs to be improved in various dimensions. Therefore, generic drug distribution in Rajasthan is studied and analyzed in the current study. The different aspects of generic drug distribution considered in the study are process view of the existing supply chain, sourcing, ordering and procurement, logistics and warehousing, inventory management and information system. The use of various techniques such as value stream mapping, inbuilt analytical tool for ordering, 5S practice and performance measurement system is explored to develop a strategy for improved resource utilization.

Homebirth fines and health cards in rural Tanzania: On the push for numbers in maternal health.

Over the last two decades, there has been a global push to improve maternal health by increasing numbers of facility births in low- and middle-income countries like Tanzania. While recent scholarship has interrogated the increasing hegemony of numbers and metrics in global health, few have ethnographically explored how this push for numbers and its accompanying technologies affect the lived experiences of parturients and those who care for them during pregnancy and childbirth in rural communities. Based on seven months of multi-sited ethnographic research conducted in three different rural communities in Mpwapwa District in 2016, this article explores how mothers and nurses in Tanzania experienced the push for numbers in maternal health, particularly as that push is enacted through homebirth fines and health cards. Intended to reduce maternal mortality, policies meant to increase facility births in rural Tanzania can inadvertently decrease access to care for the most marginalized community members, while simultaneously enticing under-resourced and over-burdened health workers to sanction non-compliant women while doing nothing to improve the wider health systems in which they work. Ethnographic interviews with mothers, nurses, and government leaders show how homebirth fines exacerbate structural inequalities in healthcare access, excluding some of the poorest women from the healthcare services they desire. Additionally, weekly participant-observation conducted at each of the community health dispensaries highlights the way female nurses engage in improvised and often punitive tactics with health cards, key documents for women to be able to access free national healthcare services. While the new sanctions can help lessen the heavy workloads of healthcare workers at rural dispensaries, they also lead to worsening relationships between nurses and the communities they serve. By prioritizing the perceptions and negotiations surrounding homebirth fines and health cards, this paper shows the unintended consequences of indicator-driven care, which most negatively affect the poor.

IMPACT OF MATERNAL MORTALITY ON SUSTAINABLE DEVELOPMENT IN THE SELECTED WEST AFRICAN COUNTRIES

Over half a million females die every year as a result of pregnancy and birth complications. The vast majority of these fatalities can be avoided. SDG 3.1’s objective is to reduce the global maternal mortality ratio by 2030 to below 70 per 100,000 live births. Despite a number of policies put in place maternal mortality in Africa remains unacceptably high. This study investigates the impact of maternal mortal- ity on sustainable development in 9 selected West African countries for the period from 1990 to 2015. Data used were adjusted net savings, maternal mortality, consumer price index, per-capita income and financial development. The second-generation econometric methods were employed: cross sectional dependence, slope homogeneity, Westerlund cointegration, Eberhadt and Teal AMG regression, and the Emirmahmutoglu and Kose bootstrap Granger causality test. Findings confirm the following: First, cross-sectional dependence and slope heterogeneity exist among the West African countries. Second, there is a long run relationship between maternal mortality and sustainable development. Third, maternal mortality impacted negatively and signifi- cantly on sustainable development. Fourth, the direction of causality varies across countries between maternal mor- tality and sustainable development. Lastly, causality runs from maternal mortality to sustainable development when analyzing the causal relationship among all countries. The findings suggest that the West African government needs to commit more funding to the health care sector and ensure access to free healthcare service to pregnant women or at low cost with quality and effective health care services if the countries must attain sustainable development by 2030.

Framework contracts for medicine inventory management in public healthcare

Learning outcomes This paper aims to highlight the implications of financial planning for public procurement process for medicine purchase. The purpose of this case is also to understand how the choice of contract type in public procurement impacts medicine inventory levels and availability. It finally highlights the appropriate configuration of framework procurement contract for procurement of discrete goods in the context of public sector procurement. Case overview/synopsis Primary and Secondary Healthcare Department (P&amp;SHD), Government of the Punjab provides free public health-care services in the Punjab province. Public health-care services of P&amp;SHD are organised in a tiered manner with almost 3,000 primary and secondary medical facilities dispersed throughout the Punjab province. P&amp;SHD maintains inventories of approximately 300 medicines to support medical service provision. Complexity academic level This case can be taught in procurement and inventory management module of MBA level operations management course. It can also be used in executive course on public sector procurement management. The case aims to highlight the interrelation between inventory planning and procurement management process. Hence, it should be used after participants have understood inventory models, procurement process and procurement contract types. Standard readings or cases on inventory and procurement management that cover topics such economic order quantity, procurement process steps and procurement contracts can be used to develop this understanding. Supplementary materials Teaching Notes are available for educators only. Please contact your library to gain login details or email support@emeraldinsight.com to request teaching notes. Subject code CSS 9: Operations and logistics.

Patients’ perspectives on integrated oral healthcare in a northern Quebec Indigenous primary health care organisation: a qualitative study

ObjectivePatient-centred care is considered to be an important element in the evaluation of integrated healthcare and has been effective in addressing oral health disparities. This study explored the patients’ perspectives...

Burden of Malaria in three Endemic Districts of Bhutan: Road to Malaria Elimination

Introduction: Bhutan is considered as a low endemic country for malaria. In the last decade, Bhutan has successfully reduced the number of malaria cases with the support from Global Fund and WHO. Sarpang, Samtse and Samdrup Jongkhar districts located in the Southern foothills of Bhutan records the most cases. Method: This retrospective study was undertaken with the available census record maintained in health centers of the three endemic districts and VDCP. Results: There were 892 confirmed malaria cases in 2009 and 41 cases in 2017 in three endemic districts. The slide positivity rate (SPR) declined from 2.2% in 2009 to 0.1% in 2017. The distribution of disease was significantly higher (p&lt;0.05) amongst the male population with the increasing trend of Plasmodium vivax infection. The study found predominance of P. vivax in Samtse (93%), and Sarpang (62%) and Plasmodium falciparum in Samdrup Jongkhar (61%). The last four years (2014-2017) data showed that maximum cases detected were imported, followed by indigenous and introduced malaria; with 50%, 44% and 6%, respectively. The mortality and morbidity due to malaria has magnificently declined in the last decade. Conclusion: The large-scale implementation of vector control interventions, such as insecticide-treated bed nets, indoor residual spraying, free health care service and active vector surveillance has achieved a marked reduction in malaria incidence. Cross border malaria is still a huge challenge for elimination of malaria in Bhutan. Thus, imported malaria is an increasing problem due to high receptivity, and vulnerability.

Oral health status and treatment needs of internally displaced persons

Background: Internally displaced persons (IDPs) from North Eastern Nigeria have limited access to dental health facilities. Information on their oral health problems is limited. There is a need to determine their oral health status and treatment needs. Objectives: The objective of this study is to assess the oral health status and treatment needs of persons in an IDP camp and provide needed oral health services. Materials and Methods: A descriptive cross-sectional study among adults and their children in an IDP camp in Lagos. Pro forma with sections on biodata, oral hygiene practice and status, and periodontal parameter was used. Descriptive statistics were used in data analysis, with P < 0.05 considered statistically significant. Results: One hundred and twenty-three individuals (67 adults and 56 children) were seen. Mean age was 16.7 ± 12.8 years, adults were 28 ± 4.9 years, and children were 3.8 ± 3.1 years. Females represented 61%. Most (68.7%) adults had secondary school education, while most children (73.2%) had not commenced formal education. Fewer (41.7%) brushed twice daily. Only 8.5% had visited the dentist. Overall caries prevalence was 20.3%, and mean Decayed, Missing, and Filled Teeth (DMFT) was 0.7 ± 1.7, while the mean dmft for children with primary teeth was 0.3 ± 1.0. Mean DMFT was significantly associated with the past dental visits (P = 0.003) and presence of at least one oral condition (P = 0.000). The restorative index was zero, while unmet treatment need was 76.7%. Low dental treatment index was 30.6%. Of the 30.1% with toothache, only 16.2% sought treatment in the hospital. Sixty-three respondents received dental treatment in the form of scaling and polishing, fluoride therapy, atraumatic restorative treatment and extractions. Conclusion: The IDPs had a caries prevalence of 20.3% and a DMFT of 0.7 which were relatively low. However, their unmet treatment needs were high, coupled with a zero-restorative index. The IDPs benefited from free oral health-care services.

An institutional analysis of the fiscal autonomy of public hospitals in Vietnam

AbstractThis paper explores the fiscal autonomy of Vietnam's public hospitals through analysing the formal autonomy rules and the actual autonomy practices among selected hospitals. We argue that Vietnam's autonomisation of public hospitals underpins the increasing switch of healthcare costs from the state onto society alongside the transition from the universal and free healthcare services to a mix of state subsidy and fees‐for‐services. Utilised as a strategic instrument, hospital autonomy is reinforced in service provision, capital mobilisation, and allocation of net revenues, leaving autonomy in other dimensions increase incrementally. Consequently, Vietnam's hospital autonomisation has occasioned various revenue‐maximising practices including the provision of “patient‐requested” services, provider‐induced supply of unnecessary services, excessive use of high‐tech diagnostic equipment, inappropriate prescription of drugs, increase in patients' length of stay, and receipt of informal payments. While discerning healthcare reform in a country context, this paper expects to offer lessons to policy‐makers in developing countries, which reform their healthcare services along the market principle.

Accessing free quality health care services and premature death.

The type of health insurance may affect the likelihood of mortality of insured people. We conducted this study to determine if accessing free quality health care services could decrease the premature mortality of people in a developing country. In a multicenter cross sectional study, "years-life-lost" (YLL) due to premature death was evaluated in 202671 insured people residing in six large regions in Iran. The participants had access to free quality health care services. The number of insured people that died in the six regions during March 20, 2014, to March 20, 2015, as well as their sex, age, and cause of the death, were collected, and the YLL was calculated based on assumptions made in Global Burden of Disease Study 2010 (GBD2010). The crude mortality rate was 2.3 per 1000, significantly lower than the overall rate of 4.6 per 1000 people in general population of Iran. The average YLL was 47years per 1000 persons, significantly lower than that in general population of Iran and many industrialized countries. The most common causes of death (and YLL) were cardiovascular diseases and malignancies. Having access to free quality health care services is associated with a significant decrease in premature death.

How do gender and disability influence the ability of the poor to benefit from pro-poor health financing policies in Kenya? An intersectional analysis

BackgroundHealth inequity has mainly been linked to differences in economic status, with the poor facing greater challenges accessing healthcare than the less poor. To extend financial coverage to the poor and vulnerable, Kenya has therefore implemented several pro-poor health policy reforms. However, other social determinants of health such as gender and disability also influence health status and access to care. This study employed an intersectional approach to explore how gender disability and poverty interact to influence how poor women in Kenya benefit from pro-poor financing policies that target them.MethodsWe applied a qualitative cross-sectional study approach in two purposively selected counties in Kenya. We collected data using in-depth interviews with women with disabilities living in poverty who were beneficiaries of the health insurance subsidy programme and those in the lowest wealth quintiles residing in the health and demographic surveillance system. We analyzed data using a thematic approach drawing from the study’s conceptual framework.ResultsWomen with disabilities living in poverty often opted to forgo seeking free healthcare services because of their roles as the primary household providers and caregivers. Due to limited mobility, they needed someone to accompany them to health facilities, leading to greater transport costs. The absence of someone to accompany them and unaffordability of the high transport costs, for example, made some women forgo seeking antenatal and skilled delivery services despite the existence of a free maternity programme. The layout and equipment at health facilities offering care under pro-poor health financing policies were disability-unfriendly. The latter in addition to negative healthcare worker attitudes towards women with disabilities discouraged them from seeking care. Negative stereotypes against women with disabilities in the society led to their exclusion from public participation forums thereby limiting their awareness about health services.ConclusionsIntersections of gender, poverty, and disability influenced the experiences of women with disabilities living in poverty with pro-poor health financing policies in Kenya. Addressing the healthcare access barriers they face could entail ensuring availability of disability-friendly health facilities and public transport systems, building cultural competence in health service delivery, and empowering them to engage in public participation.

Patients\u2019 perspectives regarding hospital visits in the universal health coverage system of Thailand: a qualitative study

BackgroundA universal health coverage policy was implemented in Thailand in 2002 and led to an increase in accessibility to, and equity of, healthcare services. The Thai government and academics have focused on the large-scale aspects, including effectiveness and impacts, of universal health coverage over one decade. Here, we aimed to identify patients’ perspectives on hospital visits under universal health coverage.MethodsA qualitative study was carried out in four public hospitals in rural Thailand. We collected data through focus group discussions (FGDs) and in-depth interviews (IDIs). The semi-structured interview guide was designed to elicit perspectives on hospital visits among participants covered by the Universal Coverage Scheme, Social Security Scheme or Civil Servant Medical Benefit Scheme. Data were transcribed and analysed using a thematic approach.ResultsTwenty-nine participants (mean age, 56.76 ± 16.65 years) participated in five FGDs and one IDI. The emerging themes and sub-themes were identified. Factors influencing decisions to visit hospitals were free healthcare services, perception of serious illness, the need for special tests, and continuity of care. Long waiting times were barriers to hospital visits. Employees, who could not leave their work during office hours, could not access some services such as health check-ups. From the viewpoint of participants, public hospitals provided quality and equitable healthcare services. Nevertheless, shared decision making for treatment plans was not common.ConclusionsThe factors and barriers to utilisation of healthcare services provide exploratory data to understand the healthcare-seeking behaviours of patients. Perceptions towards free services under universal health coverage are positive, but participation in decision making is rare. Future studies should focus on finding ways to balance the needs and barriers to hospital visits and to introduce the concept of shared decision making to both doctors and patients.

Access to Health Care Services among Young People Exchanging Sex in Detroit.

Within the related epidemics of sex exchange, drug use, and poverty, access to health care is shaped by intersecting identities, policy, and infrastructure. This study uses a unique survey sample of young adults in Detroit, who are exchanging sex on the street, in strip clubs, and at after-hours parties and other social clubs. Factors predicting access to free or affordable health care services, such as venue, patterns of sexual exchange influence, drug use and access to transportation, were examined using multivariable logistic regression and qualitative comparative analysis. The most significant predictors of low access to health care services were unstable housing and lack of access to reliable transportation. In addition, working on the street was associated with decreased access to services. Coordinated policy and programming changes are needed to increase health care access to this group, including improved access to transportation, housing, and employment, and integration of health care services.

Universal Access to Essential Medicines: An Evaluation of Nepal’s Free Health Care Scheme

Access to medicine for the poor is recognized to be difficult task and one of the major challenges in achieving universal health coverage, particularly in low-and- middle income countries. In order to ensure the availability of essential medicines free of cost in public health facilities, Nepal has also commenced Free Health Care Services (FHCS). So, this study aims to evaluate availability, expiry, and stock-out duration of essential medicines at front line service providers in Nepal. Cross-sectional survey was conducted 28 public health facilities, 7 district warehouses, and 14 private pharmacies in 7 districts of Nepal. The survey was conducted during the March and April 2014. Survey tools recommended by the WHO operational package for assessing, monitoring and evaluating country pharmaceutical situations was used with slight modification as per Nepal's situation. The availability of medicine was found to be 92.44% in this study. The percentage of expired medicines in district warehouse was found to be 8.40. The average stock-out duration in district warehouse was 0.324 days. Although the availability of essential medicines at peripheral health facilities was found to be satisfactory with lesser proportion of expired medicines, a strong monitoring and evaluation of expired and stock medicines are desirable to maintain and improve the access to essential medicines.

Satisfaction with Delivery Services Offered under the Free Maternal Healthcare Policy in Kenyan Public Health Facilities.

Background Patients' satisfaction is an individual's positive assessment regarding a distinct dimension of healthcare and the perception about the quality of services offered in that health facility. Patients who are not satisfied with healthcare services in a certain health facility will bypass the facility and are unlikely to seek treatment in that facility. Objective To determine satisfaction level of mothers with the free maternal services in selected Kenyan public health facilities after the implementation of the free maternal healthcare policy. Methods Data was collected through a quantitative exit survey questionnaire. The respondents were mothers who had delivered in the health facilities and were waiting to leave the health facilities after discharge. The sample included 2,216 mothers in 77 public health facilities across 14 counties in Kenya under tier 3 and tier 4 categories. The number of respondents to be interviewed was proportionately arrived at based on each health facility's bed capacity. Results The study established a satisfaction rate of 54.5% among the beneficiaries of the free maternal healthcare services in the country. Mothers benefiting from the free delivery services were satisfied with communication by the healthcare workers, staff availability in the delivery rooms, availability of staff in the wards, and drug and supplies availability (>56%) but unsatisfied with consultation time, cleanliness, and privacy in the wards (<56%). High education levels and lengthy stay in healthcare facilities were negatively associated with the satisfaction with the free delivery services (P < 0.05). Conclusion There is a high satisfaction with the free maternal healthcare services in Kenya. However, the implementation of the free maternal healthcare policy was associated with low privacy, poor hygiene, and low consultation time in the health facilities. Therefore there is need to address these service gaps so as to attract more mothers to deliver in public health facilities.

An Assessment of Public Health Economy in Katsina State

Health is generally an intrinsic human right as well as a central input to poverty reduction and socio-economic development. Better health is central to human happiness and well-being. It also make an important contribution to economic progress as healthy population live longer, are more productive, and more prone to saving more. This paper critically assessed the public health economy with a particular reference to accessibility, manpower distribution and major health problems in Katsina state. The paper used primary and secondary data based on the research objectives and important health indicators respectively. Descriptive statistical techniques were used in the presentation, analysis and discussions of data. Findings of the paper show that, doctor to population ratio stood at 1:67,415; ratio of nurses to population stood at 1:16,086; ratio of midwives to female population was put at 1:13,423. High blood pressure, diabetes and infectious diseases were found to have great impact on overall community health. Likewise, drug abuse, dropping out of school, and being overweight are the three (3) important risky behaviors that may generate or trigger health tension in the area. However, healthy behavior and life styles, access to health care services and clean environment are the factors which could improve the quality of life in the area. It was also found that, drugs for major health problems are free in the study area, there is awareness as regards to free health care services delivery in the area triggered by NGOs’ intervention. Conversely, it was found based on the average mean scores that, there is no availability of health manpower in the state, no sufficient beds, wheel-chairs, ambulances and other health infrastructure in the state. There is no sound interconnection and feedback between primary health care units, secondary health care unit and tertiary health care unit. It is in the wake of these findings the paper calls on government, concerned agencies and community stakeholders to institute the spirit of volunteerism, philanthropism and humanitarianism to ensure adequate supply of health manpower, health infrastructure, public health awareness, accessibility to health services and more often than not establish a friendly and healthy environment that will pave ways for new economic, social and political dawn in the realm.

Current Health Care Condition in Yemen (Aden)

Patient safety is a serious global public health issue. In recent years the importance of improving patient safety has been a major concern all over the world. The government of Yemen, like governments of other developing countries has been providing a wide range of free healthcare services to its people over a long period of time. The increase in health related problems in Yemen is due to lifestyle changes and lack of adequate care by the hospitals. Accordingly, the Ministry of Public Health and Population (MoPHP) in Yemen realized that the public sector alone is no longer capable of providing necessary health care for the people of Yemen and therefore privatized the sector to a large extent. This paper is aimed at focusing on the current health care situations available in Yemen. The secondary data of the health care related aspects are presented and discussed retrospectively. We present a review of current health care status in Yemen through a retrospective data with reference to Aden city and also discuss the possible measures need to be implemented in order to improve the situation. The paper discusses the evaluation of the health care standards in Yemen and also explores the reasons for medical tourism of Yemeni nationals to other countries like India.

An Assessment of Household’s Out of Pocket Healthcare Payment and Impoverishment in Nepal: Evidence from Nepal Living Standard Survey III

Despite Government of Nepal’s effort of universalizing basic free health care services and other demand side financing health schemes, there is an ongoing debate regarding equity in health service coverage, availability and high out of pocket payment. So this study intends to assess out of pocket payment and its associated factors and its implication on impoverishment. A cross sectional descriptive study was designed which is based on Nepal Living Standard Survey III 2010/11, a rich and well representative secondary data of Central Bureau of Statistics, National Planning Commission Nepal. The information about individuals who reported out of pocket healthcare payment was extracted from 28,747 individuals (or 7,020 households) of the survey. An individual from a household is considered as the unit of study. The major findings of the study show that age, caste ethnicity, place of residence, ecological belt and development region have statistically significant association with OOP payment. Due to OOP expenditure near about 3 percent of people are falling below the poverty line. The impoverishment rate is high among people residing in rural areas (3.4%), Terai belt (3.4%) and Eastern development region (3.7%). Higher impoverishment level in Terai and Eastern development region where health facilities are fairly available in comparison to remote Mountain belt, low developed Far west and Mid-west only signifies low availability and utilization of health services. So there is a need to address lacunae in fair coverage and utilization of health services across the country along with impoverishment.