Primary Health Care Coverage Research Articles

Health-care delivery in Cuba: nursing's role in achievement of the goal of ‘health for all’

The findings of a study of the delivery of nursing care in non-institutionalized settings in Cuba are presented. The study investigated factors associated with change in health status and the role of nursing in the community to bring about that change since the time of the 1959 revolution. Recommendations of the World Health Organization's ‘Goal of Health For All by the Year 2000’ provided guidelines for the study. In the pursuit of Health for All, the World Health Organization specifically called for universal coverage with primary health care to include the following essential elements: education covering the prevention and control of major health problems; adequate food, safe water and nutrition; maternal and child health including family planning; immunization against infectious disease; prevention and control of endemic diseases; and treatment of diseases and injuries. Findings of the study suggest that nursing can play an important role in the delivery of health care that meets the World Health Organization's goal of Health for All through universal coverage of primary health care to the defined population.

Well child clinics and mass vaccination campaigns: an evaluation of strategies for improving the coverage of primary health care in a developing country.

Millions of children in developing countries are dying from diseases that could be prevented or treated by simple interventions. To examine ways to improve the delivery of these basic services, we evaluated well child clinics and mass vaccination campaigns under operational conditions in a rural area of Nicaragua. We found that mass vaccination campaigns using volunteers reached 77.1 per cent of the population under age six. At stationary well child clinics in which villages were invited to a health center and a small food ration was used as an incentive, attendance improved to 94.1 per cent. Similar attendance levels (99.2 per cent) were attained by mobile well child clinics also using a food incentive. Attendance at stationary clinics decreased with the distance of the village from the health center. However, stationary clinics took up only half as much health workers' time as mobile clinics. Our results suggest that stationary clinics employing food as an incentive could be used for villages or neighborhoods close to a health center while mobile clinics offering food should be reserved for more isolated villages.

Evolution of the poliomyelitis vaccination program in Costa Rica.

Outbreaks of poliomyelitis in Costa Rica occurred at variable intervals until 1972. The first campaign with Salk vaccine was in 1956 and the first with Sabin vaccine was in 1959. Since then, campaigns have been irregular, depending on the occurrence of outbreaks. Continuous vaccination programs were inaugurated after the last outbreak in 1972, and the coverage of primary health care in rural areas was extended. These programs resulted in high levels of immunization. Since no cases of poliomyelitis have occurred in the last 10 years, we can say confidently that the disease has been eradicated in Costa Rica.

A quasihierarchical location-allocation model for primary health care planning

In studying primary health care (PHC) systems in developing countries, a quasihierarchical relationship between health centers and village clinics is identified; it is based not only on an organizational attachment of one or more village clinics to every health center, but also on the daily presence of a health-center-based physician at each clinic. A unique zero-one integer programming model is developed and applied to a PHC system in Jordan. The PHC coverage problem is explicitly addressed in the model; its objective is to enhance both the accessibility to PHC services and the availability of physician-provided services.

Effects of Child-Care Programs on Women's Work Effort

In recent years, Congress has considered a variety of work-subsidy programs designed to encourage work among welfare recipients. Many of these programs would subsidize individuals only if they work some minimum number of hours. Commonly used techniques cannot give direct answers to relevant policy questions since a tied offer is involved, and hence the offer cannot be treated as a simple wage change. The essence of the problem involves utility comparisons between two or more discrete alternatives. Such comparisons inherently require information about consumer preferences in a way not easily obtained from ordinary labor-supply functions. To make such comparisons, I present a method for directly estimating consumer indifference surfaces between money income and nonmarket time. Once these surfaces are determined, they can be used to compare a variety of alternative programs to investigate whether or not there is scope for Pareto-optimal redistribution of income transfers and time, improving the general level of welfare of the community at large without reducing the welfare of individuals receiving income transfers. Knowledge of these indifference surfaces allows us to estimate reservation wages to estimate the value of nonworking-women's time (Gronau 1973), laborforce participation functions, hours-of-work functions, and welfare losses due to income tax programs (Harberger 1964). I demonstrate that direct estimation of indifference surfaces allows us, at least in principle, to relax