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Search Results: 1 - 10 of 1809 matches for " Palmer Natasha "
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The use of private-sector contracts for primary health care: theory, evidence and lessons for low-income and middle-income countries
Palmer,Natasha;
Bulletin of the World Health Organization , 2000, DOI: 10.1590/S0042-96862000000600014
Abstract: contracts for the delivery of public services are promoted as a means of harnessing the resources of the private sector and making publicly funded services more accountable, transparent and efficient. this is also argued for health reforms in many low- and middle-income countries, where reform packages often promote the use of contracts despite the comparatively weaker capacity of markets and governments to manage them. this review highlights theories and evidence relating to contracts for primary health care services and examines their implications for contractual relationships in low- and middle-income countries.
The impact of user fees on health service utilization in low- and middle-income countries: how strong is the evidence?
Lagarde,Mylene; Palmer,Natasha;
Bulletin of the World Health Organization , 2008, DOI: 10.1590/S0042-96862008001100013
Abstract: objective: to assess the effects of user charges on the uptake of health services in low- and middle-income countries. methods: a systematic search of 25 social science, economics and health literature databases and other sources was performed to identify and appraise studies on the effects of introducing, removing, increasing or reducing user charges on the uptake of various health services in low- and middle-income countries. only experimental or quasi-experimental study designs were considered: cluster randomized controlled trials (c-rct), controlled " before and after" (cba) studies and interrupted time series (its) studies. papers were assessed in which the effect of the intervention was measured in terms of changes in service utilization (including equity outcomes), household expenditure or health outcomes. findings: sixteen studies were included: five cba, two c-rct and nine its. only studies reporting effects on health service utilization, sometimes across socioeconomic groups, were identified. removing or reducing user fees was found to increase the utilization of curative services and perhaps preventive services as well, but may have negatively impacted service quality. introducing or increasing fees reduced the utilization of some curative services, although quality improvements may have helped maintain utilization in some cases. when fees were either introduced or removed, the impact was immediate and abrupt. studies did not adequately show whether such an increase or reduction in utilization was sustained over the longer term. in addition, most of the studies were given low-quality ratings based on criteria adapted from those of the cochrane collaboration's effective practice and organisation of care group. conclusions: there is a need for more high-quality research examining the effects of changes in user fees for health services in low- and middle-income countries.
Constraints to Implementing the Essential Health Package in Malawi
Dirk H. Mueller,Douglas Lungu,Arnab Acharya,Natasha Palmer
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0020741
Abstract: Increasingly seen as a useful tool of health policy, Essential or Minimal Health Packages direct resources to interventions that aim to address the local burden of disease and be cost-effective. Less attention has been paid to the delivery mechanisms for such interventions. This study aimed to assess the degree to which the Essential Health Package (EHP) in Malawi was available to its population and what health system constraints impeded its full implementation. The first phase of this study comprised a survey of all facilities in three districts including interviews with all managers and clinical staff. In the second and third phase, results were discussed with District Health Management Teams and national level stakeholders, respectively, including representatives of the Ministry of Health, Central Medical Stores, donors and NGOs. The EHP in Malawi is focussing on the local burden of disease; however, key constraints to its successful implementation included a widespread shortage of staff due to vacancies but also caused by frequent trainings and meetings (only 48% of expected man days of clinical staff were available; training and meetings represented 57% of all absences in health centres). Despite the training, the percentage of health workers aware of vital diagnostic and therapeutic approaches to EHP conditions was weak. Another major constraint was shortages of vital drugs at all levels of facilities (e.g. Cotrimoxazole was sufficiently available to treat the average number of patients in only 27% of health centres). Although a few health workers noted some improvement in infrastructure and working conditions, they still considered them to be widely inadequate. In Malawi, as in similar resource poor countries, greater attention needs to be given to the health system constraints to delivering health care. Removal of these constraints should receive priority over the considerable focus on the development and implementation of essential packages of interventions.
A new face for private providers in developing countries: what implications for public health?
Palmer,Natasha; Mills,Anne; Wadee,Haroon; Gilson,Lucy; Schneider,Helen;
Bulletin of the World Health Organization , 2003, DOI: 10.1590/S0042-96862003000400011
Abstract: the use of private health care providers in low- and middle-income countries (lmics) is widespread and is the subject of considerable debate. we review here a new model of private primary care provision emerging in south africa, in which commercial companies provide standardized primary care services at relatively low cost. the structure and operation of one such company is described, and features of service delivery are compared with the most probable alternatives: a private general practitioner or a public sector clinic. in a case study of cost and quality of services, the clinics were popular with service users and run at a cost per visit comparable to public sector primary care clinics. however, their current role in tackling important public health problems was limited. the implications for public health policy of the emergence of this new model of private provider are discussed. it is argued that encouraging the use of such clinics by those who can afford to pay for them might not help to improve care available for the poorest population groups, which are an important priority for the government. encouraging such providers to compete for government funding could, however, be desirable if the range of services presently offered, and those able to access them, could be broadened. however, the constraints to implementing such a system successfully are notable, and these are acknowledged. even without such contractual arrangements, these companies provide an important lesson to the public sector that acceptability of services to users and low-cost service delivery are not incompatible objectives.
A new face for private providers in developing countries: what implications for public health?
Palmer Natasha,Mills Anne,Wadee Haroon,Gilson Lucy
Bulletin of the World Health Organization , 2003,
Abstract: The use of private health care providers in low- and middle-income countries (LMICs) is widespread and is the subject of considerable debate. We review here a new model of private primary care provision emerging in South Africa, in which commercial companies provide standardized primary care services at relatively low cost. The structure and operation of one such company is described, and features of service delivery are compared with the most probable alternatives: a private general practitioner or a public sector clinic. In a case study of cost and quality of services, the clinics were popular with service users and run at a cost per visit comparable to public sector primary care clinics. However, their current role in tackling important public health problems was limited. The implications for public health policy of the emergence of this new model of private provider are discussed. It is argued that encouraging the use of such clinics by those who can afford to pay for them might not help to improve care available for the poorest population groups, which are an important priority for the government. Encouraging such providers to compete for government funding could, however, be desirable if the range of services presently offered, and those able to access them, could be broadened. However, the constraints to implementing such a system successfully are notable, and these are acknowledged. Even without such contractual arrangements, these companies provide an important lesson to the public sector that acceptability of services to users and low-cost service delivery are not incompatible objectives.
Maintaining the Balance: Creative Practices in University-School Partnerships for Teacher Education  [PDF]
David Palmer
Creative Education (CE) , 2015, DOI: 10.4236/ce.2015.614153
Abstract: The professional placement is a central component of any teacher education program. In recent years, as teachers face a variety of new challenges that make substantial claims upon their time it is more than ever important that university-school partnerships include built-in components that will explicitly benefit teacher/mentors and the students in their schools. By including a combination of literature review and reports from experienced and innovative field operators, this paper has summarized a range of creative strategies that will enhance university partnerships with schools. For teacher education, it is vital that such partnerships continue to flourish, and it is hoped that this paper will contribute to that process.
Motivation for Learning: An Implicit Decision-Making Process  [PDF]
David Palmer
Creative Education (CE) , 2016, DOI: 10.4236/ce.2016.716229
Abstract: Motivation for learning is concerned with the activation of learning behaviors. It has previously been proposed that decision-making models might offer an explanation for how learning behaviors do become activated. The aim of this position paper was to investigate this proposal. The three main decision-making models were described and analyzed. There were problematic aspects common to all the models, so it was argued that some modifications were necessary, in the following way. It was proposed that there are many factors that can influence learning behaviors, and some of these would have a positive influence (e.g., high self-efficacy, high individual interest, supportive peers) whereas others would have a negative influence (e.g., very low self- efficacy, lack of individual interest, disruptive peers, hunger and fatigue). In one particular lesson, a student could experience a combination of positive and negative factors, so this implies that a decision-making event would be necessary in order to determine whether or not learning behaviors become activated. For several reasons, it was concluded that at least part of the process of comparing the factors and making a decision could occur at a subconscious level.
The Effects of Pre-Surgical Education on Patient Expectations in Total Knee Arthroplasties  [PDF]
Steven Furney, Natasha Montez
Open Journal of Preventive Medicine (OJPM) , 2015, DOI: 10.4236/ojpm.2015.512050
Abstract: As patients prepare for total-knee arthroplasty surgery, they have many expectations related to their long-term recovery and function. This research examined whether the use of a pre-surgical patient education class with an additional long-term expectation module addressing recovery during the first 12 months after surgery was more effective in modifying participant’s pre-surgical expectations than participants receiving the standard pre-surgical education class alone. Prior to the class each participant completed one disease-specific instrument, a general-health survey, and a total-knee replacement expectation survey. After the class, each participant once again completed the total-knee replacement survey. Included in the study were 42 participants who were enrolled in a pre-surgical education course that was randomized. The participants in the control group received the standard pre-surgical education addressing pre-surgical topics. The participants in the intervention group received the standard pre-surgical education plus an additional module that specifically addressed long-term recovery and function up to 12 months post surgery. The primary outcome of the data revealed that participants’ who received the standard pre-surgical education with the additional module and who had an educational level higher than highschool, had expectations that were able to be modified to coincide with the surgeons’ expectations.
Nephrotic Sydrome Can Be a Marker for Prostatic Carcinoma  [PDF]
Natasha Takova, Alexander Otsetov
Modern Research in Inflammation (MRI) , 2017, DOI: 10.4236/mri.2017.64004
Abstract: Paraneoplastic syndromes (PS) represent a large spectrum of symptoms, associated with malignant diseases. PS can be diagnosed in asymptomatic patients with occult carcinoma, clinically active cancer, and during clinical remission, suggesting a recurrence of the neoplasm. The underlying mechanisms of PS are not completely understood but several authors have suggested that the increased production of biologically active immune factors and cytokines from the neoplastic cells may underlie the etiology of PS. Although rare, the renal involvement of patients with prostatic carcinoma has been reported. The most common paraneoplastic-associated glomerulopathy in prostatic cancer is the membranoproliferative glomerulonephritis with nephrotic syndrome (NS). In this review, we aimed to discuss the incidence of nephrotic syndrome secondary to prostatic carcinoma, its challenging diagnosis, clinical manifestation, and treatment.
High Uptake of HIV Testing in Pregnant Women in Ontario, Canada
Robert S. Remis, Maraki Fikre Merid, Robert W. H. Palmer, Elaine Whittingham, Susan M. King, Natasha S. Danson, Lee Vernich, Carol Swantee, Carol Major
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0048077
Abstract: In 1999, Ontario implemented a policy to offer HIV counseling and testing to all pregnant women and undertook measures to increase HIV testing. We evaluated the effectiveness of the new policy by examining HIV test uptake, the number of HIV-infected women identified and, in 2002, the HIV rate in women not tested during prenatal care. We analyzed test uptake among women receiving prenatal care from 1999 to 2010. We examined HIV test uptake and HIV rate by year, age and health region. In an anonymous, unlinked study, we determined the HIV rate in pregnant women not tested. Prenatal HIV test uptake in Ontario increased dramatically, from 33% in the first quarter of 1999 to 96% in 2010. Test uptake was highest in younger women but increased in all age groups. All health regions improved and experienced similar test uptake in recent years. The HIV rate among pregnant women tested in 2010 was 0.13/1,000; in Toronto, the rate was 0.28 per 1,000. In the 2002 unlinked study, the HIV rate was 0.62/1,000 among women not tested in pregnancy compared to 0.31/1,000 among tested women. HIV incidence among women who tested more than once was 0.05/1,000 person-years. In response to the new policy in Ontario, prenatal HIV testing uptake improved dramatically among women in all age groups and health regions. A reminder to physicians who had not ordered a prenatal HIV test appeared to be very effective. In 2002, the HIV rate in women who were not tested was twice that of tested women: though 77% of pregnant women had been tested, only 63% of HIV-infected women were tested. HIV testing uptake was estimated at 98% in 2010.
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