OpenUCT :: Browsing by Author "Thiede, Michael"

Browsing by Author "Thiede, Michael"

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Open Access
Assessment of service provider preparedness and concerns in the process of implementing the National Health Insurance Scheme in Ghana : a study of the Upper West Region
(2007) Basadi, Richard Angwaasuwe; Thiede, Michael
This study focuses on assessing health provider preparedness in the move towards the implementation of national health insurance with specific reference to the Upper West Region. The paper uses both quantitative and qualitative methods to review the level of knowledge of health staff on the concept of health insurance, the availability of health professionals, essential drugs, infrastructure and equipment, which are essential for providing quality health care.
Open Access
Community health fund (CHF) in Tanzania : predictors of and barriers to enrolment
(2007) Chitama, Dereck; Thiede, Michael
Most low-income countries have not been able to fulfill the health care needs of the poor, and especially the rural population. Budgetary and other resource constraints in the health sector have been the major causes of this failure. Tanzania, like any other poor country is faced with challenges in health care financing, such that it cannot provide adequate cushion against health care costs for the majority of its population. One response to this situation was the health care financing reforms which among others saw the introduction of voluntary Community Health Fund (CHF) in 1996. The aim of the CHF was to mobilize resources through collection prepayments from households on a voluntary basis to fund primary health care for people in the informal sector operating in rural areas. However, CHF membership (enrollment) has been reported to be below the targeted coverage of 85% of the population living in rural areas. The percentage of households joining CHF has been ranging from 4% to 18% in various districts. This low enrolment prompted the need to study the predictors of and barriers to enrolment in CHF.
Open Access
The continuum of care of maternal, newborn and child health : coverage, co-coverage and equity analysis from demographic and health surveys
(2007) Kerber, Katherine J; Thiede, Michael; Lawn, Joy
The continuum of care for maternal, newborn and child health (MNCH) has recently been highlighted as a systematic approach to integrating health service provision throughout the life-cycle and across levels of service delivery. The continuum provides a framework for delivering high-impact interventions organised in health service packages to deliver high quality reproductive, maternal, newborn and child care services, ensuring appropriate linkages between family and community care, outreach and outpatient services and clinical and the first level facility and the hospital. This study, using data from Demographic and Health Surveys from eight African countries, provides an analysis of the coverage and co-coverage of four essential MNCH packages along the continuum of care, with a particular focus on inequalities in the distribution of services. The analysis of coverage of antenatal care, skilled attendance at childbirth, postnatal care and immunisation packages reveals key gaps, especially during childbirth and the postnatal period. Coverage is especially low for women and children from the poorest households in these countries, with coverage among the richest quintile up to 6 times higher than the poorest quintile. Nigeria emerges as the country with the lowest coverage overall and the largest gap between rich and poor while Malawi has the highest coverage and the most equitable coverage of services Continuity of care between these important packages increases health system efficiency as well as user and provider satisfaction. Co-coverage along the continuum of care was analysed to determine which mothers, newborns and children received all four care packages. While at least three quarters in Nigeria and up to 99% of mothers, newborns and children in Malawi and Tanzania receive at least one package of care, less than half received all four packages. There is greater variation in co-coverage between countries and within countries among the richest and poorest households compared to coverage of single packages alone. The richest quintile in Malawi is twice as likely to receive all four packages compared to the poorest quintile whereas in Nigeria the difference between richest and poorest is 13 fold. The purpose of applying these measures should be seen not as an end in itself but as a tool to describe current patterns and distribution of services and to advance improvements in the continuum of care. This research highlights the importance of integrating MNCH packages in different contexts as well as further improvements in data collection in order to effectively guide and monitor progress towards universal coverage of packages along the continuum of care to save the lives of women and children. Addressing issues of exclusion among families from the poorest households and establishing effective links between these packages is crucial to improving overall coverage. The postnatal period in particular is a notable gap that lacks a systematic package in all these countries. In the meantime, available information can be used to improve MNCH integration and service delivery along the continuum of care in order to reach the highest number of women, newborns and children with effective care.
Open Access
Demand for health care services in the urban areas of Zimbabwe : a case study of the Harare city
(2003) Mapira, Wendy; Thiede, Michael; Okorafor, Okore
The study attempts to evaluate the impact of the health sector deregulation policy on the choice of health care providers 12 years after its implementation. It gives some insights into the pattern of health care choices in Harare, the capital city of Zimbabwe with the aim of drawing some conclusions about the urban areas of Zimbabwe. The other objective is to highlight the impact of personal characteristics and factors related to the facility on the choice between public and private health care providers. Some coping mechanisms being used by urban dwellers in dealing with illness are also investigated. Micro data was gathered by administering a questionnaire to randomly selected individuals who experienced some illness or injury during the reference period. For empirical estimation, logistic regression was used. The results of the study show that the urban poor rely heavily on public health care providers, informal forms of care, and they have limited access to private sector facilities. Although the deregulation policy managed to bring in new players in the health sector, the amount of competition was not enough to lower the cost of health care because the cost of drugs and consultation fees continued to soar. The major factors found to influence health care choices are gender, net monthly income, education, occupation, and availability of essential drugs, fees and the cost of drugs. The results of the study show a clear message that deregulation of the health sector did manage to increase the size of the private sector but failed to widen the scope of provider choices especially for the poorer urban residents.
Open Access
A distributional analysis of healthcare financing in a developing country : a Nigerian case study applying a decomposable Gini index
(2005) Ichoku, Hyacinth Ementa; Thiede, Michael; Leibbrandt, Murray
The policy motivation for this research is primarily to investigate how in the direct absence of significant third-party financing mechanisms and government subsidies, direct purchase of healthcare affects the relative abilities of households to meet their other financial obligations after paying for the cost of health services. In other words, this study aims to analyze the redistributive effect of the direct healthcare financing in Nigeria.
Open Access
Factors influencing the price of medical services : a survey of the pricing behaviour of private medical providers in Kampala, Uganda
(2004) James, Batuka; Okorafor, Okore; Thiede, Michael
Understanding the pricing behaviour of medical providers in private clinics is important for the effective regulation of the private sector and ensuring that there is no extortion of patients. There is a global trend to encourage delivery of health services by the private sector reducing the public role to stewardship. Understanding the factors that inﬂuence the price of medical services in an out of pocket setting is important in designing strategies necessary to control the price of medical care. The study investigated the factors that inﬂuenced the price of medical services in Kampala district, Uganda. The respondents reported cost of drugs given to patients (type and dose of drug), other overhead expenditures, type of disease, income status of the patient and need to make proﬁt as factors which influence the price of medical services. On regression analysis, it was found that rent was a signiﬁcant factor on the price of medical services across all disease conditions. It was concluded that governments need to put in place effective regulatory mechanisms to ensure proper functioning of the private health sector.
Open Access
The impact of costs and perceived quality on utilisation of primary health care in Tanzania : rural-urban comparison
(2003) Munga, Michael A; Thiede, Michael; Okorafor, Okore
Health services utilisation, which is sometimes used as a proxy measure for equity is a complex subject to study. Identifying and explaining the important factors determining health care utilisation is a key to a better assessment of whether countries' health policies address the equity concerns of their populations in a comprehensive way. It is extensively documented that meeting the health needs of people especially those disadvantaged by such factors as geographical location, joblessness, low income, gender inequalities and lack of education among others, is an important strategy to preventing the increase in poverty and eventually reducing equity gaps. Realising this goal is not easy unless studies are done to establish policy and theoretical arguments related to why some sections of populations are more likely to use/or not to use available health care services than others. This cross-sectional study principally aims at assessing the impact of perceived quality and costs of health care on utilisation of PHC services in rural and urban areas of Tanzania. Using both quantitative and qualitative methods, it intends to explore whether there are differences between rural and urban users in terms of their perceptions of quality of health services and how these perceptions affect household decisions in utilising health services. It further examines the extent to which costs of health care are important determinant in health services utilisation and how rural and urban users are affected by this factor when it comes to deciding to use or not to use government health facilities. The study concludes that consumers of health care in rural Tanzania are highly responsive to health care costs than they are to quality concerns. As the two categories of rural and urban are affected differently by costs and their perceptions of quality when it comes to health care utilisation, it is possible that the observed utilisation trends can partly be attributed to these two factors. Furthermore, the study highlights that socio-economic variables such as gender, income, education, wealth and household size are important not only in determining user's decision making on the amount and appropriate time to seek care but also mitigates effectively on the extent to which costs and perception of quality of care affect rural and urban users of health care services. The study recommends that the government should strive to provide better "quality " information to its consumers. It further recommends that a critical evaluation of important quality aspects be done to see which mostly determine household decisions on utilisation of care among rural and urban users of care. The study has found that the kit system has had some problems, hence the study recommends that government devises mechanisms of ensuring that drugs are available at points of service. Acknowledging the existing geographical inequities, the need to incorporate the private sector in PHC provision and improve quality of health care, the study recommends for more resources to be devoted to research and venture on new opportunities provided by the ongoing reforms as a way of introduction, chapter one of the study report presents the country background information and how the health system is organised. The remainder of the report is organised as follows. In chapter two, the report presents the literature review whilst chapter three covers conceptual framework and methodology. This is followed by presentation of results and analysis in chapter four before putting forward a brief discussion of the findings in chapter five. In chapter six, conclusions and policy recommendations are presented.
Open Access
The impact of malaria among the poor and vulnerable : the role of livelihoods and coping strategies in rural Kenya
(2005) Chuma, Jane; Thiede, Michael
The thesis set out to explore how households cope with the costs of malaria and the implications of malaria cost burdens for household livelihoods and vulnerability. It uses a conceptual framework that takes a holistic approach to understand vulnerability and the link between malaria and livelihood change. In order to investigate these issues, the study was designed to meet five main objectives: to improve the understanding on the economic burden of malaria; to identify factors that make households vulnerable to the costs of malaria; to identify and explore coping strategies; to understand the role of health care providers in aggravating cost burdens and; to inform policy debates on how to improve access to effective malaria treatment and protect households from high illness costs.
Open Access
Impact of user fees removal on facility utilisation in rural Zambia
(2008) Banda, Patrick; Thiede, Michael; Govender, Veloshnee
User fees were introduced in Zambia as an additional source of revenue in response to the economic down-turn that the country experienced in the early 1990s. There is increasing evidence that user fees are a major barrier to accessing health services especially for the poor and in response the Zambian government abolished user fees in all public health facilities in rural based districts in April 2006. The aim of this study is to provide empirical evidence on the immediate impact of the abolition of user fees in the context of the Zambian health sector so as to identify optimal strategies in the delivery of health care. Both qualitative and quantitative data collection techniques were used to address the research objectives. The study focused on six 6 health facilities in two rural districts. The data collection tools included utilisation data reviews, patient exit polls, providers interviews, focus group discussions, informant interviews and drug availability data reviews. The results demonstrated that, the impact of the abolition of user fees at the district level was dependent on location of the district. Information flow was mainly cited as one of the reasons for the quick response to the user fee policy change. This brings in the need for a more deliberate and appropriately managed communication process when such policy change is being planned. The results of the study revealed that there was an impact on facility utilisation after the removal of user fees. In addition, there were shortages of drugs, low staff morale and poor maintenance of the surroundings. Patient-provider relationships seemed to be strained as a result of the increase in provider workload.
Open Access
Measuring equity in access to health care : a case study of malaria control interventions in the Kassena-Nankana district of Northen Ghana
(2005) Akweongo, Patricia; Thiede, Michael
This thesis develops a methodology for measuring equity in access to health care. The thesis deconstructs the concept of access into dimensions that represent the supply and demand side of health care and tests each of these dimensions by using the example of access to malaria services in the Kassena-Nankana district of northern Ghana. An innovative framework and a disadvantage index are developed herein, and are used to analyse the primary factors of access and to measure inequities in such access. A cross-sectional survey of 1880 household heads, focus group discussions, in-depth and key informant interviews with community members and health providers were used to explore issues in respect of malaria management, health care access and perceptions of poverty. The principal component and factor analysis statistical methods were then applied to estimate access factors and to compile a disadvantaged index of access. The key findings indicate that the dimensions, availability, affordability, information and acceptability primarily determine access to health care. On the availability dimension, physical distance to health care, provision of primary and inpatient are and travel distance are significant factors. The primary factors of affordability are associated more with the socio-economic characteristics of the household than with direct user costs. The information dimension is determined primarily by knowledge to treat levels of severity of malaria and the source of information for treatment. The acceptability of health care is related to methods and services for managing severity of levels of malaria at home as well as using qualified health care providers. The disadvantage index and poverty maps show significant disparities in health care access between geographic areas and socio-economic groups', with areas in the outskirts of the Kassena district being the most disadvantaged in terms of availability, acceptability and information. These areas are however not economically disadvantaged. The poorest households have the lowest accessibility scores across all dimensions.
Open Access
Measuring health inequity amongst a cohort of HIV positive mother and child pairs in South Africa : the relationship between household socio-economic status and child health outcomes
(2007) Nkonki, Lungiswa Leonora; Thiede, Michael
The purpose of this study was to measure health inequity amongst a cohort of HIV positive mother-child pairs in South Africa with a focus on the relationship between household socio-economic status and child health outcomes. This study is a secondary analysis to a prospective cohort study of mothers and infants participating in three of the eighteen national PMTCT sites in South Africa. Women (and their infants) were recruited prior to, or at the time of delivery and followed until the infants were 36 weeks of age. Three sites were purposefully sampled in order to reflect different socio-economic regions, rural-urban locations and my prevalence rates. The study made use of principal component analysis (PCA) to measure household socio-economic status. The selection of both variables that are indicators of socio-economic status and the use of PCA as a technique of assigning of weights to the chosen indicators of socio-economic status was informed by the literature. The selection of health outcomes was based on the renewed focus on child health. This study is organized in five chapters. The first chapter provides the rationale for measuring inequities in child health with particular focus on South Africa and states the aim and objectives. Chapter Two reviews different forms of literature that were pertinent in understanding the importance of child health, the current state of child health and the relationship between inequities and poor child health outcomes. Chapter Three gives a detailed discussion of the data collection and quality control methods employed to achieve good quality data in the primary study. Then it discusses choosing indicators of socio-economic status and intricacies involved in measuring socio-economic status. In addition, it outlines the chosen child health outcomes, motivation for their choice and their measurement.
Open Access
Provision of free ARV in public facilities in Tanzania : do the poor benefit?
(2007) Kahwa, Amos; Thiede, Michael
The impact of the HIV pandemic in Tanzania has been profound and has affected all sectors. Today, HIV/AIDS is recognized not only as a major public health concern but also as social, economic and development problem in Tanzania as in most in Sub-Saharan African countries. With a population of estimated 37 million, Tanzania has an estimated of 2.5 million people infected with human immunodeficiency virus (HIV). The availability of antiretroviral therapy (ART) which has been defined as the main form of treatment (yet not a cure) for HIV/AIDS showed to significantly prolong and improve quality of life of people infected with HIV. By and large, the entire range of antiretroviral drugs is available anywhere in the world through private channels. Where resources permit, the supply may be adequate and consistent. Through the public sector, however, and for low-income patients, the choice of drugs may be somewhat restricted. This has implications for decisions such as when to start therapy, which therapeutic regimens to use, and what to do when treatment fails. The situation requires difficult choices in priority setting, poses serious ethical issues and imposes on government the obligation to scale up programmes in ways that are ethically sound, equitable, beneficial and sustainable as possible (WHO 2004). However in Tanzania, there is no clear policy established on targeting or prioritising specific population groups in order to avoid decision making based on subjective or arbitrary criteria that may lead to discrimination. The aim of this study was to establish the socioeconomic status of those individuals who benefit most from the provision of free ARV in terms of utilisation in urban and rural settings. It also aimed to identify the criteria used in enrolment of patients for free ARV provision, the barriers for ARV provision and patient's perception on ARV.
Open Access
Rethinking the economic costs of malaria at the household level: Evidence from applying a new analytical framework in rural Kenya
(BioMed Central Ltd, 2006) Chuma, Jane; Thiede, Michael; Molyneux, Catherine
BACKGROUND:Malaria imposes significant costs on households and the poor are disproportionately affected. However, cost data are often from quantitative surveys with a fixed recall period. They do not capture costs that unfold slowly over time, or seasonal variations. Few studies investigate the different pathways through which malaria contributes towards poverty. In this paper, a framework indicating the complex links between malaria, poverty and vulnerability at the household level is developed and applied using data from rural Kenya. METHODS: Cross-sectional surveys in a wet and dry season provide data on treatment-seeking, cost-burdens and coping strategies (n = 294 and n = 285 households respectively). 15 case study households purposively selected from the survey and followed for one year provide in-depth qualitative information on the links between malaria, vulnerability and poverty. RESULTS: Mean direct cost burdens were 7.1% and 5.9% of total household expenditure in the wet and dry seasons respectively. Case study data revealed no clear relationship between cost burdens and vulnerability status at the end of the year. Most important was household vulnerability status at the outset. Households reporting major malaria episodes and other shocks prior to the study descended further into poverty over the year. Wealthier households were better able to cope. CONCLUSION: The impacts of malaria on household economic status unfold slowly over time. Coping strategies adopted can have negative implications, influencing household ability to withstand malaria and other contingencies in future. To protect the poor and vulnerable, malaria control policies need to be integrated into development and poverty reduction programmes.
Open Access
Synthesizing qualitative and quantitative evidence on non-financial access barriers: implications for assessment at the district level
(BioMed Central Ltd, 2015) O'Connell, Thomas; Bedford, K.; Thiede, Michael; McIntyre, Di
INTRODUCTION: A key element of the global drive to universal health coverage is ensuring access to needed health services for everyone, and to pursue this goal in an equitable way. This requires concerted efforts to reduce disparities in access through understanding and acting on barriers facing communities with the lowest utilisation levels. Financial barriers dominate the empirical literature on health service access. Unless the full range of access barriers are investigated, efforts to promote equitable access to health care are unlikely to succeed. This paper therefore focuses on exploring the nature and extent of non-financial access barriers. METHODS: We draw upon two structured literature reviews on barriers to access and utilization of maternal, newborn and child health services in Ghana, Bangladesh, Vietnam and Rwanda. One review analyses access barriers identified in published literature using qualitative research methods; the other in published literature using quantitative analysis of household survey data. We then synthesised the key qualitative and quantitative findings through a conjoint iterative analysis. RESULTS: Five dominant themes on non-financial access barriers were identified: ethnicity; religion; physical accessibility; decision-making, gender and autonomy; and knowledge, information and education. The analysis highlighted that non-financial factors pose considerable barriers to access, many of which relate to the acceptability dimension of access and are challenging to address. Another key finding is that quantitative research methods, while yielding important findings, are inadequate for understanding non-financial access barriers in sufficient detail to develop effective responses. Qualitative research is critical in filling this gap. The analysis also indicates that the nature of non-financial access barriers vary considerably, not only between countries but also between different communities within individual countries. CONCLUSIONS: To adequately understand access barriers as a basis for developing effective strategies to address them, mixed-methods approaches are required. From an equity perspective, communities with the lowest utilisation levels should be prioritised and the access barriers specific to that community identified. It is, therefore, critical to develop approaches that can be used at the district level to diagnose and act upon access barriers if we are to pursue an equitable path to universal health coverage.
Open Access
Willingness to pay for VCT and nevirapine for the prevention of mother to child transmission of HIV in the Kassena-Nankana district of Northern Ghana
(2004) Akanlu, George Bruno; Thiede, Michael
Mother-to-child-transmission (MTGT) of HIV is one of the tragic consequences of the HIV pandemic, There are antiretrovirals for the prevention of mother-to-child-transmission (PMTCT) and Nevirapine (NVP) is the cheapest, most feasible and highly cost-effective of all and suitable for resource poor settings. Voluntary Counselling and HIV Testing (VCT), known for its effectiveness in behavioral change, is also essential for the prevention of mother-to-child transmission of HIV and for the control of HIV/AIDS. Family Health International and Ghanaian MOH intend to implement a prevention of mother-to-child-transmission in the Kassena-Nankana district using VCT and NVP. The success of the use of VCT and NVP for the prevention of mother-to-child-transmission of HIV depends on new effective and sustainable they are implemented and patronized. The purpose of this study therefore is to assess household willingness to pay for VCT and NVP for the prevention of mother-to-child-transmission of HIV in the Kassena-Nankana district of northern Ghana to provide insights into how the impending programme can be implemented sustainably .

Browsing by Author "Thiede, Michael"

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