The Social and Ethical Implications of Universal Access to Health Care in Russia

1993 ◽  
Vol 3 (4) ◽  
pp. 411-418 ◽  
Author(s):  
Raisa V. Korotkikh ◽  
Igor Falaleyev
Keyword(s):  
Health Care ◽  
Access To Health Care ◽  
Universal Access ◽  
Ethical Implications ◽  
Access To Health ◽  
The Social

scholarly journals Estimating the local spatio‐temporal distribution of malaria from routine health information systems in areas of low health care access and reporting

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Elizabeth Hyde ◽  
Matthew H. Bonds ◽  
Felana A. Ihantamalala ◽  
Ann C. Miller ◽  
Laura F. Cordier ◽  
...  
Keyword(s):  
Health Care ◽  
Access To Health Care ◽  
Malaria Incidence ◽  
Universal Access ◽  
Surveillance Systems ◽  
Passive Surveillance ◽  
Transmission Season ◽  
Access To Health ◽  
Spatio Temporal ◽  
Geographic Access To Care

Abstract Background Reliable surveillance systems are essential for identifying disease outbreaks and allocating resources to ensure universal access to diagnostics and treatment for endemic diseases. Yet, most countries with high disease burdens rely entirely on facility-based passive surveillance systems, which miss the vast majority of cases in rural settings with low access to health care. This is especially true for malaria, for which the World Health Organization estimates that routine surveillance detects only 14% of global cases. The goal of this study was to develop a novel method to obtain accurate estimates of disease spatio-temporal incidence at very local scales from routine passive surveillance, less biased by populations' financial and geographic access to care. Methods We use a geographically explicit dataset with residences of the 73,022 malaria cases confirmed at health centers in the Ifanadiana District in Madagascar from 2014 to 2017. Malaria incidence was adjusted to account for underreporting due to stock-outs of rapid diagnostic tests and variable access to healthcare. A benchmark multiplier was combined with a health care utilization index obtained from statistical models of non-malaria patients. Variations to the multiplier and several strategies for pooling neighboring communities together were explored to allow for fine-tuning of the final estimates. Separate analyses were carried out for individuals of all ages and for children under five. Cross-validation criteria were developed based on overall incidence, trends in financial and geographical access to health care, and consistency with geographic distribution in a district-representative cohort. The most plausible sets of estimates were then identified based on these criteria. Results Passive surveillance was estimated to have missed about 4 in every 5 malaria cases among all individuals and 2 out of every 3 cases among children under five. Adjusted malaria estimates were less biased by differences in populations’ financial and geographic access to care. Average adjusted monthly malaria incidence was nearly four times higher during the high transmission season than during the low transmission season. By gathering patient-level data and removing systematic biases in the dataset, the spatial resolution of passive malaria surveillance was improved over ten-fold. Geographic distribution in the adjusted dataset revealed high transmission clusters in low elevation areas in the northeast and southeast of the district that were stable across seasons and transmission years. Conclusions Understanding local disease dynamics from routine passive surveillance data can be a key step towards achieving universal access to diagnostics and treatment. Methods presented here could be scaled-up thanks to the increasing availability of e-health disease surveillance platforms for malaria and other diseases across the developing world.

Participation as Inclusion and Exclusion: Policing the Boundaries of “Citizenship” in Roma Health Mediation

2019 ◽  
Vol 24 (3) ◽  
pp. 430-443
Author(s):  
Charlotte Kühlbrandt
Keyword(s):  
Health Care ◽  
Access To Health Care ◽  
Social Inclusion ◽  
Participant Observation ◽  
Community Members ◽  
Access To Health ◽  
The Social ◽  
Roma Health ◽  
Governing Institutions ◽  
Improve Access

Participatory health interventions have long been advocated as an approach to help marginalised community members exercise their rights as citizens, including access to health care. More than two decades ago, the Roma health mediation programme was established in Romania as a participatory community health intervention. Mediators are employed specifically to act as intermediaries between ‘Roma patients’ and local authorities or health professionals, with the overall aim to increase trust and improve access to health care. Based on data gathered during a year of ethnographic fieldwork with Roma health mediators in Romania, including participant observation and interviews, this article analyses the social processes by which participatory approaches produce both social inclusion and exclusion. It illustrates how mediators exceeded their remit of health and attempted to discipline communities into forms of neoliberal citizenship. Mediators reframed access to health care not as a right that community members already have, but as a benefit that must be individually ‘earned’ through the fulfilment of neoliberal citizenship. The article argues that far from being an ‘empowering tool’, community participation can extend the power of governing institutions and thereby may in fact contribute to the maintenance of a political status quo that perpetuates the precarisation of marginalised communities.

Global Health, Vulnerable Populations, and Law

2013 ◽  
Vol 41 (1) ◽  
pp. 42-47
Author(s):  
Solomon R. Benatar
Keyword(s):  
Health Care ◽  
Access To Health Care ◽  
Universal Access ◽  
Human Condition ◽  
Right To Health Care ◽  
Legal Provisions ◽  
Access To Health ◽  
Access To Medical Care ◽  
The Impact ◽  
Emergency Health Services

The most common response to the challenge of protecting health through law is to focus on protecting the rights of vulnerable individuals and to enhance their access to health care. Each one of us is vulnerable or potentially vulnerable because of the fragile, existential nature of the human condition. Catastrophic and unexpected events could instantaneously transform us from a state of total independence and potential vulnerability to one of extreme vulnerability and complete dependence. Some legal provisions have the potential to provide a modicum of protection when we find ourselves in those situations (for example, through legislation, effective emergency health services can be created to reduce the impact of our potential vulnerability). There are also legal provisions that contribute to beneficial social circumstances; for example, legislation enabling universal access to medical care, and operationalizing respect for the individual’s right to health care, as advocated for by other authors in this issue.

scholarly journals Estimating the local spatio-temporal distribution of disease from routine health information systems: the case of malaria in rural Madagascar

2020 ◽  
Author(s):  
Elizabeth Hyde ◽  
Matthew H Bonds ◽  
Felana Angella Ihantamalala ◽  
Ann C Miller ◽  
Laura F Cordier ◽  
...  
Keyword(s):  
Health Care ◽  
Geographic Distribution ◽  
Access To Health Care ◽  
Malaria Incidence ◽  
Universal Access ◽  
Surveillance Systems ◽  
Passive Surveillance ◽  
Transmission Season ◽  
Under Five ◽  
Access To Health

Background: Reliable surveillance systems are essential for identifying disease outbreaks and allocating resources to ensure universal access to diagnostics and treatment for endemic diseases. Yet, most countries with high disease burdens rely entirely on facility-based passive surveillance systems, which miss the vast majority of cases in rural settings with low access to health care. This is especially true for malaria, for which the World Health Organization estimates that routine surveillance detects only 14% of global cases. The goal of this study was to estimate the unobserved burden of malaria missed by routine passive surveillance in a rural district of Madagascar to produce realistic incidence estimates across space and time, less sensitive to heterogeneous health care access. Methods: We use a geographically explicit dataset of the 73,022 malaria cases confirmed at health centers in the Ifanadiana District in Madagascar from 2014 to 2017. Malaria incidence was adjusted to account for underreporting due to stock-outs of rapid diagnostic tests and variable access to healthcare. A benchmark multiplier was combined with a health care utilization index obtained from statistical models of non-malaria patients. Variations to the multiplier and several strategies for pooling neighboring communities together were explored to allow for fine-tuning of the final estimates. Separate analyses were carried out for individuals of all ages and for children under five. Cross-validation criteria were developed based on overall incidence, trends in financial and geographical access to health care, and consistency with geographic distribution in a district-representative cohort. The most plausible sets of estimates were then identified based on these criteria. Results: Passive surveillance was estimated to have missed about 4 in every 5 malaria cases among all individuals and 2 out of every 3 cases among children under five. Adjusted malaria estimates were less biased by differences in populations' financial and geographic access to care. Average adjusted monthly malaria incidence was nearly four times higher during the high transmission season than during the low transmission season. Geographic distribution in the adjusted dataset revealed high transmission clusters in low elevation areas in the northeast and southeast of the district that were stable across seasons and transmission years. Conclusions: Understanding local disease dynamics from routine passive surveillance data can be a key step towards achieving universal access to diagnostics and treatment. Methods presented here could be scaled-up thanks to the increasing availability of e-health disease surveillance platforms for malaria and other diseases across the developing world.

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