The equity dimension in evaluations of the quality and outcomes framework: A systematic review

PubMed Central

2011-01-01

Background Pay-for-performance systems raise concerns regarding inequity in health care because providers might select patients for whom targets can easily be reached. This paper aims to describe the evolution of pre-existing (in)equity in health care in the period after the introduction of the Quality and Outcomes Framework (QOF) in the UK and to describe (in)equities in exception reporting. In this evaluation, a theory-based framework conceptualising equity in terms of equal access, equal treatment and equal treatment outcomes for people in equal need is used to guide the work. Methods A systematic MEDLINE and Econlit search identified 317 studies. Of these, 290 were excluded because they were not related to the evaluation of QOF, they lacked an equity dimension in the evaluation, their qualitative research focused on experiences or on the nature of the consultation, or unsuitable methodology was used to pronounce upon equity after the introduction of QOF. Results None of the publications (n = 27) assessed equity in access to health care. Concerning equity in treatment and (intermediate) treatment outcomes, overall quality scores generally improved. For the majority of the observed indicators, all citizens benefit from this improvement, yet the extent to which different patient groups benefit tends to vary and to be highly dependent on the type and complexity of the indicator(s) under study, the observed patient group(s) and the characteristics of the study. In general, the introduction of QOF was favourable for the aged and for males. Total QOF scores did not seem to vary according to ethnicity. For deprivation, small but significant residual differences were observed after the introduction of QOF favouring less deprived groups. These differences are mainly due to differences at the practice level. The variance in exception reporting according to gender and socio-economic position is low. Conclusions Although QOF seems not to be socially selective at first glance, this does not mean QOF does not contribute to the inverse care law. Introducing different targets for specific patient groups and including appropriate, non-disease specific and patient-centred indicators that grasp the complexity of primary care might refine the equity dimension of the evaluation of QOF. Also, information on the actual uptake of care, information at the patient level and monitoring of individuals' health care utilisation tracks could make large contributions to an in-depth evaluation. Finally, evaluating pay-for-quality initiatives in a broader health systems impact assessment strategy with equity as a full assessment criterion is of utmost importance. PMID:21880136

Evaluating Electronic Reference Services: Issues, Approaches and Criteria.

ERIC Educational Resources Information Center

Novotny, Eric

2001-01-01

Discussion of electronic library reference services focuses on an overview of the chief methodologies available for conducting assessments of electronic services. Highlights include quantitative measures and benchmarks, including equity and access; quality measures; behavioral aspects of quality, including librarian-patron interaction; and future…

In pursuit of high-value healthcare: the case for improving quality and achieving equity in a time of healthcare transformation.

PubMed

Betancourt, Joseph R

2014-01-01

The passage of the Patient Protection and Affordable Care Act and current efforts in payment reform signal the beginning of a significant transformation for the US healthcare system. As we embark on this transformation, disparities have emerged as the hallmark of low-value healthcare--care that does not meet quality standards, is inefficient, and is usually of high cost. A new set of structures is being developed to facilitate increased access to care that is cost-effective and high in quality--otherwise known as high-value healthcare. Addressing disparities and achieving equity are the perfect target areas for recouping value, and doing so will pave the way for high-value healthcare. As healthcare leaders make difficult choices, they should consider the realities of healthcare equity. First, racial and ethnic disparities in healthcare persist and are a clear sign of poor-quality, low-value healthcare. Second, the root causes of these disparities are complex, but a well-developed set of evidence-based approaches is available to help leaders address healthcare inequity. Third, evidence suggests that being inattentive to the root causes of disparities adversely affects efficiency and an organization's bottom line. Finally, if healthcare organizations are progressive, thoughtful, and prepared for success in such an environment, a new healthcare system that offers accessible, high-value, equitable, culturally competent, and high-quality care to all is well within reach.

Social Equity and Access to a Philippine STEM School

ERIC Educational Resources Information Center

Talaue, Frederick Toralballa

2014-01-01

Like most developing countries in the world, there is a huge gap in opportunities to access quality science education between students from the high- and low-socioeconomic strata of Philippine society. In establishing its own science, technology, engineering, and mathematics (STEM) high school, despite limited public funding in 1964, the…

Information Communication Technology for Educational Quality: Challenges, Prospects in Ethiopian Context

ERIC Educational Resources Information Center

Sani, Dureti; Tasisa, Wakgari; Panigraphi, Manas Ranjan

2013-01-01

The major purpose of this project was to assess and review the principal role of ICT in supplementing the General Quality Improvement program (GEQIP) in Western Harerghe, Ethiopia. The project also further analyzed the contribution of Information Communication Technology (ICT) to the indicators of GEQIP like quality, equity, access and internal…

The Political Meaning of Quality.

ERIC Educational Resources Information Center

Mingle, James R.

1989-01-01

Quality as a political goal for public higher education is discussed, and its fuller acceptance at the state over the federal level is noted. Federal policy is driven by values associated with access, need, and equity. State leaders are using a rhetoric of quality and excellence, incentives for high achievement, rigor, and merit. One reason the…

Poverty, Equity and Access to Education in Bangladesh. CREATE Pathways to Access. Research Monograph No. 51

ERIC Educational Resources Information Center

Hossain, Altaf; Zeitlyn, Benjamin

2010-01-01

Bangladesh has made great improvements in the scale and quality of access to education in recent years and gender equality has almost been achieved in primary education (World Bank, 2008). Evidence from CREATE's nationwide community and school survey (ComSS) confirms results from other research (such as Al-Samarrai, 2009) which suggests that…

Pakistan's Primary Education Quality Improvement Program: Local Partners Work with Rural Communities to Support High Quality Education for Girls

ERIC Educational Resources Information Center

Afridi, Zahid A.

2006-01-01

This document describes the contributions made by the Primary Education Quality Improvement Program (1996-1999) to the broad goals of improved access, equity, and quality in girls' primary education in Pakistan. In Balochistan, the largest but least developed province of Pakistan, an innovative approach to educational development was successfully…

Health care and equity in India.

PubMed

Balarajan, Y; Selvaraj, S; Subramanian, S V

2011-02-05

In India, despite improvements in access to health care, inequalities are related to socioeconomic status, geography, and gender, and are compounded by high out-of-pocket expenditures, with more than three-quarters of the increasing financial burden of health care being met by households. Health-care expenditures exacerbate poverty, with about 39 million additional people falling into poverty every year as a result of such expenditures. We identify key challenges for the achievement of equity in service provision, and equity in financing and financial risk protection in India. These challenges include an imbalance in resource allocation, inadequate physical access to high-quality health services and human resources for health, high out-of-pocket health expenditures, inflation in health spending, and behavioural factors that affect the demand for appropriate health care. Use of equity metrics in monitoring, assessment, and strategic planning; investment in development of a rigorous knowledge base of health-systems research; development of a refined equity-focused process of deliberative decision making in health reform; and redefinition of the specific responsibilities and accountabilities of key actors are needed to try to achieve equity in health care in India. The implementation of these principles with strengthened public health and primary-care services will help to ensure a more equitable health care for India's population. Copyright © 2011 Elsevier Ltd. All rights reserved.

Expanding Educational Access in Eastern Turkey: A New Initiative

ERIC Educational Resources Information Center

O'Dwyer, John; Aksit, Necmi; Sands, Margaret

2010-01-01

The Eastern Anatolian project extends opportunity and access to quality education. The study examines the selection and learning systems adopted within the framework of gender equity, family background and higher order skills. Performance data on a range of selection measures and the initial programme are analysed. Results show that selection was…

The Future of Higher Education in Nigeria: Global Challenges and Opportunities

ERIC Educational Resources Information Center

Oni, Adesoji A.; Alade, Ibiwumi A.

2008-01-01

Among the numerous components of development of higher education are; growth in quantity, quality, relevance and diversity of curriculum [programme and courses]; widening of access and broadening of equity, innovation in teaching methods and techniques; improvement in the quantity and quality of research activities; more and better community…

After-School Programs: Expanding Access and Ensuring Quality. PPI Policy Report

ERIC Educational Resources Information Center

Gayl, Chrisanne L.

2004-01-01

High quality after-school programs provide numerous social, family, and community benefits. In addition to helping parents balance work and life responsibilities, these programs offer prime opportunities to enhance learning--particularly for struggling students. After-school programs also help to promote equity among students by providing…

Increasing Equity and Compensating Historically Academically Disadvantaged Students at a Tertiary Level: Benefits of a Science Foundation Programme as a Way of Access

ERIC Educational Resources Information Center

Downs, Colleen

2010-01-01

An approach to remedy the scarcity of Black students within the sciences at southern African universities has been the development of access programmes. There has been little acknowledgement of the contribution of these access programmes in increasing the quantity and quality of graduates. The contribution made by the Science Foundation Programme…

Modeling factors explaining physicians’ satisfaction with competence

PubMed Central

Lepnurm, Rein; Dobson, Roy Thomas; Peña-Sánchez, Juan-Nicolás; Nesdole, Robert

2015-01-01

Objective: Attention to physician wellness has increased as medical practice gains in complexity. Physician satisfaction with practice is critical for quality of care and practice growth. The purpose of this study was to model physicians’ self-reported Satisfaction with Competence as a function of their perceptions of the Quality of Health Services, Distress, Coping, Practice Management, Personal Satisfaction and Professional Equity. Methods: Comprehensive questionnaires were sent to a stratified sample of 5300 physicians across Canada. This cross-sectional study focused on physicians who examined and treated individual patients for a final study population of 2639 physicians. Response bias was negligible. The questionnaires contained measures of Satisfaction with Competence, Quality of Health Services, Distress, Coping, Personal Satisfaction, Practice Management and Professional Equity. Exploring relationships was done using Pearson correlations and one-way analysis of variance. Modeling was by hierarchical regressions. Results: The measures were reliable: Satisfaction with Competence (α = .86), Quality (α = .86), Access (α = .82), Distress (α = .82), Coping (α = .76), Personal Satisfaction (α = .78), Practice Management (α = .89) and the dimensions of Professional Equity (Fulfillment, α = .81; Financial, α = .93; and Recognition, α = .75) with comparative validity. Satisfaction with Competence was positively correlated with Quality (r = .32), Efficiency (r = .37) and Access (r = .32); negatively correlated with Distress (r = −.54); and positively correlated with Coping strategies (r = .43), Personal Satisfaction (r = .57), Practice Management (r = .17), Fulfillment (r = .53), Financial (r = .36) and Recognition (r = .54). Physicians’ perceptions on Quality, Efficiency, Access, Distress, Coping, Personal Satisfaction, Practice Management, Fulfillment, Pay and Recognition explained 60.2% of the variation in Satisfaction with Competence, controlling for years in practice, self-reported health and duties of physicians. Conclusion: Satisfaction with Competence could be affected by excessive accumulation of duties, concerns about quality, efficiency, access, excessive distress, inadequate coping abilities, personal satisfaction with life as a physician, challenges in managing practices and persistent inequities among physicians. PMID:27092256

Modeling factors explaining physicians' satisfaction with competence.

PubMed

Lepnurm, Rein; Dobson, Roy Thomas; Peña-Sánchez, Juan-Nicolás; Nesdole, Robert

2015-01-01

Attention to physician wellness has increased as medical practice gains in complexity. Physician satisfaction with practice is critical for quality of care and practice growth. The purpose of this study was to model physicians' self-reported Satisfaction with Competence as a function of their perceptions of the Quality of Health Services, Distress, Coping, Practice Management, Personal Satisfaction and Professional Equity. Comprehensive questionnaires were sent to a stratified sample of 5300 physicians across Canada. This cross-sectional study focused on physicians who examined and treated individual patients for a final study population of 2639 physicians. Response bias was negligible. The questionnaires contained measures of Satisfaction with Competence, Quality of Health Services, Distress, Coping, Personal Satisfaction, Practice Management and Professional Equity. Exploring relationships was done using Pearson correlations and one-way analysis of variance. Modeling was by hierarchical regressions. The measures were reliable: Satisfaction with Competence (α = .86), Quality (α = .86), Access (α = .82), Distress (α = .82), Coping (α = .76), Personal Satisfaction (α = .78), Practice Management (α = .89) and the dimensions of Professional Equity (Fulfillment, α = .81; Financial, α = .93; and Recognition, α = .75) with comparative validity. Satisfaction with Competence was positively correlated with Quality (r = .32), Efficiency (r = .37) and Access (r = .32); negatively correlated with Distress (r = -.54); and positively correlated with Coping strategies (r = .43), Personal Satisfaction (r = .57), Practice Management (r = .17), Fulfillment (r = .53), Financial (r = .36) and Recognition (r = .54). Physicians' perceptions on Quality, Efficiency, Access, Distress, Coping, Personal Satisfaction, Practice Management, Fulfillment, Pay and Recognition explained 60.2% of the variation in Satisfaction with Competence, controlling for years in practice, self-reported health and duties of physicians. Satisfaction with Competence could be affected by excessive accumulation of duties, concerns about quality, efficiency, access, excessive distress, inadequate coping abilities, personal satisfaction with life as a physician, challenges in managing practices and persistent inequities among physicians.

Environmental Equity and the Role of Public Policy: Experiences in the Rijnmond Region

NASA Astrophysics Data System (ADS)

Kruize, Hanneke; Driessen, Peter P. J.; Glasbergen, Pieter; van Egmond, Klaas (N. D.)

2007-10-01

This Φ Ψ study of environmental equity uses secondary quantitative data to analyze socioeconomic disparities in environmental conditions in the Rijnmond region of the Netherlands. The disparities of selected environmental indicators—exposure to traffic noise (road, rail, and air), NO2, external safety risks, and the availability of public green space—are analyzed both separately and in combination. Not only exposures to environmental burdens (“bads”) were investigated, but also access to environmental benefits (“goods”). Additionally, we held interviews and reviewed documents to grasp the mechanisms underlying the environmental equity situation, with an emphasis on the role of public policy. Environmental equity is not a priority in public policy for the greater Rotterdam region known as the Rijnmond region, yet environmental standards have been established to provide a minimum environmental quality to all local residents. In general, environmental quality has improved in this region, and the accumulation of negative environmental outcomes (“bads”) has been limited. However, environmental standards for road traffic noise and NO2 are being exceeded, probably because of the pressure on space and the traffic intensity. We found an association of environmental “bads” with income for rail traffic noise and availability of public green space. In the absence of regulation, positive environmental outcomes (“goods”) are mainly left up to market forces. Consequently, higher-income groups generally have more access to environmental “goods” than lower-income groups.

Widening Equity and Retaining Efficiency: Considerations from the IBSA Southern Coalface

ERIC Educational Resources Information Center

Akoojee, Salim; Nkomo, Mokubung

2011-01-01

Access to higher education is a key challenge of the 21st century state. The link between higher education and personal and socio-economic development has intensified the need for ensuring that greater numbers of citizens have expanded access to and have been provided with quality higher education. The article seeks to explore how initiatives for…

Access to Knowledge: The Continuing Agenda for Our Nation's Schools. Revised Edition.

ERIC Educational Resources Information Center

Goodlad, John I., Ed.; Keating, Pamela, Ed.

This book presents a collection of essays by education researchers and practitioners about issues of educational equity and excellence. The authors examine the problem of failure in schools and describe the various curricular and structural factors that block access to an equal and quality education for all students. Chapters are entitled: (1)…

Girls' Access to Education in China: Actors, Cultures and the Windmill of Development Management. CREATE Pathways to Access. Research Monograph No. 39

ERIC Educational Resources Information Center

Wang, Xiaojun Grace

2010-01-01

The world has a mixed record towards achieving EFA [Education for All] and the MDGs [Millennium Development Goals] in relation to the targets on gender equity in basic education. For researchers and practitioners, this raises the question of which factors influence the processes leading to the improvement of access and quality of girls' education…

Equitable science education in urban middle schools: Do reform efforts make a difference?

NASA Astrophysics Data System (ADS)

Hewson, Peter W.; Butler Kahle, Jane; Scantlebury, Kathryn; Davies, Darleen

2001-12-01

A central commitment of current reforms in science education is that all students, regardless of culture, gender, race, and/ or socioeconomic status, are capable of understanding and doing science. The study Bridging the Gap: Equity in Systemic Reform assessed equity in systemic reform using a nested research design that drew on both qualitative and quantitative methodologies. As part of the study, case studies were conducted in two urban middle schools in large Ohio cities. The purpose of the case studies was to identify factors affecting equity in urban science education reform. Data were analyzed using Kahle's (1998) equity metric. That model allowed us to assess progress toward equity using a range of research-based indicators grouped into three categories critical for equitable education: access to, retention in, and achievement in quality science education. In addition, a fourth category was defined for systemic indicators of equity. Analyses indicated that the culture and climate of the case study schools differentially affected their progress toward equitable reform in science education.

Reconciling Means and Ends in Equity and Access through Further and Higher Education Sector Partnerships: An Australian Case

ERIC Educational Resources Information Center

Broughton, Sharon

2005-01-01

This paper examines the educational implications of pursuing equity and access for adult learners across further and higher education sectors. It contextualizes some advantages and disadvantages in cross-sectoral arrangements by reference to a specific access and equity partnership program in Australia and analyses the impact on the equity aims of…

Expansion without Equity: An Analysis of Current Policy on Access to Higher Education in Brazil

ERIC Educational Resources Information Center

McCowan, Tristan

2007-01-01

Access to higher education in Brazil is to a large extent restricted to the higher socio-economic groups. Public universities have limited places and entry is determined by highly competitive exams, thereby excluding those who have not had a high quality secondary education or attended an expensive preparatory course. There has been considerable…

Higher Educational Cost-Sharing, Dual-Track Tuition Fees, and Higher Educational Access: The East African Experience

ERIC Educational Resources Information Center

Marcucci, Pamela; Johnstone, D. Bruce; Ngolovoi, Mary

2008-01-01

Three universal demands characterize higher education globally: the demand for higher quality, for increased access, and for greater equity. In East Africa, where resources are highly constrained, no nation has been able to meet these demands on the basis of public expenditures alone. Instead countries have had to increase resources from nonpublic…

Social justice, access and quality of healthcare in an age of austerity: users' perspective from rural Iceland.

PubMed

Gustafsdottir, Sonja S; Fenger, Kristjana; Halldorsdottir, Sigridur; Bjarnason, Thoroddur

2017-01-01

Iceland is sparsely populated but social justice and equity has been emphasised within healthcare. The aim of the study is to examine healthcare services in Fjallabyggð, in rural northern Iceland, from users' perspective and evaluate social justice, access and quality of healthcare in an age of austerity. Mixed-method approach with transformative design was used. First, data were collected with questionnaires (response rate of 53% [N=732] in 2009 and 30% [N=415] in 2012), and analysed statistically, followed by 10 interviews with healthcare users (2009 and 2014). The results were integrated and interpreted within Bronfenbrenner's Ecological Model. There was significantly less satisfaction with accessibility and variety of healthcare services in 2012 after services downsizing. Solid primary healthcare, good local elderly care, some freedom in healthcare choice and reliable emergency services were considered fundamental for life in a rural area. Equal access to healthcare is part of a fundamental human right. In times of economic downturn, people in rural areas, who are already vulnerable, may become even more vulnerable and disadvantaged, seriously threatening social justice and equity. With severe cutbacks in vitally important healthcare services people may eventually choose to self-migrate.

Social justice, access and quality of healthcare in an age of austerity: users’ perspective from rural Iceland

PubMed Central

Gustafsdottir, Sonja S.; Fenger, Kristjana; Halldorsdottir, Sigridur; Bjarnason, Thoroddur

2017-01-01

ABSTRACT Iceland is sparsely populated but social justice and equity has been emphasised within healthcare. The aim of the study is to examine healthcare services in Fjallabyggð, in rural northern Iceland, from users’ perspective and evaluate social justice, access and quality of healthcare in an age of austerity. Mixed-method approach with transformative design was used. First, data were collected with questionnaires (response rate of 53% [N=732] in 2009 and 30% [N=415] in 2012), and analysed statistically, followed by 10 interviews with healthcare users (2009 and 2014). The results were integrated and interpreted within Bronfenbrenner’s Ecological Model. There was significantly less satisfaction with accessibility and variety of healthcare services in 2012 after services downsizing. Solid primary healthcare, good local elderly care, some freedom in healthcare choice and reliable emergency services were considered fundamental for life in a rural area. Equal access to healthcare is part of a fundamental human right. In times of economic downturn, people in rural areas, who are already vulnerable, may become even more vulnerable and disadvantaged, seriously threatening social justice and equity. With severe cutbacks in vitally important healthcare services people may eventually choose to self-migrate. PMID:28762300

Argumentation in Educational Policy Disputes: Competing Visions of Quality and Equity

ERIC Educational Resources Information Center

Anagnostopoulos, Dorothea; Lingard, Bob; Sellar, Sam

2016-01-01

Current debates about test-based accountability policies revolve around questions of how to ensure that all students have access to high-quality schools and teachers. Whether and how one can meet this goal depend, in part, on the nature of the arguments that policy proponents and opponents mobilize in these debates. This article examines these…

Equity Starts Early: Addressing Racial Inequities in Child Care and Early Education Policy

ERIC Educational Resources Information Center

Johnson-Staub, Christine

2017-01-01

Child care and early education policies are shaped by a history of systemic and structural racism. This has created major racial disparities in children's access to quality child care that meets their cultural and linguistic needs and enables their parents to work. Early care and education workers are overwhelmingly in low-quality jobs with…

[Public control and equity of access to hospitals under non-State public administration].

PubMed

Carneiro Junior, Nivaldo; Elias, Paulo Eduardo

2006-10-01

To analyze social health organizations in the light of public control and the guarantee of equity of access to health services. Utilizing the case study technique, two social health organizations in the metropolitan region of São Paulo were selected. The analytical categories were equity of access and public control, and these were based on interviews with key informants and technical-administrative reports. It was observed that the overall funding and administrative control of the social health organizations are functions of the state administrator. The presence of a local administrator is important for ensuring equity of access. Public control is expressed through supervisory actions, by means of accounting and financial procedures. Equity of access and public control are not taken into consideration in the administration of these organizations. The central question lies in the capacity of the public authorities to have a presence in implementing this model at the local level, thereby ensuring equity of access and taking public control into consideration.

Perceptions of quality in primary health care: perspectives of patients and professionals based on focus group discussions

PubMed Central

2014-01-01

Background The EUprimecare project-team assessed the perception of primary health care (PHC) professionals and patients on quality of organization of PHC systems in the participating countries: Estonia, Finland, Germany, Hungary, Italy, Lithuania and Spain. This article presents the aggregated opinions, expectations and priorities of patients and professionals along some main dimensions of quality in primary health care, such as access, equity, appropriateness and patient- centeredness. Methods The focus group technique was applied in the study as a qualitative research method for exploration of attitudes regarding the health care system and health service. Discussions were addressing the topics of: general aspects of quality in primary health care; possibilities to receive/provide PHC services based on both parties needs; determinant factors of accessibility to PHC services; patient centeredness. The data sets collected during the focus group discussions were evaluated using the method of thematic analysis. Results There were 14 focus groups in total: a professional and a patient group in each of the seven partner countries. Findings of the thematic analysis were summarized along the following dimensions: access and equity, appropriateness (coordination, continuity, competency and comprehensiveness) and patient centeredness. Conclusions This study shows perceptions and views of patients in interaction with PHC and opinion of professionals working in PHC. It serves as source of criteria with relevance to everyday practice and experience. The criteria mentioned by patients and by health care professionals which were considered determining factors of the quality in primary care were quite similar among the investigated countries. However, the perception and the level of tolerance regarding some of the criteria differed among EUprimecare countries. Among these dissimilar criteria we especially note the gate-keeping role of GPs, the importance of nurses' competency and the acceptance of waiting times. The impact of waiting time on patient satisfaction is obvious; the influence of equity and access to PHC services are more dependent on the equal distribution of settings and doctors in urban and rural area. Foreseen shortage of doctors is expected to have a substantial influence on patient satisfaction in the near future. PMID:24974196

Equity in health care.

PubMed

La Rosa-Salas, Virginia; Tricas-Sauras, Sandra

2008-01-01

It has long been known that a segment of the population enjoys distinctly better health status and higher quality of health care than others. To solve this problem, prioritization is unavoidable, and the question is how priorities should be set. Rational priority setting would seek equity amongst the whole population, the extent to which people receive equal care for equal needs. Equity in health care is an ethical imperative not only because of the intrinsic worth of good health, or the value that society places on good health, but because, without good health, people would be unable to enjoy life's other sources of happiness. This paper also argues the importance of the health care's efficiency, but at the same time, it highlights how any innovation and rationalization undertaken in the provision of the health system should be achieved from the consideration of human dignity, making the person prevail over economic criteria. Therefore, the underlying principles on which this health care equity paper is based are fundamental human rights. The main aim is to ensure the implementation of these essential rights by those carrying out public duties. Viewed from this angle, equity in health care means equality: equality in access to services and treatment, and equality in the quality of care provided. As a result, this paper attempts to address both human dignity and efficiency through the context of equity to reconcile them in the middle ground.

Analyzing Turkey's Data from TIMSS 2007 to Investigate Regional Disparities in Eighth Grade Science Achievement

ERIC Educational Resources Information Center

Erberber, Ebru

2009-01-01

Turkey is expected to be a full member of the European Union (EU) by 2013. In the course of its integration into the EU, Turkey has been simultaneously facing access, quality, and equity issues in education. Over the past decade, substantial progress has been made on increasing the access. However, improving the country's low level of education…

Advancing a conceptual model to improve maternal health quality: The Person-Centered Care Framework for Reproductive Health Equity.

PubMed

Sudhinaraset, May; Afulani, Patience; Diamond-Smith, Nadia; Bhattacharyya, Sanghita; Donnay, France; Montagu, Dominic

2017-11-06

Background: Globally, substantial health inequities exist with regard to maternal, newborn and reproductive health. Lack of access to good quality care-across its many dimensions-is a key factor driving these inequities. Significant global efforts have been made towards improving the quality of care within facilities for maternal and reproductive health. However, one critically overlooked aspect of quality improvement activities is person-centered care. Main body: The objective of this paper is to review existing literature and theories related to person-centered reproductive health care to develop a framework for improving the quality of reproductive health, particularly in low and middle-income countries. This paper proposes the Person-Centered Care Framework for Reproductive Health Equity, which describes three levels of interdependent contexts for women's reproductive health: societal and community determinants of health equity, women's health-seeking behaviors, and the quality of care within the walls of the facility. It lays out eight domains of person-centered care for maternal and reproductive health. Conclusions: Person-centered care has been shown to improve outcomes; yet, there is no consensus on definitions and measures in the area of women's reproductive health care. The proposed Framework reviews essential aspects of person-centered reproductive health care.

Foreign Language Instructed Programs in Public Universities in Egypt: Implications for Resource Diversification, Quality and Equity in Higher Education

ERIC Educational Resources Information Center

Sabry, Manar A.

2010-01-01

This study seeks to assess the impact of tuition fees of the Foreign language Instructed Programs (FLIP) at Cairo University on increasing other-than-governmental resources for these programs as well as for the university, increasing student satisfaction with the quality of education, and maintaining equitable access. The study uses a theoretical…

Building Hope, Giving Affirmation: Learning Communities That Address Social Justice Issues Bring Equity to the Classroom

ERIC Educational Resources Information Center

Hirsh, Stephanie; Hord, Shirley M.

2010-01-01

A school that ensures that all students--regardless of race, creed, color, socioeconomic status, gender, or disabilities--have access to and receive the highest-quality education has achieved a key measure of social justice. Since the most significant factor in whether students learn well is quality teaching, and teaching is enhanced through…

Use, access, and equity in health care services in São Paulo, Brazil.

PubMed

Monteiro, Camila Nascimento; Beenackers, Mariëlle A; Goldbaum, Moisés; Barros, Marilisa Berti de Azevedo; Gianini, Reinaldo José; Cesar, Chester Luiz Galvão; Mackenbach, Johan P

2017-05-18

The study analyzed how socioeconomic factors are associated with seeking, access, use, and quality of health care services in São Paulo, Brazil. Data were obtained from two household health surveys in São Paulo. We used logistic regression to analyze associations between socioeconomic factors and seeking, access, use, and quality of health care services. Access to health care services was high among those who sought it (94.91% in 2003 and 94.98% in 2008). The proportion of access to and use of health care services did not change significantly from 2003 to 2008. Use of services in the public sector was more frequent in lower socioeconomic groups. There were some socioeconomic differences in seeking health care and resolution of health problems. The study showed almost universal access to health care services, but the results suggest problems in quality of services and differences in quality experienced by lower socioeconomic groups, who mostly use the Brazilian Unified National Health System (SUS).

Access and Equity for all Students: Students with Disabilities. Report 09-02

ERIC Educational Resources Information Center

Humphrey, Karen; Angeli, Mallory

2009-01-01

Access and equity for all students in higher education continues to be a high priority for the California Postsecondary Education Commission. Recent work in this area has focused on students with disabilities as well as Lesbian, Gay, Bisexual and Transgender (LGBT) students. The Commission formed an Access and Equity for All Students Advisory…

Equity and Access in the Workplace: A Feminist HRD Perspective

ERIC Educational Resources Information Center

Valenziano, Laura

2008-01-01

The issues of equity and access are becoming increasingly important as the workforce becomes diversified. As the number of minority groups in the ranks of organizations grows, there is a need to examine the issues related to equity and access from a perspective that strives for equality, e.g. feminist theory. This paper examines feminism's…

Australian Higher Education Reforms--Unification or Diversification?

ERIC Educational Resources Information Center

Coombe, Leanne

2015-01-01

The higher education policy of the previous Australian government aimed to achieve an internationally competitive higher education sector while expanding access opportunities to all Australians. This policy agenda closely reflects global trends that focus on achieving both quality and equity objectives. In this paper, the formulation and…

Equity and Access: All Students Are Mathematical Problem Solvers

ERIC Educational Resources Information Center

Franz, Dana Pompkyl; Ivy, Jessica; McKissick, Bethany R.

2016-01-01

Often mathematical instruction for students with disabilities, especially those with learning disabilities, includes an overabundance of instruction on mathematical computation and does not include high-quality instruction on mathematical reasoning and problem solving. In fact, it is a common misconception that students with learning disabilities…

Vouchers for health: A demand side output-based aid approach to reproductive health services in Kenya.

PubMed

Janisch, C P; Albrecht, M; Wolfschuetz, A; Kundu, F; Klein, S

2010-01-01

Reaching the United Nation's Millennium Development Goals has been a focus for many countries and development partners. In Kenya, as in many other countries with low levels of development, access to and equity of basic quality health services is limited, especially for the very poor. Among poor populations, maternal mortality is high as access to medical care and financial means are lacking. In 2005, the Governments of Kenya and Germany in cooperation with KfW Banking Group made funds available for the Reproductive Health OBA Voucher Programme offering vouchers for Safe Motherhood, Family Planning and Gender Violence Recovery Services. This programme, herein referred to as Vouchers for Health, was launched in June of 2006 in five Kenyan districts with the aim of providing health services for safe deliveries, long-term family planning methods and victims of gender violence. The way that the programme is being implemented in Kenya demonstrates that the voucher-based approach comprises a variety of key structural elements of a national health insurance scheme: accreditation; quality assurance; reimbursement system; claims processing; integrating the private sector; client choice; provider competition; and access to and equity of services provided.

Health care and equity in India

PubMed Central

Balarajan, Yarlini; Selvaraj, S; Subramanian, S V

2011-01-01

India’s health system faces the ongoing challenge of responding to the needs of the most disadvantaged members of Indian society. Despite progress in improving access to health care, inequalities by socioeconomic status, geography and gender continue to persist. This is compounded by high out-of-pocket expenditures, with the rising financial burden of health care falling overwhelming on private households, which account for more than three-quarter of health spending in India. Health expenditures are responsible for more than half of Indian households falling into poverty; the impact of this has been increasing pushing around 39 million Indians into poverty each year. In this paper, we identify key challenges to equity in service delivery, and equity in financing and financial risk protection in India. These include imbalanced resource allocation, limited physical access to quality health services and inadequate human resources for health; high out-of-pocket health expenditures, health spending inflation, and behavioral factors that affect the demand for appropriate health care. Complementing other paper in this Series, we argue for the application of certain principles in the pursuit of equity in health care in India. These are the adoption of equity metrics in monitoring, evaluation and strategic planning, investment in developing a rigorous knowledge-base of health systems research; development of more equity-focused process of deliberative decision-making in health reform, and redefinition of the specific responsibilities and accountabilities of key actors. The implementation of these principles, together with strengthening of public health and primary care services, provide an approach for ensuring more equitable health care for India’s population. PMID:21227492

Addressing disparities and achieving equity: cultural competence, ethics, and health-care transformation.

PubMed

Betancourt, Joseph R; Corbett, James; Bondaryk, Matthew R

2014-01-01

The passage of health-care reform and current efforts in payment reform signal the beginning of a significant transformation of the US health-care system. An entire new set of structures is being developed to facilitate increased access to care that is cost-effective and of high quality. As described in The Institute of Medicine report "Crossing the Quality Chasm," our nation is charting a path toward quality health care that aims to be safe, efficient, effective, timely, patient-centered, and equitable. As our health-care system rapidly undergoes dramatic transformation, several truths-and challenges-remain. First, racial and ethnic disparities in health care persist and are a clear sign of inequality in quality. Second, although the root causes for these disparities are complex, there exists a well-developed set of evidence-based approaches to address them; among these is improving the cultural competence of health-care providers and the health-care system. Third, as part of our care redesign, we must assure that we are prepared to meet the ethical challenges ahead and reassert the importance of equity, fairness, and caring as key building blocks of a new care delivery system. As we move ahead, it is critical to assure that our health-care system is culturally competent and has the capacity to deliver high-quality care for all, while eliminating disparities and assuring equity. Disparities are unjust, unethical, costly, and unacceptable-and integrating strategies to achieve equity as part of our health-care system's transformation will give us an incredible opportunity to comprehensively address them.

The Australian Perspective: Access, Equity, Quality, and Accountability in Higher Education

ERIC Educational Resources Information Center

Sharma, Rajendra

2008-01-01

The Australian higher education system has experienced significant changes since the mid-1980s. Notable are introduction of an income-contingent loan (the Higher Education Contribution Scheme) for "government" funded places; changing from aid to trade with respect to international students, including introduction of full fees for such…

America's Opportunity: Teacher Effectiveness and Equity in K-12 Classrooms

ERIC Educational Resources Information Center

Goe, Laura, Ed.

2009-01-01

Questions about whether states play a role in ensuring access to high-quality teaching talent in local communities have ceased. Increasingly, states are encouraging and requiring more robust preparation programs; more efficient human resources departments that identify, recruit, place, and support the most effective educators; and more continuous…

Basic Education and Policy Support (BEPS) Activity.

ERIC Educational Resources Information Center

Creative Associates International, Inc., Washington, DC.

The Basic Education and Policy Support (BEPS) Activity is a multi-year, worldwide, indefinite quantity contract by which the U.S. Agency for International Development (USAID) Global Bureau Center for Human Capacity (G/HCD) can work to achieve four objectives: (1) improve the quality, efficiency, access, and equity of education, particularly basic…

Access to University Education in Nigeria: A Review

ERIC Educational Resources Information Center

Agboola, B. M.; Ofoegbu, F. I.

2010-01-01

Demand for university education has increased due to the recent innovations of universal, free and compulsory education at the basic and senior secondary education level. Education has been expanding very rapidly at all levels in Nigeria. However, there are serious problems related to quality, equity, unavailable human and material resources and…

A Matter of Equity: Preschool in America

ERIC Educational Resources Information Center

US Department of Education, 2015

2015-01-01

Each year, about 4 million children enter kindergarten in the United States. All parents hope their child will start school ready for success, and many parents turn that hope into action, seeking out supportive and high-quality early learning opportunities. Unfortunately, not every parent finds those opportunities, and access differs based on…

Health equity issues at the local level: socio-geography, access, and health outcomes in the service area of the Hôpital Albert Schweitzer-Haiti.

PubMed

Perry, Henry B; King-Schultz, Leslie W; Aftab, Asma S; Bryant, John H

2007-08-01

Although health equity issues at regional, national and international levels are receiving increasing attention, health equity issues at the local level have been virtually overlooked. Here, we describe here a comprehensive equity assessment carried out by the Hôpital Albert Schweitzer-Haiti (HAS) in 2003. HAS has been operating health and development programs in the Artibonite Valley of Haiti for 50 years. We reviewed all available information arising from a comprehensive evaluation of the programs of HAS carried out in 1999 and 2000. As part of this evaluation, two demographic and health surveys were carried out. We carried out exit interviews with clients receiving primary health care, observations within health facilities, interviews with households related to quality of care, and focus group discussions with community-based health workers. A special study was carried out in 2003 to assess factors determining the use of prenatal care services. Finally, selected findings were obtained from the HAS information system. We found markedly reduced access to health services in the peripheral mountainous areas compared to the central plains. The quality of services was more deficient and the coverage of key services was lower in the mountains. Finally, health status, as measured by under-five mortality rates and levels of childhood malnutrition, was also worse in the mountains. These findings indicate that local health programs need to give attention to monitoring the health status as well as the quality and coverage of basic services among marginalized groups within the program service area. Health inequities will not be overcome until such monitoring occurs and leaders of health programs ensure that inequities identified are addressed in the local programming of activities. It is quite likely that, within relatively small geographic areas in resource-poor settings around the world, similar, if not even greater, levels of health inequities exist. These inequities need to be measured and addressed in order for health programs to achieve equity and maximum improvement in health status within the population.

[The virtual library in equity, health, and human development].

PubMed

Valdés, América

2002-01-01

This article attempts to describe the rationale that has led to the development of information sources dealing with equity, health, and human development in countries of Latin America and the Caribbean within the context of the Virtual Health Library (Biblioteca Virtual en Salud, BVS). Such information sources include the scientific literature, databases in printed and electronic format, institutional directories and lists of specialists, lists of events and courses, distance education programs, specialty journals and bulletins, as well as other means of disseminating health information. The pages that follow deal with the development of a Virtual Library in Equity, Health, and Human Development, an effort rooted in the conviction that decision-making and policy geared toward achieving greater equity in health must, of necessity, be based on coherent, well-organized, and readily accessible first-rate scientific information. Information is useless unless it is converted into knowledge that benefits society. The Virtual Library in Equity, Health, and Human Development is a coordinated effort to develop a decentralized regional network of scientific information sources, with strict quality control, from which public officials can draw data and practical examples that can help them set health and development policies geared toward achieving greater equity for all.

Operationalisation of the construct of access to dental care: a position paper and proposed conceptual definitions.

PubMed

Harris, R V

2013-06-01

'Access' is a term readily used in a political and policy context, but one which has not leant itself to measurement of progress towards policy goals or comparisons between health systems. Like 'quality', 'access' is a multi-dimensional construct, but currently often remains a vague and abstract concept which is difficult to translate into something specific, concrete and therefore measureable. The paper describes previous work and identifies a need for a greater consensus and conceptual clarity in the selection of metrics for dental access. The construct of dental access is described as involving the concepts of 1: opportunity for access; 2, realised access (utilisation); 3, equity and 4, outcomes. Proposed conceptual definitions are given and a case made for measuring 'initial utilisation' separately from 'continued utilisation', reflecting modern approaches which distinguish 'entry access' (gaining entry to the dental care system), from the process of gaining access to higher levels of care. Using a distinction between 'entry access' and 'effective access' allows a choice of whether to restrict measurement to mainly supply side considerations, or alternatively to extend the measurement to include whether there is equity in the proportion of patients who are able obtain effective needed interventions. A development of conceptual definitions of dental access could facilitate measurement of progress towards policy goals and operationalisation of the construct.

Latino Park Access: Examining Environmental Equity in a “New Destination” County in the South

Treesearch

Cassandra Johnson Gaither

2011-01-01

This paper examines Latino migration to a “new destination” county in the southeastern U.S., Hall County, Georgia, where environmental equity is considered in terms of Latino communities’ walking access to public and private parks in the county. Park access is considered an environmental equity or justice issue because some research shows less park acreage available to...

Insights on the Intersection of Health Equity and School Nutrition Policy Implementation: An Exploratory Qualitative Secondary Analysis

ERIC Educational Resources Information Center

Asada, Yuka; Hughes, Alejandro; Chriqui, Jamie

2017-01-01

Background: Recent federal policies aimed to ensure that all children have equitable access to healthy school nutrition environments. However, historically, disparities have persisted in the quality of school nutrition environments across geographic and socioeconomic groups. There is limited literature addressing if and how recent efforts to…

The Role and Mission of African Higher Education: Preparing for the 21st Century and Beyond.

ERIC Educational Resources Information Center

Assie-Lumumba, N'Dri T.

1996-01-01

Summarizes issues and recommendations from eight recent studies of the mission of African higher education, including those concerning demand, access, equity, quality and relevance, science and technology, governance, links between universities and the broader society (including business and government), adequate and sustainable funding, and…

American Higher Education: A History. Second Edition

ERIC Educational Resources Information Center

Lucas, Christopher J.

2006-01-01

The roots of controversy surrounding higher education in the US extend deep into the past. This original, incisive history goes far in offering a needed sense of perspective on current debates over such issues as access, costs, academic quality, social equity, and curricula. Eminently readable and always lively, this timely historical account is…

Research Committee Issues Brief: Professional Development for Virtual Schooling and Online Learning

ERIC Educational Resources Information Center

Davis, Niki; Rose, Ray

2007-01-01

This report examines the types of professional development necessary to implement successful online learning initiatives. The potential for schools utilizing online learning is tremendous: schools can develop new distribution methods to enable equity and access for all students, they can provide high quality content for all students and they can…

Equity and Excellence: African-American Children's Access to Quality Preschool

ERIC Educational Resources Information Center

Barnett, Steve; Carolan, Megan; Johns, David

2013-01-01

The White House Initiative on Educational Excellence for African-Americans (WHIEEAA) has a mandate on behalf of African-American students to close the achievement gap. This goal requires attention to the full education continuum, from the early childhood years through adulthood. Learning begins at birth and the preparation for learning starts well…

Assessing health system performance in developing countries: a review of the literature.

PubMed

Kruk, Margaret Elizabeth; Freedman, Lynn P

2008-03-01

With the setting of ambitious international health goals and an influx of additional development assistance for health, there is growing interest in assessing the performance of health systems in developing countries. This paper proposes a framework for the assessment of health system performance and reviews the literature on indicators currently in use to measure performance using online medical and public health databases. This was complemented by a review of relevant books and reports in the grey literature. The indicators were organized into three categories: effectiveness, equity, and efficiency. Measures of health system effectiveness were improvement in health status, access to and quality of care and, increasingly, patient satisfaction. Measures of equity included access and quality of care for disadvantaged groups together with fair financing, risk protection and accountability. Measures of efficiency were appropriate levels of funding, the cost-effectiveness of interventions, and effective administration. This framework and review of indicators may be helpful to health policy makers interested in assessing the effects of different policies, expenditures, and organizational structures on health outputs and outcomes in developing countries.

Medicaid case-mix nursing home reimbursement in three states.

PubMed

Swan, James H; Pickard, Ruth B

2003-01-01

Case-mix nursing facility payment raises issues of access, quality, equity, and cost. Case-mix should better match payment to costs, improve access, and provide incentives to increased staffing and quality of care; but it may also increase costs. This paper reports analysis of Medicaid cost-report data from three case-mix states. Case-mix did not discourage capacity building and was more equitable for providers. Medicaid access declined in one state but increased in another. There were shifts toward greater skilled care in two states, with evidence of greater focus of resources on patient care. Case-mix showed no evidence of cost-constraint and some signs of increased costs. Whether such mixed outcomes are viable in the current era remains to be seen.

[Health and justice in Germany].

PubMed

Rosenbrock, R

2007-12-01

"What do we owe each other?" Variously grounded postulates and theories of social justice try to answer this question with regard to health. Equality of opportunity is widely acclaimed and in Germany also anchored in social security laws. From the perspective of equal opportunity, the author examines the state of affairs and the perspectives of equity in health. Although the deficiencies with regard to access and quality of health care are significant, but relatively moderate, they present serious threats to equity and fairness for the future. Regarding non-medical primary prevention, the reduction of inequality in health has barely begun. The largest obstacles to equity in health are to be found in the distribution and dynamics of opportunities for education, work and income. One of the tasks of public health professionals is to place the health consequences of existing policies on the political agenda.

Public housing into private assets: wealth creation in urban China.

PubMed

Walder, Andrew G; He, Xiaobin

2014-07-01

State socialist economies provided public housing to urban citizens at nominal cost, while allocating larger and better quality apartments to individuals in elite occupations. In transitions to a market economy, ownership is typically transferred to existing occupants at deeply discounted prices, making home equity the largest component of household wealth. Housing privatization is therefore a potentially important avenue for the conversion of bureaucratic privilege into private wealth. We estimate the resulting inequalities with data from successive waves of a Chinese national income survey that details household assets and participation in housing programs. Access to privatization programs was relatively equal across urban residents in state sector occupations. Elite occupations had substantially greater wealth in the form of home equity shortly after privatization, due primarily to their prior allocations of newer and higher quality apartments. The resulting gaps in private wealth were nonetheless small by the standards of established market economies, and despite the inherent biases in the process, housing privatization distributed home equity widely across those who were resident in public housing immediately prior to privatization. Copyright © 2014 Elsevier Inc. All rights reserved.

Student Equity at Antelope Valley College: An Examination of Underrepresented Student Access and Success.

ERIC Educational Resources Information Center

Lewallen, Willard Clark

In February 1994, Antelope Valley College (AVC), in California, adopted a Student Equity Plan to determine the access and success of historically underrepresented students. As part of the Plan, AVC collected data on five student equity indicators: a comparison of ethnic group enrollment to representation in the service area, the ratio of courses…

The effects of mandatory health insurance on equity in access to outpatient care in Indonesia.

PubMed

Hidayat, Budi; Thabrany, Hasbullah; Dong, Hengjin; Sauerborn, Rainer

2004-09-01

This paper examines the effects of mandatory health insurance on access and equity in access to public and private outpatient care in Indonesia. Data from the second round of the 1997 Indonesian Family Life Survey were used. We adopted the concentration index as a measure of equity, and this was calculated from actual data and from predicted probability of outpatient-care use saved from a multinomial logit regression. The study found that a mandatory insurance scheme for civil servants (Askes) had a strongly positive impact on access to public outpatient care, while a mandatory insurance scheme for private employees (Jamsostek) had a positive impact on access to both public and private outpatient care. The greatest effects of Jamsostek were observed amongst poor beneficiaries. A substantial increase in access will be gained by expanding insurance to the whole population. However, neither Askes nor Jamsostek had a positive impact on equity. Policy implications are discussed.

Equity impact of interventions and policies to reduce smoking in youth: systematic review.

PubMed

Brown, Tamara; Platt, Stephen; Amos, Amanda

2014-11-01

A systematic review to assess the equity impact of interventions/policies on youth smoking. Biosis, Cinahl, Cochrane Library, Conference Proceedings Citation Index, Embase, Eric, Medline, Psycinfo, Science Citation Index Expanded, Social Sciences Citation Index and tobacco control experts. Published January 1995 to October 2013. Primary studies of interventions/policies reporting smoking-related outcomes in youth (11-25 years) of lower compared to higher socioeconomic status (SES). References were screened and independently checked. Studies were quality assessed; characteristics and outcomes were extracted. A narrative synthesis by intervention/policy type. Equity impact was assessed as: positive (reduced inequity), neutral (no difference by SES), negative (increased inequity), mixed (equity impact varied) or unclear.Thirty-eight studies of 40 interventions/policies were included: smokefree (12); price/tax (7); mass media campaigns (1); advertising controls (4); access controls (5); school-based programmes (5); multiple policies (3), individual-level cessation support (2), individual-level support for smokefree homes (1). The distribution of equity effects was: 7 positive, 16 neutral, 12 negative, 4 mixed, 1 unclear. All 7 positive equity studies were US-based: price/tax (4), age-of-sales laws (2) and text-messaging cessation support (1). A British school-based intervention (A Stop Smoking in Schools Trial (ASSIST)) showed mixed equity effects (neutral and positive). Most neutral equity studies benefited all SES groups. Very few studies have assessed the equity impact of tobacco control interventions/policies on young people. Price/tax increases had the most consistent positive equity impact. There is a need to strengthen the evidence base for the equity impact of youth tobacco control interventions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The AGARD tip research agenda for Scientific and Technical Information (STI)

NASA Technical Reports Server (NTRS)

Blados, Walter R.

1992-01-01

The Research Agenda contains three themes: information management, provision of information, and access to information. Provision of information is further divided into two subordinate themes, dissemination and bibliographic control; access to information is also further divided into two subordinate themes, barriers and equity and networking. Each theme or sub-theme was examined from four possible aspects, namely, human resources, quality assurance, cost, and technology. It was concluded that, in fact, a theme or sub-theme need not contain all four aspects.

Community Member and Stakeholder Perspectives on a Healthy Environment Initiative in North Carolina.

PubMed

Carter-Edwards, Lori; Lowe-Wilson, Abby; Mouw, Mary Sherwyn; Jeon, Janet Yewon; Baber, Ceola Ross; Vu, Maihan B; Bethell, Monique

2015-08-13

The North Carolina Community Transformation Grant Project (NC-CTG) aimed to implement policy, system, and environmental strategies to promote healthy eating, active living, tobacco-free living, and clinical and community preventive services to advance health equity and reduce health disparities for the state's most vulnerable communities. This article presents findings from the Health Equity Collaborative Evaluation and Implementation Project, which assessed community and stakeholder perceptions of health equity for 3 NC-CTG strategies: farmers markets, shared use, and smoke-free multiunit housing. In a triangulated qualitative evaluation, 6 photo elicitation (PE) sessions among 45 community members in 1 urban and 3 rural counties and key informant interviews among 22 stakeholders were conducted. Nine participants from the PE sessions and key informant interviews in the urban county subsequently participated in a stakeholder power analysis and mapping session (SPA) to discuss and identify people and organizations in their community perceived to be influential in addressing health equity-related issues. Evaluations of the PE sessions and key informant interviews indicated that access (convenience, cost, safety, and awareness of products and services) and community fit (community-defined quality, safety, values, and norms) were important constructs across the strategies. The SPA identified specific community- and faith-based organizations, health care organizations, and local government agencies as key stakeholders for future efforts. Both community fit and access are essential constructs for promoting health equity. Findings demonstrate the feasibility of and need for formative research that engages community members and local stakeholders to shape context-specific, culturally relevant health promotion strategies.

A Research Agenda to Assure Equity During Periods of Emergency Department Crowding

PubMed Central

Hwang, Ula; Weber, Ellen J.; Richardson, Lynne D.; Sweet, Vicki; Todd, Knox; Abraham, Gallane; Ankel, Felix

2012-01-01

The effect of emergency department (ED) crowding on equitable care is the least studied of the domains of quality as defined by the Institute of Medicine (IOM). Inequities in access and treatment throughout the health care system are well documented in all fields of medicine. While there is little evidence demonstrating that inequity is worsened by crowding, theory and evidence from social science disciplines, as well as known barriers to care for vulnerable populations, would suggest that crowding will worsen inequities. To design successful interventions, however, it is important to first understand how crowding can result in disparities and base interventions on these mechanisms. A research agenda is proposed to understand mechanisms that may threaten equity during periods of crowding and design and test potential interventions that may ensure the equitable aspect of quality of care. PMID:22168197

Dual Language Immersion Program Equity and Access: Is There Equity for All Students?

ERIC Educational Resources Information Center

Fernandez, Patricia Espinoza

2016-01-01

This is a mixed methods study of K-12 school administrators with dual language immersion school leadership expertise. The paramount research focus was to identify equity and access issues in dual language immersion programs serving grades K-12, as identified by school administrators who have led such programs. A total pool of 498 were invited to…

State Policy Responses to Ensuring Excellent Educators in Rural Schools

ERIC Educational Resources Information Center

Gagnon, Douglas J.; Mattingly, Marybeth J.

2015-01-01

The Excellent Educators for All initiative is the most recent federal policy effort to address unequal access to teacher quality in the United States. States were required to submit equity plans to the U.S. Department of Education that detailed how to ensure that poor and minority children do not receive instruction from less qualified teachers.…

Educational Development and Reformation in the Malaysian Education System: Challenges in the New Millennium.

ERIC Educational Resources Information Center

bin Zakaria, Haji Azmi

2000-01-01

Development of the education system in Malaysia is tied to the National Development Policy. Malaysia will address issues related to equity, access, and democratization of education, education quality, efficiency, and values education as the country responds to the demands of being part of the global village while ensuring domestic growth and…

Consequential Boards: Adding Value Where It Matters Most. Report of the National Commission on College and University Board Governance

ERIC Educational Resources Information Center

Association of Governing Boards of Universities and Colleges, 2014

2014-01-01

The value of American higher education faces multiple risks, and changes in governance are needed to address them. At risk are accessibility and degree attainment for current and future students, institutional fiscal sustainability, educational quality, economic development and social equity, service to communities, and knowledge creation. Higher…

International Education for the Millennium: Toward Access, Equity, and Quality. Harvard Educational Review Reprint Series.

ERIC Educational Resources Information Center

Piper, Benjamin, Ed.; Dryden-Peterson, Sarah, Ed.; Kim, Young-Suk, Ed.

2006-01-01

This volume sheds light on contemporary theoretical work and research, on a range of national and international polices, and on education reform in developing countries. International Education has become an increasingly prominent and urgent matter in recent decades. Since the 1990 and 2000 Education for All conferences in Thailand, and Senegal,…

Fiscal Year 2015: Interim Results Report. Highlights. Volume I

ERIC Educational Resources Information Center

Global Partnership for Education, 2015

2015-01-01

It is the aim of the Global Partnership for Education (GPE) to improve access, equity, and learning outcomes for all. It seeks to contribute to improvements in the number of children completing primary and lower secondary levels of school in GPE partner countries; to lower the number of children out of school; and to improve education quality, as…

Inclusive & Quality Education for Tribals: Case Study KISS (Odisha)

ERIC Educational Resources Information Center

Ghadai, Sanjaya Ku.

2016-01-01

The 12th Plan highlighted Equity, Access & Excellence as the tripod of India's education policy. The RTE Act 2009 has ensured a high level of Gross Enrolment Ratio (GER). However, the Annual Status of Education Report (ASER) present a dismal picture of the outcome dimensions of our schooling system. The Sustainable Development Goal (SDG)…

Teacher Voice in Global Conversations around Education Access, Equity, and Quality

ERIC Educational Resources Information Center

Gozali, Charlina; Claassen Thrush, Elizabeth; Soto-Peña, Michelle; Whang, Christine; Luschei, Thomas F.

2017-01-01

Despite public commitments internationally and nationally to include the voices of all stakeholders, the voices of teachers have continued to be marginalized in the literature and in policy-making related to global educational development. The purpose of the current study is to examine the process of invoking teacher voice using a sample of…

Report from the Field: Education under Structural Adjustment in Nigeria and Zambia.

ERIC Educational Resources Information Center

Babalola, Joel B.; Lungwangwa, Geoffrey; Adeyinka, Augustus A.

1999-01-01

Investigates the effects of the Structural Adjustment Program (SAP) on the educational systems in Nigeria and Zambia. Reports that SAP impacted the public expenditure on education, the purchasing power of the incomes earned by both learning institutions and their staff, and on access, equity, and quality indicators in education at all levels. (CMK)

The Role of School Based Health Centers (SBHCs) in Improving Health Equity and Reducing Health Disparities. Position Statement

ERIC Educational Resources Information Center

Blacksin, Beth; Gall, Gail; Feldman, Elizabeth; Miller, Elizabeth

2010-01-01

Health inequities exist largely among socially disadvantaged people who are denied the highest attainable standard of health available to many Americans. Access to culturally competent, high quality, first-contact primary care through school-based health centers is an effective way to reduce health inequities and, therefore, improve health…

Promoting Primary Education for Girls in Pakistan. CDIE Impact Evaluation.

ERIC Educational Resources Information Center

Agency for International Development (IDCA), Washington, DC.

This report details a field study to evaluate the efforts of Pakistan's Primary Education Development Program (PED) to improve the access, equity, and quality of primary education in Pakistan, especially for rural girls. A 3-week visit was conducted in 1997 by a team from the United States Agency for International Development (USAID) Center for…

Dental Care in an Equal Access System Valuing Equity: Are There Racial Disparities?

PubMed

Boehmer, Ulrike; Glickman, Mark; Jones, Judith A; Orner, Michelle B; Wheler, Carolyn; Berlowitz, Dan R; Kressin, Nancy R

2016-11-01

Racial disparities in dental care have previously been shown in the Veterans Health Administration (VA)-a controlled access setting valuing equitable, high-quality care. The aim of this study is to examine current disparities in dental care by focusing on the receipt of root canal therapy (RCT) versus tooth extraction. This is a retrospective analysis of data contained in the VA's electronic health records. We performed logistic regressions on the independent measures along with a facility-specific random effect, using dependent binary variables that distinguished RCT from tooth extraction procedures. VA outpatients who had at least 1 tooth extraction or RCT visit in the VA in fiscal year 2011. A dependent binary measure of tooth extraction or RCT. Other measures are medical record data on medical comorbidities, dental morbidity, prior dental utilization, and demographic characteristics. The overall rate of preferred tooth-preserving RCT was 18.1% during the study period. Black and Asian patients were most dissimilar with respect to dental morbidity, medical and psychological disorders, and black patients had the least amount of eligibility for comprehensive dental care. After adjustment for known confounding factors of RCT, black patients had the lowest RCT rates, whereas Asians had the highest. Current quality improvement efforts and a value to improve the equity of care are not sufficient to address racial/ethnic disparities in VA dental care; rather more targeted efforts will be needed to achieve equity for all.

The impact of clinical social franchising on health services in low- and middle-income countries: a systematic review.

PubMed

Beyeler, Naomi; York De La Cruz, Anna; Montagu, Dominic

2013-01-01

The private sector plays a large role in health services delivery in low- and middle-income countries; yet significant gaps remain in the quality and accessibility of private sector services. Clinical social franchising, which applies the commercial franchising model to achieve social goals and improve health care, is increasingly used in developing countries to respond to these limitations. Despite the growth of this approach, limited evidence documents the effect of social franchising on improving health care quality and access. We examined peer-reviewed and grey literature to evaluate the effect of social franchising on health care quality, equity, cost-effectiveness, and health outcomes. We included all studies of clinical social franchise programs located in low- and middle-income countries. We assessed study bias using the WHO-Johns Hopkins Rigour Scale and used narrative synthesis to evaluate the findings. Of 113 identified articles, 23 were included in this review; these evaluated a small sample of franchises globally and focused on reproductive health franchises. Results varied widely across outcomes and programs. Social franchising was positively associated with increased client volume and client satisfaction. The findings on health care utilization and health impact were mixed; some studies find that franchises significantly outperform other models of health care, while others show franchises are equivalent to or worse than other private or public clinics. In two areas, cost-effectiveness and equity, social franchises were generally found to have poorer outcomes. Our review indicates that social franchising may strengthen some elements of private sector health care. However, gaps in the evidence remain. Additional research should include: further documentation of the effect of social franchising, evaluating the equity and cost-effectiveness of this intervention, and assessing the role of franchising within the context of the greater healthcare delivery system.

Literacy and Race: Access, Equity, and Freedom

ERIC Educational Resources Information Center

Willis, Arlette Ingram

2015-01-01

The coupling of literacy and race emphasizes their historic and contemporaneous intersection in literacy research. In this article, I draw on my scholarship and use three counternarratives to articulate how literacy and race significantly influence access, equity, and freedom. First, I examine access within the sociohistoric context of African…

Reducing the distance: equity issues in distance learning in public education

NASA Astrophysics Data System (ADS)

Campbell, Patricia B.; Storo, Jennifer

1996-12-01

Distance learning and educational equity both began with an emphasis on access, on providing underserved students with an increased access to education. Today definitions of equity have gone beyond simple access to include equal or equivalent treatment and outcomes while definitions of underserved students have expanded to include girls, children of color, children with limited English proficiency and children with disabilities. At the same time the definition of distance learning has expanded to include new technologies, new audiences and new roles. Based on these new definitions and roles, the article raises a number of equity challenges for distance learning educators centering around who is taught, what is taught and how the teaching is done. To answer these challenges, a series of recommendations are suggested that educators can implement to make distance learning a leader in increasing educational equity for all students. The time to act is now.

A cost-based equity weight for use in the economic evaluation of primary health care interventions: case study of the Australian Indigenous population

PubMed Central

Ong, Katherine S; Kelaher, Margaret; Anderson, Ian; Carter, Rob

2009-01-01

Background Efficiency and equity are both important policy objectives in resource allocation. The discipline of health economics has traditionally focused on maximising efficiency, however addressing inequities in health also requires consideration. Methods to incorporate equity within economic evaluation techniques range from qualitative judgements to quantitative outcomes-based equity weights. Yet, due to definitional uncertainties and other inherent limitations, no method has been universally adopted to date. This paper proposes an alternative cost-based equity weight for use in the economic evaluation of interventions delivered from primary health care services. Methods Equity is defined in terms of 'access' to health services, with the vertical equity objective to achieve 'equitable access for unequal need'. Using the Australian Indigenous population as an illustrative case study, the magnitude of the equity weight is constructed using the ratio of the costs of providing specific interventions via Indigenous primary health care services compared with the costs of the same interventions delivered via mainstream services. Applying this weight to the costs of subsequent interventions deflates the costs of provision via Indigenous health services, and thus makes comparisons with mainstream more equitable when applied during economic evaluation. Results Based on achieving 'equitable access', existing measures of health inequity are suitable for establishing 'need', however the magnitude of health inequity is not necessarily proportional to the magnitude of resources required to redress it. Rather, equitable access may be better measured using appropriate methods of health service delivery for the target group. 'Equity of access' also suggests a focus on the processes of providing equitable health care rather than on outcomes, and therefore supports application of equity weights to the cost side rather than the outcomes side of the economic equation. Conclusion Cost-based weights have the potential to provide a pragmatic method of equity weight construction which is both understandable to policy makers and sensitive to the needs of target groups. It could improve the evidence base for resource allocation decisions, and be generalised to other disadvantaged groups who share similar concepts of equity. Development of this decision-making tool represents a potentially important avenue for further health economics research. PMID:19807930

Can rural health insurance improve equity in health care utilization? a comparison between China and Vietnam

PubMed Central

2012-01-01

Introduction Health care financing reforms in both China and Vietnam have resulted in greater financial difficulties in accessing health care, especially for the rural poor. Both countries have been developing rural health insurance for decades. This study aims to evaluate and compare equity in access to health care in rural health insurance system in the two countries. Methods Household survey and qualitative study were conducted in 6 counties in China and 4 districts in Vietnam. Health insurance policy and its impact on utilization of outpatient and inpatient service were analyzed and compared to measure equity in access to health care. Results In China, Health insurance membership had no significant impact on outpatient service utilization, while was associated with higher utilization of inpatient services, especially for the higher income group. Health insurance members in Vietnam had higher utilization rates of both outpatient and inpatient services than the non-members, with higher use among the lower than higher income groups. Qualitative results show that bureaucratic obstacles, low reimbursement rates, and poor service quality were the main barriers for members to use health insurance. Conclusions China has achieved high population coverage rate over a short time period, starting with a limited benefit package. However, poor people have less benefit from NCMS in terms of health service utilization. Compared to China, Vietnam health insurance system is doing better in equity in health service utilization within the health insurance members. However with low population coverage, a large proportion of population cannot enjoy the health insurance benefit. Mutual learning would help China and Vietnam address these challenges, and improve their policy design to promote equitable and sustainable health insurance. PMID:22376290

Adequacy, Efficiency and Equity of Higher Education Financing: The Case of Egypt

ERIC Educational Resources Information Center

Fahim, Yasmine; Sami, Noha

2011-01-01

To meet its future challenges in financing higher education, Egypt has no option but to search for alternative funding arrangements. This article considers the question of how to do so, keeping in mind the need to ensure equitable access to good quality education for those who cannot afford it. To this end, the article begins by assessing public…

Communique Declaration: The New Dynamics of Higher Education and Research for Societal Change and Development (2nd UNESCO Higher Education Assembly July, 2009)

ERIC Educational Resources Information Center

Adult Learning, 2012

2012-01-01

This article presents the communique declaration on the new dynamics of higher education and research for societal change and development. This declaration begins with a preamble and focuses on (1) social responsibility of higher education; (2) access, equity and quality; (3) internationalisation, regionalisation and globalisation; (4) learning…

A Forward Glance in a Mirror: Diversity Challenged--Access, Equity, and Success in Higher Education. 2005 DeWitt Wallace-"Reader's Digest" Distinguished Lecture

ERIC Educational Resources Information Center

Allen, Walter R.

2005-01-01

Affirmative action addresses disparities in higher education. Recent trends threaten gains, resegregation is underway nationally. California outlawed affirmative action, the quality of K-12 education is declining, and prison construction is soaring. African American and Latino participation in higher education has declined; both groups are…

Equality or Equity: Gender Awareness Issues in Secondary Schools in Pakistan

ERIC Educational Resources Information Center

Halai, Anjum

2011-01-01

This paper focuses on gender awareness issues as a dimension of addressing the wider issue of the quality of education in Pakistan from the perspective of social justice. In Pakistan classrooms, boys and girls learn separately and therefore teachers and others tend to think that there are no gender issues once access is achieved and the learners…

Gender, equity: new approaches for effective management of communicable diseases.

PubMed

Theobald, Sally; Tolhurst, Rachel; Squire, S Bertel

2006-04-01

This editorial article examines what is meant by sex, gender and equity and argues that these are critical concepts to address in the effective management of communicable disease. Drawing on examples from the three major diseases of poverty (HIV, tuberculosis [TB] and malaria), the article explores how, for women and men, gender and poverty can lead to differences in vulnerability to illness; access to quality preventive and curative measures; and experience of the impact of ill health. This exploration sets the context for the three companion papers which outline how gender and poverty shape responses to the three key diseases of poverty in different geographical settings: HIV/AIDS in Kenya; TB in India; and malaria in Ghana.

Is healthcare really equal for all? Assessing the horizontal and vertical equity in healthcare utilisation among older Ghanaians.

PubMed

Dei, Vincent; Sebastian, Miguel San

2018-06-20

There is a lack of focused research on the older population in Ghana and about issues pertaining to their access to healthcare services. Furthermore, information is lacking regarding the fairness in the access to these services. This study aimed to ascertain whether horizontal and vertical equity requirements were being met in the healthcare utilisation among older adults aged 50 years and above. This study was based on a secondary cross-sectional data from the World Health Organization's Study on global AGEing (SAGE) and adult health wave 1 conducted from 2007 to 2008 in Ghana. Data on 4304 older adults aged 50 years-plus were analysed. Bivariate and multivariable analyses were carried out to analyse the association between outpatient/inpatient utilisation and (1) socioeconomic status (SES), controlling for need variables (horizontal equity) and (2) need variables, controlling for SES (vertical equity). Odds ratios with 95% confidence intervals were calculated to analyse the association between relevant variables. Horizontal and vertical inequities were found in the utilisation of outpatient services. Inpatient healthcare utilisation was both horizontally and vertically equitable. Women were found to be more likely to use outpatient services than men but had reduced odds of using inpatient services. Possessing a health insurance was also significantly associated with the use of both inpatient and outpatient services. Whilst equity exists in inpatient care utilisation, more needs to be done to achieve equity in the access to outpatient services. The study reaffirms the need to evaluate both the horizontal and vertical dimensions in the assessment of equity in healthcare access. It provides the basis for further research in bridging the healthcare access inequity gap among older adults in Ghana.

Open Access Enabling Courses: Risking Academic Standards or Meeting Equity Aspirations

ERIC Educational Resources Information Center

Shah, Mahsood; Whannell, Robert

2017-01-01

Open access enabling courses have experienced growth in Australia. The growth is evidenced in student enrolments and the number of public and private institutions offering such courses. Traditionally these courses have provided a second chance to many students from various equity groups who have been unable to access tertiary education due to poor…

Gender Equity and Mass Communication's Female Student Majority.

ERIC Educational Resources Information Center

Golombisky, Kim

2002-01-01

Provides an overview of the history and politics of gender equity to make problematic the phrase "gender equity," to introduce the gender equity in education literature, and to outline some issues relevant to mass communication. Suggests that equal access represents a sex-blind approach dependent on a male standard. (SG)

Can contracted out health facilities improve access, equity, and quality of maternal and newborn health services? Evidence from Pakistan.

PubMed

Zaidi, Shehla; Riaz, Atif; Rabbani, Fauziah; Azam, Syed Iqbal; Imran, Syeda Nida; Pradhan, Nouhseen Akber; Khan, Gul Nawaz

2015-11-25

The case of contracting out government health services to non-governmental organizations (NGOs) has been weak for maternal, newborn, and child health (MNCH) services, with documented gains being mainly in curative services. We present an in-depth assessment of the comparative advantages of contracting out on MNCH access, quality, and equity, using a case study from Pakistan. An end-line, cross-sectional assessment was conducted of government facilities contracted out to a large national NGO and government-managed centres serving as controls, in two remote rural districts of Pakistan. Contracting out was specific for augmenting MNCH services but without contractual performance incentives. A household survey, a health facility survey, and focus group discussions with client and spouses were used for assessment. Contracted out facilities had a significantly higher utilization as compared to control facilities for antenatal care, delivery, postnatal care, emergency obstetric care, and neonatal illness. Contracted facilities had comparatively better quality of MNCH services but not in all aspects. Better household practices were also seen in the district where contracting involved administrative control over outreach programs. Contracting was also faced with certain drawbacks. Facility utilization was inequitably higher amongst more educated and affluent clients. Contracted out catchments had higher out-of-pocket expenses on MNCH services, driven by steeper transport costs and user charges for additional diagnostics. Contracting out did not influence higher MNCH service coverage rates across the catchment. Physical distances, inadequate transport, and low demand for facility-based care in non-emergency settings were key client-reported barriers. Contracting out MNCH services at government health facilities can improve facility utilization and bring some improvement in  quality of services. However, contracting out of health facilities is insufficient to increase service access across the catchment in remote rural contexts and requires accompanying measures for demand enhancement, transportation access, and targeting of the more disadvantaged clientele.

Evaluating transportation equity : an intermetropolitan comparison of regional accessibility and urban form.

DOT National Transportation Integrated Search

2013-06-01

The concept of accessibility is used as the measurement tool to assess the link between social equity and the built environment because : it simultaneously accounts for both land-use patterns and a transportation system. This study compares 25 metrop...

Digital Learning: Reforming Teacher Education to Promote Access, Equity and Quality in Sub-Saharan Africa

ERIC Educational Resources Information Center

Moon, Bob; Villet, Charmaine

2016-01-01

The purpose of this report is to provide an overview of the present and future impact of digital learning on teacher education in Sub-Saharan Africa. The focus of the report is student-teachers and teachers, and its central argument is that existing institutional structures will be insufficient to meet the scale of demand for well-prepared,…

New Technology and Digital Worlds: Analyzing Evidence of Equity in Access, Use, and Outcomes

ERIC Educational Resources Information Center

Warschauer, Mark; Matuchniak, Tina

2010-01-01

In this chapter, the authors take a broad perspective on how to analyze issues of technology and equity for youth in the United States. They begin with "access" as a starting point, but consider not only whether diverse groups of youth have digital media available to them but also how that access is supported or constrained by…

Cyber Charter Schools and Students with Dis/abilities: Rebooting the IDEA to Address Equity, Access, and Compliance

ERIC Educational Resources Information Center

Collins, Kathleen M.; Green, Preston C., III; Nelson, Steven L.; Madahar, Santosh

2015-01-01

This article takes up the question of equity, access, and cyber charter schools from the perspective of disability studies in education (DSE). DSE positions inclusion and educational access as social justice concerns. In doing so, we assert the importance of making visible the social justice implications of the current laws that impact cyber…

Gender and the utilisation of health services in the Ashanti Region, Ghana.

PubMed

Buor, Daniel

2004-09-01

The survey seeks to structure a model for gender-based health services utilisation for the Ashanti Region of Ghana, and in addition, recommend intervention measures to ensure gender equity in the utilisation of health services. A sample size of 650 covered over 3108 houses, and the main research instruments were the questionnaire and formal interview. A multiple regression model is used for the analysis of the relationship between the complex independent variables and utilisation by gender. Results show that although females have a greater need for health services than males, they do not utilise health services as much. Secondly, whereas quality of service, health status, service cost and education have greater effect on male utilisation than females, distance and income have higher impact on female utilisation. It is recommended that, to ensure equity in health care utilisation, females be empowered through increased access to formal education and sustainable income opportunities. The introduction of a national health insurance scheme is also recommended to ensure adequate access by both sexes.

Equity and equality in health and health care.

PubMed

Culyer, A J; Wagstaff, A

1993-12-01

This paper explores four definitions of equity in health care: equality of utilization, distribution according to need, equality of access, and equality of health. We argue that the definitions of 'need' in the literature are inadequate and propose a new definition. We also argue that, irrespective of how need and access are defined, the four definitions of equity are, in general, mutually incompatible. In contrast to previous authors, we suggest that equality of health should be the dominant principle and that equity in health care should therefore entail distributing care in such a way as to get as close as is feasible to an equal distribution of health.

Disability and Equity in Higher Education Accessibility

ERIC Educational Resources Information Center

Alphin, Henry C., Jr., Ed.; Lavine, Jennie, Ed.; Chan, Roy Y., Ed.

2017-01-01

Education is the foundation to almost all successful lives. It is vital that learning opportunities are available on a global scale, regardless of individual disabilities or differences, and to create more inclusive educational practices. "Disability and Equity in Higher Education Accessibility" is a comprehensive reference source for…

Equity of Access to Higher Education in the Context of South-South Cooperation in Latin America: A Pluri-Scalar Analysis

ERIC Educational Resources Information Center

Muhr, Thomas

2016-01-01

This article draws from an education governance approach to conduct a pluri-scalar analysis of equity of access to tertiary education in the context of South-South cooperation. An account of distributional justice in access to tertiary education in the Federative Republic of Brazil and the Bolivarian Republic of Venezuela is integrated with a…

Access & Equity for All Students: LGBT Student Needs. Commission Report 08-22

ERIC Educational Resources Information Center

California Postsecondary Education Commission, 2008

2008-01-01

Access and equity for all students in California colleges and universities have always been high priorities of the California Postsecondary Education Commission. The Commission has conducted research, gathered data, and made recommendations to expand opportunities and improve outcomes for all students in the state's postsecondary systems.…

Equity Access Plans: A Regulatory and Educational State Response Model.

ERIC Educational Resources Information Center

DeLisle, James

1984-01-01

Introduces the basic notion of equity access plans as property-based solutions to the cash flow needs of elderly homeowners and then proposes a normative response model that states can adopt to help manage the risk exposures. The recommended model incorporates regulatory, information dissemination, and educational elements. (BH)

Adult Instructors' Perceptions on ICT and Diffusion Practices: Implications for Equity of Access

ERIC Educational Resources Information Center

Salinas-Amescua, Bertha

2007-01-01

This study suggests equity of access goes beyond technological availability. Based on a larger exploratory study of the initial implementation stage of the Mexican government's community technology centers, CTCs ("plazas comunitarias"), adult education instructors' perceptions and diffusion practices are described as a mediating factor…

Revisiting Educational Equity and Quality in China through Confucianism, Policy, Research, and Practice

ERIC Educational Resources Information Center

Mu, Guanglun Michael; Zheng, Xinrong; Jia, Ning; Li, Xiaohua; Wang, Shaoyi; Chen, Yanchuan; He, Ying; May, Lyn; Carter, Merilyn; Dooley, Karen; Berwick, Adon; Sobyra, Angela; Diezmann, Carmel

2013-01-01

The promotion of educational equity and improvement of educational quality in China are contextualised in tenets of Confucianism and policy directives, inspiring educational research and practice. In this paper, we first explore the historical and cultural roots of educational equity and quality through Confucianism and elaborate on the current…

Community Member and Stakeholder Perspectives on a Healthy Environment Initiative in North Carolina

PubMed Central

Lowe-Wilson, Abby; Mouw, Mary Sherwyn; Jeon, Janet Yewon; Baber, Ceola Ross; Vu, Maihan B.; Bethell, Monique

2015-01-01

Introduction The North Carolina Community Transformation Grant Project (NC-CTG) aimed to implement policy, system, and environmental strategies to promote healthy eating, active living, tobacco-free living, and clinical and community preventive services to advance health equity and reduce health disparities for the state’s most vulnerable communities. This article presents findings from the Health Equity Collaborative Evaluation and Implementation Project, which assessed community and stakeholder perceptions of health equity for 3 NC-CTG strategies: farmers markets, shared use, and smoke-free multiunit housing. Methods In a triangulated qualitative evaluation, 6 photo elicitation (PE) sessions among 45 community members in 1 urban and 3 rural counties and key informant interviews among 22 stakeholders were conducted. Nine participants from the PE sessions and key informant interviews in the urban county subsequently participated in a stakeholder power analysis and mapping session (SPA) to discuss and identify people and organizations in their community perceived to be influential in addressing health equity–related issues. Results Evaluations of the PE sessions and key informant interviews indicated that access (convenience, cost, safety, and awareness of products and services) and community fit (community-defined quality, safety, values, and norms) were important constructs across the strategies. The SPA identified specific community- and faith-based organizations, health care organizations, and local government agencies as key stakeholders for future efforts. Conclusions Both community fit and access are essential constructs for promoting health equity. Findings demonstrate the feasibility of and need for formative research that engages community members and local stakeholders to shape context-specific, culturally relevant health promotion strategies. PMID:26270741

Spatial Equity in Trans Jogja Performance in the Yogyakarta Urbanized Area (YUA)

NASA Astrophysics Data System (ADS)

Ramadhani, D. P.; Herwangi, Y.

2018-05-01

The availability of facilities and supporting infrastructure in a region is an absolutely necessity. Public transportation is important in accommodating the movement of low-income groups or captive users who have limited mobility options. However, most of the low-income people in the Yogyakarta Urbanized Area (YUA) currently prefer to use motorcycles rather than Trans Jogja. This is expected to be caused by the poor quality of public transport and the lack of equity in Trans Jogja services. This research focuses on transport equity by overlaying the effectiveness of Trans Jogja as the public transportation and the distribution of low-income communities per sub-district in the YUA. This study found that the performance of Trans Jogja based on the indicators of affordability, availability, accessibility, and acceptability is already effective. However, in the agglomeration of Sleman and Bantul Regency, the affordability aspect is still less effective. Meanwhile, the appraisal of the public transport equity found that there are some areas that are fair, with a large low-income population and effective performance of Trans Jogja. Some other areas are considered unfair because the low-income population is high but the performance of Trans Jogja is less effective.

Socioeconomic Inequalities in Green Space Quality and Accessibility-Evidence from a Southern European City.

PubMed

Hoffimann, Elaine; Barros, Henrique; Ribeiro, Ana Isabel

2017-08-15

Background : The provision of green spaces is an important health promotion strategy to encourage physical activity and to improve population health. Green space provision has to be based on the principle of equity. This study investigated the presence of socioeconomic inequalities in geographic accessibility and quality of green spaces across Porto neighbourhoods (Portugal). Methods : Accessibility was evaluated using a Geographic Information System and all the green spaces were audited using the Public Open Space Tool. Kendall's tau-b correlation coefficients and ordinal regression were used to test whether socioeconomic differences in green space quality and accessibility were statistically significant. Results : Although the majority of the neighbourhoods had an accessible green space, mean distance to green space increased with neighbourhood deprivation. Additionally, green spaces in the more deprived neighbourhoods presented significantly more safety concerns, signs of damage, lack of equipment to engage in active leisure activities, and had significantly less amenities such as seating, toilets, cafés, etc. Conclusions : Residents from low socioeconomic positions seem to suffer from a double jeopardy; they lack both individual and community resources. Our results have important planning implications and might contribute to understanding why deprived communities have lower physical activity levels and poorer health.

India of Ideas: Mapping the Status of Higher Education in India and Mobilizing Discourse towards a Quest for Equity and Excellence

ERIC Educational Resources Information Center

Kuriakose, Francis; Iyer, Deepa Kylasam

2016-01-01

The problems, policies and debates on the quality and access of research cannot be decoupled from higher education in an educational system like that of India where the impact of primary, secondary and higher education is sequential. The article traces the idea of education from the early Greek and Indian philosophers, the university tradition of…

Evaluation of Education Programs Developed by the Public and Private Alliance between the Coffee Growers Committee of Caldas and the State Government of Caldas, Colombia. Final Report

ERIC Educational Resources Information Center

Moore, Audrey-Marie Schuh; Florez, Ana; Grajeda, Eva

2010-01-01

This evaluation of progress in tackling the problems of access, quality, equity and completion of primary and secondary education examines the results of an alliance between the Coffee Growers Committee of Caldas (CGC) and the Department of Caldas, Colombia. The evaluation team employed a retrospective approach to understanding the social,…

Equity of access to maternal health interventions in Brazil and Colombia: a retrospective study.

PubMed

De La Torre, Amaila; Nikoloski, Zlatko; Mossialos, Elias

2018-04-11

Reducing maternal mortality is a top priority in Latin American countries. Despite the progress in maternal mortality reduction, Brazil and Colombia still lag behind countries at similar levels of development. Using data from the Demographic Health Survey, this study quantified and compared, by means of concentration indices, the socioeconomic-related inequity in access to four key maternal health interventions in Brazil and Colombia. Decomposition analysis of the concentration index was used for two indicators - skilled attendance at birth and postnatal care in Brazil. Coverage levels of the four key maternal health interventions were similar in the two countries. More specifically, we found that coverage of some of the interventions (e.g. ante-natal care and skilled birth assistance) was higher than 90% in both countries. Nevertheless, the concentration index analysis pointed to significant pro-rich inequities in access in all four key interventions in both countries. Interestingly, the analysis showed that Colombia fared slightly better than Brazil in terms of equity in access of the interventions studied. Finally, the decomposition analysis for the presence of a skilled attendant at birth and postnatal care in Brazil underlined the significance of regional disparities, wealth inequalities, inequalities in access to private hospitals, and inequalities in access to private health insurance. There are persistent pro-rich inequities in access to four maternal health interventions in both Brazil and Colombia. The decomposition analysis conducted on Brazilian data suggests the existence of disparities in system capacity and quality of care between the private and the public health services, resulting in inequities of access to maternal health services.

The Impact of Clinical Social Franchising on Health Services in Low- and Middle-Income Countries: A Systematic Review

PubMed Central

Beyeler, Naomi; York De La Cruz, Anna; Montagu, Dominic

2013-01-01

Background The private sector plays a large role in health services delivery in low- and middle-income countries; yet significant gaps remain in the quality and accessibility of private sector services. Clinical social franchising, which applies the commercial franchising model to achieve social goals and improve health care, is increasingly used in developing countries to respond to these limitations. Despite the growth of this approach, limited evidence documents the effect of social franchising on improving health care quality and access. Objectives and Methods We examined peer-reviewed and grey literature to evaluate the effect of social franchising on health care quality, equity, cost-effectiveness, and health outcomes. We included all studies of clinical social franchise programs located in low- and middle-income countries. We assessed study bias using the WHO-Johns Hopkins Rigour Scale and used narrative synthesis to evaluate the findings. Results Of 113 identified articles, 23 were included in this review; these evaluated a small sample of franchises globally and focused on reproductive health franchises. Results varied widely across outcomes and programs. Social franchising was positively associated with increased client volume and client satisfaction. The findings on health care utilization and health impact were mixed; some studies find that franchises significantly outperform other models of health care, while others show franchises are equivalent to or worse than other private or public clinics. In two areas, cost-effectiveness and equity, social franchises were generally found to have poorer outcomes. Conclusions Our review indicates that social franchising may strengthen some elements of private sector health care. However, gaps in the evidence remain. Additional research should include: further documentation of the effect of social franchising, evaluating the equity and cost-effectiveness of this intervention, and assessing the role of franchising within the context of the greater healthcare delivery system. PMID:23637757

Horizontal equity and efficiency at primary health care facilities in rural Afghanistan: a seemingly unrelated regression approach.

PubMed

Johns, Benjamin; Steinhardt, Laura; Walker, Damian G; Peters, David H; Bishai, David

2013-07-01

Producing services efficiently and equitably are important goals for health systems. Many countries pursue horizontal equity - providing people with the same illnesses equal access to health services - by locating facilities in remote areas. Staff are often paid incentives to work at such facilities. However, there is little evidence on how many fewer people are treated at remote facilities than facilities in more densely settled areas. This research explores if there is an association between the efficiency of health centers in Afghanistan and the remoteness of their location. Survey teams collected data on facility level inputs and outputs at a stratified random sample of 579 health centers in 2005. Quality of care was measured by observing staff interact with patients and determining if staff completed a set of normative patient care tasks. We used seemingly unrelated regression to determine if facilities in remote areas have fewer outpatient visits than other rural facilities. In this analysis, one equation compares the number of outpatient visits to facility inputs, while another compares quality of care to determinants of quality. The results indicate remote facilities have about 13% fewer outpatient visits than non-remote facilities, holding inputs constant. Our analysis suggests that facilities in remote areas are realizing horizontal equity since their clients are receiving comparable quality of care to those at non-remote facilities. However, we find the average labor cost for a visit at a remote facility is $1.44, but only $0.97 at other rural facilities, indicating that a visit in a remote facility would have to be 'worth' 1.49 times a visit at a rural facility for there to be no equity - efficiency trade-off. In determining where to build or staff health centers, this loss of efficiency may be offset by progress toward a social policy objective of providing services to disadvantaged rural populations. Copyright © 2013 Elsevier Ltd. All rights reserved.

Inequalities in public health care delivery in Zambia

PubMed Central

2014-01-01

Background Access to adequate health services that is of acceptable quality is important in the move towards universal health coverage. However, previous studies have revealed inequities in health care utilisation in the favour of the rich. Further, those with the greatest need for health services are not getting a fair share. In Zambia, though equity in access is extolled in government documents, there is evidence suggesting that those needing health services are not receiving their fair share. This study seeks therefore, to assess if socioeconomic related inequalities/inequities in public health service utilisation in Zambia still persist. Methods The 2010 nationally representative Zambia Living Conditions and Monitoring Survey data are used. Inequality is assessed using concentration curves and concentrations indices while inequity is assessed using a horizontal equity index: an index of inequity across socioeconomic status groups, based on standardizing health service utilisation for health care need. Public health services considered include public health post visits, public clinic visits, public hospital visits and total public facility visits. Results There is evidence of pro-poor inequality in public primary health care utilisation but a pro-rich inequality in hospital visits. The concentration indices for public health post visits and public clinic visits are −0.28 and −0.09 respectively while that of public hospitals is 0.06. After controlling for need, the pro-poor distribution is maintained at primary facilities and with a pro-rich distribution at hospitals. The horizontal equity indices for health post and clinic are estimated at −0.23 and −0.04 respectively while that of public hospitals is estimated at 0.11. A pro-rich inequity is observed when all the public facilities are combined (horizontal equity index = 0.01) though statistically insignificant. Conclusion The results of the paper point to areas of focus in ensuring equitable access to health services especially for the poor and needy. This includes strengthening primary facilities that serve the poor and reducing access barriers to ensure that health care utilisation at higher-level facilities is distributed in accordance with need for it. These initiatives may well reduce the observed inequities and accelerate the move towards universal health coverage in Zambia. PMID:24645826

The impact of rural hospital closures on equity of commuting time for haemodialysis patients: simulation analysis using the capacity-distance model.

PubMed

Matsumoto, Masatoshi; Ogawa, Takahiko; Kashima, Saori; Takeuchi, Keisuke

2012-07-23

Frequent and long-term commuting is a requirement for dialysis patients. Accessibility thus affects their quality of lives. In this paper, a new model for accessibility measurement is proposed in which both geographic distance and facility capacity are taken into account. Simulation of closure of rural facilities and that of capacity transfer between urban and rural facilities are conducted to evaluate the impacts of these phenomena on equity of accessibility among dialysis patients. Post code information as of August 2011 of all the 7,374 patients certified by municipalities of Hiroshima prefecture as having first or third grade renal disability were collected. Information on post code and the maximum number of outpatients (capacity) of all the 98 dialysis facilities were also collected. Using geographic information systems, patient commuting times were calculated in two models: one that takes into account road distance (distance model), and the other that takes into account both the road distance and facility capacity (capacity-distance model). Simulations of closures of rural and urban facilities were then conducted. The median commuting time among rural patients was more than twice as long as that among urban patients (15 versus 7 minutes, p<0.001). In the capacity-distance model 36.1% of patients commuted to the facilities which were different from the facilities in the distance model, creating a substantial gap of commuting time between the two models. In the simulation, when five rural public facilitiess were closed, Gini coefficient of commuting times among the patients increased by 16%, indicating a substantial worsening of equity, and the number of patients with commuting times longer than 90 minutes increased by 72 times. In contrast, closure of four urban public facilities with similar capacities did not affect these values. Closures of dialysis facilities in rural areas have a substantially larger impact on equity of commuting times among dialysis patients than closures of urban facilities. The accessibility simulations using the capacity-distance model will provide an analytic framework upon which rational resource distribution policies might be planned.

The impact of rural hospital closures on equity of commuting time for haemodialysis patients: simulation analysis using the capacity-distance model

PubMed Central

2012-01-01

Background Frequent and long-term commuting is a requirement for dialysis patients. Accessibility thus affects their quality of lives. In this paper, a new model for accessibility measurement is proposed in which both geographic distance and facility capacity are taken into account. Simulation of closure of rural facilities and that of capacity transfer between urban and rural facilities are conducted to evaluate the impacts of these phenomena on equity of accessibility among dialysis patients. Methods Post code information as of August 2011 of all the 7,374 patients certified by municipalities of Hiroshima prefecture as having first or third grade renal disability were collected. Information on post code and the maximum number of outpatients (capacity) of all the 98 dialysis facilities were also collected. Using geographic information systems, patient commuting times were calculated in two models: one that takes into account road distance (distance model), and the other that takes into account both the road distance and facility capacity (capacity-distance model). Simulations of closures of rural and urban facilities were then conducted. Results The median commuting time among rural patients was more than twice as long as that among urban patients (15 versus 7 minutes, p < 0.001). In the capacity-distance model 36.1% of patients commuted to the facilities which were different from the facilities in the distance model, creating a substantial gap of commuting time between the two models. In the simulation, when five rural public facilitiess were closed, Gini coefficient of commuting times among the patients increased by 16%, indicating a substantial worsening of equity, and the number of patients with commuting times longer than 90 minutes increased by 72 times. In contrast, closure of four urban public facilities with similar capacities did not affect these values. Conclusions Closures of dialysis facilities in rural areas have a substantially larger impact on equity of commuting times among dialysis patients than closures of urban facilities. The accessibility simulations using thecapacity-distance model will provide an analytic framework upon which rational resource distribution policies might be planned. PMID:22824294

The digital divide in public e-health: barriers to accessibility and privacy in state health department websites.

PubMed

West, Darrell M; Miller, Edward Alan

2006-08-01

State health departments have placed a tremendous amount of information, data, and services online in recent years. With the significant increase in online resources at official health sites, though, have come questions concerning equity of access and the confidentiality of electronic medical materials. This paper reports on an examination of public health department websites maintained by the 50 state governments. Using a content analysis of health department sites undertaken each year from 2000 to 2005, we investigate several dimensions of accessibility and privacy: readability levels, disability access, non-English accessibility, and the presence of privacy and security statements. We argue that although progress has been made at improving the accessibility and confidentiality of health department electronic resources, there remains much work to be done to ensure quality access for all Americans in the area of public e-health.

Continuing Professional Library and Information Science Education for Advancing Equity of Access.

ERIC Educational Resources Information Center

Roy, Loriene; Lee, Seung-ah

Equity of access is one of the American Library Association's (ALA's) five key action areas. Discussions of digital divide issues sometimes sound confusing and unfocused; however, the digital divide issue provides information professionals with the opportunity to discover more about their own skills and potential, to understand more about library…

Access, Equity, and Capacity in Asia-Pacific Higher Education. International and Development Education

ERIC Educational Resources Information Center

Neubauer, Deane, Ed.; Tanaka, Yoshiro, Ed.

2011-01-01

Access, equity and capacity are elements within the higher education environment that interact in complex ways to affect virtually all other aspects of such institutions. This volume examines various features of how these concepts are generated, transformed throughout policy environments, and deployed across the complex differences of higher…

Equity Audit: Focusing on Distance Education Students and Students with Individualized Educational Plans

ERIC Educational Resources Information Center

Dupree, Almecia

2016-01-01

Problem: Many inequities frequently have been found to exist in representations of students and access to school programs in public schools. Theory: The purpose of this equity audit is to utilize theoretical positioning and conduct an empirical study involving student representations and access to educational opportunities. The audit focuses on…

Incorporating Access to More Effective Teachers into Assessments of Educational Resource Equity

ERIC Educational Resources Information Center

Bastian, Kevin C.; Henry, Gary T.; Thompson, Charles L.

2013-01-01

To address gaps in achievement between more- and less-affluent students, states and districts need to ensure that high-poverty students and schools have equitable access to educational resources. Traditionally, assessments of resource equity have focused on per-pupil expenditures and more proximal inputs, such as teacher credentials and class…

The prospects of the domestic water equity indicators in Indonesia: a review

NASA Astrophysics Data System (ADS)

Nastiti, A.; Komarulzaman, A.; Sudradjat, A.

2018-01-01

Despite the major progress achieved by the domestic water supply sector since the commencement of the Millennium Development Goals (MDGs), there is still a concern that access towards water does not distribute evenly among citizens in different geographical areas or diverse economic groups. The Sustainable Development Goals (SDGs) strive for a universal water target that highlights the sustainable access to safe and affordable water supply for all. Hence, the ensuing challenge is how to comprehensively report the progress of achieving water equity in relation to the SDGs target. This paper reviews the current research and policy papers on equity metrics in the water supply sector. This study has identified that water inequity may manifest in the variations of the level of access, the dimensions of access, and the impacts of poor water supply—spatially, socially, economically, or the combination thereof. This paper also presents challenges related to the application of equity measurements in the context of Indonesia. The results will be useful in designing appropriate tool to inform decision making in water sector policy.

Measuring and monitoring equity in access to deceased donor kidney transplantation.

PubMed

Stewart, D E; Wilk, A R; Toll, A E; Harper, A M; Lehman, R R; Robinson, A M; Noreen, S A; Edwards, E B; Klassen, D K

2018-05-07

The Organ Procurement and Transplantation Network monitors progress toward strategic goals such as increasing the number of transplants and improving waitlisted patient, living donor, and transplant recipient outcomes. However, a methodology for assessing system performance in providing equity in access to transplants was lacking. We present a novel approach for quantifying the degree of disparity in access to deceased donor kidney transplants among waitlisted patients and determine which factors are most associated with disparities. A Poisson rate regression model was built for each of 29 quarterly, period-prevalent cohorts (January 1, 2010-March 31, 2017; 5 years pre-kidney allocation system [KAS], 2 years post-KAS) of active kidney waiting list registrations. Inequity was quantified as the outlier-robust standard deviation (SD w ) of predicted transplant rates (log scale) among registrations, after "discounting" for intentional, policy-induced disparities (eg, pediatric priority) by holding such factors constant. The overall SD w declined by 40% after KAS implementation, suggesting substantially increased equity. Risk-adjusted, factor-specific disparities were measured with the SD w after holding all other factors constant. Disparities associated with calculated panel-reactive antibodies decreased sharply. Donor service area was the factor most associated with access disparities post-KAS. This methodology will help the transplant community evaluate tradeoffs between equity and utility-centric goals when considering new policies and help monitor equity in access as policies change. © 2018 The American Society of Transplantation and the American Society of Transplant Surgeons.

Experiences of adult patients using primary care services in Poland - a cross-sectional study in QUALICOPC study framework.

PubMed

Oleszczyk, Marek; Krztoń-Królewiecka, Anna; Schäfer, Willemijn L A; Boerma, Wienke G W; Windak, Adam

2017-11-22

Patients as real healthcare system users are important observers of primary care and are able to provide reliable information about the quality of care. The aim of this study was to explore the patients' experiences and their level of satisfaction with the process and outcomes of care provided by primary care physicians in Poland and to identify the characteristics of the patients, their physicians, and facilities associated with patient satisfaction. The study is based on data from the Polish part of the Quality and Costs of Primary Care in Europe (QUALICOPC) cross-sectional, questionnaire-based study. In Poland, a nationally representative sample of 220 PC physicians and 1980 of their patients were recruited to take part in the study. As a study tool we used 3 out of 4 QUALICOPC questionnaires: "Patient Experience", "PC Physician" and "Fieldworker" questionnaires. The areas of the best quality perceived by Polish PC patients are: equity, accessibility of care and quality of service. Coordination and comprehensiveness of care are evaluated relatively worse. The patients' and their physicians' characteristics have a limited influence on patient satisfaction and experiences with Polish primary care. Primary health care in Poland is of good overall quality as perceived by the patients. Study participants were at most satisfied with accessibility and equity of care and less satisfied with coordination and comprehensiveness of care. Longer patient-doctor relationship and older age of patients were found as the most influential determinants of higher satisfaction. However, variables used in this study poorly explain the overall level of satisfaction. Further research is needed to identify the other determinants of patient satisfaction in the Polish population. Rural practices deserve additional attention due to highest proportions of both extremely satisfied and dissatisfied patients.

What does equity in health mean?

PubMed

Mooney, G

1987-01-01

The author posits some ethical concerns and theories of distribution in order to gain some insight into the meaning of equity in health, as referred to in WHO documents. It is pointed out that the lack of clarity in the WHO positions is evidenced by examining 1) the European strategy document, which focuses on giving equal health to all and equity access to health care, and 2) the Global Strategy for Health, which talks about reducing inequality and health as a human right. The question raised in document 1 is whether more equal sharing of health might mean less health for the available quantity of resources. The question raised in document 2 is whether there is a right to health per se. The question is how does one measure health policy effects. Health effects are different for an 8-year-old girl and an octogenarian. How does one measure the fairness of access to health care in remote mountain villages versus an urban area? Is equal utilization which is more easily measured comparable to equal need as a measure? How does one distribute doctors equitably? The author espouses the determinant of health as Aday's illness and health promotion, which is not biased by class and controversy. The Aday definition embraces both demand and need, although his definition is still open to question. Concepts of health with distinction between need and demand are made. Theories of Veatch which relate to distributive justice and equity in health care are provided as entitlement theory (market forces determine allocation of resources), utilitarianism (greatest good for the greatest number regardless of redistribution issues), maximum theory (maximize the minimum position or giver priority to the least well off), and equality (fairness in distribution). Different organizational and financing structures will influence the approach to equity. The conclusion is that equity is a value laden concept which has no uniquely correct definition. 5 theories of equity in distribution of health resources are discussed: 1) a theory of maximum (Rawl's theory modified to include health care institutions providing opportunity as the social good), 2) altruism as a basis for equity (Titmuss' Kantian view of national responsibility to provide equitable service delivery altruistically or equal access), 3) a fair share theory of distribution (Margolis' process utility theory of doing one's fair share or equality of access for equal need, 4) commitment to equity (Sen's focus on sympathy and commitment to another's ill health status and access), and 5) equity as externality (Culyer's health care consumption where government determines the merit good or extent of consumption). If policy objectives are not clear and the definitions muddy, resources may be badly wasted or misdirected and the pursuit of equity unfulfilled, even though there is agreement in principle.

Designing and Evaluating Interventions to Eliminate Racial and Ethnic Disparities in Health Care

PubMed Central

Cooper, Lisa A; Hill, Martha N; Powe, Neil R

2002-01-01

A large number of factors contribute to racial and ethnic disparities in health status. Health care professionals, researchers, and policymakers have believed for some time that access to care is the centerpiece in the elimination of these health disparities. The Institute of Medicine's (IOM) model of access to health services includes personal, financial, and structural barriers, health service utilization, and mediators of care. This model can be used to describe the interactions among these factors and their impact on health outcomes and equity of services among racial and ethnic groups. We present a modified version of the IOM model that incorporates the features of other access models and highlights barriers and mediators that are relevant for interventions designed to eliminate disparities in U.S. health care. We also suggest that interventions to eliminate disparities and achieve equity in health care services be considered within the broader context of improving quality of care. Some health service intervention studies have shown improvements in the health of disadvantaged groups. If properly designed and implemented, these interventions could be used to reduce health disparities. Successful features of interventions include the use of multifaceted, intense approaches, culturally and linguistically appropriate methods, improved access to care, tailoring, the establishment of partnerships with stakeholders, and community involvement. However, in order to be effective in reducing disparities in health care and health status, important limitations of previous studies need to be addressed, including the lack of control groups, nonrandom assignment of subjects to experimental interventions, and use of health outcome measures that are not validated. Interventions might be improved by targeting high-risk populations, focusing on the most important contributing factors, including measures of appropriateness and quality of care and health outcomes, and prioritizing dissemination efforts. PMID:12133164

Seven Years of Gender Equity: Building California's Workforce.

ERIC Educational Resources Information Center

California Community Colleges, Sacramento. Office of the Chancellor.

Since 1984, the Gender Equity and Civil Rights specialist of the Chancellor's Office of the California Community Colleges (CCC) has led the colleges in the strategic development of statewide and college-based Gender Equity, Single Parent, Displaced Homemaker, and Single Pregnant Woman programs designed to improve access and eliminate barriers to…

April Spotlight: National Minority Health Month

Cancer.gov

Each April, we recognize National Minority Health Month (NMHM) because of its direct relevance to us at the National Cancer Institute’s Center to Reduce Cancer Health Disparities (NCI CRCHD). This year’s NMHM theme, Partnering for Health Equity, brings attention to the need for individuals, institutions, and communities to work together to address social determinants of health, including those related to access to educational, economic, and job opportunities and the quality of education and job training.

Access and Equity: California Master Plan for Higher Education and Disadvantaged Student Success

ERIC Educational Resources Information Center

Davis, Kevin P.

2015-01-01

The California Master Plan for Higher Education sets a policy objective of equity through access to higher education. The California State University system is California's primary institution for providing the social mobility that accompanies a four-year college degree. The purpose of this study is to examine the education lifecycle outcomes for…

Equity in Access to Health Promotion and Risk Reduction Services: Implications for Elder Health.

ERIC Educational Resources Information Center

Smith, Nancy H.; Howze, Elizabeth Harper

Although there is a national emphasis on health promotion and preventive practices, questions remain regarding the equity of access to these services by low income and minority groups, and the implications of inequities for elder health. Data from a systematic survey of 500 public and private providers of health promotion services in northern…

Cultivating Equity and Access: Focus on Men in Dance

ERIC Educational Resources Information Center

McGreevy-Nichols, Susan; Dooling-Cain, Shannon

2017-01-01

This year, the National Dance Education Organization (NDEO) is taking a special look at the questions of equity and access in the field of dance education. The Decade of Dance Education (2015-2025), NDEO's ten-year campaign designed to raise the profile of dance education in the arts, provides a unique opportunity to examine their commitment to…

Equity in Informal Science Education: Developing an Access and Equity Framework for Science Museums and Science Centres

ERIC Educational Resources Information Center

Dawson, Emily

2014-01-01

Informal science education (ISE) is a popular pursuit, with millions of people visiting science museums, science centres, zoos, botanic gardens, aquaria, science festivals and more around the world. Questions remain, however, about how accessible and inclusive ISE practices are. This article reviews research on participation in ISE through the…

Social Justice in Chinese Higher Education: Regional Issues of Equity and Access

ERIC Educational Resources Information Center

Jacob, W. James

2006-01-01

A topic of growing concern in Chinese higher education to policy-makers, scholars, and future student applicants is social justice. With the trend toward increasing enrollments in China's higher-education institutions, issues of equity and access have begun to surface, especially as they relate to China's minority population of over 100 million…

Equity and Computers for Mathematics Learning: Access and Attitudes

ERIC Educational Resources Information Center

Forgasz, Helen J.

2004-01-01

Equity and computer use for secondary mathematics learning was the focus of a three year study. In 2003, a survey was administered to a large sample of grade 7-10 students. Some of the survey items were aimed at determining home access to and ownership of computers, and students' attitudes to mathematics, computers, and computer use for…

Accessibility: global gateway to health literacy.

PubMed

Perlow, Ellen

2010-01-01

Health literacy, cited as essential to achieving Healthy People 2010's goals to "increase quality and years of healthy life" and to "eliminate health disparities," is defined by Healthy People as "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions." Accessibility, by definition, the aforementioned "capacity to obtain," thus is health literacy's primary prerequisite. Accessibility's designation as the global gateway to health literacy is predicated also on life's realities: global aging and climate change, war and terrorism, and life-extending medical and technological advances. People with diverse access needs are health professionals' raison d'être. However, accessibility, consummately cross-cultural and universal, is virtually absent as a topic of health promotion and practice research and scholarly discussion of health literacy and equity. A call to action to place accessibility in its rightful premier position on the profession's agenda is issued.

[Spending and financing in health care: situation and trends].

PubMed

Molina, R; Pinto, M; Henderson, P; Vieira, C

2000-01-01

Being knowledgeable about national health expenditures and sources of financing is essential for decision-making. This awareness also makes it possible to evaluate the equity of allocation and the efficiency of utilization of these resources. Changes in financing have been a substantial component of health sector reform in the Americas. The goal has shifted from merely one of financial sustainability to simultaneously seeking equitable access to quality services. In this article the Pan American Health Organization (PAHO) presents a proposal for analyzing and designing a policy on health financing. The aim of the policy is to identify the mix of financing mechanisms most likely to simultaneously produce financial sustainability, equity, access, and efficiency. The PAHO proposal combines traditional mechanisms for generating resources (public funds from taxes, as well as private health insurance, national health insurance, and user fees) with complementary subsidy mechanisms for vulnerable groups. Health financing strategies ought to explicitly consider the financing both of care for individuals and of health interventions for the general public good, for which public financing is the most equitable and efficient approach.

Learning Equity in a University Classroom

ERIC Educational Resources Information Center

van der Westhuizen, G. J.

2012-01-01

Since 1994, education policy documents in South Africa have prioritised the goal of equity in education, understood as increased access to programmes, more equitable staff and student profiles, and curricula that are more responsive to the needs of all students. The challenge of effecting the goal of equity at levels of teaching and learning in…

Building Equity in the Birth-to-3 System: Who Is in the Room?

ERIC Educational Resources Information Center

Harris, Wendy; Horn, Benita Rodriguez; Tripp, Susan; Yasui, Barbara

2016-01-01

The Birth-to-Three Equity Initiative launched in April 2015 as a multiyear systems change process to strengthen equitable access, services, and child and family outcomes in the "early intervention" system in Martin Luther King County, Washington. This article describes the training of agency leaders and "equity facilitators"…

Implications of Financing Higher Education for Access and Equity: The Case of Syria

ERIC Educational Resources Information Center

Kabbani, Nader; Salloum, Siba

2011-01-01

This article examines the implications for access and equity of the Syrian government's efforts to reform higher education in the country over the past decade. In the context of social and economic reforms that are moving the county from a state-controlled to a social market economy, it focuses on adequacy in financing higher education, as well as…

Access, Equity, and Community Colleges: The Truman Commission and Federal Higher Education Policy from 1947 To 2011

ERIC Educational Resources Information Center

Gilbert, Claire Krendl; Heller, Donald E.

2013-01-01

The 1947 President's Commission on Higher Education offers insight into higher education policy in the United States. This article reviews and assesses the adoption of its policy recommendations in two key areas: 1) improving college access and equity and 2) expanding the role of community colleges. (Contains 1 figure and 4 notes.)

Equity and Access to Higher Education in the Context of Educational Expansion and Differentiation in China

ERIC Educational Resources Information Center

Jia, Qiong

2013-01-01

Internationally, higher education has expanded greatly since the closing decades of the twentieth century. China was no exception. This study is intended to examine the status quo of issues relating to equity and access to higher education in the context of educational expansion and differentiation in China. Two research questions are addressed in…

Exploring Access and Equity in Higher Education: Policy and Performance in a Comparative Perspective

ERIC Educational Resources Information Center

Clancy, Patrick; Goastellec, Gaele

2007-01-01

A comparative analysis of how access and equity are defined and how policies have evolved reveals a number of commonalities and differences between countries. The overall trend is a movement from the priority given to "inherited merit" in the admission process through a commitment to formal equality, towards the application of some modes of…

Educational Equity in the Access to Post-Secondary Education: A Comparison of Ethnic Minorities in China with Aboriginals in Canada

ERIC Educational Resources Information Center

Wang, Fei

2013-01-01

This study provides insight into equity issues in post-secondary education by exploring and assessing the history, the reality and the potential developments in higher education for minority students in China, in comparison to post-secondary education for aboriginal students in Canada. It highlights access to post-secondary education by these…

Access and Equity for All Students: Meeting the Needs of LGBT Students. Report 09-14

ERIC Educational Resources Information Center

Angeli, Mallory

2009-01-01

Access and equity for all students in California colleges and universities is a high priority of the California Postsecondary Education Commission. Over the past year, CPEC staff have reviewed research, collected data, convened an advisory committee, and hosted a panel of experts, students, and advocates on the issues faced by lesbian, gay,…

Impact of regulation of Community Pharmacies on efficiency, access and equity. Evidence from the UK and Spain.

PubMed

Lluch, Maria; Kanavos, Panos

2010-05-01

In this paper, we focus on regulatory restrictions on Community Pharmacies and whether these have an impact on efficiency, access and equity and thus in the delivery of services community pharmacists provide to patients. Primary data collection through semi-structured interviews and secondary data collection through literature review have been used with a particular focus on Spain (a country where Community Pharmacy is strictly regulated) and the UK (a country where Community Pharmacy is considered liberalised by EU standards). The findings indicate that improved pharmacy operational efficiency is the result of appropriate incentive structures, ownership liberalisation and OTC price freedom as is the case in the UK. Equity and access seem to be better achieved by establishing geographic, demographic or needs-based criteria to open new pharmacies (as is the case in Spain). In sum, there are useful lessons for both countries: the UK could look into the policies applied in Spain that increase access and equity whilst Spain could adopt some of the policies from the UK to increase efficiency in the system. Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.

ESHRE Task Force on Ethics and Law 14: equity of access to assisted reproductive technology.

PubMed

Pennings, G; de Wert, G; Shenfield, F; Cohen, J; Tarlatzis, B; Devroey, P

2008-04-01

Justice and access are among the most urgent questions for medically assisted reproduction. This paper analyses this question not only for people suffering from infertility, but also for people who need assistance to prevent the birth of a child with a specific genetic disorder. Based on the impact of not being able to have a child on the quality of life of a person, the position is defended that infertility treatment should be at least partially reimbursed. Simultaneously, the medical professionals have an obligation towards their patients and the health care system to bring down the costs as far as reasonably possible.

Value Organization Linkages, Educational Restructuring, and Historical Reforms.

ERIC Educational Resources Information Center

Wirt, Frederick M.

A century or more of reform in urban services, including schooling, has seen a competition over four core values: quality, equity, efficiency, and choice. These four are not always mutually compatible. Quality opposes equity and choice but is reinforced by efficiency, which is supported by equity. The choice value is incompatible with all the…

Equity in Science at South African Schools: A pious platitude or an achievable goal?

NASA Astrophysics Data System (ADS)

Dewnarain Ramnarain, Umesh

2011-07-01

The apartheid policies in South Africa had a marked influence on the accessibility and quality of school science experienced by the different race groups. African learners in particular were seriously disadvantaged in this regard. The issues of equity and redress were foremost in transformation of the education system, and the accompanying curriculum reform. This paper reports on equity in terms of equality of outputs and equality of inputs in South African school science, with a particular focus on the implementation of practical science investigations. This was a qualitative case study of two teachers on their implementation of science investigations at two schools, one a township school, previously designated for black children, and the other a former Model C school, previously reserved for white children. My study was guided by the curriculum implementation framework by Rogan and Grayson in trying to understand the practice of these teachers at schools located in contextually diverse communities. The framework helped profile the implementation of science investigations and also enabled me to explore the factors which are able to support or hinder this implementation.

Designing at Scale: Lessons in Relevance, Quality, and Equity from ChangeScale, a Bay Area environmental education collaborative

NASA Astrophysics Data System (ADS)

Babcock, E.

2015-12-01

The best environmental education equips people with the know-how and drive to create healthy communities and a healthy planet. While there are many wonderful organizations providing environmental learning, ensuring quality, cultural relevance and equity of access remains an elusive goal--especially if environmental education organizations work in isolation. Organizations across 12 counties in the Bay Area have come together to create a different model. They have founded ChangeScale, a regional collaborative dedicated to providing high quality environmental education to hundreds of thousands of youth---by working together. ChangeScale's work involves setting up school district-level partnerships, providing technical assistance to local environmental education networks, and training environmental educators across the region. In this talk, the presenter, who is a founding member and steering committee chair for ChangeScale, will outline the challenges of working at a regional scale with dozens of organizations. She will share the processes ChangeScale has used to develop a business plan and build membership. She will conclude by sharing the short term and long term potential impacts of working collectively for environmental literacy in the Bay Area.

Equity in access to health care in a rural population in Malaysia: A cross-sectional study.

PubMed

Lim, Ka Keat; Sivasampu, Sheamini; Mahmud, Fatihah

2017-04-01

To examine the extent of equity in access to health care, their determinants and reasons of unmet need of a rural population in Malaysia. Exploratory cross-sectional survey administered by trained interviewers among participants of a health screening program. A rural plantation estate in the West Coast of Peninsular Malaysia. One hundred and thirty out of 142 adults above 18 years old who attended the program. Percentages of respondents reporting realised access and unmet need to health care, determinants of both access indicators and reasons for unmet need. Realised access associated with need but not predisposing or enabling factors and unmet need not associated with any variables were considered equitable. A total of 88 (67.7%) respondents had visited a doctor (realised access) in the past 6 months and 24.8% (n = 31) experienced unmet need in the past 12 months. Using logistic regression, realised access was associated with presence of chronic disease (OR 6.97, P < 0.001), whereas unmet need was associated with low education level (OR 6.50, P < 0.05), 'poor' or 'fair' self-assessed health status (OR 6.03, P < 0.05) and highest income group (> RM 2000 per month) (OR 51.27, P < 0.05). Personal choice (67.7%) was more commonly expressed than barriers (54.8%) as reasons for unmet need. The study found equity in realised access and inequity in unmet need among the rural population, the latter associated with education level, subjective health status and income. Despite not being generalisable, the findings highlight the need for a national level study on equity in access before the country reforms its health system. © 2016 National Rural Health Alliance Inc.

Post-apartheid challenges: household access and use of health care in South Africa.

PubMed

Gilson, Lucy; McIntyre, Di

2007-01-01

Since 1994 the South African government has placed equity at the heart of its health policy goals. However, there has as yet been surprisingly little assessment of the success of policies in reducing inequity. This article provides insights on these issues by applying the Affordability Ladder conceptual framework in synthesizing evidence drawn from a series of household surveys and studies undertaken between 1992 and 2003. These data suggest that, despite policy efforts, inequities in access and utilization between socioeconomic groups remain. Underlying challenges include worsening community perceptions of the quality of publicly provided care and the influence of insurance status on utilization patterns. Further and more detailed evaluation of household-level policy impacts requires both improvements in the quality of South African survey data, particularly in enhancing consistency in survey design over time, and more detailed, focused studies.

The Political Is Personal: Measurement and Application of Nation-Level Indicators of Gender Equity in Psychological Research

ERIC Educational Resources Information Center

Else-Quest, Nicole M.; Grabe, Shelly

2012-01-01

Consistent with the dictum, "the personal is political," feminist scholars have maintained that gender equity in security, access to education, economic opportunity, and property ownership are central to women's well-being. Empirical research evaluating this thesis can include nation-level indicators of gender equity, such as the United Nation…

Conviction, Confrontation, and Risk in New Teachers' Advocating for Equity

ERIC Educational Resources Information Center

Athanases, Steven Z.; de Oliveira, Luciana C.

2007-01-01

Despite frustration with school constraints, new teachers who graduated from a program focused on advocacy for equity spoke for students in need in school forums and spoke up about issues of equity. Speaking for students, driven by convictions about equitable access to resources and a responsibility to act, often helped garner support and affected…

Access and Equity in Financing Higher Education: The Case of Morocco

ERIC Educational Resources Information Center

Bougroum, Mohammed; Ibourk, Aomar

2011-01-01

This paper explores the higher education financing policy in Morocco in light of the central issue of equity. First, it surveys the current situation, using a critical approach to the present financing policy, and looking at the three dimensions of adequacy, efficiency, and equity. Second, it describes the principal policy challenges in financing…

Social equity, mobility, and access.

DOT National Transportation Integrated Search

2014-03-01

This report discusses how transportation policies can aggravate or alleviate social equity problems. Current transit systems : (Detroit, Atlanta, Cleveland, Denver, and St. Louis) were studied with respect to their strategies and relative success in ...

Gender Equity Expert Panel: Exemplary & Promising Gender Equity Programs, 2000.

ERIC Educational Resources Information Center

Department of Education, Washington, DC.

The U.S. Department of Education developed the Gender Equity Expert Panel to identify promising and exemplary programs that promote gender equity in and through education. This panel of experts reviewed self-nominated programs to determine whether they met four criteria: evidence of success/effectiveness in promoting gender equity; quality of the…

Simple Solutions to Complex Problems: Moral Panic and the Fluid Shift from "Equity" to "Quality" in Education

ERIC Educational Resources Information Center

Mockler, Nicole

2014-01-01

Education is increasingly conceptualised by governments and policymakers in western democracies in terms of productivity and human capital, emphasising elements of individualism and competition over concerns around democracy and equity. More and more, solutions to intransigent educational problems related to equity are seen in terms of quality and…

Examining equity in access to long-lasting insecticide nets and artemisinin-based combination therapy in Anambra State, Nigeria.

PubMed

Mbachu, Chinyere O; Onwujekwe, Obinna E; Uzochukwu, Benjamin S C; Uchegbu, Eloka; Oranuba, Joseph; Ilika, Amobi L

2012-05-22

In order to achieve universal health coverage, the government of Anambra State, southeast Nigeria has distributed free Long-lasting Insecticide treated Nets (LLINs) to the general population and delivered free Artemisinin-based Combination Therapy (ACT) to pregnant women and children less than 5 years. However, the levels of coverage with LLINS and ACTs is not clear, especially coverage of different socio-economic status (SES) population groups. This study was carried out to determine the level of coverage and access to LLINs and ACTs amongst different SES groups. A questionnaire was used to collect data from randomly selected households in 19 local government areas of the State. Selected households had a pregnant woman and/or a child less than 5 years. The lot quality assurance sampling (LQAS) methodology was used in sampling. The questionnaire explored the availability and utilization of LLINs and ACTs from 2394 households. An asset-based SES index was used to examine the level of access of LLINS and ACTs to different SES quintiles. It was found that 80.5% of the households had an LLIN and 64.4% of the households stated that they actually used the nets the previous night. The findings showed that 42.3% of pregnant women who had fever within the past month received ACTs, while 37.5% of children<5 years old who had malaria in the past month had received ACTs. There was equity in ownership of nets for the range 1-5 nets per household. No significant SES difference was found in use of ACTs for treatment of malaria in children under five years old and in pregnant women. The free distribution of LLINs and ACTs increased household coverage of both malaria control interventions and bridged the equity gap in access to them among the most vulnerable groups.

Examining equity in access to long-lasting insecticide nets and artemisinin-based combination therapy in Anambra state, Nigeria

PubMed Central

2012-01-01

Background In order to achieve universal health coverage, the government of Anambra State, southeast Nigeria has distributed free Long-lasting Insecticide treated Nets (LLINs) to the general population and delivered free Artemisinin-based Combination Therapy (ACT) to pregnant women and children less than 5 years. However, the levels of coverage with LLINS and ACTs is not clear, especially coverage of different socio-economic status (SES) population groups. This study was carried out to determine the level of coverage and access to LLINs and ACTs amongst different SES groups. Methods A questionnaire was used to collect data from randomly selected households in 19 local government areas of the State. Selected households had a pregnant woman and/or a child less than 5 years. The lot quality assurance sampling (LQAS) methodology was used in sampling. The questionnaire explored the availability and utilization of LLINs and ACTs from 2394 households. An asset-based SES index was used to examine the level of access of LLINS and ACTs to different SES quintiles. Results It was found that 80.5 % of the households had an LLIN and 64.4 % of the households stated that they actually used the nets the previous night. The findings showed that 42.3 % of pregnant women who had fever within the past month received ACTs, while 37.5 % of children ≪5 years old who had malaria in the past month had received ACTs. There was equity in ownership of nets for the range 1–5 nets per household. No significant SES difference was found in use of ACTs for treatment of malaria in children under five years old and in pregnant women. Conclusions The free distribution of LLINs and ACTs increased household coverage of both malaria control interventions and bridged the equity gap in access to them among the most vulnerable groups. PMID:22545723

Equity in primary health care delivery: an examination of the cohesiveness of strategies relating to the primary healthcare system, the health workforce and hepatitis C.

PubMed

Scarborough, Jane; Eliott, Jaklin; Miller, Emma; Aylward, Paul

2015-04-01

To suggest ways of increasing the cohesiveness of national primary healthcare strategies and hepatitis C strategies, with the aim of ensuring that all these strategies include ways to address barriers and facilitators to access to primary healthcare and equity for people with hepatitis C. A critical review was conducted of the first national Primary Healthcare System Strategy and Health Workforce Strategy with the concurrent Hepatitis C Strategy. Content relating to provision of healthcare in private general practice was examined, focussing on issues around access and equity. In all strategies, achieving access to care and equity was framed around providing sufficient medical practitioners for particular locations. Equity statements were present in all policies but only the Hepatitis C Strategy identified discrimination as a barrier to equity. Approaches detailed in the Primary Healthcare System Strategy and Health Workforce Strategy regarding current resource allocation, needs assessment and general practitioner incentives were limited to groups defined within these documents and may not identify or meet the needs of people with hepatitis C. Actions in the primary healthcare system and health workforce strategies should be extended to additional groups beyond those listed as priority groups within the strategies. Future hepatitis C strategies should outline appropriate, detailed needs assessment methodologies and specify how actions in the broad strategies can be applied to benefit the primary healthcare needs of people with hepatitis C.

Intergenerational equity and long-term stewardship plans.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hocking, E. K.

2002-02-05

For an untold number of contaminated sites throughout the world, stewardship will be inevitable. For many such sites, stewardship will be a reasonable approach because of the uncertainties associated with present and future site conditions and site contaminants, the limited performance of available technologies, the nonavailability of technologies, and the risk and cost associated with complete cleanup. Regardless of whether stewardship is a realistic approach to site situations or simply a convenient default, it could be required at most contaminated sites for multiple generations. Because the stewardship plan is required to protect the release of hazardous contaminants to the environment,more » some use restrictions will be put in place to provide that protection. These use restrictions will limit access to resources for as long as the protection is required. The intergenerational quality of long-term stewardship plans and their inherent limitations on resource use require that they be designed to achieve equity among the affected generations. Intergenerational equity, defined here as the fairness of access to resources across generations, could be achieved through a well-developed stewardship plan that provides future generations with the information they need to make wise decisions about resource use. Developing and implementing such a plan would take into account the failure mechanisms of the plan's components, feature short stewardship time blocks that would allow for periodic reassessments of the site and of the stewardship program's performance, and provide present and future generations with necessary site information.« less

Finnish NGOs promoting health equity in the context of welfare economy.

PubMed

Rouvinen-Wilenius, Päivi; Ahokas, Jussi; Kiukas, Vertti; Aalto-Kallio, Mervi

2018-04-05

Health inequality is a national challenge in Finland. The WHO global strategy of Health for All implies that all people should have an equal opportunity to develop and maintain their health through fair and just access to health resources. This article examines the role of Finnish Non-Governmental Organizations (NGO) in strengthening the health equity. The article presents the strategy and specific criteria constructed by the NGOs to promote health equity in society. The health equity criteria and welfare economy strategy are combined to a framework which NGOs can utilize in their work to promote health equity. The welfare economy strategy describes the important issues that NGOs have to address when working towards a specific societal goal, in this case equity. The health equity criteria in turn are an instrument for the practical implementation of the preconditions of equity.

Education and Social Equity: With a Special Focus on Scheduled Castes and Scheduled Tribes in Elementary Education. CREATE Pathways to Access. Research Monograph No. 19

ERIC Educational Resources Information Center

Sedwal, Mona; Kamat, Sangeeta

2008-01-01

The Scheduled Castes (SCs, also known as Dalits) and Scheduled Tribes (STs, also known as Adivasis) are among the most socially and educationally disadvantaged groups in India. This paper examines issues concerning school access and equity for Scheduled Caste and Scheduled Tribe communities and also highlights their unique problems, which may…

Migrant women's perceptions of healthcare during pregnancy and early motherhood: addressing the social determinants of health.

PubMed

Almeida, Lígia Moreira; Casanova, Catarina; Caldas, José; Ayres-de-Campos, Diogo; Dias, Sónia

2014-08-01

Recent guidelines from the World Health Organization emphasize the need to monitor the social determinants of health, with particular focus on the most vulnerable groups. With this in mind, we evaluated the access, use and perceived quality of care received by migrant women during pregnancy and early motherhood, in a large urban area in northern Portugal. We performed semi-structured interviews in 25 recent mothers, contacted through welfare institutions, who had immigrated from Eastern European countries, Brazil, or Portuguese-speaking African countries. Six native-Portuguese women of equal economic status were also interviewed for comparison. Misinformation about legal rights and inadequate clarification during medical appointments frequently interacted with social determinants, such as low social-economic status, unemployment, and poor living conditions, to result in lower perceived quality of healthcare. Special attention needs to be given to the most vulnerable populations in order to improve healthcare. Challenges reside not only in assuring access, but also in promoting equity in the quality of care.

Tackling child health inequalities due to deprivation: using health equity audit to improve and monitor access to a community paediatric service.

PubMed

Maharaj, V; Rahman, F; Adamson, L

2014-03-01

Deprived children constitute a large population with high levels of ill health, and difficulty with access to healthcare contributes to their poor health outcomes. There is debate on how best to engage deprived families and the literature on differential access to paediatric care based on deprivation is limited. To demonstrate that community paediatrics can contribute to reduction of health inequalities by providing services that are accessible to and preferentially used by children whose health is likely to be affected by deprivation. To provide a template for others to improve and monitor equity in their services. Long-term service reconfiguration and health equity audit. We used routinely collected activity data and the Indices of Multiple Deprivation to construct equity profiles of the children using our service, and compared these with the profile of the population aged 0-16 years in the geographical area covered by the service. The new patient contact rate for the most deprived children in the population was more than three times that of the least deprived [odds ratio (OR) 3.29, 95% confidence interval (CI) 2.76-3.93]. Deprived children were more than twice as likely to require multi-agency meetings as part of their medical care (OR 2.28, 95% CI 1.94-2.69). Seventy per cent (3693/5312) of our total contacts were with children in the two most deprived quintiles. There was a marked socio-economic gradient in all types of contact. The model of care used by our community paediatric service successfully engages deprived families, thereby reducing health inequalities due to poor access. Key features are multi-agency working, removing barriers to access, raising staff awareness and use of health equity audit. Our findings provide support for tackling health inequalities via health services that are available to all, but capable of responding proportionately according to level of need, a model recently described as proportionate universalism. © 2012 John Wiley & Sons Ltd.

The Equity of Public Education Funding in Georgia, 1988-1996.

ERIC Educational Resources Information Center

Rubenstein, Ross; Doering, Dwight; Gess, Larry

2000-01-01

Employs school funding formulas enacted under Georgia's Quality Basic Education Act to explore changes in interdistrict equity over time. Regarding overall distribution of per-pupil resources across districts (horizontal equity) and for special- needs students (vertical equity), dispersion measures approach Odden and Picus' suggested equity…

Systematic development and implementation of interventions to OPtimise Health Literacy and Access (Ophelia).

PubMed

Beauchamp, Alison; Batterham, Roy W; Dodson, Sarity; Astbury, Brad; Elsworth, Gerald R; McPhee, Crystal; Jacobson, Jeanine; Buchbinder, Rachelle; Osborne, Richard H

2017-03-03

The need for healthcare strengthening to enhance equity is critical, requiring systematic approaches that focus on those experiencing lesser access and outcomes. This project developed and tested the Ophelia (OPtimising HEalth LIteracy and Access) approach for co-design of interventions to improve health literacy and equity of access. Eight principles guided this development: Outcomes focused; Equity driven, Needs diagnosis, Co-design, Driven by local wisdom, Sustainable, Responsive and Systematically applied. We report the application of the Ophelia process where proof-of-concept was defined as successful application of the principles. Nine sites were briefed on the aims of the project around health literacy, co-design and quality improvement. The sites were rural/metropolitan, small/large hospitals, community health centres or municipalities. Each site identified their own priorities for improvement; collected health literacy data using the Health Literacy Questionnaire (HLQ) within the identified priority groups; engaged staff in co-design workshops to generate ideas for improvement; developed program-logic models; and implemented their projects using Plan-Do-Study-Act (PDSA) cycles. Evaluation included assessment of impacts on organisations, practitioners and service users, and whether the principles were applied. Sites undertook co-design workshops involving discussion of service user needs informed by HLQ (n = 813) and interview data. Sites generated between 21 and 78 intervention ideas and then planned their selected interventions through program-logic models. Sites successfully implemented interventions and refined them progressively with PDSA cycles. Interventions generally involved one of four pathways: development of clinician skills and resources for health literacy, engagement of community volunteers to disseminate health promotion messages, direct impact on consumers' health literacy, and redesign of existing services. Evidence of application of the principles was found in all sites. The Ophelia approach guided identification of health literacy issues at each participating site and the development and implementation of locally appropriate solutions. The eight principles provided a framework that allowed flexible application of the Ophelia approach and generation of a diverse set of interventions. Changes were observed at organisational, staff, and community member levels. The Ophelia approach can be used to generate health service improvements that enhance health outcomes and address inequity of access to healthcare.

Applying an Equity Lens to the Child Care Setting.

PubMed

Scott, Krista; Looby, Anna Ayers; Hipp, Janie Simms; Frost, Natasha

2017-03-01

In the current landscape, child care is increasingly being seen as a place for early education, and systems are largely bundling child care in the Early Care and Education sphere through funding and quality measures. As states define school readiness and quality, they often miss critical elements, such as equitable access to quality and cultural traditions. This article provides a summary of the various definitions and structures of child care. It also discusses how the current child care policy conversation can and ought to be infused with a framework grounded in the context of institutional racism and trauma. Models and examples will explore the differences between state government regulations, and how those differ than the regulation and structure of child care in Indian Country.

Socioeconomic Inequalities in Green Space Quality and Accessibility—Evidence from a Southern European City

PubMed Central

Hoffimann, Elaine; Barros, Henrique; Ribeiro, Ana Isabel

2017-01-01

Background: The provision of green spaces is an important health promotion strategy to encourage physical activity and to improve population health. Green space provision has to be based on the principle of equity. This study investigated the presence of socioeconomic inequalities in geographic accessibility and quality of green spaces across Porto neighbourhoods (Portugal). Methods: Accessibility was evaluated using a Geographic Information System and all the green spaces were audited using the Public Open Space Tool. Kendall’s tau-b correlation coefficients and ordinal regression were used to test whether socioeconomic differences in green space quality and accessibility were statistically significant. Results: Although the majority of the neighbourhoods had an accessible green space, mean distance to green space increased with neighbourhood deprivation. Additionally, green spaces in the more deprived neighbourhoods presented significantly more safety concerns, signs of damage, lack of equipment to engage in active leisure activities, and had significantly less amenities such as seating, toilets, cafés, etc. Conclusions: Residents from low socioeconomic positions seem to suffer from a double jeopardy; they lack both individual and community resources. Our results have important planning implications and might contribute to understanding why deprived communities have lower physical activity levels and poorer health. PMID:28809798

Return to nursing home investment: Issues for public policy

PubMed Central

Baldwin, Carliss Y.; Bishop, Christine E.

1984-01-01

Because Government policy does much to determine the return available to nursing home investment, the profitability of the nursing home industry has been a subject of controversy since Government agencies began paying a large portion of the Nation's nursing home bill. Controversy appears at several levels. First is the rather narrow concern, often conceived in accounting terms, of the appropriate reimbursement of capital-related expense under Medicaid and Medicare. Second is the concern about how return to capital affects the flow of investment into nursing homes, leading either to inadequate access to care or to over-capacity. Third is the concern about how-sources of return to nursing home investment affect the pattern of nursing home ownership and the amount of equity held by owners since the pattern of ownership and amount of equity have been linked to quality of care. PMID:10310945

Community Engaged Leadership to Advance Health Equity and Build Healthier Communities

PubMed Central

Holden, Kisha; Akintobi, Tabia; Hopkins, Jammie; Belton, Allyson; McGregor, Brian; Blanks, Starla; Wrenn, Glenda

2016-01-01

Health is a human right. Equity in health implies that ideally everyone should have a fair opportunity to attain their full health potential and, more pragmatically, that no one should be disadvantaged from achieving this potential. Addressing the multi-faceted health needs of ethnically and culturally diverse individuals in the United States is a complex issue that requires inventive strategies to reduce risk factors and buttress protective factors to promote greater well-being among individuals, families, and communities. With growing diversity concerning various ethnicities and nationalities; and with significant changes in the constellation of multiple of risk factors that can influence health outcomes, it is imperative that we delineate strategic efforts that encourage better access to primary care, focused community-based programs, multi-disciplinary clinical and translational research methodologies, and health policy advocacy initiatives that may improve individuals’ longevity and quality of life. PMID:27713839

Health equity and migrants in the Greater Mekong Subregion

PubMed Central

McMichael, Celia; Healy, Judith

2017-01-01

ABSTRACT Background: Migrant health is receiving increasing international attention, reflecting recognition of the health inequities experienced among many migrant populations and the need for health systems to adapt to diverse migrant populations. In the Greater Mekong Subregion (GMS) there is increasing migration associated with uneven economic integration and growth, socio-economic vulnerabilities, and disparities between countries. There has been limited progress, however, in improving migrant access to health services in the Subregion. This paper examines the health needs, access barriers, and policy responses to cross-border migrants in five GMS countries. Methods: A review of published literature and research was conducted on migrant health and health service access in Cambodia, Lao People’s Democratic Republic, Myanmar, Thailand, and Viet Nam, as well as analysis of current migration trends and universal health coverage (UHC) indicators in the Subregion. The review included different migrant types: i.e. migrant workers, irregular migrants, victims of trafficking, refugees and asylum seekers, and casual cross-border migrants. Results: There is substantial diversity in the capacity of GMS health systems to address migrant populations. Thailand has sought to enhance migrant health coverage, including development of migrant health policies/programs, bilateral migrant worker agreements, and migrant health insurance schemes; Viet Nam provides health protection for emigrant workers. Overall, however, access to good quality health care remains weak for many citizens in GMS countries let alone migrants. Migrant workers – and irregular migrants in particular – face elevated health risks yet are not adequately covered and incur high out-of-pocket (OOP) payments for health services. Conclusions: UHC implies equity: UHC is only achieved when everyone has the opportunity to access and use good-quality health care. Efforts to achieve UHC in the GMS require deliberate policy decisions to include migrants. The emergence of the UHC agenda, and the focus on migrant health among policy makers and partners, present an opportunity to tackle barriers to health service access, extend coverage, and strengthen partnerships in order to improve migrant health. This is an opportune time for GMS countries to develop migrant-inclusive health systems. PMID:28452652

Comparing private sector family planning services to government and NGO services in Ethiopia and Pakistan: how do social franchises compare across quality, equity and cost?

PubMed Central

Shah, Nirali M; Wang, Wenjuan; Bishai, David M

2011-01-01

Policy makers in developing countries need to assess how public health programmes function across both public and private sectors. We propose an evaluation framework to assist in simultaneously tracking performance on efficiency, quality and access by the poor in family planning services. We apply this framework to field data from family planning programmes in Ethiopia and Pakistan, comparing (1) independent private sector providers; (2) social franchises of private providers; (3) non-government organization (NGO) providers; and (4) government providers on these three factors. Franchised private clinics have higher quality than non-franchised private clinics in both countries. In Pakistan, the costs per client and the proportion of poorest clients showed no differences between franchised and non-franchised private clinics, whereas in Ethiopia, franchised clinics had higher costs and fewer clients from the poorest quintile. Our results highlight that there are trade-offs between access, cost and quality of care that must be balanced as competing priorities. The relative programme performance of various service arrangements on each metric will be context specific. PMID:21729919

Comparing private sector family planning services to government and NGO services in Ethiopia and Pakistan: how do social franchises compare across quality, equity and cost?

PubMed

Shah, Nirali M; Wang, Wenjuan; Bishai, David M

2011-07-01

Policy makers in developing countries need to assess how public health programmes function across both public and private sectors. We propose an evaluation framework to assist in simultaneously tracking performance on efficiency, quality and access by the poor in family planning services. We apply this framework to field data from family planning programmes in Ethiopia and Pakistan, comparing (1) independent private sector providers; (2) social franchises of private providers; (3) non-government organization (NGO) providers; and (4) government providers on these three factors. Franchised private clinics have higher quality than non-franchised private clinics in both countries. In Pakistan, the costs per client and the proportion of poorest clients showed no differences between franchised and non-franchised private clinics, whereas in Ethiopia, franchised clinics had higher costs and fewer clients from the poorest quintile. Our results highlight that there are trade-offs between access, cost and quality of care that must be balanced as competing priorities. The relative programme performance of various service arrangements on each metric will be context specific.

Matching services with local preferences: managing primary education services in a rural district of India.

PubMed

Subrahmanian, R

1999-02-01

India's poorest households have particularly little access to education. Urgent reforms are therefore needed to improve the universal availability of quality basic services and universal access to those services. At least 32 million children in India are estimated to not be enrolled and attending school. These children must be brought into schools in order to meet the goal of Universal Elementary Education (UEE). Widespread support exists for the decentralization of public services due to the equity and efficiency benefits associated with it. In particular, decentralization is seen to facilitate the matching of services with local preferences, increasing the chances of meeting policy goals. This approach is explored in the context of research conducted in a village of Raichur district, where poor households' preferences with regard to school timing are analyzed. Sections consider the equity and efficiency merits of decentralization, the agenda for improving education service delivery in India, users' relationship to the education system in Raichur district, how preferences are revealed, whose preferences are important in the conflict between local and policy perspectives, preference heterogeneity in the village context, and whether aspects of education services can be selectively decentralized.

The changing public/private mix in dentistry in the UK--a supply-side perspective.

PubMed

Lynch, Mauricea; Calnan, Michael

2003-04-01

This paper examines the factors beyond NHS dentists' remuneration which may explain the variations in the public/private mix in general dental practitioners' workload in the UK. Given that NHS dentistry is subject to a fixed price system, the study focused mainly on non-income supply-side factors. Using data from a postal survey of a national random sample of dentists practising in the NHS in England in 1997, the study found that the strategies adopted by dentists in the management of NHS lists and the evidence that dentists spent significantly more time in private consultations compared with NHS consultations support concerns over equity of access to dental care and the quality of NHS dentistry. Dentists' attitudes to NHS and private dentistry revealed considerable ambiguity towards the NHS. While, on the one hand, the lack of sufficient demand for private dentistry emerged as a strong reason for remaining in the NHS, on the other, there was evidence that equity in access to dental treatment is still seen as an important principle. The implications of these findings in the context of recent discussion of the future of NHS dentistry are considered. Copyright 2002 John Wiley & Sons, Ltd.

Improving reproductive health in rural China through participatory planning.

PubMed

Kaufman, Joan; Liu, Yunguo; Fang, Jing

2012-01-01

China's new health reform initiative aims to provide quality accessible health care to all, including remote rural populations, by 2020. Public health insurance coverage for the rural poor has increased, but rural women have fared worse because of lower status and lack of voice in shaping the services they need. Use of prenatal care, safe delivery and reproductive tract infections (RTIs) services is inadequate and service seeking for health problems remains lower for men. We present findings from a study of gender and health equity in rural China from 2002 to 2008 and offer recommendations from over a decade of applied research on reproductive health in rural China. Three studies, conducted in poor counties between 1994 and 2008, identified problems in access and pilot tested interventions and mechanisms to increase women's participation in health planning. They were done in conjunction with a World Bank programme and the global Gender and Health Equity Network (GHEN). Reproductive health service-seeking improved and the study interventions increased local government commitment to providing such services through new health insurance mechanisms. Findings from the studies were summarised into recommendations on gender and health for inclusion in new health reform efforts.

Improving mental health outcomes: achieving equity through quality improvement.

PubMed

Poots, Alan J; Green, Stuart A; Honeybourne, Emmi; Green, John; Woodcock, Thomas; Barnes, Ruth; Bell, Derek

2014-04-01

To investigate equity of patient outcomes in a psychological therapy service, following increased access achieved by a quality improvement (QI) initiative. Retrospective service evaluation of health outcomes; data analysed by ANOVA, chi-squared and Statistical Process Control. A psychological therapy service in Westminster, London, UK. People living in the Borough of Westminster, London, attending the service (from either healthcare professional or self-referral) between February 2009 and May 2012. s) Social marketing interventions were used to increase referrals, including the promotion of the service through local media and through existing social networks. s) (i) Severity of depression on entry using Patient Health Questionnaire-9 (PHQ9). (ii) Changes to severity of depression following treatment (ΔPHQ9). (iii) Changes in attainment of a meaningful improvement in condition assessed by a key performance indicator. Patients from areas of high deprivation entered the service with more severe depression (M = 15.47, SD = 6.75), compared with patients from areas of low (M = 13.20, SD = 6.75) and medium (M = 14.44, SD = 6.64) deprivation. Patients in low, medium and high deprivation areas attained similar changes in depression score (ΔPHQ9: M = -6.60, SD = 6.41). Similar proportions of patients achieved the key performance indicator across initiative phase and deprivation categories. QI methods improved access to mental health services; this paper finds no evidence for differences in clinical outcomes in patients, regardless of level of deprivation, interpreted as no evidence of inequity in the service with respect to this outcome.

Data resource profile: Pathways to Health and Social Equity for Children (PATHS Equity for Children).

PubMed

Nickel, Nathan C; Chateau, Dan G; Martens, Patricia J; Brownell, Marni D; Katz, Alan; Burland, Elaine M J; Walld, Randy; Hu, Mingming; Taylor, Carole R; Sarkar, Joykrishna; Goh, Chun Yan

2014-10-01

The PATHS Data Resource is a unique database comprising data that follow individuals from the prenatal period to adulthood. The PATHS Resource was developed for conducting longitudinal epidemiological research into child health and health equity. It contains individual-level data on health, socioeconomic status, social services and education. Individuals' data are linkable across these domains, allowing researchers to follow children through childhood and across a variety of sectors. PATHS includes nearly all individuals that were born between 1984 and 2012 and registered with Manitoba's universal health insurance programme at some point during childhood. All PATHS data are anonymized. Key concepts, definitions and algorithms necessary to work with the PATHS Resource are freely accessible online and an interactive forum is available to new researchers working with these data. The PATHS Resource is one of the richest and most complete databases assembled for conducting longitudinal epidemiological research, incorporating many variables that address the social determinants of health and health equity. Interested researchers are encouraged to contact [mchp_access@cpe.umanitoba.ca] to obtain access to PATHS to use in their own programmes of research. © The Author 2014. Published by Oxford University Press on behalf of the International Epidemiological Association.

The Effects of Gendered Social Capital on U.S. Migration: A Comparison of Four Latin American Countries.

PubMed

Côté, Rochelle R; Jensen, Jessica Eva; Roth, Louise Marie; Way, Sandra M

2015-06-01

This article contributes to understandings of gendered social capital by analyzing the effects of gendered ties on the migration of men and women from four Latin American countries (Mexico, Costa Rica, Nicaragua, and the Dominican Republic) to the United States. The research theorizes the importance of strong and weak ties to men and women in each sending country as a product of the gender equity gap in economic participation (low/high) and incidence of female-led families (low/high). The findings reveal that ties to men increase the odds of migration from countries where gender equity and incidence of female-led families are low, while ties to women are more important for migration from countries where gender equity and female-led families are high. Previous research on migration and social capital details the importance of network ties for providing resources and the role of gender in mediating social capital quality and access to network support. Results reveal that not only are different kinds of ties important to female and male migration, but migrants from different countries look to different sources of social capital for assistance.

Protocol for the process evaluation of interventions combining performance-based financing with health equity in Burkina Faso.

PubMed

Ridde, Valéry; Turcotte-Tremblay, Anne-Marie; Souares, Aurélia; Lohmann, Julia; Zombré, David; Koulidiati, Jean Louis; Yaogo, Maurice; Hien, Hervé; Hunt, Matthew; Zongo, Sylvie; De Allegri, Manuela

2014-10-12

The low quality of healthcare and the presence of user fees in Burkina Faso contribute to low utilization of healthcare and elevated levels of mortality. To improve access to high-quality healthcare and equity, national authorities are testing different intervention arms that combine performance-based financing with community-based health insurance and pro-poor targeting. There is a need to evaluate the implementation of these unique approaches. We developed a research protocol to analyze the conditions that led to the emergence of these intervention arms, the fidelity between the activities initially planned and those conducted, the implementation and adaptation processes, the sustainability of the interventions, the possibilities for scaling them up, and their ethical implications. The study adopts a longitudinal multiple case study design with several embedded levels of analyses. To represent the diversity of contexts where the intervention arms are carried out, we will select three districts. Within districts, we will select both primary healthcare centers (n =18) representing different intervention arms and the district or regional hospital (n =3). We will select contrasted cases in relation to their initial performance (good, fair, poor). Over a period of 18 months, we will use quantitative and qualitative data collection and analytical tools to study these cases including in-depth interviews, participatory observation, research diaries, and questionnaires. We will give more weight to qualitative methods compared to quantitative methods. Performance-based financing is expanding rapidly across low- and middle-income countries. The results of this study will enable researchers and decision makers to gain a better understanding of the factors that can influence the implementation and the sustainability of complex interventions aiming to increase healthcare quality as well as equity.

Access to medication in the Public Health System and equity: populational health surveys in São Paulo, Brazil.

PubMed

Monteiro, Camila Nascimento; Gianini, Reinaldo José; Barros, Marilisa Berti de Azevedo; Cesar, Chester Luiz Galvão; Goldbaum, Moisés

2016-03-01

Since 2003, the access to medication has been increasing in Brazil and particularly in São Paulo. The present study aimed to analyze the access to medication obtained in the public sector and the socioeconomic differences in this access in 2003 and 2008. Also, we explored the difference in access to medication from 2003 to 2008. Data were obtained from two cross-sectional population-based household surveys from São Paulo, Brazil (ISA-Capital 2003 and ISA-Capital 2008). Concentration curve and concentration index were calculated to analyze the associations between socioeconomic factors and access to medication in the public sector. Additionally, the differences between 2003 and 2008 regarding socioeconomic characteristics and access to medication were studied. Access to medication was 89.55% in 2003 and 92.99% in 2008, and the proportion of access to medication did not change in the period. Access in the public sector increased from 26.40% in 2003 to 48.55% in 2008 and there was a decrease in the concentration index between 2003 and 2008 in access to medication in the public sector. The findings indicate an expansion of Brazilian Unified Health System (Sistema Único de Saúde ) users, with the inclusion of people of higher socioeconomic position in the public sector. As the SUS gives more support to people of lower socioeconomic position in terms of medication provision, the SUS tends to equity. Nevertheless, universal coverage for medication and equity in access to medication in the public sector are still challenges for the Brazilian public health system.

What predicts the quality of advanced cancer care in Latin America? A look at five countries: Argentina, Brazil, Cuba, Mexico, and Peru.

PubMed

Torres Vigil, Isabel; Aday, Lu Ann; De Lima, Liliana; Cleeland, Charles S

2007-09-01

Cancer is now a leading cause of death among adults in most Latin American nations. Yet, until recently, there has been limited research on the quality of, and access to, advanced cancer care in developing regions such as Latin America. This landmark, cross-national study assessed the quality of advanced cancer care in five Latin American countries by surveying a convenience sample of 777 physicians and nurses, and identifying the most salient influences on their quality-of-care assessments based on multiple linear regression analyses. Strategies for disseminating this survey included mass mailings, distribution at professional meetings/conferences, collaboration with Latin American institutions, professional organizations, and the Pan American Health Organization, and online posting. Results indicate that the respondents' assessments of the quality of, access to, and affordability of advanced cancer care varied significantly across nations (P<0.001). The strongest predictor of providers' national-level assessments of the quality of care was their ratings of access to advanced cancer care (Beta=0.647). Other predictors included affordability of care, country (Cuba vs. the other four countries), income-gap quintile, and institutional availability of opioid analgesics. Low prioritization of palliative care in both health care policy formulation and provider education also predicted the quality-of-care ratings. Findings from this study suggest that providers from five different nations hold similar equitable notions of quality care that are dependent on the provision of accessible and affordable care. Measures of social equity, such as the income-gap quintile of nations, and measures of policy barriers, such as the scale developed in this study, should be replicated in future studies to enable policy makers to assess and improve advanced cancer care in their countries.

Significant components of service brand equity in healthcare sector.

PubMed

Chahal, Hardeep; Bala, Madhu

2012-01-01

The purpose of the study is to examine three significant components of service brand equity--i.e. perceived service quality, brand loyalty, and brand image--and analyze relationships among the components of brand equity and also their relationship with brand equity, which is still to be theorized and developed in the healthcare literature. Effective responses were received from 206 respondents, selected conveniently from the localities of Jammu city. After scale item analysis, the data were analyzed using factor analysis, correlations, t-tests, multiple regression analysis and path modeling using SEM. The findings of the study support that service brand equity in the healthcare sector is greatly influenced by brand loyalty and perceived quality. However, brand image has an indirect effect on service brand equity through brand loyalty (mediating variable). The research can be criticized on the ground that data were selected conveniently from respondents residing in the city of Jammu, India. But at the same time the respondents were appropriate for the study as they have adequate knowledge about the hospitals, and were associated with the selected hospital for more than four years. Furthermore, the validity and reliability of the data are strong enough to take care of the limitations of the convenience sampling selection method. The study has unique value addition to the service marketing vis-à-vis healthcare literature, from both theoretical and managerial perspectives. The study establishes a direct and significant relationship between service brand equity and its two components, i.e. perceived service quality and brand loyalty in the healthcare sector. It also provides directions to healthcare service providers in creating, enhancing, and maintaining service brand equity through service quality and brand loyalty, to sustain competitive advantage.

Global Monitoring of Water Supply and Sanitation: History, Methods and Future Challenges

PubMed Central

Bartram, Jamie; Brocklehurst, Clarissa; Fisher, Michael B.; Luyendijk, Rolf; Hossain, Rifat; Wardlaw, Tessa; Gordon, Bruce

2014-01-01

International monitoring of drinking water and sanitation shapes awareness of countries’ needs and informs policy, implementation and research efforts to extend and improve services. The Millennium Development Goals established global targets for drinking water and sanitation access; progress towards these targets, facilitated by international monitoring, has contributed to reducing the global disease burden and increasing quality of life. The experiences of the MDG period generated important lessons about the strengths and limitations of current approaches to defining and monitoring access to drinking water and sanitation. The methods by which the Joint Monitoring Programme (JMP) of WHO and UNICEF tracks access and progress are based on analysis of data from household surveys and linear regression modelling of these results over time. These methods provide nationally-representative and internationally-comparable insights into the drinking water and sanitation facilities used by populations worldwide, but also have substantial limitations: current methods do not address water quality, equity of access, or extra-household services. Improved statistical methods are needed to better model temporal trends. This article describes and critically reviews JMP methods in detail for the first time. It also explores the impact of, and future directions for, international monitoring of drinking water and sanitation. PMID:25116635

Environmental equity as a criterion for water management

NASA Astrophysics Data System (ADS)

Grande, M.; Galvão, C.; Miranda, L.; Rufino, I.

2014-09-01

Environmental equity is a concept derived from the (un)equal exposure to environmental degradation by different social groups, usually minorities and low-income people exposed to major environmental risks, also known as environmental justice. It is assumed that no group of people, independent of race, ethnicity or socio-economic class, should support, either in concentrated or unevenly distributed form, the negative environmental impacts resulting from industrial, agricultural, commercial and infrastructure activities or government programs and policies. In this paper the concept of environmental equity is explored as a criterion for water management through the analysis of a typical coupled human-natural system: the Epitácio Pessoa Reservoir, located in the semi-arid region of Brazil. Inefficient water resource management has caused unequal access to water by the population, particularly during drought periods. However, census data indicate that population have practically the same access to water, which actually is not able to reflect the actual picture. This study argues that environmental equity can be an additional criterion to improve water management.

Health policy and systems research in access to medicines: a prioritized agenda for low- and middle-income countries.

PubMed

Bigdeli, Maryam; Javadi, Dena; Hoebert, Joelle; Laing, Richard; Ranson, Kent

2013-10-14

To identify priority policy issues in access to medicines (ATM) relevant for low- and middle-income countries, to identify research questions that would help address these policy issues, and to prioritize these research questions in a health policy and systems research (HPSR) agenda. The study involved i) country- and regional-level priority-setting exercises performed in 17 countries across five regions, with a desk review of relevant grey and published literature combined with mapping and interviews of national and regional stakeholders; ii) interviews with global-level stakeholders; iii) a scoping of published literature; and iv) a consensus building exercise with global stakeholders which resulted in the formulation and ranking of HPSR questions in the field of ATM. A list of 18 priority policy issues was established following analysis of country-, regional-, and global-level exercises. Eighteen research questions were formulated during the global stakeholders' meeting and ranked according to four ranking criteria (innovation, impact on health and health systems, equity, and lack of research). The top three research questions were: i) In risk protection schemes, which innovations and policies improve equitable access to and appropriate use of medicines, sustainability of the insurance system, and financial impact on the insured? ii) How can stakeholders use the information available in the system, e.g., price, availability, quality, utilization, registration, procurement, in a transparent way towards improving access and use of medicines? and iii) How do policies and other interventions into private markets, such as information, subsidies, price controls, donation, regulatory mechanisms, promotion practices, etc., impact on access to and appropriate use of medicines? Our HPSR agenda adopts a health systems perspective and will guide relevant, innovative research, likely to bear an impact on health, health systems and equity.

Serving All Students.

ERIC Educational Resources Information Center

Humphrey, Karen

2001-01-01

Equity as absence of discrimination is an outdated concept and a measurement nightmare. Focusing on (academic) results can strengthen educational equity and contribute to economic opportunity; in fact, quality and equity go together. California's concentration of resources on professional development should help more students meet higher…

[Proposals for health reform and equity in Uruguay: a redefinition of the Welfare State?].

PubMed

Mitjavila, Myriam; Fernandez, José; Moreira, Constanza

2002-01-01

This article reviews and analyzes health sector reform proposals in Uruguay and the possible effects of such reforms in terms of equity, the health sector's institutional structure, and the power relationship between the various actors in the process. The authors contend that a highly structured yet simultaneously fragmented system has conspired against any attempt to introduce major reforms into the system. Thus the only possibility for reform resides neither in the consolidation of the so-called Institutions for Collective Medical Care (IAMCs) nor in the move towards a residual model. Rather, Uruguay is witnessing the system's passive restructuring (i.e., reform by default). In this context and given the system's built-in inequities, the current trend is towards an even more regressive distribution of goods and services. The authors use qualitative and quantitative techniques to show that inequities in expenditure, access, and quality have resulted from long-term developments and adaptive movements of an IAMC system in fiscal stress and the public system's declining quality. Thus, in the absence of changes in state policy that redefine the actors' power or in the absence of system collapse, the country should expect this same regressive trend to deepen.

Quality improvement strategies at primary care level to reduce inequalities in diabetes care: an equity-oriented systematic review.

PubMed

Terens, Natalie; Vecchi, Simona; Bargagli, Anna Maria; Agabiti, Nera; Mitrova, Zuzana; Amato, Laura; Davoli, Marina

2018-05-29

There is evidence that disparities exist in diabetes prevalence, access to diabetes care, diabetes-related complications, and the quality of diabetes care. A wide range of interventions has been implemented and evaluated to improve diabetes care. We aimed to review trials of quality improvement (QI) interventions aimed to reduce health inequities among people with diabetes in primary care and to explore the extent to which experimental studies addressed and reported equity issues. Pubmed, EMBASE, CINAHL, and the Cochrane Library were searched to identify randomized controlled studies published between January 2005 and May 2016. We adopted the PROGRESS Plus framework, as a tool to explore differential effects of QI interventions across sociodemographic and economic factors. From 1903 references fifty-eight randomized trials met the inclusion criteria (with 17.786 participants), mostly carried out in USA. The methodological quality was good for all studies. Almost all studies reported the age, gender/sex and race distribution of study participants. The majority of trials additionally used at least one further PROGRESS-Plus factor at baseline, with education being the most commonly used, followed by income (55%). Large variation was observed between these studies for type of interventions, target populations, and outcomes evaluated. Few studies examined differential intervention effects by PROGRESS-plus factors. Existing evidence suggests that some QI intervention delivered in primary care can improve diabetes-related health outcomes in social disadvantaged population subgroups such as ethnic minorities. However, we found very few studies comparing health outcomes between population subgroups and reporting differential effect estimates of QI interventions. This review provides evidence that QI interventions for people with diabetes is feasible to implement and highly acceptable. However, more research is needed to understand their effective components as well as the adoption of an equity-oriented approach in conducting primary studies. Moreover, a wider variety of socio-economic characteristics such as social capital, place of residence, occupation, education, and religion should be addressed.

Implications of the growth of dental education in India.

PubMed

Mahal, Ajay S; Shah, Naseem

2006-08-01

By influencing the supply of trained human resources, the dental education sector can play a significant role in influencing policy goals of ensuring good quality and equitable access to oral health services in developing countries. Our research goal was to assess quantitatively the size of the Indian dental education sector, its growth over time, and the implications of this growth for equity and quality in oral health care. Information on the location of teaching institutions, the year of establishment, type of ownership, and seat capacity was obtained from government sources, the Dental Council of India, and websites of individual institutions to estimate the growth in the undergraduate dental education sector, including the role of the private sector from 1950 to 2005. Data on location of training capacity and institutions were used to assess the geographical distribution of undergraduate dental education capacity in India. Registration data on dentists, the size of available faculty relative to regulatory requirements, and penalties imposed on offending faculty and education institutions were used to assess the impact of the growing Indian dental education sector on graduate quality and equitable access. Dental colleges and enrollment capacity have grown rapidly over the five decades since 1950, mainly due to a growing private sector. There is regional inequality in the location of dental education schools in India with a bias toward economically better-off regions. The growth in the dental education sector has translated into increased overall access, although accompanied by rising inequality in access and possibly lower quality of dental education.

The Computer Explosion: Implications for Educational Equity. Resource Notebook.

ERIC Educational Resources Information Center

Denbo, Sheryl, Comp.

This notebook was prepared to provide resources for educators interested in using computers to increase opportunities for all students. The notebook contains specially prepared materials and selected newspaper and journal articles. The first section reviews the issues related to computer equity (equal access, tracking through different…

Equity, Institutional Diversity and Regional Development: A Cross-Country Comparison

ERIC Educational Resources Information Center

Pinheiro, Rómulo; Charles, David; Jones, Glen A.

2016-01-01

This paper investigates historical and current developments regarding governmental policies aimed at enhancing spatial equity (access) or decentralisation of higher education provision in three countries--Australia, Canada and Norway. We then shed light on the links or interrelations between policy objectives and initiatives and institutional…

[Democracy without equity: analysis of health reform and nineteen years of National Health System in Brazil].

PubMed

Coelho, Ivan Batista

2010-01-01

This paper aims to evaluate the nineteen years of the National Health System in Brazil, under the prism of equity. It takes into account the current political context in Brazil in the 80s, that the democratization of the country and the health sector could, per se, lead to a more equitable situation regarding the access to health services. Democracy and equity concepts are here discussed; analyzing which situations may facilitate or make it difficult its association in a theoretical plan, applying them to the Brazilian context in a more general form and, to emphasizing practical implications to the National Health System and to groups of activism related to health reforms. It also seeks to show the limits and possibilities of these groups with regards to the reduction of inequality, in relation to the access to health services, which still remain. To conclude, the author points out the need for other movements to be established which seek the reduction of such and other inequalities, such as access to education, housing, etc, drawing special attention to the role played by the State, which is questioned regarding its incapacity of promoting equity, once it presents itself as being powerful when approaching other matters.

Intergenerational equity and environmental restoration cleanup levels.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hocking, E. K.; Environmental Assessment

2001-01-01

The United States Department of Energy environmental restoration program faces difficult decisions about the levels of cleanup to be achieved at its many contaminated sites and has acknowledged the need for considering intergenerational equity in its decision making. Intergenerational equity refers to the fairness of access to resources across generations. Environmental restoration cleanup levels can have unintended and unfair consequences for future generations access to resources. The potentially higher costs associated with using low, non-risk-based cleanup levels for remediation may divert funding from other activities that could have a greater beneficial impact on future generations. Low, non-risk-based cleanup levels couldmore » also result in more damage to the nation's resources than would occur if a higher cleanup level were used. The loss or impairment of these resources could have an inequitable effect on future generations. However, intergenerational inequity could arise if sites are not completely restored and if access to and use of natural and cultural resources are unfairly limited as a result of residual contamination. In addition to concerns about creating possible intergenerational inequities related to selected cleanup levels, the tremendous uncertainties associated with sites and their restoration can lead site planners to rely on stewardship by default. An ill-conceived stewardship program can contribute to intergenerational inequity by limiting access to resources while passing on risks to future generations and not preparing them for those risks. This paper presents a basic model and process for designing stewardship programs that can achieve equity among generations.« less

Health sector employment: a tracer indicator for universal health coverage in national Social Protection Floors.

PubMed

Scheil-Adlung, Xenia; Behrendt, Thorsten; Wong, Lorraine

2015-08-31

Health sector employment is a prerequisite for availability, accessibility, acceptability and quality (AAAQ) of health services. Thus, in this article health worker shortages are used as a tracer indicator estimating the proportion of the population lacking access to such services: The SAD (ILO Staff Access Deficit Indicator) estimates gaps towards UHC in the context of Social Protection Floors (SPFs). Further, it highlights the impact of investments in health sector employment equity and sustainable development. The SAD is used to estimate the share of the population lacking access to health services due to gaps in the number of skilled health workers. It is based on the difference of the density of the skilled health workforce per population in a given country and a threshold indicating UHC staffing requirements. It identifies deficits, differences and developments in access at global, regional and national levels and between rural and urban areas. In 2014, the global UHC deficit in numbers of health workers is estimated at 10.3 million, with most important gaps in Asia (7.1 million) and Africa (2.8 million). Globally, 97 countries are understaffed with significantly higher gaps in rural than in urban areas. Most affected are low-income countries, where 84 per cent of the population remains excluded from access due to the lack of skilled health workers. A positive correlation of health worker employment and population health outcomes could be identified. Legislation is found to be a prerequisite for closing access as gaps. Health worker shortages hamper the achievement of UHC and aggravate weaknesses of health systems. They have major impacts on socio-economic development, particularly in the world's poorest countries where they act as drivers of health inequities. Closing the gaps by establishing inclusive multi-sectoral policy approaches based on the right to health would significantly increase equity, reduce poverty due to ill health and ultimately contribute to sustainable development and social justice.

Assessing First- and Second-Order Equity for the Common-Item Nonequivalent Groups Design Using Multidimensional IRT

ERIC Educational Resources Information Center

Andrews, Benjamin James

2011-01-01

The equity properties can be used to assess the quality of an equating. The degree to which expected scores conditional on ability are similar between test forms is referred to as first-order equity. Second-order equity is the degree to which conditional standard errors of measurement are similar between test forms after equating. The purpose of…

Coercion or Compulsion?: Rationales behind Informal Payments for Education in Azerbaijan

ERIC Educational Resources Information Center

Lepisto, Eric; Kazimzade, Elmina

2009-01-01

Although informal payments are necessary for education systems in many countries, they prohibit education accessibility and equity in Eastern Europe and neighboring states. Exploring the rationales and the relationships is a promising approach for understanding corruption in education and ensuring educational equity. In this article, rationales…

Second Chance Education: Barriers, Supports and Engagement Strategies

ERIC Educational Resources Information Center

Savelsberg, Harry; Pignata, Silvia; Weckert, Pauline

2017-01-01

Second chance education programs are now a well-established presence in institutions seeking to provide access and equity pathways for socio-economically disadvantaged groups. This paper focusses on the strategies used to support positive engagement in second chance equity programs, drawing upon evaluation research data from four TAFE sponsored…

Health in all policies: a start in Rhode Island.

PubMed

Ritchie, Dianne; Nolan, Patricia A

2013-07-01

In Rhode Island, health care access, whether measured as having a regular source of care or as having health insurance, is better than the U.S. average. However, health care access does not necessarily translate into better health outcomes. Rhode Island has not fared better than the rest of the nation in ending or decreasing health disparities across socioeconomic and racial demographics in spite of improved access to quality health insurance products. In June 2011, law RIGL 23-64.1 directed the establishment of a Commission of Heath Advocacy and Equity. It requires a cross-section of state agency and community members to focus on the social determinants of health, and prepare biennial reports with public participation. The law will serve to remind the government and the public that objectives for the well-being of the population are best achieved when all sectors include health as a key component of policy development.

Exploring competing experiences and expectations of the revitalized community health worker programme in Mozambique: an equity analysis.

PubMed

Give, Celso Soares; Sidat, Mohsin; Ormel, Hermen; Ndima, Sozinho; McCollum, Rosalind; Taegtmeyer, Miriam

2015-09-01

Mozambique launched its revitalized community health programme in 2010 in response to inequitable coverage and quality of health services. The programme is focused on health promotion and disease prevention, with 20 % of community health workers' (known in Mozambique as Agentes Polivalentes Elementares (APEs)) time spent on curative services and 80 % on activities promoting health and preventing illness. We set out to conduct a health system and equity analysis, exploring experiences and expectations of APEs, community members and healthcare workers supervising APEs. This exploratory qualitative study captured the perspectives of a range of participants including women caring for children under 5 years (service clients), community leaders, service providers (APEs) and their supervisors. Participants in the Moamba and Manhiça districts, located in Maputo Province (Mozambique), were selected purposively. In total, 29 in-depth interviews and 9 focus group discussions were conducted in the local language and/or Portuguese. A framework approach was used for analysis, assisted by NVivo10 software. Our analysis revealed that health equity is viewed as linked to the quality and coverage of the APE programme. Demand and supply factors interplay to shape health equity. The availability of responsive and appropriate services led to tensions between community expectations for curative services (and APEs' willingness to perform them) and official policy focusing APE efforts mainly on preventive services and health promotion. The demand for more curative services by community members is a result of having limited access to healthcare services other than those offered by APEs. This study highlights the need to pay attention to the determinants of demand and supply of community interventions in health, to understand the opportunities and challenges of the difficult interface role played by APEs and to create communication among stakeholders in order to build a stronger, more effective and equitable community programme.

Promoting Health Equity And Eliminating Disparities Through Performance Measurement And Payment.

PubMed

Anderson, Andrew C; O'Rourke, Erin; Chin, Marshall H; Ponce, Ninez A; Bernheim, Susannah M; Burstin, Helen

2018-03-01

Current approaches to health care quality have failed to reduce health care disparities. Despite dramatic increases in the use of quality measurement and associated payment policies, there has been no notable implementation of measurement strategies to reduce health disparities. The National Quality Forum developed a road map to demonstrate how measurement and associated policies can contribute to eliminating disparities and promote health equity. Specifically, the road map presents a four-part strategy whose components are identifying and prioritizing areas to reduce health disparities, implementing evidence-based interventions to reduce disparities, investing in the development and use of health equity performance measures, and incentivizing the reduction of health disparities and achievement of health equity. To demonstrate how the road map can be applied, we present an example of how measurement and value-based payment can be used to reduce racial disparities in hypertension among African Americans.

Essential Medicines in National Constitutions: Progress Since 2008.

PubMed

Katrina Perehudoff, S; Toebes, Brigit; Hogerzeil, Hans

2016-06-01

A constitutional guarantee of access to essential medicines has been identified as an important indicator of government commitment to the progressive realization of the right to the highest attainable standard of health. The objective of this study was to evaluate provisions on access to essential medicines in national constitutions, to identify comprehensive examples of constitutional text on medicines that can be used as a model for other countries, and to evaluate the evolution of constitutional medicines-related rights since 2008. Relevant articles were selected from an inventory of constitutional texts from WHO member states. References to states' legal obligations under international human rights law were evaluated. Twenty-two constitutions worldwide now oblige governments to protect and/or to fulfill accessibility of, availability of, and/or quality of medicines. Since 2008, state responsibilities to fulfill access to essential medicines have expanded in five constitutions, been maintained in four constitutions, and have regressed in one constitution. Government commitments to essential medicines are an important foundation of health system equity and are included increasingly in state constitutions.

Essential Medicines in National Constitutions

PubMed Central

Toebes, Brigit; Hogerzeil, Hans

2016-01-01

Abstract A constitutional guarantee of access to essential medicines has been identified as an important indicator of government commitment to the progressive realization of the right to the highest attainable standard of health. The objective of this study was to evaluate provisions on access to essential medicines in national constitutions, to identify comprehensive examples of constitutional text on medicines that can be used as a model for other countries, and to evaluate the evolution of constitutional medicines-related rights since 2008. Relevant articles were selected from an inventory of constitutional texts from WHO member states. References to states’ legal obligations under international human rights law were evaluated. Twenty-two constitutions worldwide now oblige governments to protect and/or to fulfill accessibility of, availability of, and/or quality of medicines. Since 2008, state responsibilities to fulfill access to essential medicines have expanded in five constitutions, been maintained in four constitutions, and have regressed in one constitution. Government commitments to essential medicines are an important foundation of health system equity and are included increasingly in state constitutions. PMID:27781006

What does 'access to health care' mean?

PubMed

Gulliford, Martin; Figueroa-Munoz, Jose; Morgan, Myfanwy; Hughes, David; Gibson, Barry; Beech, Roger; Hudson, Meryl

2002-07-01

Facilitating access is concerned with helping people to command appropriate health care resources in order to preserve or improve their health. Access is a complex concept and at least four aspects require evaluation. If services are available and there is an adequate supply of services, then the opportunity to obtain health care exists, and a population may 'have access' to services. The extent to which a population 'gains access' also depends on financial, organisational and social or cultural barriers that limit the utilisation of services. Thus access measured in terms of utilisation is dependent on the affordability, physical accessibility and acceptability of services and not merely adequacy of supply. Services available must be relevant and effective if the population is to 'gain access to satisfactory health outcomes'. The availability of services, and barriers to access, have to be considered in the context of the differing perspectives, health needs and material and cultural settings of diverse groups in society. Equity of access may be measured in terms of the availability, utilisation or outcomes of services. Both horizontal and vertical dimensions of equity require consideration. Copyright The Royal Society of Medicine Press Ltd 2002.

Fostering Health Equity: Clinical and Research Training Strategies from Nursing Education

PubMed Central

Deatrick, Janet A.; Lipman, Terri H.; Gennaro, Susan; Sommers, Marilyn; de Leon Siantz, Mary Lou; Mooney-Doyle, Kim; Hollis, Genevieve; Jemmott, Loretta S.

2015-01-01

Racism, ethnocentrism, segregation, stereotyping, and classism are tightly linked to health equity and social determinants of health. They lead to lack of power, money, resources, and education which may result in poor health care access and outcomes. Health profession faculties must address the complex relationships that exist between individual, interpersonal, institutional, social and political factors that influence health outcomes in both clinical and research training. Thus, the purposes of this paper are to provide examples of training strategies from nursing education that foster cultural sensitivity. First, assumptions about health equity, culture, ethnicity and race are explored. Second, clinical training within an undergraduate and graduate context are explored, including an undergraduate cancer case study and in a graduate pediatric nursing program are described to demonstrate how cultural models can be used to integrate the biomedical and psychosocial content in a course. Third, research training for summer scholars and doctoral and post doctoral fellows (short and long term) is described to demonstrate how to increase the number and quality of scholars prepared to conduct research with vulnerable populations. Research training strategies include a summer research institute, policy fellowship, and a scholars “pipeline” program. A unique perspective is presented through collaboration between a nursing school and a center for health disparities research. PMID:19717366

Evaluating the Impact of Social Media Marketing on Online Course Registration

ERIC Educational Resources Information Center

Spackman, Jonathan S.; Larsen, Ross

2017-01-01

This article validated one possible method, found in the luxury fashion industry, for evaluating the effectiveness of Facebook marketing activities on increasing enrollments in continuing higher education online courses. A survey assessing the qualities of social media marketing, value equity, relationship equity, brand equity, and purchase…

Gender Equity and the Year 2000. WEEA Digest.

ERIC Educational Resources Information Center

Education Development Center, Inc., Newton, MA.

During the past 17 years, the Women's Educational Equity Act (WEEA) program has accomplished the following: funded programs to open math, science, and technology courses and careers to women and girls; helped females gain access to nontraditional vocational education; funded projects to eliminate bias against females in school and the workplace;…

Digital Equity and Intercultural Education

ERIC Educational Resources Information Center

Resta, Paul; Laferrière, Thérèse

2015-01-01

Digital equity and intercultural education continue to be areas of concern in the emerging knowledge-based society. The digital divide is present across the globe as the result of a complex of factors such as the inequality in: access to hardware and connectivity; autonomy of use; digital and literacy skills; availability of technical and social…

Pricing Policy, Social Equity and Institutional Survival in Tertiary Education in New Jersey.

ERIC Educational Resources Information Center

Lee, Alfred M.

New Jersey aids private institutions but is deficit in low-priced open access to public colleges. Discussed is higher education in New Jersey in light of this historical condition; pricing policy; social equity; decisions, especially regarding institutional support, student aid, and public tuition; and the "free market." While the…

Fighting for Equity and Community in an Urban Research University

ERIC Educational Resources Information Center

Ho, Mary; Sanchez, George

2018-01-01

The equity lens evaluates institutional barriers that prevent students of color from gaining access to resources for college success (Bensimon, 2005). The first-generation college students at the University of Southern California are 16% of the total student body and students of color comprise two-thirds of this population. Since 2008, how to…

Trends in Educational Equity of Girls & Women.

ERIC Educational Resources Information Center

Bae, Yupin; Choy, Susan; Geddes, Claire; Sable, Jennifer; Snyder, Thomas

This statistical report responds to a request by Congress for a report on educational equity for girls and women. The report assembles a series of indicators that examine the extent to which males and females have access to the same educational opportunities, avail themselves of these opportunities, perform at the same level, succeed at the same…

Indigenous Higher Education Student Equity: Focusing on What Works

ERIC Educational Resources Information Center

Devlin, Marcia

2009-01-01

The rates of higher education access, participation and completion for Indigenous students are much lower than those for non-Indigenous students in Australia. This paper argues for a research-led focus on what works in terms of Indigenous student equity in higher education. Undertaking independent evaluation of existing initiatives and leveraging…

Equity and achievement in access to contraceptives in East Africa between 2000 and 2010.

PubMed

Shah, Chirag M; Griffith, April M; Ciera, James; Zulu, Eliya M; Palermo, Tia M

2016-04-01

To examine trends in equity in contraceptive use, and in contraceptive-prevalence rates in six East African countries. In this repeated cross-sectional study, Demographic and Health Surveys Program data from women aged 15-49 years in Ethiopia, Kenya, Malawi, Rwanda, Tanzania, and Uganda between 2000 and 2010 were analyzed. Individuals were ranked according to wealth quintile, stratified urban/rural populations, and calculated concentration index-a statistic integrating information from all wealth quintiles to analyze disparities. Equity and contraceptive-prevalence rates increased in most country regions over the study period. Notably, in rural Rwanda, contraceptive-prevalence rates increased from 3.9 to 44.0, and urban Kenya became the most equitable country region, with a concentration index of 0.02. The Pearson correlation coefficient between improvements in concentration index and contraceptive-prevalence rates was 0.52 (P=0.011). The results indicate that countries seeking to increase contraceptive use should prioritize equity in access to services and contraceptives. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Protocol for the development of a CONSORT-equity guideline to improve reporting of health equity in randomized trials.

PubMed

Welch, Vivian; Jull, J; Petkovic, J; Armstrong, R; Boyer, Y; Cuervo, L G; Edwards, Sjl; Lydiatt, A; Gough, D; Grimshaw, J; Kristjansson, E; Mbuagbaw, L; McGowan, J; Moher, D; Pantoja, T; Petticrew, M; Pottie, K; Rader, T; Shea, B; Taljaard, M; Waters, E; Weijer, C; Wells, G A; White, H; Whitehead, M; Tugwell, P

2015-10-21

Health equity concerns the absence of avoidable and unfair differences in health. Randomized controlled trials (RCTs) can provide evidence about the impact of an intervention on health equity for specific disadvantaged populations or in general populations; this is important for equity-focused decision-making. Previous work has identified a lack of adequate reporting guidelines for assessing health equity in RCTs. The objective of this study is to develop guidelines to improve the reporting of health equity considerations in RCTs, as an extension of the Consolidated Standards of Reporting Trials (CONSORT). A six-phase study using integrated knowledge translation governed by a study executive and advisory board will assemble empirical evidence to inform the CONSORT-equity extension. To create the guideline, the following steps are proposed: (1) develop a conceptual framework for identifying "equity-relevant trials," (2) assess empirical evidence regarding reporting of equity-relevant trials, (3) consult with global methods and content experts on how to improve reporting of health equity in RCTs, (4) collect broad feedback and prioritize items needed to improve reporting of health equity in RCTs, (5) establish consensus on the CONSORT-equity extension: the guideline for equity-relevant trials, and (6) broadly disseminate and implement the CONSORT-equity extension. This work will be relevant to a broad range of RCTs addressing questions of effectiveness for strategies to improve practice and policy in the areas of social determinants of health, clinical care, health systems, public health, and international development, where health and/or access to health care is a primary outcome. The outcomes include a reporting guideline (CONSORT-equity extension) for equity-relevant RCTs and a knowledge translation strategy to broadly encourage its uptake and use by journal editors, authors, and funding agencies.

The role of higher education in equitable human development

NASA Astrophysics Data System (ADS)

Peercy, Chavanne; Svenson, Nanette

2016-04-01

As developing countries continue to battle poverty despite strong economic growth, understanding the relationship between equity and human development becomes increasingly important. In this context, equity is not equivalent to equality for any specific outcome such as health status, education or income. It is an objective ideal whereby people's achievements are increasingly dependent upon personal effort, choice and initiative rather than predetermined characteristics such as race, gender and socioeconomic background. As such, equity becomes an issue of moral equality based on the belief that people should be treated as equals, with equal access to life chances. This ideal pursues equal access to public services, infrastructure and rights for all citizens, including the right to education. While evidence suggests that education builds healthier, richer, more equitable societies, research on this has focused predominantly on primary and secondary schooling. The authors of this paper begin with an extensive review of existing research and relevant literature. In the second part of their article, they then report on their own study which furthers the discussion by exploring connections between tertiary education and development using equity as a reflection of human development - a holistic extension of economic development. After extracting relevant data from a number of available world reports by the United Nations, the World Bank and other organisations, they carried out a cross-national statistical analysis designed to examine the relationship between tertiary enrolment levels and a composite equity variable. Their results indicate a strong association between higher post-secondary education levels and higher levels of social equity.

Racism, Equity, and Quality of Education for International Students in South Korean Higher Education Institutes

ERIC Educational Resources Information Center

Kim, Jin-Hee

2016-01-01

This study aims to understand equity issues of international students' learning in Korean higher education institutions by engaging with the issue of racism and identifies how international students in Korea reshape their learning trajectory and how we could provide equitable and quality education for international students. Espousing a…

Commissioning and equity in primary care in Australia: Views from Primary Health Networks.

PubMed

Henderson, Julie; Javanparast, Sara; MacKean, Tamara; Freeman, Toby; Baum, Fran; Ziersch, Anna

2018-01-01

This paper reports findings from 55 stakeholder interviews undertaken in six Primary Health Networks (PHNs) in Australia as part of a study of the impact of population health planning in regional primary health organisations on service access and equity. Primary healthcare planning is currently undertaken by PHNs which were established in 2015 as commissioning organisations. This was a departure from the role of Medicare Locals, the previous regional primary health organisations which frequently provided services. This paper addresses perceptions of 23 senior staff, 11 board members and 21 members of clinical and community advisory councils or health priority groups from six case study PHNs on the impact of commissioning on equity. Participants view the collection of population health data as facilitating service access through redistributing services on the basis of need and through bringing objectivity to decision-making about services. Conversely, participants question the impact of the political and geographical context and population profile on capacity to improve service access and equity through service commissioning. Service delivery was seen as fragmented, the model is at odds with the manner in which Aboriginal Community Controlled Health Organisations (ACCHOs) operate and rural regions lack services to commission. As a consequence, reliance upon commissioning of services may not be appropriate for the Australian primary healthcare context. © 2017 John Wiley & Sons Ltd.

Equitable Access for Secondary English Learner Students: Course Taking as Evidence of EL Program Effectiveness

PubMed Central

Callahan, Rebecca M.; Shifrer, Dara

2016-01-01

Purpose EL education policy has long directed schools to address English learner (EL) students’ linguistic and academic development, and must do so without furthering inequity or segregation (Lau, 1974; Castañeda, 1981). The recent ESSA (2015) reauthorization expresses a renewed focus on evidence of equity, effectiveness, and opportunity to learn. We propose that high school course taking patterns provide evidence of program effectiveness and equity in access. Research Design Using data from the nationally representative Educational Longitudinal Study of 2002 (ELS: 2002), we employ multinomial regression models to predict students’ likelihood of completing two types of high school coursework (basic graduation, college preparatory) by their linguistic status. Findings Despite considerable linguistic, sociodemographic, and academic controls, marked disparities in high school course taking patterns remain, with EL students experiencing significantly less academic exposure. Implications for Policy and Practice Building on McKenzie and Scheurich’s (2004) notion of an equity trap and evidence of a long-standing EL opportunity gap, we suggest that school leaders might use our findings and their own course taking patterns to prompt discussions about the causes and consequences of local EL placement processes. Such discussions have the potential to raise awareness about how educators and school leaders approach educational equity and access, key elements central to the spirit of EL education policy. PMID:27429476

Long term care needs and personal care services under Medicaid: a survey of administrators.

PubMed

Palley, H A; Oktay, J S

1991-01-01

Home and community based care services constitute a public initiative in the development of a long term care service network. One such home based initiative is the personal care service program of Medicaid. The authors conducted a national survey of administrators of this program. They received a response from 16 administrators of such programs in 1987-1988. The responses raise significant issues regarding training, access to and equity of services, quality of services, administrative oversight and the coordination of home-based care in a network of available services. Based on administrator responses, the authors draw several conclusions.

[Conditions for universal access to health in Latin America: social rights, social protection and financial and political constraints].

PubMed

Sojo, Ana

2011-06-01

After a brief review of the concept of health equity and its social and sectoral determinants, some macroeconomic aspects of health expenditure in Latin America are considered. Given the significant contemporary tensions with regard to social rights and the definition of health benefits, three emblematic experiences are analyzed in very different health systems, namely those of Chile, Colombia and Mexico. They cover different aspects, such as the guarantee of health benefits, the reduction of forms of implicit rationing and/or barriers to admission, and also aspects related to the quality of services.

Education of children with disabilities in New Delhi: When does exclusion occur?

PubMed Central

Babulal, Ganesh M.; Trani, Jean-Francois

2017-01-01

Background In the new Sustainable Development Goal 4, quality of education defined as equity and inclusion alongside traditional learning outcomes, has replaced the narrow goal of access to primary education stipulated in the Millennium Development Goal 2. Since 2000, considerable progress has been made towards improving access to school for children in India, yet questions remain regarding not just children with disabilities’ access and acquisition of basic learning skills, but also completion of learning cycles. Methods and findings Between November, 2, 2011 and June 20th 2012, we interviewed 1294 households about activity limitations and functioning difficulties associated with a health problem among all family members using a validated screening instruments, as well as questions about access, retention and barriers to education. We found that vulnerable children, particularly children with disabilities are less likely to start school and more likely to drop out of school earlier and before completing their high school education than non-disabled children, showing that the learning process is not inclusive in practice. The gap is wider for girls, economically deprived children, or children from households where the head is uneducated. Conclusions Firstly, in order to fill the existing knowledge gap on education of children with disabilities in line with SDG4, not only is there a necessity for relevant data with regards to learning outcomes, but also an urgent requirement for more innovative information pertaining to relational aspects of learning that reflect inclusion. Secondly, a stronger understanding of the implications of early assessment would further promote equity in education. Finally, research should tackle learning as a complex and dynamic phenomenon. Education needs to fulfil its instrumental value, but must also re-claim its intrinsic value that often gets watered down in the journey from policies to implementation. PMID:28877203

Education of children with disabilities in New Delhi: When does exclusion occur?

PubMed

Bakhshi, Parul; Babulal, Ganesh M; Trani, Jean-Francois

2017-01-01

In the new Sustainable Development Goal 4, quality of education defined as equity and inclusion alongside traditional learning outcomes, has replaced the narrow goal of access to primary education stipulated in the Millennium Development Goal 2. Since 2000, considerable progress has been made towards improving access to school for children in India, yet questions remain regarding not just children with disabilities' access and acquisition of basic learning skills, but also completion of learning cycles. Between November, 2, 2011 and June 20th 2012, we interviewed 1294 households about activity limitations and functioning difficulties associated with a health problem among all family members using a validated screening instruments, as well as questions about access, retention and barriers to education. We found that vulnerable children, particularly children with disabilities are less likely to start school and more likely to drop out of school earlier and before completing their high school education than non-disabled children, showing that the learning process is not inclusive in practice. The gap is wider for girls, economically deprived children, or children from households where the head is uneducated. Firstly, in order to fill the existing knowledge gap on education of children with disabilities in line with SDG4, not only is there a necessity for relevant data with regards to learning outcomes, but also an urgent requirement for more innovative information pertaining to relational aspects of learning that reflect inclusion. Secondly, a stronger understanding of the implications of early assessment would further promote equity in education. Finally, research should tackle learning as a complex and dynamic phenomenon. Education needs to fulfil its instrumental value, but must also re-claim its intrinsic value that often gets watered down in the journey from policies to implementation.

Social franchising of TB care through private GPs in Myanmar: an assessment of treatment results, access, equity and financial protection.

PubMed

Lönnroth, Knut; Aung, Tin; Maung, Win; Kluge, Hans; Uplekar, Mukund

2007-05-01

This article assesses whether social franchising of tuberculosis (TB) services in Myanmar has succeeded in providing quality treatment while ensuring equity in access and financial protection for poor patients. Newly diagnosed TB patients receiving treatment from private general practitioners (GPs) belonging to the franchise were identified. They were interviewed about social conditions, health seeking and health care costs at the time of starting treatment and again after 6 months follow-up. Routine data were used to ascertain clinical outcomes as well as to monitor trends in case notification. The franchisees contributed 2097 (21%) of the total 9951 total new sputum smear-positive pulmonary cases notified to the national TB programme in the study townships. The treatment success rate for new smear-positive cases was 84%, close to the World Health Organization target of 85% and similar to the treatment success of 81% in the national TB programme in Myanmar. People from the lower socio-economic groups represented 68% of the TB patients who access care in the franchise. Financial burden related to direct and indirect health care costs for tuberculosis was high, especially among the poor. Patients belonging to lower socio-economic groups incurred on average costs equivalent to 68% of annual per capita household income, with a median of 28%. However, 83% of all costs were incurred before starting treatment in the franchise, while 'shopping' for care. During treatment in the franchise, the cost of care was relatively low, corresponding to a median proportion of annual per capita income of 3% for people from lower socio-economic groups. This study shows that highly subsidized TB care delivered through a social franchise scheme in the private sector in Myanmar helped reach the poor with quality services, while partly protecting them from high health care expenditure. Extended outreach to others parts of the private sector may reduce diagnostic delay and patient costs further.

Mapping mental health service access: achieving equity through quality improvement.

PubMed

Green, Stuart A; Poots, Alan J; Marcano-Belisario, Jose; Samarasundera, Edgar; Green, John; Honeybourne, Emmi; Barnes, Ruth

2013-06-01

Improving access to psychological therapies (IAPTs) services deliver evidence-based care to people with depression and anxiety. A quality improvement (QI) initiative was undertaken by an IAPT service to improve referrals providing an opportunity to evaluate equitable access. QI methodologies were used by the clinical team to improve referrals to the service. The collection of geo-coded data allowed referrals to be mapped to small geographical areas according to deprivation. A total of 6078 patients were referred to the IAPT service during the period of analysis and mapped to 120 unique lower super output areas (LSOAs). The average weekly referral rate rose from 17 during the baseline phase to 43 during the QI implementation phase. Spatial analysis demonstrated all 15 of the high deprivation/low referral LSOAs were converted to high deprivation/high or medium referral LSOAs following the QI initiative. This work highlights the importance of QI in developing clinical services aligned to the needs of the population through the analysis of routine data matched to health needs. Mapping can be utilized to communicate complex information to inform the planning and organization of clinical service delivery and evaluate the progress and sustainability of QI initiatives.

The Health Equity Scholars Program: Innovation in the Leaky Pipeline.

PubMed

Upshur, Carole C; Wrighting, Diedra M; Bacigalupe, Gonzalo; Becker, Joan; Hayman, Laura; Lewis, Barbara; Mignon, Sylvia; Rokop, Megan E; Sweet, Elizabeth; Torres, Marie Idali; Watanabe, Paul; Woods, Cedric

2018-04-01

Despite attempts to increase enrollment of under-represented minorities (URMs: primarily Black/African American, Hispanic/Latino, and Native American students) in health professional programs, limited progress has been made. Compelling reasons to rectify this situation include equity for URMs, better prepared health professionals when programs are diverse, better quality and access to health care for UMR populations, and the need for diverse talent to tackle difficult questions in health science and health care delivery. However, many students who initiate traditional "pipeline" programs designed to link URMs to professional schools in health professions and the sciences, do not complete them. In addition, program requirements often restrict entry to highly qualified students while not expanding opportunities for promising, but potentially less well-prepared candidates. The current study describes innovations in an undergraduate pipeline program, the Health Equity Scholars Program (HESP) designed to address barriers URMs experience in more traditional programs, and provides evaluative outcomes and qualitative feedback from participants. A primary outcome was timely college graduation. Eighty percent (80%) of participants, both transfer students and first time students, so far achieved this outcome, with 91% on track, compared to the campus average of 42% for all first time students and 58-67% for transfers. Grade point averages also improved (p = 0.056) after program participation. Graduates (94%) were working in health care/human services positions and three were in health-related graduate programs. Creating a more flexible program that admits a broader range of URMs has potential to expand the numbers of URM students interested and prepared to make a contribution to health equity research and clinical care.

Equity and Value in 'Precision Medicine'.

PubMed

Gray, Muir; Lagerberg, Tyra; Dombrádi, Viktor

2017-04-01

Precision medicine carries huge potential in the treatment of many diseases, particularly those with high-penetrance monogenic underpinnings. However, precision medicine through genomic technologies also has ethical implications. We will define allocative, personal, and technical value ('triple value') in healthcare and how this relates to equity. Equity is here taken to be implicit in the concept of triple value in countries that have publicly funded healthcare systems. It will be argued that precision medicine risks concentrating resources to those that already experience greater access to healthcare and power in society, nationally as well as globally. Healthcare payers, clinicians, and patients must all be involved in optimising the potential of precision medicine, without reducing equity. Throughout, the discussion will refer to the NHS RightCare Programme, which is a national initiative aiming to improve value and equity in the context of NHS England.

The Impact of School Closures on Equity of Access in Chicago

ERIC Educational Resources Information Center

Lee, Jin; Lubienski, Christopher

2017-01-01

This study examines the impact of school closures on the sociospatial distribution of equitable access to schooling following the school closure policy pursued by the Chicago Public Schools in 2013. By examining access in terms of proximity between students and schools, the study estimates the changes in accessibility before and after school…

Fiscal Equalization and Access to Educational Resources in the New England States.

ERIC Educational Resources Information Center

Fastrup, Jerry C.

1997-01-01

Analyzes 1990-91 school finance data for six New England states. Examines state support for local education, distribution of state aid in relation to local wealth differences, these policies' effect on funding equity for local taxpayers, and the relationship between taxpayer equity and per-pupil spending disparities. Only Maine and Vermont have…

College Women Still Face Many Obstacles in Reaching Their Full Potential

ERIC Educational Resources Information Center

Sax, Linda J.

2007-01-01

We have reached a critical juncture in the history of women and men in higher education. Today--decades after the women's movement started what became monumental gains for female students in terms of access, equity, and opportunity--the popular notion is that gender equity has been achieved. Some higher-education statistics do paint a rosy picture…

Education Loans and Financing Higher Education in India: Addressing Equity

ERIC Educational Resources Information Center

Rani, P. Geetha

2014-01-01

The education loan programme since its inception has been rapidly growing both in terms of number of students who have taken education loans for pursuing higher education and the amount of education loans released. Nevertheless, these financing mechanisms of higher education do not appear to improve access and equity in the higher education system…

Equity: The Critical Link in Southern Economic Development. Cross-Cutting Issue Report No. 2.

ERIC Educational Resources Information Center

Southern Growth Policies Board, Research Triangle Park, NC.

This report presents a general overview of equity issues in the modern South. It discusses access to such needs as jobs and job opportunities, health, housing, education, government benefits, political power, resources, and protection. Six at-risk groups receive special focus: the poor; Blacks; Hispanics; women; older Southerners; and the…

Rejecting Babel: Examining Multilingualism without Citizenship in the U.S. Postnational Scenario

ERIC Educational Resources Information Center

Barros, Sandro R.

2017-01-01

Despite the long history of multilingualism in the U.S., language rights debates have tended to center almost exclusively on the acquisition of English as an issue of equity for citizens who are speakers of other languages. Policies advanced in the name of "access" and "equity" continue to frame English as the only viable means…

A Case Study of One Teach for America Corps Member's Use of Equity Pedagogy

ERIC Educational Resources Information Center

Hu, Lindsay Anne Kwock

2009-01-01

This study investigates equitable practices used by a Teach For America (TFA) corps member (CM) in her second year of teaching low income, minority students. This study's conceptual framework is based on a contemporary conceptualization of equity pedagogy that includes: (a) tools of power and access (Delpit, 1988); (b) culturally relevant…

Travelling against the Current: An Examination of Upstream and Downstream Educational Interventions across the Life Span

ERIC Educational Resources Information Center

Silburn, Jenny; Box, Geraldine

2008-01-01

Current social and economic circumstances are presenting universities with a more diverse general student intake whose support needs are increasingly similar to those of traditionally defined equity groups. This paper examines a Murdoch University equity program to demonstrate that simply increasing access does not always translate into increased…

Project Baiterek: A Patient Access Program to Improve Clinical Outcomes and Quality of Life in Children with Type 1 Diabetes in Kazakhstan.

PubMed

Muratalina, Aigul; Smith-Palmer, Jayne; Nurbekova, Akmaral; Abduakhassova, Gulmira; Zhubandykova, Leila; Roze, Stéphane; Karamalis, Manolis; Shamshatova, Gulzhakhan; Demessinov, Adi; D'Agostino, Nicola Dunne; Lynch, Peter; Yedigarova, Larisa; Klots, Motty; Valentine, William; Welsh, John; Kaufman, Francine

2015-09-01

Diabetes is a key driver in the rise of noncommunicable diseases globally. It causes expensive and burdensome short- and long-term complications, with both an economic and social impact. In many countries, however, access to care and disease management in type 1 diabetes is suboptimal, increasing the risk for complications. In 2011, Project Baiterek was initiated as a collaborative effort between the Kazakhstan Ministry of Health, industry (Medtronic Plc), local physicians, and the Diabetes Association of the Republic of Kazakhstan to enhance patient access to continuous subcutaneous insulin infusion (CSII) therapy. It was the first countrywide project to provide equity and universal access to insulin pump therapy among children with type 1 diabetes, increasing pump use from zero to two-thirds of this population in less than 3 years. The project also involved instigating longitudinal data collection, and long-term clinical outcomes continue to be monitored. Here, we provide an overview of the clinical, quality-of-life, and economic outcomes to date associated with providing CSII therapy to children with type 1 diabetes in Kazakhstan. Initial clinical data show that CSII therapy improved clinical outcomes and quality of life for patients entered into the program and that CSII therapy was cost-effective relative to multiple daily injection therapy. The positive outcomes of Project Baiterek provide a template for similar patient access programs in other settings, and its framework could be adapted to initiatives to change health care infrastructures and standards of care for other noncommunicable diseases. Copyright © 2015. Published by Elsevier Inc.

Bridging the gap: exploring the barriers to using economic evidence in healthcare decision making and strategies for improving uptake.

PubMed

Merlo, Gregory; Page, Katie; Ratcliffe, Julie; Halton, Kate; Graves, Nicholas

2015-06-01

Evidence from economic evaluations is often not used to inform healthcare policy despite being well regarded by policy makers and physicians. This article employs the accessibility and acceptability framework to review the barriers to using evidence from economic evaluation in healthcare policy and the strategies used to overcome these barriers. Economic evaluations are often inaccessible to policymakers due to the absence of relevant economic evaluations, the time and cost required to conduct and interpret economic evaluations, and lack of expertise to evaluate quality and interpret results. Consistently reported factors that limit the translation of findings from economic evaluations into healthcare policy include poor quality of research informing economic evaluations, assumptions used in economic modelling, conflicts of interest, difficulties in transferring resources between sectors, negative attitudes to healthcare rationing, and the absence of equity considerations. Strategies to overcome these barriers have been suggested in the literature, including training, structured abstract databases, rapid evaluation, reporting checklists for journals, and considering factors other than cost effectiveness in economic evaluations, such as equity or budget impact. The factors that prevent or encourage decision makers to use evidence from economic evaluations have been identified, but the relative importance of these factors to decision makers is uncertain.

An Examination of Possible Relationships between Service Quality and Brand Equity in Online Higher Education

ERIC Educational Resources Information Center

Jarrell, Charles M.

2012-01-01

Researchers and marketers lack information about possible relationships between service quality and online brand equity in intangible and often undifferentiated service businesses. The services sector of the economy is large with 72% of the economic output and 80% of the workers in the United States in 2007. Within the services sector, Internet…

75 FR 64700 - Certain Hot-Rolled Flat-Rolled Carbon-Quality Steel Products From Brazil: Preliminary Results of...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-20

... listed below: 1. Equity Infusions In the investigation of HRS, we found that the GOB had granted subsidies in the form of equity infusions to USIMINAS from 1983 through 1988, and to COSIPA from 1983 through 1989, and in 1991. The countervailable benefits from those equity infusions were fully allocated...

Assessing equity in health care through the national health insurance schemes of Nigeria and Ghana: a review-based comparative analysis

PubMed Central

2013-01-01

Background Nigeria and Ghana have recently introduced a National Health Insurance Scheme (NHIS) with the aim of moving towards universal health care using more equitable financing mechanisms. This study compares health and economic indicators, describes the structure of each country’s NHIS within the wider healthcare system, and analyses impacts on equity in financing and access to health care. Methods The World Bank and other sources were used to provide comparative health and economic data. Pubmed, Embase and EconLit were searched to locate studies providing descriptions of each NHIS and empirical evidence regarding equity in financing and access to health care. A diagrammatical representation of revenue-raising, pooling, purchasing and provision was produced in order to analyse the two countries’ systems. Results Over the period 2000–2010, Ghana maintained a marked advantage in life expectancy, infant mortality, under-5 year mortality, and has a lower burden of major diseases. Health care expenditure is about 5% of GDP in both countries but public expenditure in 2010 was 38% of total expenditure in Nigeria and 60% in Ghana. Financing and access are less equitable in Nigeria as, inter alia, private out-of-pocket expenditure has fallen from 80% to 66% of total spending in Ghana since the introduction of its NHIS but has remained at over 90% in Nigeria; NHIS membership in Nigeria and Ghana is approximately 3.5% and 65%, respectively; Nigeria offers a variable benefits package depending on membership category while Ghana has uniform benefits across all beneficiaries. Both countries exhibit improvements in equity but there is a pro-rich and pro-urban bias in membership. Conclusions Major health indicators are more favourable in Ghana and overall equity in financing and access are weaker in Nigeria. Nigeria is taking steps to expand NHIS membership and has potential to expand its public spending to achieve greater equity. However, heavy burdens of poverty, disease and remote settings make this a substantial challenge. Ghana’s relative success has to be tempered by the high number of exemptions through taxation and the threat of moral hazard. The results and methods are anticipated to be informative for policy makers and researchers in both countries and other developing countries more widely. PMID:23339606

Assessing equity in health care through the national health insurance schemes of Nigeria and Ghana: a review-based comparative analysis.

PubMed

Odeyemi, Isaac A O; Nixon, John

2013-01-22

Nigeria and Ghana have recently introduced a National Health Insurance Scheme (NHIS) with the aim of moving towards universal health care using more equitable financing mechanisms. This study compares health and economic indicators, describes the structure of each country's NHIS within the wider healthcare system, and analyses impacts on equity in financing and access to health care. The World Bank and other sources were used to provide comparative health and economic data. Pubmed, Embase and EconLit were searched to locate studies providing descriptions of each NHIS and empirical evidence regarding equity in financing and access to health care. A diagrammatical representation of revenue-raising, pooling, purchasing and provision was produced in order to analyse the two countries' systems. Over the period 2000-2010, Ghana maintained a marked advantage in life expectancy, infant mortality, under-5 year mortality, and has a lower burden of major diseases. Health care expenditure is about 5% of GDP in both countries but public expenditure in 2010 was 38% of total expenditure in Nigeria and 60% in Ghana. Financing and access are less equitable in Nigeria as, inter alia, private out-of-pocket expenditure has fallen from 80% to 66% of total spending in Ghana since the introduction of its NHIS but has remained at over 90% in Nigeria; NHIS membership in Nigeria and Ghana is approximately 3.5% and 65%, respectively; Nigeria offers a variable benefits package depending on membership category while Ghana has uniform benefits across all beneficiaries. Both countries exhibit improvements in equity but there is a pro-rich and pro-urban bias in membership. Major health indicators are more favourable in Ghana and overall equity in financing and access are weaker in Nigeria. Nigeria is taking steps to expand NHIS membership and has potential to expand its public spending to achieve greater equity. However, heavy burdens of poverty, disease and remote settings make this a substantial challenge. Ghana's relative success has to be tempered by the high number of exemptions through taxation and the threat of moral hazard. The results and methods are anticipated to be informative for policy makers and researchers in both countries and other developing countries more widely.

Disparities in access to care and satisfaction among U.S. children: the roles of race/ethnicity and poverty status.

PubMed

Shi, Leiyu; Stevens, Gregory D

2005-01-01

The study assessed the progress made toward reducing racial and ethnic disparities in access to health care among U.S. children between 1996 and 2000. Data are from the Household Component of the 1996 and 2000 Medical Expenditure Panel Survey. Bivariate associations of combinations of race/ethnicity and poverty status groups were examined with four measures of access to health care and a single measure of satisfaction. Logistic regression was used to examine the association of race/ethnicity with access, controlling for sociodemographic factors associated with access to care. To highlight the role of income, we present models with and without controlling for poverty status. Racial and ethnic minority children experience significant deficits in accessing medical care compared with whites. Asians, Hispanics, and blacks were less likely than whites to have a usual source of care, health professional or doctor visit, and dental visit in the past year. Asians were more likely than whites to be dissatisfied with the quality of medical care in 2000 (but not 1996), while blacks and Hispanics were more likely than whites to be dissatisfied with the quality of medical care in 1996 (but not in 2000). Both before and after controlling for health insurance coverage, poverty status, health status, and several other factors associated with access to care, these disparities in access to care persisted between 1996 and 2000. Continued monitoring of racial and ethnic differences is necessary in light of the persistence of racial/ethnic and socioeconomic disparities in access to care. Given national goals to achieve equity in health care and eliminate racial/ ethnic disparities in health, greater attention needs to be paid to the interplay of race/ethnicity factors and poverty status in influencing access.

Perceived barriers to healthcare for persons living in poverty in Quebec, Canada: the EQUIhealThY project.

PubMed

Loignon, Christine; Hudon, Catherine; Goulet, Émilie; Boyer, Sophie; De Laat, Marianne; Fournier, Nathalie; Grabovschi, Cristina; Bush, Paula

2015-01-17

Ensuring access to timely and appropriate primary healthcare for deprived patients is an issue facing all countries, even those with universal healthcare systems. There is a paucity of information on how patients living in a context of material and social deprivation perceive barriers in the healthcare system. This study combines the perspectives of persons living in poverty and of healthcare providers to explore barriers to responsive care for underserved persons with a view to developing equity-focused primary care. In this participatory action research we used photovoice, together with a method known as 'merging of knowledge and practice' developed by ATD Fourth World, an international community organization working to eradicate poverty. The study was conducted in two teaching primary care practices in the Canadian province of Quebec. Participants consisted of 15 health professionals and six members of ATD Fourth World; approximately 60 group meetings were held. Data were analyzed through thematic analysis, in part with the involvement of persons living in poverty. Three main barriers to responsive care in a context of poverty were highlighted by all participants: the difficult living conditions of people living in poverty, the poor quality of interactions between providers and underserved patients, and the complexity of healthcare system organization and functioning. Our research revealed that unhealthy living conditions prevent persons living in poverty from accessing quality healthcare and maintaining good health. Also, the complexity of the healthcare system's organization and functioning has a negative impact on the interactions with healthcare providers. Changes in policy and practice are needed to address those barriers and to achieve greater equity and provide more responsive care for persons living in poverty.

University of Global Health Equity's Contribution to the Reduction of Education and Health Services Rationing.

PubMed

Binagwaho, Agnes

2017-05-29

The inadequate supply of health workers and demand-side barriers due to clinical practice that heeds too little attention to cultural context are serious obstacles to achieving universal health coverage and the fulfillment of the human rights to health, especially for the poor and vulnerable living in remote rural areas. A number of strategies have been deployed to increase both the supply of healthcare workers and the demand for healthcare services. However, more can be done to improve service delivery as well as mitigate the geographic inequalities that exist in this field. To contribute to overcoming these barriers and increasing access to health services, especially for the most vulnerable, Partners In Health (PIH), a US non-governmental organization specializing in equitable health service delivery, has created the University of Global Health Equity (UGHE) in a remote rural district of Rwanda. The act of building this university in such a rural setting signals a commitment to create opportunities where there have traditionally been few. Furthermore, through its state-of-the-art educational approach in a rural setting and its focus on cultural competency, UGHE is contributing to progress in the quest for equitable access to quality health services. © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Private sector participation and health system performance in sub-saharan Africa.

PubMed

Yoong, Joanne; Burger, Nicholas; Spreng, Connor; Sood, Neeraj

2010-10-07

The role of the private health sector in developing countries remains a much-debated and contentious issue. Critics argue that the high prices charged in the private sector limits the use of health care among the poorest, consequently reducing access and equity in the use of health care. Supporters argue that increased private sector participation might improve access and equity by bringing in much needed resources for health care and by allowing governments to increase focus on underserved populations. However, little empirical exists for or against either side of this debate. We examine the association between private sector participation and self-reported measures of utilization and equity in deliveries and treatment of childhood respiratory disease using regression analysis, across a sample of nationally-representative Demographic and Health Surveys from 34 SSA economies. We also examine the correlation between private sector participation and key background factors (socioeconomic development, business environment and governance) and use multivariate regression to control for potential confounders. Private sector participation is positively associated with greater overall access and reduced disparities between rich and poor as well as urban and rural populations. The positive association between private sector participation and improved health system performance is robust to controlling for confounders including per capita income and maternal education. Private sector participation is positively correlated with measures of socio-economic development and favorable business environment. Greater participation is associated with favorable intermediate outcomes in terms of access and equity. While these results do not establish a causal link between private sector participation and health system performance, they suggest that there is no deleterious link between private sector participation and health system performance in SSA.

77 FR 5295 - Over-the-Road Bus Accessibility Program Announcement of Project Selections

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-02

... DEPARTMENT OF TRANSPORTATION Federal Transit Administration Over-the-Road Bus Accessibility...-Road Bus (OTRB) Accessibility Program, authorized by Section 3038 of the Transportation Equity Act for... of over-the-road buses to help finance the incremental capital and training costs of complying with...

75 FR 2583 - Over-the-Road Bus Accessibility Program Grants

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-15

... Transportation Equity Act for the 21st Century (TEA-21). The OTRB Accessibility Program makes funds available to... (TEA-21), Public Law 105-85 as amended by the Safe, Accountable, Flexible, Efficient, Transportation.... transportation system. TEA-21 authorized FTA's OTRB Accessibility Program to assist OTRB operators in complying...

Access and Equity in Higher Education in Antigua and Barbuda

ERIC Educational Resources Information Center

Hewlett-Thomas, Elsie

2009-01-01

Across the international higher education spectrum access represents a significant issue. The literature is replete with analyses of access in various higher education systems. Low and inequitable patterns of participation in higher education are particularly prominent in developing countries. This dissertation is a case study of the higher…

Equity in access to health care among asylum seekers in Germany: evidence from an exploratory population-based cross-sectional study.

PubMed

Bozorgmehr, Kayvan; Schneider, Christine; Joos, Stefanie

2015-11-09

Research on inequities in access to health care among asylum-seekers has focused on disparities between asylum-seekers and resident populations, but little attention has been paid to potential inequities in access to care within the group of asylum-seekers. We aimed to analyse the principles of horizontal equity (i.e., equal access for equal need irrespective of socioeconomic status, SES) and vertical equity (higher allocation of resources to those with higher need) among asylum-seekers in Germany. We performed a secondary exploratory analysis on cross-sectional data obtained from a population-based questionnaire survey among all asylum-seekers (aged 18 or above) registered in three administrative districts in Germany during the three-month study period (N = 1017). Data were collected on health care access (health care utilisation of four types of services and unmet medical need), health care need (approximated by sex, age and self-rated health status), and SES (highest educational attainment and subjective social status, SSS). We calculated odds ratios and 95% confidence intervals (CI) in multiple logistic regression models to analyse associations between SES indicators and access to health care under control of need. We contacted 60.4% (614) of the total asylum-seekers population, of which 25.4% (N = 156) participated in the study. Educational attainment showed no significant effect on health care access in crude models, but was positively associated with utilisation of psychotherapists and hospital admissions in adjusted models. Higher SSS was positively associated with health care utilisation of all types of services. The odds of hospitals admissions for asylum-seekers in the medium and highest SSS category were 3.18 times [1.06, 9.59] and 1.6 times [0.49, 5.23] the odds of those in the lowest SSS category. After controlling for need variables none of the SES indicators were significantly associated with measures of access to care, but a positive association remained, indicating higher utilisation of health care among asylum-seekers with higher SES. Age, sex or general health status were the only significant predictors of health care utilisation in fully adjusted models. The adjusted odds of reporting unmet medical needs among asylum-seekers with "fair/bad/very bad" health status were 2.16 times [0.84, 5.59] the odds of those with "good/very good" health status. Our findings revealed that utilisation of health services among asylum-seekers is associated with higher need (vertical equity met). Horizontal equity was met with respect to educational attainment for most outcomes, but a social gradient in health care utilisation was observed across SSS. Further confirmatory research is needed, especially on potential inequities in unmet medical need and on measurements of SES among asylum-seekers.

Iranian nursing students' perspectives of educational equity.

PubMed

Ghiyasvandian, Shahrzad; Nikbakht-Nasrabadi, Alireza; Mohammadpour, Ali; Abbasi, Mahmoud; Javadi, Mostafa

2014-01-01

Around the world there is a growing consensus that students' rights must be protected, regardless of race, creed, color, sex, religion, and socioeconomic status. One of these rights is the educational equity. However, little is known about these phenomena in nursing education. The aim of this study was to explore the educational equity from the perspective of nursing students. A qualitative study was conducted. Thus, we purposefully recruited for in-depth interviews 13 nursing students (8 female and 5 male). All interviews were transcribed verbatim and analyzed by thematic analysis approach to identify categories and themes. Four main themes emerged from the data: Fair Educational Opportunity, fair evaluation, attempts to combat discrimination, and employing qualified teachers.  It is argued that educational equity should be developed in higher education. Principles of equity and students' rights may form the most basic rationale for all formal and informal efforts to extend the right of equal access to education.

Different shades of gray: crafting a regulatory response to private equity buyouts in electricity

DOE Office of Scientific and Technical Information (OSTI.GOV)

Vaheesan, Sandeep

2009-01-15

Private equity has made a dramatic entry into the once-staid world of electric utilities. These investors, with their superior management expertise and greater access to capital, have the potential to improve utility operations and increase investment in badly needed generation and transmission facilities. Their acquisitions do not come without their share of risks, however. (author)

Equity and Excellence: The Emergence, Consolidation and Internalization of Education Development at the University of Natal

ERIC Educational Resources Information Center

Odendaal, Marie; Deacon, Roger

2009-01-01

Education development in South Africa emerged during the transition from apartheid to democracy, in a context especially marked by political and financial pressures. This case study of the University of Natal (now the University of KwaZulu-Natal) demonstrates how a strategy combining equity with excellence aimed to facilitate increased access to…

Digital Equity in Cultural Context: Exploring the Influence of Confucian Heritage Culture on Hong Kong Families

ERIC Educational Resources Information Center

Yuen, Allan H.; Park, Jae Hyung; Chen, Lu; Cheng, Miaoting

2017-01-01

Our study examines digital equity in a cultural context. Many studies have used classic analytical variables such as socioeconomic status and gender to investigate the problem of unequal access to, and more recently differences in the use of, information and communication technology (ICT). The few studies that have explored cultural variables have…

A Study of Equity in Mathematics Education: Lessons from Japan for U.S. Teacher Preparation

ERIC Educational Resources Information Center

Furuto, Linda H. L.

2015-01-01

This study comes at an opportune moment for Japanese and U.S. educators, policymakers, and researchers given the trends of global policy and equity-based reform. Discussions of academic achievement in both societies allow us to examine accessibility in mathematics education in order to best prepare teachers to serve the needs of students.…

Teaching Large Classes in an Increasingly Internationalising Higher Education Environment: Pedagogical, Quality and Equity Issues

ERIC Educational Resources Information Center

Maringe, Felix; Sing, Nevensha

2014-01-01

Marketisation, increased student mobility, the massification of Higher Education (HE) and stagnating staff numbers in universities have combined to cause a ripple effect of change both in the demography and size of university classes across the world. This has implications for the quality and equity of learning and the need to examine and to…

Cultural democracy: the way forward for primary care of hard to reach New Zealanders.

PubMed

Finau, Sitaleki A; Finau, Eseta

2007-09-01

The use of cultural democracy, the freedom to practice one's culture without fear, as a framework for primary care service provision is essential for improved health service in a multi cultural society like New Zealand. It is an effective approach to attaining health equity for all. Many successful health ventures are ethnic specific and have gone past cultural competency to the practice of cultural democracy. That is, the services are freely taking on the realities of clients without and malice from those of other ethnicities. In New Zealand the scientific health service to improve the health of a multi cultural society are available but there is a need to improve access and utilization by hard to reach New Zealanders. This paper discusses cultural democracy and provide example of how successful health ventures that had embraced cultural democracy were implemented. It suggests that cultural democracy will provide the intellectual impetus and robust philosophy for moving from equality to equity in health service access and utilization. This paper would provide a way forward to improved primary care utilization, efficiency, effectiveness and equitable access especially for the hard to reach populations. use the realities of Pacificans in New Zealand illustrate the use of cultural democracy, and thus equity to address the "inverse care law" of New Zealand. The desire is for primary care providers to take cognizance and use cultural democracy and equity as the basis for the design and practice of primary health care for the hard to reach New Zealanders.

Promoting High-Quality Cancer Care and Equity Through Disciplinary Diversity in Team Composition.

PubMed

Parsons, Susan K; Fineberg, Iris C; Lin, Mingqian; Singer, Marybeth; Tang, May; Erban, John K

2016-11-01

Disciplinary diversity in team composition is a valuable vehicle for oncology care teams to provide high-quality, person-centered comprehensive care. Such diversity facilitates care that effectively addresses the complex needs (biologic, psychosocial, and spiritual) of the whole person. The concept of professional or disciplinary diversity centers on differences in function, education, and culture, reflecting variety and heterogeneity in the perspectives of team members contributing to care. Thorough understanding of the skills, knowledge, and education related to each team member's professional or lay expertise is critical for members to be able to optimize the team's potential. Furthermore, respect and appreciation for differences and similarities across disciplinary cultures allow team members to create a positive collaboration dynamic that maintains a focus on the care of the person with cancer. We present a case study of one oncology team's provision of care to the patient, a Chinese immigrant woman with breast cancer. The case illuminates the strengths and challenges of disciplinary diversity in team composition in assessing and addressing potential barriers to care. Coordinated sharing of information among the varied team members facilitated understanding and care planning focused on the patient's concerns, needs, and strengths. Importantly, collaboration across the disciplinarily diverse set of team members facilitated high-quality oncology care and promoted equity in access to the full range of care options, including enrollment on a National Cancer Institute-sponsored clinical trial. Further implications of disciplinary diversity in oncology care teams are considered for both clinical practice and research.

On evaluating health centers groups in Lisbon and Tagus Valley: efficiency, equity and quality

PubMed Central

2013-01-01

Background Bearing in mind the increasing health expenses and their weight in the Portuguese gross domestic product, it is of the utmost importance to evaluate the performance of Primary Health Care providers taking into account both efficiency, quality and equity. This paper aims to contribute to a better understanding of the performance of Primary Health Care by measuring it in a Portuguese region (Lisbon and Tagus Valley) and identifying best practices. It also intends to evaluate the quality and equity provided. Methods For the purpose of measuring the efficiency of the health care centers (ACES) the non-parametric full frontier technique of data envelopment analysis (DEA) was adopted. The recent partial frontier method of order-m was also used to estimate the influence of exogenous variables on the efficiency of the ACES. The horizontal equity was investigated by applying the non-parametric Kruskal-Wallis test with multiple comparisons. Moreover, the quality of service was analyzed by using the ratio between the complaints and the total activity of the ACES. Results On the whole, a significant level of inefficiency was observed, although there was a general improvement in efficiency between 2009 and 2010. It was found that nursing was the service with the lowest scores. Concerning the horizontal equity, the analysis showed that there is no evidence of relevant disparities between the different subregions(NUTS III). Concerning the exogenous variables, the purchasing power, the percentage of patients aged 65 years old or older and the population size affect the efficiency negatively. Conclusions This research shows that better usage of the available resources and the creation of a learning network and dissemination of best practices will contribute to improvements in the efficiency of the ACES while maintaining or even improving quality and equity. It was also proved that the market structure does matter when efficiency measurement is addressed. PMID:24359014

The Irish health system: developments in strategy, structure, funding and delivery since 1980.

PubMed

Wiley, Miriam M

2005-09-01

As the Irish health system embarks upon its first major structural reorganisation in over 30 years, developments within this system over the past two decades are assessed. Real cuts in health expenditure achieved in the 1980s contrast sharply with the unprecedented increase in resources devoted to the health system in the 1990s. While successive statements of health strategy have prioritised the objectives of equity, efficiency and quality of care, questions arise regarding the return achieved with the increased investment. With higher levels of economic growth, more people have been buying private health insurance such that almost half the population are now privately insured. At the same time, the numbers with eligibility for health services without charge have decreased while those from lower socio-economic groups continue to have higher levels of utilisation. Equity issues arise, however, with regard to access to public hospitals as the rate of growth in admissions for private patients outstrips that for public patients. The establishment of a National Treatment Purchase Fund to purchase treatment in private facilities for public patients on waiting lists raises efficiency and equity questions as the treatment of private patients in public hospitals is heavily subsidised while the State pays full cost for the treatment of public patients in private facilities. Copyright (c) 2005 John Wiley & Sons, Ltd.

Equity in access to fortified maize flour and corn meal

PubMed Central

Zamora, Gerardo; De-Regil, Luz Maria

2014-01-01

Mass fortification of maize flour and corn meal with a single or multiple micronutrients is a public health intervention that aims to improve vitamin and mineral intake, micronutrient nutritional status, health, and development of the general population. Micronutrient malnutrition is unevenly distributed among population groups and is importantly determined by social factors, such as living conditions, socioeconomic position, gender, cultural norms, health systems, and the socioeconomic and political context in which people access food. Efforts trying to make fortified foods accessible to the population groups that most need them require acknowledgment of the role of these determinants. Using a perspective of social determinants of health, this article presents a conceptual framework to approach equity in access to fortified maize flour and corn meal, and provides nonexhaustive examples that illustrate the different levels included in the framework. Key monitoring areas and issues to consider in order to expand and guarantee a more equitable access to maize flour and corn meal are described. PMID:24329609

Measuring Equity in Access to Pharmaceutical Services Using Concentration Curve; Model Development.

PubMed

Davari, Majid; Khorasani, Elahe; Bakhshizade, Zahra; Jafarian Jazi, Marzie; Ghaffari Darab, Mohsen; Maracy, Mohammad Reza

2015-01-01

This paper has two objectives. First, it establishes a model for scoring the access to pharmaceutical services. Second, it develops a model for measuring socioeconomic indicators independent of the time and place of study. These two measures are used for measuring equity in access to pharmaceutical services using concentration curve. We prepared an open-ended questionnaire and distributed it to academic experts to get their ideas to form access indicators and assign score to each indicator based on the pharmaceutical system. An extensive literature review was undertaken for the selection of indicators in order to determine the socioeconomic status (SES) of individuals. Experts' opinions were also considered for scoring these indicators. These indicators were weighted by the Stepwise Adoption of Weights and were used to develop a model for measuring SES independent of the time and place of study. Nine factors were introduced for assessing the access to pharmaceutical services, based on pharmaceutical systems in middle-income countries. Five indicators were selected for determining the SES of individuals. A model for income classification based on poverty line was established. Likewise, a model for scoring home status based on national minimum wage was introduced. In summary, five important findings emerged from this study. These findings may assist researchers in measuring equity in access to pharmaceutical services and also could help them to apply a model for determining SES independent of the time and place of study. These also could provide a good opportunity for researchers to compare the results of various studies in a reasonable way; particularly in middle-income countries.

Prioritizing action on health inequities in cities: An evaluation of Urban Health Equity Assessment and Response Tool (Urban HEART) in 15 cities from Asia and Africa.

PubMed

Prasad, Amit; Kano, Megumi; Dagg, Kendra Ann-Masako; Mori, Hanako; Senkoro, Hawa Hamisi; Ardakani, Mohammad Assai; Elfeky, Samar; Good, Suvajee; Engelhardt, Katrin; Ross, Alex; Armada, Francisco

2015-11-01

Following the recommendations of the Commission on Social Determinants of Health (2008), the World Health Organization (WHO) developed the Urban Health Equity Assessment and Response Tool (HEART) to support local stakeholders in identifying and planning action on health inequities. The objective of this report is to analyze the experiences of cities in implementing Urban HEART in order to inform how the future development of the tool could support local stakeholders better in addressing health inequities. The study method is documentary analysis from independent evaluations and city implementation reports submitted to WHO. Independent evaluations were conducted in 2011-12 on Urban HEART piloting in 15 cities from seven countries in Asia and Africa: Indonesia, Iran, Kenya, Mongolia, Philippines, Sri Lanka, and Vietnam. Local or national health departments led Urban HEART piloting in 12 of the 15 cities. Other stakeholders commonly engaged included the city council, budget and planning departments, education sector, urban planning department, and the Mayor's office. Ten of the 12 core indicators recommended in Urban HEART were collected by at least 10 of the 15 cities. Improving access to safe water and sanitation was a priority equity-oriented intervention in 12 of the 15 cities, while unemployment was addressed in seven cities. Cities who piloted Urban HEART displayed confidence in its potential by sustaining or scaling up its use within their countries. Engagement of a wider group of stakeholders was more likely to lead to actions for improving health equity. Indicators that were collected were more likely to be acted upon. Quality of data for neighbourhoods within cities was one of the major issues. As local governments and stakeholders around the world gain greater control of decisions regarding their health, Urban HEART could prove to be a valuable tool in helping them pursue the goal of health equity. Copyright © 2015. Published by Elsevier Ltd.

Coverage, universal access and equity in health: a characterization of scientific production in nursing.

PubMed

Mendoza-Parra, Sara

2016-01-01

to characterize the scientific contribution nursing has made regarding coverage, universal access and equity in health, and to understand this production in terms of subjects and objects of study. this was cross-sectional, documentary research; the units of analysis were 97 journals and 410 documents, retrieved from the Web of Science in the category, "nursing". Descriptors associated to coverage, access and equity in health, and the Mesh thesaurus, were applied. We used bibliometric laws and indicators, and analyzed the most important articles according to amount of citations and collaboration. the document retrieval allowed for 25 years of observation of production, an institutional and an international collaboration of 31% and 7%, respectively. The mean number of coauthors per article was 3.5, with a transience rate of 93%. The visibility index was 67.7%, and 24.6% of production was concentrated in four core journals. A review from the nursing category with 286 citations, and a Brazilian author who was the most productive, are issues worth highlighting. the nursing collective should strengthen future research on the subject, defining lines and sub-lines of research, increasing internationalization and building it with the joint participation of the academy and nursing community.

Assessing barriers to health insurance and threats to equity in comparative perspective: The Health Insurance Access Database

PubMed Central

2012-01-01

Background Typologies traditionally used for international comparisons of health systems often conflate many system characteristics. To capture policy changes over time and by service in health systems regulation of public and private insurance, we propose a database containing explicit, standardized indicators of policy instruments. Methods The Health Insurance Access Database (HIAD) will collect policy information for ten OECD countries, over a range of eight health services, from 1990–2010. Policy indicators were selected through a comprehensive literature review which identified policy instruments most likely to constitute barriers to health insurance, thus potentially posing a threat to equity. As data collection is still underway, we present here the theoretical bases and methodology adopted, with a focus on the rationale underpinning the study instruments. Results These harmonized data will allow the capture of policy changes in health systems regulation of public and private insurance over time and by service. The standardization process will permit international comparisons of systems’ performance with regards to health insurance access and equity. Conclusion This research will inform and feed the current debate on the future of health care in developed countries and on the role of the private sector in these changes. PMID:22551599

Education and the Consolidation of Democracy in Latin America: Innovations To Provide Quality Basic Education with Equity. Advocacy Series Education and Development 4.

ERIC Educational Resources Information Center

Reimers, Fernando

Three case studies show innovative education programs that provide quality basic education with equity. After explaining the significance of educational innovation of democracy in Latin America and the constraints to educational development, the investigation of the three programs follows. The program of Fe y Alegria (Faith and Joy) in 12…

Advancing the Quality and Equity of Education for Latino Students: A White Paper. Research Report. ETS RR-12-01

ERIC Educational Resources Information Center

Young, John W.; Lakin, Joni; Courtney, Rosalea; Martiniello, María

2012-01-01

This white paper provides an overview of the issues that affect the quality and equity of education in grades K-16 for Latino students in the United States. This paper is organized chronologically to reflect the typical educational timeline for students in the United States, and we focused on several key transition points in the educational…

Balancing Considerations of Equity, Content Quality, and Technical Excellence in Designing, Validating and Implementing Performance Assessments in the Context of Mathematics Instructional Reform: The Experience of the QUASAR Project.

ERIC Educational Resources Information Center

Silver, Edward A.; Lane, Suzanne

Issues of educational equity and quality are explored in the context of the Quantitative Understanding: Amplifying Student Achievement and Reasoning (QUASAR) project, a national educational reform project aimed at fostering and studying the development and implementation of enhanced mathematics instructional programs for students attending middle…

Quality and equity in early childhood care in Peru

NASA Astrophysics Data System (ADS)

Izu, Regina Moromizato

2007-01-01

The present study examines educational policy documents and programs on early childhood development and education in Peru. The author provides an evaluation of early childhood learning programs and their outcomes in different education centers in Peru. Health, nutrition, development, and participation are identified as key areas of concern. The study concludes with a reference to the importance of monitoring quality and equity in early childhood care.

Achieving Equity and Quality in Japanese Elementary Schools: Balancing the Roles of State, Teachers, and Students

ERIC Educational Resources Information Center

Parmenter, Lynne

2016-01-01

The aim of this paper is to explore perspectives on equity, quality, motivation, and resilience by focusing in depth on the perspectives of educators in one small, semi-rural school in Japan. The paper is intended to provide rich, in-depth data and discussion as a way of providing insights from different perspectives into findings from large-scale…

Women's narratives on quality in prenatal care: a multicultural perspective.

PubMed

Wheatley, Robyn R; Kelley, Michele A; Peacock, Nadine; Delgado, Jaime

2008-11-01

Although significant progress has been made to increase prenatal care access, national organizations concerned with health equity emphasize that eliminating disparities will require greater attention to quality of care, assessed from both the biomedical and patient perspectives. In this study, we examined narratives about pregnancy experiences from low-income primiparous African American, Mexican American, Puerto Rican, and White women who participated in focus groups conducted in 1996. We reanalyzed transcripts from these discussions, extracting passages in which women talked about the content and quality of their prenatal care experiences. Data were mapped to four domains reflecting patient-centeredness markers identified in the 2005 U.S. National Healthcare Disparities Report (NHDR). These markers include the extent to which the women perceived that their provider listened carefully, explained things, showed respect, and spent enough time with them. The narratives provided by the study participants suggest a critical and intuitive understanding of the NHDR patient-centeredness markers and some shared understanding across cultural groups. Implications for improving quality and its measurement in prenatal care are discussed.

Reconceptualising Access in Education Policy: Method and Mindset

ERIC Educational Resources Information Center

Vongalis-Macrow, Athena

2010-01-01

Enhancing access to education and knowledge is a long-held principle enshrined in education policy. Access to education offers leverage for educational attainment and achievement, at the individual and social levels. In policy, the term equates with concepts of inclusion, social justice and equity. Over the last decades, as education policy has…

Social Justice and Out-of-School Science Learning: Exploring Equity in Science Television, Science Clubs and Maker Spaces

ERIC Educational Resources Information Center

Dawson, Emily

2017-01-01

This article outlines how social justice theories, in combination with the concepts of infrastructure access, literacies and community acceptance, can be used to think about equity in out-of-school science learning. The author applies these ideas to out-of-school learning via television, science clubs, and maker spaces, looking at research as well…

The Relationship of Gender Equity to Compensation, Career Advancement and Leadership in Selected Colleges of Business in Finland, Jamaica and the United States

ERIC Educational Resources Information Center

Leslie, Hewlett Steve

2017-01-01

The purpose of the study was to examine the relationship of gender equity to faculty compensation, career advancement, and access to leadership roles in colleges of business in Finland, Jamaica and the United States. This quantitative study, anchored by feminist, human capital and socialization theories supported the emergence of a conceptual…

Free establishment of primary health care providers: effects on geographical equity.

PubMed

Isaksson, David; Blomqvist, Paula; Winblad, Ulrika

2016-01-23

A reform in 2010 in Swedish primary care made it possible for private primary care providers to establish themselves freely in the country. In the former, publicly planned system, location was strictly regulated by local authorities. The goal of the new reform was to increase access and quality of health care. Critical arguments were raised that the reform could have detrimental effects on equity if the new primary health care providers chose to establish foremost in socioeconomically prosperous areas. The aim of this study is to examine how the primary care choice reform has affected geographical equity by analysing patterns of establishment on the part of new private providers. The basis of the design was to analyse socio-economic data on individuals who reside in the same electoral areas in which the 1411 primary health care centres in Sweden are established. Since the primary health care centres are located within 21 different county councils with different reimbursement schemes, we controlled for possible cluster effects utilizing generalized estimating equations modelling. The empirical material used in the analysis is a cross-sectional data set containing socio-economic data of the geographical areas in which all primary health care centres are established. When controlling for the effects of the county council regulation, primary health care centres established after the primary care choice reform were found to be located in areas with significantly fewer older adults living alone as well as fewer single parents - groups which generally have lower socio-economic status and high health care needs. However, no significant effects were observed for other socio-economic variables such as mean income, percentage of immigrants, education, unemployment, and children <5 years. The primary care choice reform seems to have had some negative effects on geographical equity, even though these seem relatively minor.

Medical pluralism: global perspectives on equity issues.

PubMed

Marian, Florica

2007-12-01

Over the last decades, awareness has increased about the phenomenon of medical pluralism and the importance to integrate biomedicine and other forms of health care. The broad variety of healing cultures existing alongside biomedicine is called complementary or alternative medicine (CAM) in industrialized countries and traditional medicine (TM) in developing countries. Considerable debate has arisen about ethical problems related to the growing use of CAM in industrialized countries. This article focuses on equity issues and aims to consider them from a global perspective of medical pluralism. Several dimensions of equity are explored and their interrelatedness discussed: access to care, research (paradigm and founding) and recognition. This so-called 'equity circle' is then related to Iris Marion Young's justice theory and particularly to the concepts of cultural imperialism, powerlessness and marginalisation.

Moving the Dial to Advance Population Health Equity in New York City Asian American Populations

PubMed Central

Trinh-Shevrin, Chau; Kwon, Simona C.; Nadkarni, Smiti Kapadia; Islam, Nadia S.

2015-01-01

The shift toward a health equity framework for eliminating the health disparities burden of racial/ethnic minority populations has moved away from a disease-focused model to a social determinants framework that aims to achieve the highest attainment of health for all. The New York University Center for the Study of Asian American Health (CSAAH) has identified core themes and strategies for advancing population health equity for Asian American populations in New York City that are rooted in the following: social determinants of health; multisectoral, community-engaged approaches; leveraging community assets; improved disaggregated data collection and access to care; and building sustainability through community leadership and infrastructure-building activities. We describe the strategies CSAAH employed to move the dial on population health equity. PMID:25905858

Storytelling to access social context and advance health equity research.

PubMed

Banks, JoAnne

2012-11-01

Increased understanding of individual and social determinants of health is crucial to moving toward health equity. This essay examines storytelling as a vehicle for advancing health equity research. Contemplative examination of storytelling as a research strategy. An overview of story theory is provided. This is followed by an examination of storytelling as a tool for increasing understanding about the contexts in which people negotiate health, strengthening participation of communities in addressing health issues, and building bridges between researchers and target populations. Storytelling can be a powerful tool for advancing health equity research. However, its effective use requires a renegotiation of relationships between researchers and target communities, as well as setting aside routine time to attend storytelling events and read a variety of stories. Copyright © 2011 Elsevier Inc. All rights reserved.

An evaluation of gender equity in different models of primary care practices in Ontario

PubMed Central

2010-01-01

Background The World Health Organization calls for more work evaluating the effect of health care reforms on gender equity in developed countries. We performed this evaluation in Ontario, Canada where primary care models resulting from reforms co-exist. Methods This cross sectional study of primary care practices uses data collected in 2005-2006. Healthcare service models included in the study consist of fee for service (FFS) based, salaried, and capitation based. We compared the quality of care delivered to women and men in practices of each model. We performed multi-level, multivariate regressions adjusting for patient socio-demographic and economic factors to evaluate vertical equity, and adjusting for these and health factors in evaluating horizontal equity. We measured seven dimensions of health service delivery (e.g. accessibility and continuity) and three dimensions of quality of care using patient surveys (n = 5,361) and chart abstractions (n = 4,108). Results Health service delivery measures were comparable in women and men, with differences ≤ 2.2% in all seven dimensions and in all models. Significant gender differences in the health promotion subjects addressed were observed. Female specific preventive manoeuvres were more likely to be performed than other preventive care. Men attending FFS practices were more likely to receive influenza immunization than women (Adjusted odds ratio: 1.75, 95% confidence intervals (CI) 1.05, 2.92). There was no difference in the other three prevention indicators. FFS practices were also more likely to provide recommended care for chronic diseases to men than women (Adjusted difference of -11.2%, CI -21.7, -0.8). A similar trend was observed in Community Health Centers (CHC). Conclusions The observed differences in the type of health promotion subjects discussed are likely an appropriate response to the differential healthcare needs between genders. Chronic disease care is non equitable in FFS but not in capitation based models. We recommend that efforts to monitor and address gender based differences in the delivery of chronic disease management in primary care be pursued. PMID:20331861

Scrambling for access: availability, accessibility, acceptability and quality of healthcare for lesbian, gay, bisexual and transgender people in South Africa.

PubMed

Müller, Alex

2017-05-30

Sexual orientation and gender identity are social determinants of health for people identifying as lesbian, gay, bisexual and transgender (LGBT), and health disparities among sexual and gender minority populations are increasingly well understood. Although the South African constitution guarantees sexual and gender minority people the right to non-discrimination and the right to access to healthcare, homo- and transphobia in society abound. Little is known about LGBT people's healthcare experiences in South Africa, but anecdotal evidence suggests significant barriers to accessing care. Using the framework of the UN International Covenant on Economic, Social and Cultural Rights General Comment 14, this study analyses the experiences of LGBT health service users using South African public sector healthcare, including access to HIV counselling, testing and treatment. A qualitative study comprised of 16 semi-structured interviews and two focus group discussions with LGBT health service users, and 14 individual interviews with representatives of LGBT organisations. Data were thematically analysed within the framework of the UN International Covenant on Economic, Social and Cultural Rights General Comment 14, focusing on availability, accessibility, acceptability and quality of care. All interviewees reported experiences of discrimination by healthcare providers based on their sexual orientation and/or gender identity. Participants recounted violations of all four elements of the UN General Comment 14: 1) Availability: Lack of public health facilities and services, both for general and LGBT-specific concerns; 2) Accessibility: Healthcare providers' refusal to provide care to LGBT patients; 3) Acceptability: Articulation of moral judgment and disapproval of LGBT patients' identity, and forced subjection of patients to religious practices; 4) Quality: Lack of knowledge about LGBT identities and health needs, leading to poor-quality care. Participants had delayed or avoided seeking healthcare in the past, and none had sought out accountability or complaint mechanisms within the health system. Sexual orientation and gender identity are important categories of analysis for health equity, and lead to disparities in all four dimensions of healthcare access as defined by General Comment 14. Discriminatory and prejudicial attitudes by healthcare providers, combined with a lack of competency and knowledge are key reasons for these disparities in South Africa.

Gender Equity Matters!

ERIC Educational Resources Information Center

Thorius, Kathleen King

2010-01-01

Despite remarkable progress along many indicators of equitable access, participation, and outcomes of schooling, there are still persistent, pervasive issues that must be addresses, including continued disparities in access to athletics and academic programs, sexual harassment, hate crimes, and discriminatory treatment of girls and women. This…

[Lack of access to information on oral health problems among adults: an approach based on the theoretical model for literacy in health].

PubMed

Roberto, Luana Leal; Noronha, Daniele Durães; Souza, Taiane Oliveira; Miranda, Ellen Janayne Primo; Martins, Andréa Maria Eleutério de Barros Lima; Paula, Alfredo Maurício Batista De; Ferreira, Efigênia Ferreira E; Haikal, Desirée Sant'ana

2018-03-01

This study sought to investigate factors associated with the lack of access to information on oral health among adults. It is a cross-sectional study, carried out among 831 adults (35-44 years of age). The dependent variable was access to information on how to avoid oral problems, and the independent variables were gathered into subgroups according to the theoretical model for literacy in health. Binary logistic regression was carried out, and results were corrected by the design effect. It was observed that 37.5% had no access to information about dental problems. The lack of access was higher among adults who had lower per capita income, were dissatisfied with the dental services provided, did not use dental floss, had unsatisfactory physical control of the quality of life, and self-perceived their oral health as fair/poor/very poor. The likelihood of not having access to information about dental problems among those dissatisfied with the dental services used was 3.28 times higher than for those satisfied with the dental services used. Thus, decreased access to information was related to unfavorable conditions among adults. Health services should ensure appropriate information to their users in order to increase health literacy levels and improve satisfaction and equity.

What does the development of medical tourism in Barbados hold for health equity? an exploratory qualitative case study.

PubMed

Labonté, Ronald; Runnels, Vivien; Crooks, Valorie A; Johnston, Rory; Snyder, Jeremy

2017-01-01

Although the global growth of privatized health care services in the form of medical tourism appears to generate economic benefits, there is debate about medical tourism's impacts on health equity in countries that receive medical tourists. Studies of the processes of economic globalization in relation to social determinants of health suggest that medical tourism's impacts on health equity can be both direct and indirect. Barbados, a small Caribbean nation which has universal public health care, private sector health care and a strong tourism industry, is interested in developing an enhanced medical tourism sector. In order to appreciate Barbadians' understanding of how a medical tourism industry might impact health equity. We conducted 50 individual and small-group interviews in Barbados with stakeholders including government officials, business and health professionals. The interviews were coded and analyzed deductively using the schedule's questions, and inductively for novel findings, and discussed by the authors. The findings suggest that in spite of Barbados' universal health care and strong population health indicators, there is expressed concern for medical tourism's impact on health equity. Informants pointed to the direct ways in which the domestic population might access more health care through medical tourism and how privately-provided medical tourism in Barbados could provide health benefits indirectly to the Barbadian populations. At the same time, they cautioned that these benefits may not materialize. For example, the transfer of public resources - health workers, money, infrastructure and equipment - to the private sector to support medical tourism with little to no return to government revenues could result in health inequity through reductions in access to and availability of health care for residents. In clarifying the direct and indirect pathways by which medical tourism can impact health equity, these findings have implications for health system stakeholders and decision-makers in Barbados and other countries attempting both to build a medical tourism industry and to protect health equity.

Media reporting, carbon information disclosure, and the cost of equity financing: evidence from China.

PubMed

Li, Li; Liu, Quanqi; Tang, Dengli; Xiong, Jucheng

2017-04-01

By using Shanghai and Shenzhen A-share listed companies in heavy polluting industry as research object from 2009 to 2014, this paper examines the relationship between media reporting, carbon information disclosure, and the cost of equity financing. The results show that media reporting can improve the quality of carbon information disclosure, and carbon information disclosure level is negatively associated with the cost of equity financing. This study also finds that financial carbon information disclosure and non-financial carbon information disclosure have significant negative relationship with the cost of equity financing respectively. Moreover, this paper shows that media reporting can strengthen the relationship between carbon information disclosure and the cost of equity financing.

Bringing Equity and Quality Learning Together: Institutional Priorities for Tracking and Advancing Underserved Students' Success. Key Findings from a Survey and In-Depth Interviews among Administrators at AAC&U Member Institutions

ERIC Educational Resources Information Center

Association of American Colleges and Universities, 2015

2015-01-01

The Association of American Colleges and Universities (AAC&U) surveyed Chief Academic Officers at member institutions from July-October 2015 concerning priorities related to learning outcomes, assessment, general education design, high-impact practices, and data tracking and goal setting around equity and quality learning. With support from…

76 FR 17738 - Over-the-Road Bus Accessibility Program Announcement of Project Selections

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-30

... Transportation Equity Act for the 21st Century (TEA-21). The OTRB Accessibility Program makes funds available to... to any new vehicles delivered on or after June 9, 1998, the effective date of TEA-21, is eligible for...

South Asian Nomads--A Literature Review. CREATE Pathways to Access. Research Monograph No. 58

ERIC Educational Resources Information Center

Sharma, Anita

2011-01-01

This review of literature on South Asian nomads is part of a series of monographs on educational access published by the Consortium for Research on Educational Access Transitions and Equity (CREATE). In the context of India, most recent work has focused on access to the education system for the poor. CREATE research in India has focused on …

Setting Housing Standards to Improve Global Health

PubMed Central

Howden-Chapman, Philippa; Roebbel, Nathalie

2017-01-01

Developing World Health Organization international guidelines is a highly formal process. Yet the resulting guidelines, which Member States are encouraged, but not required to adopt, are a powerful way of developing rigorous policy and fostering implementation. Using the example of the housing and health guidelines, which are currently being finalised, this paper outlines the process for developing WHO guidelines. This includes: forming a Guidelines Review Group that represents all regions of the world, and ensures gender balance and technical expertise; identifying key health outcomes of interest; commissioning systematic reviews of the evidence; assessing the evidence; and formulating recommendations. The strength of each recommendation is assessed based on the quality of the evidence, along with consideration of issues such as equity, acceptability, and feasibility of the implementation of the recommendation. The proposed housing guidelines will address: cold and hot indoor temperatures, home injuries, household crowding, accessibility and access to active travel infrastructure. PMID:29232827

[Organ allocation system: between efficiency and equity].

PubMed

Antoine, Corinne

2007-02-15

Despite considerable efforts to promote organ donation and increase the amount of organ retrieval, demand for grafts is increasing and remains much higher then availability. This short supply is noticeable for all organ transplantation whether for heart, lungs, liver or pancreas but mainly for kidneys. The objective of graft allocation and attribution rules is to insure an allocation as fair as possible, to find the best recipient, to take into account the emergency of the need for grafting or the access difficulty for certain patients, and to seek optimal graft usage. These rules are based on the setting up of priority categories for patients whose lives are threatened on a very short-term basis or for those having difficult access to transplantation. This implies the issue of seeking the balance between an allocation as fair as possible and technical constraints associated with organ retrieval, transportation and graft quality preservation.

Key Data Highlights on Equity and Opportunity Gaps in Our Nation's Public Schools. 2013-2014 Civil Rights Data Collection. A First Look. Revised

ERIC Educational Resources Information Center

Office for Civil Rights, US Department of Education, 2016

2016-01-01

This document provides results of a survey of all public schools and school districts in the United States. The CRDC measures student access to courses, programs, instructional and other staff, and resources--as well as school climate factors, such as student discipline and bullying and harassment--that impact education equity and opportunity for…

Policy Discourses in Higher Education: Impact on Access and Equity

ERIC Educational Resources Information Center

Panigrahi, Jinusha

2014-01-01

The article examines the question of access to higher education (HE) in the context of unprecedented and irreversible changes in the higher education sector in the current scenario. It is based on a comparative study that seeks to probe the question of access based on a secondary data analysis using the NSSO data regarding household consumer…

The spatial equity principle in the administrative division of the Central European countries

PubMed Central

Klapka, Pavel; Bačík, Vladimír; Klobučník, Michal

2017-01-01

The paper generally builds on the concept of justice in social science. It attempts to interpret this concept in a geographical and particularly in a spatial context. The paper uses the concept of accessibility to define the principle of spatial equity. The main objective of the paper is to propose an approach with which to assess the level of spatial equity in the administrative division of a territory. In order to fulfil this objective the paper theoretically discusses the concept of spatial equity and relates it to other relevant concepts, such as spatial efficiency. The paper proposes some measures of spatial equity and uses the territory of four Central European countries (Austria, the Czech Republic, Hungary, Slovakia) as example of the application of the proposed measures and the corroboration of the proposed approach. The analysis is based on the administrative division of four countries and is carried out at different hierarchical levels as defined by the Nomenclature of Units for Territorial Statistics (NUTS). PMID:29091953

Poverty, equity, human rights and health.

PubMed

Braveman, Paula; Gruskin, Sofia

2003-01-01

Those concerned with poverty and health have sometimes viewed equity and human rights as abstract concepts with little practical application, and links between health, equity and human rights have not been examined systematically. Examination of the concepts of poverty, equity, and human rights in relation to health and to each other demonstrates that they are closely linked conceptually and operationally and that each provides valuable, unique guidance for health institutions' work. Equity and human rights perspectives can contribute concretely to health institutions' efforts to tackle poverty and health, and focusing on poverty is essential to operationalizing those commitments. Both equity and human rights principles dictate the necessity to strive for equal opportunity for health for groups of people who have suffered marginalization or discrimination. Health institutions can deal with poverty and health within a framework encompassing equity and human rights concerns in five general ways: (1) institutionalizing the systematic and routine application of equity and human rights perspectives to all health sector actions; (2) strengthening and extending the public health functions, other than health care, that create the conditions necessary for health; (3) implementing equitable health care financing, which should help reduce poverty while increasing access for the poor; (4) ensuring that health services respond effectively to the major causes of preventable ill-health among the poor and disadvantaged; and (5) monitoring, advocating and taking action to address the potential health equity and human rights implications of policies in all sectors affecting health, not only the health sector.

Poverty, equity, human rights and health.

PubMed Central

Braveman, Paula; Gruskin, Sofia

2003-01-01

Those concerned with poverty and health have sometimes viewed equity and human rights as abstract concepts with little practical application, and links between health, equity and human rights have not been examined systematically. Examination of the concepts of poverty, equity, and human rights in relation to health and to each other demonstrates that they are closely linked conceptually and operationally and that each provides valuable, unique guidance for health institutions' work. Equity and human rights perspectives can contribute concretely to health institutions' efforts to tackle poverty and health, and focusing on poverty is essential to operationalizing those commitments. Both equity and human rights principles dictate the necessity to strive for equal opportunity for health for groups of people who have suffered marginalization or discrimination. Health institutions can deal with poverty and health within a framework encompassing equity and human rights concerns in five general ways: (1) institutionalizing the systematic and routine application of equity and human rights perspectives to all health sector actions; (2) strengthening and extending the public health functions, other than health care, that create the conditions necessary for health; (3) implementing equitable health care financing, which should help reduce poverty while increasing access for the poor; (4) ensuring that health services respond effectively to the major causes of preventable ill-health among the poor and disadvantaged; and (5) monitoring, advocating and taking action to address the potential health equity and human rights implications of policies in all sectors affecting health, not only the health sector. PMID:12973647

Equity in healthcare resource allocation decision making: A systematic review.

PubMed

Lane, Haylee; Sarkies, Mitchell; Martin, Jennifer; Haines, Terry

2017-02-01

To identify elements of endorsed definitions of equity in healthcare and classify domains of these definitions so that policy makers, managers, clinicians, and politicians can form an operational definition of equity that reflects the values and preferences of the society they serve. Systematic review where verbatim text describing explicit and implicit definitions of equity were extracted and subjected to a thematic analysis. The full holdings of the AMED, CINAHL plus, OVID Medline, Scopus, PsychInfo and ProQuest (ProQuest Health & Medical Complete, ProQuest Nursing and Allied Health Source, ProQuest Social Science Journals) were individually searched in April 2015. Studies were included if they provided an original, explicit or implicit definition of equity in regards to healthcare resource allocation decision making. Papers that only cited earlier definitions of equity and provided no new information or extensions to this definition were excluded. The search strategy yielded 74 papers appropriate for this review; 60 of these provided an explicit definition of equity, with a further 14 papers discussing implicit elements of equity that the authors endorsed in regards to healthcare resource allocation decision making. FIVE KEY THEMES EMERGED: i) Equalisation across the health service supply/access/outcome chain, ii) Need or potential to benefit, iii) Groupings of equalisation, iv) Caveats to equalisation, and v) Close enough is good enough. There is great inconsistency in definitions of equity endorsed by different authors. Operational definitions of equity need to be more explicit in addressing these five thematic areas before they can be directly applied to healthcare resource allocation decisions. Copyright © 2016 Elsevier Ltd. All rights reserved.

Towards equity and sustainability of rural and remote health services access: supporting social capital and integrated organisational and professional development.

PubMed

Schoo, Adrian; Lawn, Sharon; Carson, Dean

2016-04-02

Access to rural health services is compromised in many countries including Australia due to workforce shortages. The issues that consequently impact on equity of access and sustainability of rural and remote health services are complex. The purpose of this paper is to describe a number of approaches from the literature that could form the basis of a more integrated approach to health workforce and rural health service enhancement that can be supported by policy. A case study is used to demonstrate how such an approach could work. Disjointed health services are common in rural areas due to the 'tyranny of distance.' Recruitment and retention of health professionals in rural areas and access to and sustainability of rural health services is therefore compromised. Strategies to address these issues tend to have a narrow focus. An integrated approach is needed to enhance rural workforce and health services; one that develops, acknowledges and accounts for social capital and social relations within the rural community.

Using decision trees for measuring gender equity in the timing of angiography in patients with acute coronary syndrome: a novel approach to equity analysis.

PubMed

Bierman, Arlene S; Brown, Adalsteinn D; Levinton, Carey M

2015-12-23

Methods to measure or quantify equity in health care remain scarce, if not difficult to interpret. A novel method to measure health equity is presented, applied to gender health equity, and illustrated with an example of timing of angiography in patients following a hospital admission for an acute coronary syndrome. Linked administrative hospital discharge and survey data was used to identify a retrospective cohort of patients hospitalized with Acute Coronary Syndrome (ACS) between 2002 and 2008 who also responded to the Canadian Community Health Survey (CCHS), was analyzed using decision trees to determine whether gender impacted the delay to angiography following an ACS. Defining a delay to angiography as 1 day or more, resulted in a non-significant difference in an equity score of 0.14 for women and 0.12 for men, where 0 and 1 represents perfect equity and inequity respectively. Using 2 and 3 day delays as a secondary outcome resulted in women and men producing scores of 0.19 and 0.17 for a 2 day delay and 0.22 and 0.23 for a 3 day delay. A technique developed expressly for measuring equity suggests that men and women in Ontario receive equitable care in access to angiography with respect to timeliness following an ACS.

The role of the physical environment in crossing the quality chasm.

PubMed

Henriksen, Kerm; Isaacson, Sandi; Sadler, Blair L; Zimring, Craig M

2007-11-01

Evidence-based design findings are available to help inform hospital decision makers of opportunities for ensuring that quality and safety are designed into new and refurbished facilities. The Institute of Medicine's six quality aims of patient centeredness, safety, effectiveness, efficiency, timeliness, and equity provide an organizing framework for introducing a representative portion of the evidence. Design improvements include single-bed and variable-acuity rooms; electronic access to medical records; greater accommodation for families and visitors; handrails to prevent patient falls; standardization (room layout, equipment, and supplies for improved efficiencies); improved work process flow to reduce delays and wait times; and better assessment of changing demographics, disease conditions, and community needs for appropriately targeted health care services. A recent analysis of the business case suggests that a slight, one-time incremental cost for ensuring safety and quality would be paid back in two to three years in the form of operational savings and increased revenues. Hospitals leaders anticipating new construction projects should take advantage of evidence-based design findings that have the potential of raising the quality of acute care for decades to come.

Socio-ethical analysis of equity in access to nutrigenomics interventions for obesity prevention: a focus group study.

PubMed

Lévesque, Lise; Ozdemir, Vural; Godard, Béatrice

2008-12-01

The goal of nutrigenomics is to develop nutritional interventions targeted to individual genetic make-up. Obesity is a prime candidate for nutrigenomics research. Personalized approaches to prevention of diseases associated with obesity may be available in the near future. Nevertheless, in the context of limited resources, access to a nutrigenomics personalized health service raises questions around equity. Using focus groups, the present qualitative research study provides empirical data on ethical concerns and values surrounding the nutrigenomics-guided personalized nutrition for obesity prevention. Eight focus groups were convened including 27 healthy individuals and 21 individuals who self-identified as obese or at risk of obesity. The transcripts of the focus group were analyzed according to the qualitative method of grounded theory. Responsibility, reciprocity, and solidarity emerged as the key ethical criteria perceived by the respondents to be significant in terms of how health professionals should determine access to personalized nutrition services. Still, exclusion of individuals from specific nutrigenomic services is likely to conflict with the imperatives of medical deontology and contemporary social consensus. The representation of equity in this paper is novel: it considers the intersection of nutrigenomics and personalized nutritional interventions specifically in the context of limited public resources for health services.

Coverage, universal access and equity in health: a characterization of scientific production in nursing

PubMed Central

Mendoza-Parra, Sara

2016-01-01

Objectives: to characterize the scientific contribution nursing has made regarding coverage, universal access and equity in health, and to understand this production in terms of subjects and objects of study. Material and methods: this was cross-sectional, documentary research; the units of analysis were 97 journals and 410 documents, retrieved from the Web of Science in the category, "nursing". Descriptors associated to coverage, access and equity in health, and the Mesh thesaurus, were applied. We used bibliometric laws and indicators, and analyzed the most important articles according to amount of citations and collaboration. Results: the document retrieval allowed for 25 years of observation of production, an institutional and an international collaboration of 31% and 7%, respectively. The mean number of coauthors per article was 3.5, with a transience rate of 93%. The visibility index was 67.7%, and 24.6% of production was concentrated in four core journals. A review from the nursing category with 286 citations, and a Brazilian author who was the most productive, are issues worth highlighting. Conclusions: the nursing collective should strengthen future research on the subject, defining lines and sub-lines of research, increasing internationalization and building it with the joint participation of the academy and nursing community. PMID:26959329

Health care of people in homelessness: a comparative study of mobile units in Portugal, United States and Brazil.

PubMed

Borysow, Igor da Costa; Conill, Eleonor Minho; Furtado, Juarez Pereira

2017-03-01

This paper describes and analyzes the legal and normative framework guiding the use of mobile units in Portugal, United States and Brazil, which seek to improve access and continuity of care for people in homelessness. We used a comparative analysis through literature and documentary review relating three categories: context (demographic, socio-economic and epidemiological), services system (access, coverage, organization, management and financing) and, specifically, mobile units (design, care and financing model). The analysis was based on the theory of convergence/divergence between health systems from the perspective of equity in health. Improving access, addressing psychoactive substances abuse, outreach and multidisciplinary work proved to be common to all three countries, with the potential to reduce inequities. Relationships with primary healthcare, use of vehicles and the type of financing are considered differently in the three countries, influencing the greater or lesser extent of equity in the analyzed proposals.

'Net Equity: A Report on Income and Internet Access.

ERIC Educational Resources Information Center

Moss, Mitchell; Mitra, Steve

1998-01-01

Examines the structure of the subscriber base formed under the current pricing policies of Internet providers and investigates how access to the Internet varies in communities with different demographic characteristics. Report is based on a survey from a national Internet service provided in 1997. (SLD)

An Introductory Mixed-Methods Intersectionality Analysis of College Access and Equity: An Examination of First-Generation Asian Americans and Pacific Islanders

ERIC Educational Resources Information Center

Museus, Samuel D.

2011-01-01

In this article, the author discusses how researchers can use mixed-methods approaches and intersectional analyses to understand college access among first-generation Asian American and Pacific Islanders (AAPIs). First, he discusses the utility of mixed-methods approaches and intersectionality research in studying college access. Then, he…

Equal Access to Content Instruction for English Learners: An Example from Science

ERIC Educational Resources Information Center

Brown, Zoe Ann; DiRanna, Kathy

2012-01-01

Equal access to content instruction is the foundation of educational equity--it reduces opportunity gaps that lead to achievement gaps. Achievement gaps lead to gaps in college and career access, which lead to income gaps. Income gaps lead to language gaps, thus perpetuating one of the most critical gaps we face in education. This paper is about…

Colleges and Universities and Their Stewardship of Place: A Guide for Developing Performance Measures for the Equity of Access and Student Success

ERIC Educational Resources Information Center

Kelly, Patrick J.; Ewell, Peter T.

2009-01-01

NCHEMS (National Center for Higher Education Management Systems) has worked with the National Association of Systems heads (NASH)--with support from the Lumina Foundation for Education--to develop (1) empirically-based access regions for postsecondary institutions based on student enrollment patterns and (2) access, transition, and completion…

Access to antiretroviral treatment, issues of well-being and public health governance in Chad: what justifies the limited success of the universal access policy?

PubMed Central

2013-01-01

Universal access to antiretroviral treatment (ART) in Chad was officially declared in December 2006. This presidential initiative was and is still funded 100% by the country’s budget and external donors’ financial support. Many factors have triggered the spread of AIDS. Some of these factors include the existence of norms and beliefs that create or increase exposure, the low-level education that precludes access to health information, social unrest, and population migration to areas of high economic opportunities and gender-based discrimination. Social forces that influence the distribution of dimensions of well-being and shape risks for infection also determine the persistence of access barriers to ART. The universal access policy is quite revolutionary but should be informed by the systemic barriers to access so as to promote equity. It is not enough to distribute ARVs and provide health services when health systems are poorly organized and managed. Comprehensive access to ART raises many organizational, ethical and policy problems that need to be solved to achieve equity in access. This paper argues that the persistence of access barriers is due to weak health systems and a poor public health leadership. AIDS has challenged health systems in a manner that is essentially different from other health problems. PMID:23902732

The effects of MCH insurance cards on improving equity in access and use of maternal and child health care services in Tanzania: a mixed methods analysis.

PubMed

Kuwawenaruwa, August; Mtei, Gemini; Baraka, Jitihada; Tani, Kassimu

2016-11-18

Inequity in access and use of child and maternal health services is impeding progress towards reduction of maternal mortality in low-income countries. To address low usage of maternal and newborn health care services as well as financial protection of families, some countries have adopted demand-side financing. In 2010, Tanzania introduced free health insurance cards to pregnant women and their families to influence access, use, and provision of health services. However, little is known about whether the use of the maternal and child health cards improved equity in access and use of maternal and child health care services. A mixed methods approach was used in Rungwe district where maternal and child health insurance cards had been implemented. To assess equity, three categories of beneficiaries' education levels were used and were compared to that of women of reproductive age in the region from previous surveys. To explore factors influencing women's decisions on delivery site and use of the maternal and child health insurance card and attitudes towards the birth experience itself, a qualitative assessment was conducted at representative facilities at the district, ward, facility, and community level. A total of 31 in-depth interviews were conducted on women who delivered during the previous year and other key informants. Women with low educational attainment were under-represented amongst those who reported having received the maternal and child health insurance card and used it for facility delivery. Qualitative findings revealed that problems during the current pregnancy served as both a motivator and a barrier for choosing a facility-based delivery. Decision about delivery site was also influenced by having experienced or witnessed problems during previous birth delivery and by other individual, financial, and health system factors, including fines levied on women who delivered at home. To improve equity in access to facility-based delivery care using strategies such as maternal and child health insurance cards is necessary to ensure beneficiaries and other stakeholders are well informed of the programme, as giving women insurance cards only does not guarantee facility-based delivery.

Private-Sector Social Franchising to Accelerate Family Planning Access, Choice, and Quality: Results From Marie Stopes International.

PubMed

Munroe, Erik; Hayes, Brendan; Taft, Julia

2015-06-17

To achieve the global Family Planning 2020 (FP2020) goal of reaching 120 million more women with voluntary family planning services, rapid scale-up of services is needed. Clinical social franchising, a service delivery approach used by Marie Stopes International (MSI) in which small, independent health care businesses are organized into quality-assured networks, provides an opportunity to engage the private sector in improving access to family planning and other health services. We analyzed MSI's social franchising program against the 4 intended outputs of access, efficiency, quality, and equity. The analysis used routine service data from social franchising programs in 17 African and Asian countries (2008-2014) to estimate number of clients reached, couple-years of protection (CYPs) provided, and efficiency of services; clinical quality audits of 636 social franchisees from a subset of the 17 countries (2011-2014); and exit interviews with 4,844 clients in 14 countries (2013) to examine client satisfaction, demographics (age and poverty), and prior contraceptive use. The MSI "Impact 2" model was used to estimate population-level outcomes by converting service data into estimated health outcomes. Between 2008 and 2014, an estimated 3,753,065 women cumulatively received voluntary family planning services via 17 national social franchise programs, with a sizable 68% choosing long-acting reversible contraceptives (LARCs). While the number of social franchisee outlets increased over time, efficiency also significantly improved over time, with each outlet delivering, on average, 178 CYPs in 2008 compared with 941 CYPs in 2014 (P = .02). Clinical quality audit scores also significantly improved; 39.8% of social franchisee outlets scored over 80% in 2011 compared with 84.1% in 2014. In 2013, 40.7% of the clients reported they had not been using a modern method during the 3 months prior to their visit (95% CI = 37.4, 44.0), with 46.1% (95% CI = 40.9, 51.2) of them reporting having never previously used family planning at all. Analysis of age and poverty levels of clients indicate mixed results in bridging equity gaps: 57.4% of clients lived on under US$2.50/day in 2013 (95% CI = 54.9, 60.0) and 26.1% were 15-24 years old (95% CI = 23.8, 28.4), but only 15.1% lived on less than $1.25/day (95% CI = 13.8, 16.4) and 5.0% were 15-19 years old (95% CI = 3.9, 6.1). The services provided via social franchising are estimated to avert 4,958,000 unintended pregnancies and 7,150 maternal deaths. Social franchising through the existing private sector has the ability to rapidly scale-up access to high-quality family planning services, including LARCs, for the general population as well as young women and the poor, providing a promising model to help achieve the global FP2020 goal. © Munroe et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit http://creativecommons.org/licenses/by/3.0/

Equity of access to primary healthcare for vulnerable populations: the IMPACT international online survey of innovations.

PubMed

Richard, Lauralie; Furler, John; Densley, Konstancja; Haggerty, Jeannie; Russell, Grant; Levesque, Jean-Frederic; Gunn, Jane

2016-04-12

Improving access to primary healthcare (PHC) for vulnerable populations is important for achieving health equity, yet this remains challenging. Evidence of effective interventions is rather limited and fragmented. We need to identify innovative ways to improve access to PHC for vulnerable populations, and to clarify which elements of health systems, organisations or services (supply-side dimensions of access) and abilities of patients or populations (demand-side dimensions of access) need to be strengthened to achieve transformative change. The work reported here was conducted as part of IMPACT (Innovative Models Promoting Access-to-Care Transformation), a 5-year Canadian-Australian research program aiming to identify, implement and trial best practice interventions to improve access to PHC for vulnerable populations. We undertook an environmental scan as a broad screening approach to identify the breadth of current innovations from the field. We distributed a brief online survey to an international audience of PHC researchers, practitioners, policy makers and stakeholders using a combined email and social media approach. Respondents were invited to describe a program, service, approach or model of care that they considered innovative in helping vulnerable populations to get access to PHC. We used descriptive statistics to characterise the innovations and conducted a qualitative framework analysis to further examine the text describing each innovation. Seven hundred forty-four responses were recorded over a 6-week period. 240 unique examples of innovations originating from 14 countries were described, the majority from Canada and Australia. Most interventions targeted a diversity of population groups, were government funded and delivered in a community health, General Practice or outreach clinic setting. Interventions were mainly focused on the health sector and directed at organisational and/or system level determinants of access (supply-side). Few innovations were developed to enhance patients' or populations' abilities to access services (demand-side), and rarely did initiatives target both supply- and demand-side determinants of access. A wide range of innovations improving access to PHC were identified. The access framework was useful in uncovering the disparity between supply- and demand-side dimensions and pinpointing areas which could benefit from further attention to close the equity gap for vulnerable populations in accessing PHC services that correspond to their needs.

Challenges for the German Health Care System.

PubMed

Dietrich, C F; Riemer-Hommel, P

2012-06-01

The German Health Care System (GHCS) faces many challenges among which an aging population and economic problems are just a few. The GHCS traditionally emphasised equity, universal coverage, ready access, free choice, high numbers of providers and technological equipment; however, real competition among health-care providers and insurance companies is lacking. Mainly in response to demographic changes and economic challenges, health-care reforms have focused on cost containment and to a lesser degree also quality issues. In contrast, generational accounting, priorisation and rationing issues have thus far been completely neglected. The paper discusses three important areas of health care in Germany, namely the funding process, hospital management and ambulatory care, with a focus on cost control mechanisms and quality improving measures as the variables of interest. Health Information Technology (HIT) has been identified as an important quality improvement tool. Health Indicators have been introduced as possible instruments for the priorisation debate. © Georg Thieme Verlag KG Stuttgart · New York.

[Equity issues in health care reform in Argentina].

PubMed

Belmartino, Susana

2002-01-01

This article analyzes the historical and contemporary development of the Argentine health care system from the viewpoint of equity, a principle which is not explicitly mentioned in the system's founding documents. However, other values can be identified such as universal care, accessibility, and solidarity, which are closely related to equity. Nevertheless, the political dynamics characterizing the development of the country's health care system led to the suppression of more universalistic approaches, with group solidarity the only remaining principle providing structure to the system. The 1980s financial crisis highlighted the relative value of this principle as the basis for an equitable system. The authors illustrate the current situation with data on coverage under the medical social security system.

What impact do prescription drug charges have on efficiency and equity? Evidence from high-income countries

PubMed Central

Gemmill, Marin C; Thomson, Sarah; Mossialos, Elias

2008-01-01

As pharmaceutical expenditure continues to rise, third-party payers in most high-income countries have increasingly shifted the burden of payment for prescription drugs to patients. A large body of literature has examined the relationship between prescription charges and outcomes such as expenditure, use, and health, but few reviews explicitly link cost sharing for prescription drugs to efficiency and equity. This article reviews 173 studies from 15 high-income countries and discusses their implications for important issues sometimes ignored in the literature; in particular, the extent to which prescription charges contain health care costs and enhance efficiency without lowering equity of access to care. PMID:18454849

Charting the evolution of approaches employed by the Global Alliance for Vaccines and Immunizations (GAVI) to address inequities in access to immunization: a systematic qualitative review of GAVI policies, strategies and resource allocation mechanisms through an equity lens (1999-2014).

PubMed

Gandhi, Gian

2015-11-30

GAVI's focus on reducing inequities in access to vaccines, immunization, and GAVI funds, - both between and within countries - has changed over time. This paper charts that evolution. A systematic qualitative review was conducted by searching PubMed, Google Scholar and direct review of available GAVI Board papers, policies, and program guidelines. Documents were included if they described or evaluated GAVI policies, strategies, or programs and discussed equity of access to vaccines, utilization of immunization services, or GAVI funds in countries currently or previously eligible for GAVI support. Findings were grouped thematically, categorized into time periods covering GAVI's phases of operations, and assessed depending on whether the approaches mediated equity of opportunity or equity of outcomes between or within countries. Serches yielded 2816 documents for assessment. After pre-screening and removal of duplicates, 552 documents underwent detailed evaluation and pertinent information was extracted from 188 unique documents. As a global funding mechanism, GAVI responded rationally to a semi-fixed funding constraint by focusing on between-country equity in allocation of resources. GAVI's predominant focus and documented successes have been in addressing between-country inequities in access to vaccines comparing lower income (GAVI-eligible) countries with higher income (ineligible) countries. GAVI has had mixed results at addressing between-country inequities in utilization of immunization services, and has only more recently put greater emphasis and resources towards addressing within-country inequities in utilization to immunization services. Over time, GAVI has progressively added vaccines to its portfolio. This expansion should have addressed inter-country, inter-regional, inter-generational and gender inequities in disease burden, however, evidence is scant with respect to final outcomes. In its next phase of operations, the Alliance can continue to demonstrate its strength as a highly effective multi-partner enterprise, capable of learning and innovating in a world that has changed much since its inception. By building on its successes, developing more coherent and consistent approaches to address inequities between and within countries and by monitoring progress and outcomes, GAVI is well-positioned to bring the benefits of vaccination to previously unreached and underserved communities towards provision of universal health coverage.

Measuring equity in utilization of emergency obstetric care at Wolisso Hospital in Oromiya, Ethiopia: a cross sectional study

PubMed Central

2013-01-01

Introduction Improving equity in access to services for the treatment of complications that arise during pregnancy and childbirth, namely Emergency Obstetric Care (EmOC), is fundamental if maternal and neonatal mortality are to be reduced. Consequently, there is a growing need to monitor equity in access to EmOC. The objective of this study was to develop a simple questionnaire to measure equity in utilization of EmOC at Wolisso Hospital, Ethiopia and compare the wealth status of EmOC users with women in the general population. Methods Women in the Ethiopia 2005 Demographic and Health Survey (DHS) constituted our reference population. We cross-tabulated DHS wealth variables against wealth quintiles. Five variables that differentiated well across quintiles were selected to create a questionnaire that was administered to women at discharge from the maternity from January to August 2010. This was used to identify inequities in utilization of EmOC by comparison with the reference population. Results 760 women were surveyed. An a posteriori comparison of these 2010 data to the 2011 DHS dataset, indicated that women using EmOC were wealthier and more likely to be urban dwellers. On a scale from 0 (poorest) to 15 (wealthiest), 31% of women in the 2011 DHS sample scored less than 1 compared with 0.7% in the study population. 70% of women accessing EmOC belonged to the richest quintile with only 4% belonging to the poorest two quintiles. Transportation costs seem to play an important role. Conclusions We found inequity in utilization of EmOC in favour of the wealthiest. Assessing and monitoring equitable utilization of maternity services is feasible using this simple tool. PMID:23607604

New Mexico Educator Equity Plan

ERIC Educational Resources Information Center

New Mexico Public Education Department, 2015

2015-01-01

Both the U.S. Department of Education and the New Mexico Public Education Department (PED) believe that equal opportunity is a core American value. Equal access to excellent education provides meaningful opportunities for students to achieve their goals. Recognizing that family income and race often predicts a student's ability to access excellent…

Access to Elementary Education in India. Country Analytical Review

ERIC Educational Resources Information Center

Govinda, R.; Bandyopadhyay, Madhumita

2008-01-01

This analytical review aims at exploring trends in educational access and delineating different groups, which are vulnerable to exclusion from educational opportunities at the elementary stage. This review has drawn references from series of analytical papers developed on different themes i.e. regional disparity in education, social equity and…

Russian Higher Education: Who Can Afford It?

ERIC Educational Resources Information Center

Gounko, Tatiana

2012-01-01

The article explores the issue of access and equity in the Russian higher education system by examining recent government initiatives. While recently introduced measures such as the Unified State Examination and student loan project are designed to aid students and expand participation, they alone cannot ensure equitable access to higher education…

The Digital School Library: A World-Wide Development and a Fascinating Challenge.

ERIC Educational Resources Information Center

Loertscher, David

2003-01-01

Explores the academic environment of a total information system for school libraries based on the idea of a digital intranet. Discusses safety; customization; the core library collection; curriculum-specific collections; access to short-term resources; Internet access; personalized features; search engines; equity issues; and staffing. (LRW)

Mobility and Hierarchy in the Age of Near-Universal Access

ERIC Educational Resources Information Center

Parry, Gareth

2011-01-01

With the shift toward near-universal access, the movement of students within and between systems of higher education has assumed a new importance, especially for policies aimed at widening participation and social equity. Globalization has given rise to increasing levels of student mobility across national boundaries, with participation in…

Educational Leadership and Comprehensive Reform for Improving Equity and Access for All

ERIC Educational Resources Information Center

Yavuz, Olcay

2016-01-01

Disparities in college access for underrepresented urban students are one of the most urgent educational problems of America's education system. In response to growing national concern, this longitudinal study investigated how school leaders worked collaboratively with key stakeholders to implement research-supported student services in order to…

Private-Sector Social Franchising to Accelerate Family Planning Access, Choice, and Quality: Results From Marie Stopes International

PubMed Central

Munroe, Erik; Hayes, Brendan; Taft, Julia

2015-01-01

Background: To achieve the global Family Planning 2020 (FP2020) goal of reaching 120 million more women with voluntary family planning services, rapid scale-up of services is needed. Clinical social franchising, a service delivery approach used by Marie Stopes International (MSI) in which small, independent health care businesses are organized into quality-assured networks, provides an opportunity to engage the private sector in improving access to family planning and other health services. Methods: We analyzed MSI’s social franchising program against the 4 intended outputs of access, efficiency, quality, and equity. The analysis used routine service data from social franchising programs in 17 African and Asian countries (2008–2014) to estimate number of clients reached, couple-years of protection (CYPs) provided, and efficiency of services; clinical quality audits of 636 social franchisees from a subset of the 17 countries (2011–2014); and exit interviews with 4,844 clients in 14 countries (2013) to examine client satisfaction, demographics (age and poverty), and prior contraceptive use. The MSI “Impact 2” model was used to estimate population-level outcomes by converting service data into estimated health outcomes. Results: Between 2008 and 2014, an estimated 3,753,065 women cumulatively received voluntary family planning services via 17 national social franchise programs, with a sizable 68% choosing long-acting reversible contraceptives (LARCs). While the number of social franchisee outlets increased over time, efficiency also significantly improved over time, with each outlet delivering, on average, 178 CYPs in 2008 compared with 941 CYPs in 2014 (P = .02). Clinical quality audit scores also significantly improved; 39.8% of social franchisee outlets scored over 80% in 2011 compared with 84.1% in 2014. In 2013, 40.7% of the clients reported they had not been using a modern method during the 3 months prior to their visit (95% CI = 37.4, 44.0), with 46.1% (95% CI = 40.9, 51.2) of them reporting having never previously used family planning at all. Analysis of age and poverty levels of clients indicate mixed results in bridging equity gaps: 57.4% of clients lived on under US$2.50/day in 2013 (95% CI = 54.9, 60.0) and 26.1% were 15–24 years old (95% CI = 23.8, 28.4), but only 15.1% lived on less than $1.25/day (95% CI = 13.8, 16.4) and 5.0% were 15–19 years old (95% CI = 3.9, 6.1). The services provided via social franchising are estimated to avert 4,958,000 unintended pregnancies and 7,150 maternal deaths. Conclusion: Social franchising through the existing private sector has the ability to rapidly scale-up access to high-quality family planning services, including LARCs, for the general population as well as young women and the poor, providing a promising model to help achieve the global FP2020 goal. PMID:26085018

Poverty and access to health care in developing countries.

PubMed

Peters, David H; Garg, Anu; Bloom, Gerry; Walker, Damian G; Brieger, William R; Rahman, M Hafizur

2008-01-01

People in poor countries tend to have less access to health services than those in better-off countries, and within countries, the poor have less access to health services. This article documents disparities in access to health services in low- and middle-income countries (LMICs), using a framework incorporating quality, geographic accessibility, availability, financial accessibility, and acceptability of services. Whereas the poor in LMICs are consistently at a disadvantage in each of the dimensions of access and their determinants, this need not be the case. Many different approaches are shown to improve access to the poor, using targeted or universal approaches, engaging government, nongovernmental, or commercial organizations, and pursuing a wide variety of strategies to finance and organize services. Key ingredients of success include concerted efforts to reach the poor, engaging communities and disadvantaged people, encouraging local adaptation, and careful monitoring of effects on the poor. Yet governments in LMICs rarely focus on the poor in their policies or the implementation or monitoring of health service strategies. There are also new innovations in financing, delivery, and regulation of health services that hold promise for improving access to the poor, such as the use of health equity funds, conditional cash transfers, and coproduction and regulation of health services. The challenge remains to find ways to ensure that vulnerable populations have a say in how strategies are developed, implemented, and accounted for in ways that demonstrate improvements in access by the poor.

A systematic analysis of the needs of people with HIV in Australia: stakeholder views of the key elements for a healthy life.

PubMed

Dodson, Sarity; Batterham, Roy; McDonald, Karalyn; Elliott, Julian H; Osborne, Richard H

2016-07-04

Background: The HealthMap project is developing an intervention to reduce cardiovascular risk in people living with HIV. As part of the formative stages of the intervention design, we sought to understand the needs of people with HIV (PWHIV). Methods: Two concept-mapping workshops with PWHIV (n=10), and one with HIV care providers (n=6) were conducted. The workshop findings were consolidated into a questionnaire administered to PWHIV (n=300) and HIV care providers (n=107). Participants were asked to rate the importance of each of 81 presented needs and the degree to which it was currently being met. Results: Workshops provided insights into what PWHIV perceive they need, to live with and manage their condition, and its impact on their life; these included: (1) clinical science research and development; (2) information and support; (3) personal situation; (4) healthcare quality; (5) access to services; (6) access to services specific to ageing; and (7) social justice. Questionnaire results revealed that PWHIV considered information and support, and research and development most important. For providers, healthcare quality, clients' personal situation, and social justice were most important. In terms of unmet needs, PWHIV and providers both highlighted issues in the areas of social justice, and access to aged care services. Conclusions: PWHIV and HIV providers continue to report unmet needs in the areas of social justice and emerging concerns about access to aged care services. Services must continue to address these issues of access and equity.

Markets for hospital services in Zambia.

PubMed

Nakamba, Pamela; Hanson, Kara; McPake, Barbara

2002-01-01

Hospital reforms involving the introduction of measures to increase competition in hospital markets are being implemented in a range of low and middle-income countries. However, little is understood about the operation of hospital markets outside the USA and the UK. This paper assesses the degree of competition for hospital services in two hospital markets in Zambia (Copperbelt and Midlands), and the implications for prices, quality and efficiency. We found substantial differences among different hospital types in prices, costs and quality, suggesting that the hospital service market is a segmented market. The two markets differ significantly in their degree of competition, with the high cost inpatient services market in Copperbelt relatively more competitive than that in the Midlands market. The implications of these differences are discussed in terms of the potential for competition to improve hospital performance, the impact of market structure on equity of access, and how the government should address the problem of the mine hospitals.

[Using the concept of universal health coverage to promote the health system reform in China].

PubMed

Hu, S L

2016-11-06

The paper is systematically explained the definition, contents of universal health coverage (UHC). Universal health coverage calls for all people to have access to quality health services they need without facing undue financial burden. The relationship between five main attributes, i.e., quality, efficiency, equity, accountability and resilience, and their 15 action plans has been explained. The nature of UHC is belonged to the State and government. The core function is commitment with equality. The whole-of-system method is used to promoting the health system reform. In China, the universal health coverage has been reached to the preliminary achievements, which include universal coverage of social medical insurance, basic medical services, basic public health services, and the provision of essential medicines. China has completed millennium development goals (MDG) and is being stepped to the sustainable development goals (SDG).

Birth outcome racial disparities: A result of intersecting social and environmental factors.

PubMed

Burris, Heather H; Hacker, Michele R

2017-10-01

Adverse birth outcomes such as preterm birth, low-birth weight, and infant mortality continue to disproportionately affect black and poor infants in the United States. Improvements in healthcare quality and access have not eliminated these disparities. The objective of this review was to consider societal factors, including suboptimal education, income inequality, and residential segregation, that together lead to toxic environmental exposures and psychosocial stress. Many toxic chemicals, as well as psychosocial stress, contribute to the risk of adverse birth outcomes and black women often are more highly exposed than white women. The extent to which environmental exposures combine with stress and culminate in racial disparities in birth outcomes has not been quantified but is likely substantial. Primary prevention of adverse birth outcomes and elimination of disparities will require a societal approach to improve education quality, income equity, and neighborhoods. Copyright © 2017 Elsevier Inc. All rights reserved.

Beyond Access: An Analysis of the Influence of the E-Rate Program in Bridging the Digital Divide in American Schools

ERIC Educational Resources Information Center

Park, Euna; Sinha, Hansa; Chong, Jing

2007-01-01

E-Rate is a U.S. federal funding program for providing discounts for telecommunications, Internet access and internal networking costs for schools and libraries to ensure access equity across poor and rich, rural, urban and suburban areas, and highly served and underserved areas. This paper examines the impact of the E-Rate program on social…

Has equity in government subsidy on healthcare improved in China? Evidence from the China's National Health Services Survey.

PubMed

Si, Lei; Chen, Mingsheng; Palmer, Andrew J

2017-01-10

Monitoring the equity of government healthcare subsidies (GHS) is critical for evaluating the performance of health policy decisions. China's low-income population encounters barriers in accessing benefits from GHS. This paper focuses on the distribution of China's healthcare subsidies among different socio-economic populations and the factors that affect their equitable distribution. It examines the characteristics of equitable access to benefits in a province of northeastern China, comparing the equity performance between urban and rural areas. Benefit incidence analysis was applied to GHS data from two rounds of China's National Health Services Survey (2003 and 2008, N = 27,239) in Heilongjiang province, reflecting the information in 2002 and 2007 respectively. Concentration index (CI) was used to evaluate the absolute equity of GHSs in outpatient and inpatient healthcare services. A negative CI indicates disproportionate concentration of GHSs among the poor, while a positive CI indicates the GHS is pro-rich, a CI of zero indicates perfect equity. In addition, Kakwani index (KI) was used to evaluate the progressivity of GHSs. A positive KI denotes the GHS is regressive, while a negative value denotes the GHS is progressive. CIs for inpatient care in urban and rural residents were 0.2036 and 0.4497 respectively in 2002, and those in 2007 were 0.4433 and 0.5375. Likewise, CIs for outpatient care are positive in both regions in 2002 and 2007, indicating that both inpatient and outpatient GHSs were pro-rich in both survey periods irrespective of region. In addition, KIs for inpatient services were -0.3769 (urban) and 0.0576 (rural) in 2002 and those in 2007 were 0.0280 and 0.1868. KIs for outpatient service were -0.4278 (urban) and -0.1257 (rural) in 2002, those in 2007 were -0.2572 and -0.1501, indicating that equity was improved in GHS in outpatient care in both regions but not in inpatient services. The benefit distribution of government healthcare subsidies has been strongly influenced by China's health insurance schemes. Their compensation policies and benefit packages need reform to improve the benefit equity between outpatient and inpatient care both in urban and rural areas.

Equity and Efficiency in Greek Higher Education Policies in the Past Three Decades: A Shift of Emphasis to the Issue of Efficiency/"Quality Assurance" in the 2000s

ERIC Educational Resources Information Center

Prokou, Eleni

2013-01-01

This article argues that, in Greek higher education policies of the 2000s, "equality of educational opportunities" is not given as much importance as in the 1980s and the 1990s, when higher education had been massively expanded. In the 2000s, the issue of equity is giving way to that of efficiency/quality, in accordance with a neoliberal…

Equity impact of population-level interventions and policies to reduce smoking in adults: a systematic review.

PubMed

Brown, Tamara; Platt, Stephen; Amos, Amanda

2014-05-01

There is strong evidence about which tobacco control policies reduce smoking. However, their equity impact is uncertain. The aim was to assess the effectiveness of population-level interventions/policies to reduce socioeconomic inequalities in adult smoking. Systematic review of studies of population-level interventions/policies reporting smoking-related outcomes in adults of lower compared to higher socioeconomic status (SES). References were screened and independently checked. Studies were quality assessed. Results are presented in a narrative synthesis. Equity impact was assessed as: positive (reduced inequality), neutral (no difference by SES), negative (increased inequality), mixed (equity impact varied) or unclear. 117 studies of 130 interventions/policies were included: smokefree (44); price/tax (27); mass media campaigns (30); advertising controls (9); cessation support (9); settings-based interventions (7); multiple policies (4). The distribution of equity effects was: 33 positive, 36 neutral, 38 negative, 6 mixed, 17 unclear. Most neutral equity studies benefited all SES groups. Fourteen price/tax studies were equity positive. Voluntary, regional and partial smokefree policies were more likely to be equity negative than national, comprehensive smokefree policies. Mass media campaigns had inconsistent equity effects. Cigarette marketing controls were equity positive or neutral. Targeted national smoking cessation services can be equity positive by achieving higher reach among low SES, compensating for lower quit rates. Few studies have assessed the equity impact of tobacco control policy/interventions. Price/tax increases had the most consistent positive equity impact. More research is needed to strengthen the evidence-base for reducing smoking inequalities and to develop effective equity-orientated tobacco control strategies. Copyright © 2014. Published by Elsevier Ireland Ltd.

Introducing health gains in location-allocation models: A stochastic model for planning the delivery of long-term care

NASA Astrophysics Data System (ADS)

Cardoso, T.; Oliveira, M. D.; Barbosa-Póvoa, A.; Nickel, S.

2015-05-01

Although the maximization of health is a key objective in health care systems, location-allocation literature has not yet considered this dimension. This study proposes a multi-objective stochastic mathematical programming approach to support the planning of a multi-service network of long-term care (LTC), both in terms of services location and capacity planning. This approach is based on a mixed integer linear programming model with two objectives - the maximization of expected health gains and the minimization of expected costs - with satisficing levels in several dimensions of equity - namely, equity of access, equity of utilization, socioeconomic equity and geographical equity - being imposed as constraints. The augmented ε-constraint method is used to explore the trade-off between these conflicting objectives, with uncertainty in the demand and delivery of care being accounted for. The model is applied to analyze the (re)organization of the LTC network currently operating in the Great Lisbon region in Portugal for the 2014-2016 period. Results show that extending the network of LTC is a cost-effective investment.

Sustaining mother tongue medium education: An inter-community self-help framework in Cameroon

NASA Astrophysics Data System (ADS)

Chiatoh, Blasius A.

2011-12-01

Advocating mother tongue education implies recognising the centrality of linguistic and cultural diversity in quality and accessible education planning and delivery. In minority linguistic settings, this need becomes particularly urgent. Decades of exclusive promotion of foreign languages have rendered the educational system incapable of guaranteeing maximum quality, accessibility and equity. Also, due to long periods of marginalisation and disempowerment, most indigenous communities are unable to undertake viable self-reliant educational initiatives. As a result, planning and management of education is not adapted to the needs and realities of target populations. What such an educational approach has succeeded in achieving is to cultivate a culture of near-total dependence and consumerism. In minority language situations where mother tongue education is still primarily in the hands of private institutions and individuals, successful planning also means influencing the perceptions and attitudes of indigenous people and systematically integrating them into the educational process. This paper discusses grass-roots mother tongue education in Cameroon. It focuses on the inter-community self-help initiative as a local response framework and argues that this initiative is a strong indication of the desire of communities to learn and promote learning in their own languages.

Overutilization, overutilized.

PubMed

Levine, Deborah; Mulligan, Jessica

2015-04-01

Overutilization is commonly blamed for escalating costs, compromising quality, and limiting access to the US health care system. Recent estimates suggest that nearly one-third of health care spending in the United States is a result of unnecessary care. Despite the surge of exposés that purport to uncover this "new" problem, narratives about overutilization have been circulating in health policy debates since the beginnings of the health insurance industry. This article traces how the term overutilization has spread in popularity from a relatively small community of mid-twentieth-century insurance experts to economists, physicians, epidemiologists, and eventually the news media of the early twenty-first century. A quick glimpse at the history of the term reveals that there has been constant disagreement and debate over the meaning and impact of overutilization. Moreover, the term has been put to very different uses, from keeping socialism at bay to preserving the fiscal integrity of Medicare to protecting the health of patients. The overutilization narrative, seductive in its promise of cutting costs without sacrificing access to quality care, too often drowns out other difficult conversations about social welfare, health equity, prices, and universal coverage. Copyright © 2015 by Duke University Press.

7 CFR 4280.139 - Credit quality.

Code of Federal Regulations, 2014 CFR

2014-01-01

... credit analysis, including adequacy of equity, cash flow, collateral, history, management, and the current status of the industry for which credit is to be extended. (a) Cash flow. All efforts will be made... paragraph (d)(2) of this section for loans of $600,000 or less. Cash equity injection, as discussed in...

7 CFR 4280.139 - Credit quality.

Code of Federal Regulations, 2012 CFR

2012-01-01

... credit analysis, including adequacy of equity, cash flow, collateral, history, management, and the current status of the industry for which credit is to be extended. (a) Cash flow. All efforts will be made... paragraph (d)(2) of this section for loans of $600,000 or less. Cash equity injection, as discussed in...

7 CFR 4280.139 - Credit quality.

Code of Federal Regulations, 2013 CFR

2013-01-01

... credit analysis, including adequacy of equity, cash flow, collateral, history, management, and the current status of the industry for which credit is to be extended. (a) Cash flow. All efforts will be made... paragraph (d)(2) of this section for loans of $600,000 or less. Cash equity injection, as discussed in...

Leading for Equity: Opportunities for State Education Chiefs

ERIC Educational Resources Information Center

Council of Chief State School Officers, 2017

2017-01-01

Every student deserves an education that prepares him or her for lifelong learning, success in the world of work, and participation in representative government. Unfortunately, far too many students are not receiving the high-quality educational experiences needed to help them reach these goals. Meaningful progress toward equity in education does…

Insular pathways to health care in the city: a multilevel analysis of access to hospital care in urban Kerala, India.

PubMed

Levesque, Jean-Frédéric; Haddad, Slim; Narayana, Delampady; Fournier, Pierre

2007-07-01

To identify individual and urban unit characteristics associated with access to inpatient care in public and private sectors in urban Kerala, and to discuss policy implications of inequalities in access. We analysed the NSSO survey (1995-1996) for urban Kerala with regard to source and trajectories of hospitalization. Multinomial multilevel regression models were built for 695 cases nested in 24 urban units. Private sector accounts for 62% of hospitalizations. Only 31% of hospitalizations are in free wards and 20% of public hospitalizations involve payment. Hospitalization pathways suggest a segmentation of public and private health markets. Members of poor and casual worker households have lower propensity of hospitalization in paying public wards or private hospitals. There were important variations between cities, with higher odds of private hospitalization in towns with fewer hospital beds overall and in districts with high private-public bed ratios. Cities from districts with better economic indicators and dominance of private services have higher proportion of private hospitalizations. The private sector is the predominant source of inpatient care in urban Kerala. The public sector has an important role in providing access to care for the poor. Investing in the quality of public services is essential to ensure equity in access.

Ethical and equity issues in lung transplantation and lung volume reduction surgery.

PubMed

Glanville, A R

2006-01-01

New medical and scientific disciplines are often developed in haste with rampant enthusiasm and scant regard for the balance between action and thoughtful deliberation. Driven by the desire to prolong life and provide a better quality of life for desperately sick individuals, the twin modalities of lung transplantation and lung volume reduction therapy have only just reached their majority. Both are invested with the capacity to help and to harm so it is right to consider carefully their ethical and equitable distribution. Much has been learned in the last 20 years to assist in these deliberations. First, how can we ensure equity of access to transplant services and equality of outcomes? How do we balance resource allocation of a precious and scarce resource with individual recipient needs? Does the concept of distributive justice prevail in our daily work in this field? How do we honour the donor and their family? How do we as practitioners avoid ethical dilemmas related to personal bias and justifiable reward for services rendered? Finally, how do we learn to incorporate ethical forethought and planning guided by experts in the area into everyday behaviour?

GRADE equity guidelines 3: considering health equity in GRADE guideline development: rating the certainty of synthesized evidence.

PubMed

Welch, Vivian A; Akl, Elie A; Pottie, Kevin; Ansari, Mohammed T; Briel, Matthias; Christensen, Robin; Dans, Antonio; Dans, Leonila; Eslava-Schmalbach, Javier; Guyatt, Gordon; Hultcrantz, Monica; Jull, Janet; Katikireddi, Srinivasa Vittal; Lang, Eddy; Matovinovic, Elizabeth; Meerpohl, Joerg J; Morton, Rachael L; Mosdol, Annhild; Murad, M Hassan; Petkovic, Jennifer; Schünemann, Holger; Sharaf, Ravi; Shea, Bev; Singh, Jasvinder A; Solà, Ivan; Stanev, Roger; Stein, Airton; Thabaneii, Lehana; Tonia, Thomy; Tristan, Mario; Vitols, Sigurd; Watine, Joseph; Tugwell, Peter

2017-10-01

The aim of this paper is to describe a conceptual framework for how to consider health equity in the Grading Recommendations Assessment and Development Evidence (GRADE) guideline development process. Consensus-based guidance developed by the GRADE working group members and other methodologists. We developed consensus-based guidance to help address health equity when rating the certainty of synthesized evidence (i.e., quality of evidence). When health inequity is determined to be a concern by stakeholders, we propose five methods for explicitly assessing health equity: (1) include health equity as an outcome; (2) consider patient-important outcomes relevant to health equity; (3) assess differences in the relative effect size of the treatment; (4) assess differences in baseline risk and the differing impacts on absolute effects; and (5) assess indirectness of evidence to disadvantaged populations and/or settings. The most important priority for research on health inequity and guidelines is to identify and document examples where health equity has been considered explicitly in guidelines. Although there is a weak scientific evidence base for assessing health equity, this should not discourage the explicit consideration of how guidelines and recommendations affect the most vulnerable members of society. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Defining quality of care.

PubMed

Campbell, S M; Roland, M O; Buetow, S A

2000-12-01

This paper defines quality of health care. We suggest that there are two principal dimensions of quality of care for individual patients; access and effectiveness. In essence, do users get the care they need, and is the care effective when they get it? Within effectiveness, we define two key components--effectiveness of clinical care and effectiveness of inter-personal care. These elements are discussed in terms of the structure of the health care system, processes of care, and outcomes resulting from care. The framework relates quality of care to individual patients and we suggest that quality of care is a concept that is at its most meaningful when applied to the individual user of health care. However, care for individuals must placed in the context of providing health care for populations which introduces additional notions of equity and efficiency. We show how this framework can be of practical value by applying the concepts to a set of quality indicators contained within the UK National Performance Assessment Framework and to a set of widely used indicators in the US (HEDIS). In so doing we emphasise the differences between US and UK measures of quality. Using a conceptual framework to describe the totality of quality of care shows which aspects of care any set of quality indicators actually includes and measures and, and which are not included.

Addressing equity in interventions to reduce air pollution in urban areas: a systematic review.

PubMed

Benmarhnia, Tarik; Rey, Lynda; Cartier, Yuri; Clary, Christelle M; Deguen, Séverine; Brousselle, Astrid

2014-12-01

We did a systematic review to assess quantitative studies investigating the association between interventions aiming to reduce air pollution, health benefits and equity effects. Three databases were searched for studies investigating the association between evaluated interventions aiming to reduce air pollution and heath-related benefits. We designed a two-stage selection process to judge how equity was assessed and we systematically determined if there was a heterogeneous effect of the intervention between subgroups or subareas. Of 145 identified articles, 54 were reviewed in-depth with eight satisfying the inclusion criteria. This systematic review showed that interventions aiming to reduce air pollution in urban areas have a positive impact on air quality and on mortality rates, but the documented effect on equity is less straightforward. Integration of equity in evidence-based public health is a great challenge nowadays. In this review we draw attention to the importance of considering equity in air pollution interventions. We also propose further methodological and theoretical challenges when assessing equity in interventions to reduce air pollution and we present opportunities to develop this research area.

Equity of access to elective surgery: reflections from NZ clinicians.

PubMed

McLeod, Deborah; Dew, Kevin; Morgan, Sonya; Dowell, Anthony; Cumming, Jackie; Cormack, Donna; McKinlay, Eileen; Love, Tom

2004-10-01

To explore factors potentially influencing equitable access to elective surgery in New Zealand by describing clinicians' perceptions of equity and the factors they consider when prioritising patients for elective surgery. A qualitative study in selected New Zealand localities. A purposive sample of 49 general practitioners, specialists and registrars were interviewed. Data were analysed thematically. General practitioners described unequal opportunities for patients to access primary and secondary care and, in particular, private sector elective surgery. They felt that socio-economically disadvantaged patients were less able to advocate for themselves and were more vulnerable to being lost to the elective surgical booking system as well as being less able to access private care. Both GPs and secondary care clinicians described situations where they would personally advocate for individual patients to improve their access. Advocacy was related to clinicians' perceptions of the 'value' that patients would receive from the surgery and patients' needs for public sector funding. The structure of the health system contributes to inequities in access to elective care in New Zealand. Subjective decision making by clinicians has the potential to advantage or disadvantage patients through the weighting clinicians place on socio-demographic factors when making rationing decisions. Review of the potential structural barriers to equitable access, further public debate and guidance for clinicians on the relative importance of socio-demographic factors in deciding access to rationed services are required for allocation of services to be fair.

The research, policy and practice interface: reflections on using applied social research to promote equity in health in Malawi.

PubMed

Theobald, Sally; Nhlema-Simwaka, Bertha

2008-09-01

The case for research to promote equity in health in resource poor contexts such as Malawi is compelling. In Malawi, nearly half of all the people with tuberculosis cannot afford to access free tuberculosis services. In this scenario, there is a clear need to understand the multiple barriers poor women and men face in accessing services and pilot interventions to address these in a way that engages policy makers, practitioners and communities. This paper provides a critical reflection on our experience as applied social researchers working at the REACH (Research for Equity and Community Health) Trust in Malawi. Our work largely uses qualitative research methodologies as a tool for applied social research to explore the equity dimensions of health services in the country. We argue that a key strength of qualitative research methods and analysis is the ability to bring the perceptions and experiences of marginalised groups to policy makers and practitioners. The focus of this paper is two-fold. The first focus lies in synthesising the opportunities and challenges we have encountered in promoting the use of applied social research, and in particular qualitative research methods, on TB and HIV in Malawi. The second focus is on documenting and reflecting on our experiences of using applied social research to promote gender equity in TB/HIV policy and practice in Malawi. In this paper, we reflect on the strategic frameworks we have used in the Malawian context to try and bring the voices of poor women and men to policy makers and practitioners and hence intensify the research to policy and practice interface.

Education and Development: Dynamics of Access, Equity, and Social Justice in Nigeria

ERIC Educational Resources Information Center

Oghenekohwo, Jonathan E.; Torunarigha, Young D.

2018-01-01

Widening access to education as social justice is basic in any discourse on educational investment, growth and development in developing country such as Nigeria. Presently, there is disconnect between educational development expectations and public policy frameworks designed to drive the united nations sustainable development goals (SDGs) in 2030…

Equity and Access in Charter Schools: Identifying Issues and Solutions

ERIC Educational Resources Information Center

Marshall, David T.

2017-01-01

School choice exists in American public schooling, even where official school choice policy is absent. Parents with means can elect to live in neighborhoods zoned for desirable schools, whereas parents without means are locked out of that opportunity. In their ideal, charter schools have the ability to expand access to desirable schools to…

Broadband Access and Implications for Efforts to Address Equity Gaps in Postsecondary Attainment

ERIC Educational Resources Information Center

Sisneros, Lauren; Sponsler, Brian A.

2016-01-01

This education trends report focuses on two related but distinct challenges confronting state policy leaders and students as they seek to leverage online distance education to meet personal and statewide education goals: (1) access to the infrastructure necessary to provide industry-standard broadband speeds and (2) ensuring availability of the…

White Clinical Psychology Trainees' Views on Racial Equity within Programme Selection in South Africa

ERIC Educational Resources Information Center

Traub, Craig M.; Swartz, Leslie

2013-01-01

The issue of diversity in both physical and epistemological access to programmes in higher education is an important concern worldwide. In South Africa, as elsewhere, access to professional clinical psychology training programmes is extremely competitive, and there is an important imperative to diversify the student profile. Perspectives of black…

Factors Influencing Females' Access to the High School Principalship

ERIC Educational Resources Information Center

Kruse, Rae Ann

2012-01-01

Scope and Method of Study: The purpose of this study was to identify the factors influencing females' access to the Oklahoma secondary school principalship. Although in the United States federal laws and policies are in place to promote equity, research indicates females are underrepresented in secondary school administration. Regardless of equity…

Who Should We Help? The Negative Social Consequences of Merit Scholarships.

ERIC Educational Resources Information Center

Heller, Donald E., Ed.; Marin, Patricia, Ed.

This is a collection of papers from a 2001 symposium at Harvard University entitled "State Merit Aid Programs: College Access and Equity." After a Foreword by Gary Orfield, the seven papers are (1) "State Merit Scholarship Programs: An Introduction" (Donald E. Heller); (2) "Merit Scholarships and College Access: Evidence…

The determinants of long-term care utilization and equity of access to care among older adults in Dong-Ku of Incheon Metropolitan city, South Korea.

PubMed

Park, J M

2005-01-01

Under the current health care system, around three percent of the elderly remain uninsured. Based on the 2003 Dong-Ku Health Status Survey and the Aday and Andersen Access Framework, the present study examined the social and behavioral determinants of long-term care utilization and the extent to which equity in the use of long-term care services for the elderly has been achieved. The results indicate that universal health insurance system has not yielded a fully equitable distribution of services. Type of coverage and resource availability do not remain predictors of long-term care utilization. The data suggest that a universal health insurance system exists in South Korea with significant access problems for the population without insurance. Access differences also arise from obstacles in expanding the scope and level of plan benefits due to financial disparity among insurers. Health policy reforms must continue to concentrate on extending insurance coverage to the uninsured and establishing long-term insurance system for the elderly.

The AAS Working Group on Accessibility and Disability (WGAD) Year 1 Highlights and Database Access

NASA Astrophysics Data System (ADS)

Knierman, Karen A.; Diaz Merced, Wanda; Aarnio, Alicia; Garcia, Beatriz; Monkiewicz, Jacqueline A.; Murphy, Nicholas Arnold

2017-06-01

The AAS Working Group on Accessibility and Disability (WGAD) was formed in January of 2016 with the express purpose of seeking equity of opportunity and building inclusive practices for disabled astronomers at all educational and career stages. In this presentation, we will provide a summary of current activities, focusing on developing best practices for accessibility with respect to astronomical databases, publications, and meetings. Due to the reliance of space sciences on databases, it is important to have user centered design systems for data retrieval. The cognitive overload that may be experienced by users of current databases may be mitigated by use of multi-modal interfaces such as xSonify. Such interfaces would be in parallel or outside the original database and would not require additional software efforts from the original database. WGAD is partnering with the IAU Commission C1 WG Astronomy for Equity and Inclusion to develop such accessibility tools for databases and methods for user testing. To collect data on astronomical conference and meeting accessibility considerations, WGAD solicited feedback from January AAS attendees via a web form. These data, together with upcoming input from the community and analysis of accessibility documents of similar conferences, will be used to create a meeting accessibility document. Additionally, we will update the progress of journal access guidelines and our social media presence via Twitter. We recommend that astronomical journals form committees to evaluate the accessibility of their publications by performing user-centered usability studies.

A New UK 2006 National Kidney Allocation Scheme for deceased heart-beating donor kidneys.

PubMed

Johnson, Rachel J; Fuggle, Susan V; Mumford, Lisa; Bradley, J Andrew; Forsythe, John L R; Rudge, Chris J

2010-02-27

In 2004, it was agreed that a new allocation scheme for kidneys from deceased heart-beating donors was required in the United Kingdom to address observed inequities in access to transplant. The 2006 National Kidney Allocation Scheme (2006 NKAS) was developed to meet agreed objectives and preparatory work included a review of the criteria for human leukocyte antigen (HLA) matching and simulation evidence about the effectiveness of alternative schemes. ALGORITHM FOR 2006 NKAS: The 2006 NKAS gives absolute priority to all 000 HLA-A, -B, -DR-mismatched patients and well-matched pediatric patients (<18 years), and then a points score defines priorities for allocation with waiting time being most influential. Points for age and HLA mismatch are linked in a novel approach to ensure well-matched transplants for younger patients while recognizing that HLA matching is less important for older patients as retransplantation is less likely to be required. To improve equity for difficult to match patients, rare HLA specificities were defaulted to more common, related specificities. IMPACT OF 2006 NKAS: After 3 years, the scheme is already making good progress in achieving its objectives, with overall results similar to those observed in the simulations. There has been a significant benefit for patients waiting more than 5 years for transplant. A number of other advantages of the scheme are also apparent with equity of access improving in many respects, including the achievement of equity of access to transplant for HLA-DR homozygous patients, but geographical inequity of access will take a number of years to address fully.

Health-equity issues related to childhood obesity: a scoping review.

PubMed

Vargas, Clemencia M; Stines, Elsie M; Granado, Herta S

2017-06-01

The purpose of this scoping review was to determine the health-equity issues that relate to childhood obesity. Health-equity issues related to childhood obesity were identified by analyzing food environment, natural and built environment, and social environment. The authors searched Medline, PubMed, and Web of Science, using the keywords "children" and "obesity." Specific terms for each environment were added: "food desert," "advertising," "insecurity," "price," "processing," "trade," and "school" for food environment; "urban design," "land use," "transportation mode," "public facilities," and "market access" for natural and built environment; and "financial capacity/poverty," "living conditions," "transport access," "remoteness," "social support," "social cohesion," "working practices," "eating habits," "time," and "social norms" for social environment. Inclusion criteria were studies or reports with populations under age 12, conducted in the United States, and published in English in 2005 or later. The final search yielded 39 references (16 for food environment, 11 for built environment, and 12 for social environment). Most food-environment elements were associated with obesity, except food insecurity and food deserts. A natural and built environment that hinders access to physical activity resources and access to healthy foods increased the risk of childhood obesity. Similarly, a negative social environment was associated with childhood obesity. More research is needed on the effects of food production, living conditions, time for shopping, and exercise, as related to childhood obesity. Most elements of food, natural and built, and social-environments were associated with weight in children under age 12, except food insecurity and food deserts. © 2017 American Association of Public Health Dentistry.

The social ecology of water in a Mumbai slum: failures in water quality, quantity, and reliability.

PubMed

Subbaraman, Ramnath; Shitole, Shrutika; Shitole, Tejal; Sawant, Kiran; O'Brien, Jennifer; Bloom, David E; Patil-Deshmukh, Anita

2013-02-26

Urban slums in developing countries that are not recognized by the government often lack legal access to municipal water supplies. This results in the creation of insecure "informal" water distribution systems (i.e., community-run or private systems outside of the government's purview) that may increase water-borne disease risk. We evaluate an informal water distribution system in a slum in Mumbai, India using commonly accepted health and social equity indicators. We also identify predictors of bacterial contamination of drinking water using logistic regression analysis. Data were collected through two studies: the 2008 Baseline Needs Assessment survey of 959 households and the 2011 Seasonal Water Assessment, in which 229 samples were collected for water quality testing over three seasons. Water samples were collected in each season from the following points along the distribution system: motors that directly tap the municipal supply (i.e., "point-of-source" water), hoses going to slum lanes, and storage and drinking water containers from 21 households. Depending on season, households spend an average of 52 to 206 times more than the standard municipal charge of Indian rupees 2.25 (US dollars 0.04) per 1000 liters for water, and, in some seasons, 95% use less than the WHO-recommended minimum of 50 liters per capita per day. During the monsoon season, 50% of point-of-source water samples were contaminated. Despite a lack of point-of-source water contamination in other seasons, stored drinking water was contaminated in all seasons, with rates as high as 43% for E. coli and 76% for coliform bacteria. In the multivariate logistic regression analysis, monsoon and summer seasons were associated with significantly increased odds of drinking water contamination. Our findings reveal severe deficiencies in water-related health and social equity indicators. All bacterial contamination of drinking water occurred due to post-source contamination during storage in the household, except during the monsoon season, when there was some point-of-source water contamination. This suggests that safe storage and household water treatment interventions may improve water quality in slums. Problems of exorbitant expense, inadequate quantity, and poor point-of-source quality can only be remedied by providing unrecognized slums with equitable access to municipal water supplies.

The social ecology of water in a Mumbai slum: failures in water quality, quantity, and reliability

PubMed Central

2013-01-01

Background Urban slums in developing countries that are not recognized by the government often lack legal access to municipal water supplies. This results in the creation of insecure “informal” water distribution systems (i.e., community-run or private systems outside of the government’s purview) that may increase water-borne disease risk. We evaluate an informal water distribution system in a slum in Mumbai, India using commonly accepted health and social equity indicators. We also identify predictors of bacterial contamination of drinking water using logistic regression analysis. Methods Data were collected through two studies: the 2008 Baseline Needs Assessment survey of 959 households and the 2011 Seasonal Water Assessment, in which 229 samples were collected for water quality testing over three seasons. Water samples were collected in each season from the following points along the distribution system: motors that directly tap the municipal supply (i.e., “point-of-source” water), hoses going to slum lanes, and storage and drinking water containers from 21 households. Results Depending on season, households spend an average of 52 to 206 times more than the standard municipal charge of Indian rupees 2.25 (US dollars 0.04) per 1000 liters for water, and, in some seasons, 95% use less than the WHO-recommended minimum of 50 liters per capita per day. During the monsoon season, 50% of point-of-source water samples were contaminated. Despite a lack of point-of-source water contamination in other seasons, stored drinking water was contaminated in all seasons, with rates as high as 43% for E. coli and 76% for coliform bacteria. In the multivariate logistic regression analysis, monsoon and summer seasons were associated with significantly increased odds of drinking water contamination. Conclusions Our findings reveal severe deficiencies in water-related health and social equity indicators. All bacterial contamination of drinking water occurred due to post-source contamination during storage in the household, except during the monsoon season, when there was some point-of-source water contamination. This suggests that safe storage and household water treatment interventions may improve water quality in slums. Problems of exorbitant expense, inadequate quantity, and poor point-of-source quality can only be remedied by providing unrecognized slums with equitable access to municipal water supplies. PMID:23442300

Influence of gender equity awareness on women's reproductive healthcare in rural areas of midwest China.

PubMed

Wang, Lei; Cui, Ying; Zhang, Li; Wang, Chao; Jiang, Yan; Shi, Wei

2013-11-01

To investigate the impact of married women's gender equity awareness on use of reproductive healthcare services in rural China. The questionnaire-based study recruited 1500 married women who were aged 15-49years, had at least 1 pregnancy, and were living in rural Gansu, Qinghai, Shanxi, or Xinjiang, China, between October and December 2010. "Gender equity awareness" was quantified by responses to 7 statements, graded in accordance with a system scoring the strength of overall belief (≥19, strong; 15-18, moderate; and ≤14, weak). Only 383 women (26.3%) demonstrated high gender equity awareness. The percentage of women who received consistent prenatal care was highest in the group scoring 15 points or more (P<0.001); the percentage of women with hospital delivery and gynecologic examination (P<0.001) was highest in the group scoring 19 points or more; and the percentage of women with reproductive tract infections was highest in the group with the lowest scores (P<0.001). Women's gender equity awareness is not strong in rural midwest China. There was a positive correlation between gender equity awareness and use of reproductive healthcare services. There should be an emphasis on various activities to educate women so that they can fully access reproductive healthcare. © 2013.

Do efforts to standardize, assess and improve the quality of health service provision to adolescents by government-run health services in low and middle income countries, lead to improvements in service-quality and service-utilization by adolescents?

PubMed

Chandra-Mouli, Venkatraman; Chatterjee, Subidita; Bose, Krishna

2016-02-06

Researchers and implementers working in adolescent health, and adolescents themselves question whether government-run health services in conservative and resource-constrained settings can be made adolescent friendly. This paper aims to find out what selected low and middle income country (LMIC) governments have set out to do to improve the quality of health service provision to adolescents; whether their efforts led to measurable improvements in quality and to increased health service-utilization by adolescents. We gathered normative guidance and reports from eight LMICs in Asia, Africa, Central and Eastern Europe and the Western Pacific. We analysed national quality standards for adolescent friendly health services, findings from the assessments of the quality of health service provision, and findings on the utilization of health services. Governments of LMICs have set out to improve the accessibility, acceptability, equity, appropriateness and effectiveness of health service provision to adolescents by defining standards and actions to achieve them. Their actions have led to measurable improvements in quality and to increases in health service utilisation by adolescents. With support, government-run health facilities in LMICs can improve the quality of health services and their utilization by adolescents.

Creating Teacher Incentives for School Excellence and Equity

ERIC Educational Resources Information Center

Berry, Barnett; Eckert, Jon

2012-01-01

Ensuring that all students in America's public schools are taught by good teachers is an educational and moral imperative. Teacher incentive proposals are rarely grounded on what high-quality research indicates are the kinds of teacher incentives that lead to school excellence and equity. Few of the current approaches to creating teacher…

Extending the PRISMA statement to equity-focused systematic reviews (PRISMA-E 2012): explanation and elaboration.

PubMed

Welch, Vivian; Petticrew, Mark; Petkovic, Jennifer; Moher, David; Waters, Elizabeth; White, Howard; Tugwell, Peter

2015-10-08

The promotion of health equity, the absence of avoidable and unfair differences in health outcomes, is a global imperative. Systematic reviews are an important source of evidence for health decision-makers, but have been found to lack assessments of the intervention effects on health equity. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) is a 27 item checklist intended to improve transparency and reporting of systematic reviews. We developed an equity extension for PRISMA (PRISMA-E 2012) to help systematic reviewers identify, extract, and synthesise evidence on equity in systematic reviews. In this explanation and elaboration paper we provide the rationale for each extension item. These items are additions or modifications to the existing PRISMA Statement items, in order to incorporate a focus on equity. An example of good reporting is provided for each item as well as the original PRISMA item. This explanation and elaboration document is intended to accompany the PRISMA-E 2012 Statement and the PRISMA Statement to improve understanding of the reporting guideline for users. The PRISMA-E 2012 reporting guideline is intended to improve transparency and completeness of reporting of equity-focused systematic reviews. Improved reporting can lead to better judgement of applicability by policy makers which may result in more appropriate policies and programs and may contribute to reductions in health inequities. To encourage wide dissemination of this article it is accessible on the International Journal for Equity in Health, Journal of Clinical Epidemiology, and Journal of Development Effectiveness web sites.

Toward scientific equity for the prevention of depression and depressive symptoms in vulnerable youth.

PubMed

Perrino, Tatiana; Beardslee, William; Bernal, Guillermo; Brincks, Ahnalee; Cruden, Gracelyn; Howe, George; Murry, Velma; Pantin, Hilda; Prado, Guillermo; Sandler, Irwin; Brown, C Hendricks

2015-07-01

Certain subgroups of youth are at high risk for depression and elevated depressive symptoms, and experience limited access to quality mental health care. Examples are socioeconomically disadvantaged, racial/ethnic minority, and sexual minority youth. Research shows that there are efficacious interventions to prevent youth depression and depressive symptoms. These preventive interventions have the potential to play a key role in addressing these mental health disparities by reducing youth risk factors and enhancing protective factors. However, there are comparatively few preventive interventions directed specifically to these vulnerable subgroups, and sample sizes of diverse subgroups in general prevention trials are often too low to assess whether preventive interventions work equally well for vulnerable youth compared to other youth. In this paper, we describe the importance and need for "scientific equity," or equality and fairness in the amount of scientific knowledge produced to understand the potential solutions to such health disparities. We highlight possible strategies for promoting scientific equity, including the following: increasing the number of prevention research participants from vulnerable subgroups, conducting more data synthesis analyses and implementation science research, disseminating preventive interventions that are efficacious for vulnerable youth, and increasing the diversity of the prevention science research workforce. These strategies can increase the availability of research evidence to determine the degree to which preventive interventions can help address mental health disparities. Although this paper utilizes the prevention of youth depression as an illustrative case example, the concepts are applicable to other health outcomes for which there are disparities, such as substance use and obesity.

Equity in access to health care provision under the medicare security for small scale entrepreneurs in Dar es Salaam.

PubMed

Urassa, J A E

2012-03-01

The main objective of this study was to assess equity in access to health care provision under the Medicare Security for Small Scale Entrepreneurs (SSE). Methodological triangulation was used to an exploratory and randomized cross- sectional study in order to supplement information on the topic under investigation. Questionnaires were administered to 281 respondents and 6 Focus Group Discussions (FGDs) were held with males and females. Documentary review was also used. For quantitative aspect of the study, significant associations were measured using confidence intervals (95% CI) testing. Qualitative data were analyzed with assistance of Open code software. The results show that inequalities in access to health care services were found in respect to affordability of medical care costs, distance from home to health facilities, availability of drugs as well as medical equipments and supplies. As the result of existing inequalities some of clients were not satisfied with the provided health services. The study concludes by drawing policy and research implications of the findings.

[Contexts, impasses and challenges for training Public Health workers in Brazil].

PubMed

de Almeida Filho, Naomar Monteiro

2013-06-01

An introductory comment is made on the historical background, institutional impasses and curriculum challenges for training Public Health workers in Brazil. Initially, a thesis is proposed, namely that the Brazilian state has not fulfilled its responsibility to ensure quality public services for the population, with access and equity, shaping "the four perversions of Brazilian education." Secondly, it analyzes the public health system, which is theoretically universal, but being underfunded and with acknowledged shortcomings, contributes to the increase in social exclusion. Lastly, it highlights the need for new models for training people who are technologically competent, suitable for teamwork, creative, autonomous, problem-solving, engaged in health promotion, open to social participation and committed to the humanization of health.

The Belgian Health System Performance Report 2012: snapshot of results and recommendations to policy makers.

PubMed

Vrijens, France; Renard, Françoise; Jonckheer, Pascale; Van den Heede, Koen; Desomer, Anja; Van de Voorde, Carine; Walckiers, Denise; Dubois, Cécile; Camberlin, Cécile; Vlayen, Joan; Van Oyen, Herman; Léonard, Christian; Meeus, Pascal

2013-09-01

Following the commitments of the Tallinn Charter, Belgium publishes the second report on the performance of its health system. A set of 74 measurable indicators is analysed, and results are interpreted following the five dimensions of the conceptual framework: accessibility, quality of care, efficiency, sustainability and equity. All domains of care are covered (preventive, curative, long-term and end-of-life care), as well as health status and health promotion. For all indicators, national/regional values are presented with their evolution over time. Benchmarking to results of other EU-15 countries is also systematic. The policy recommendations represent the most important output of the report. Copyright © 2013 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Balancing equity and efficiency in the Dutch basic benefits package using the principle of proportional shortfall.

PubMed

van de Wetering, E J; Stolk, E A; van Exel, N J A; Brouwer, W B F

2013-02-01

Economic evaluations are increasingly used to inform decisions regarding the allocation of scarce health care resources. To systematically incorporate societal preferences into these evaluations, quality-adjusted life year gains could be weighted according to some equity principle, the most suitable of which is a matter of frequent debate. While many countries still struggle with equity concerns for priority setting in health care, the Netherlands has reached a broad consensus to use the concept of proportional shortfall. Our study evaluates the concept and its support in the Dutch health care context. We discuss arguments in the Netherlands for using proportional shortfall and difficulties in transitioning from principle to practice. In doing so, we address universal issues leading to a systematic consideration of equity concerns for priority setting in health care. The article thus has relevance to all countries struggling with the formalization of equity concerns for priority setting.

[Immigration and health: social inequalities in health disparities in the health system, in welfare and work].

PubMed

Pullini, A

2011-01-01

Within the analysis of the socio-economic context and the data from hospital discharges, the themes of social inequalities, health disparities, determinants of health care are discussed. Regular immigrants versus irregular, wealthy people versus those in poverty, they have access to and receive different health treatments, besides presenting risk conditions significantly different in relation to their social situation. Through the analysis of hospital discharge records as well as data from injuries at work, besides underestimations in foreign people and the greater risk of injuries for immigrants, it is evident how the aspects of inequalities connected to socioeconomic determinants and the different access to health services are pivotal for our health and welfare and that a profound change is required to tackle them properly, focusing on intervention on health care system, according to models which take into account not only evidence based medicine, but also narrative medicine, not only health protection, but also health promotion, so that equity and quality of health care is warranted for everyone.

The impact of contracting-out on health system performance: a conceptual framework.

PubMed

Liu, Xingzhu; Hotchkiss, David R; Bose, Sujata

2007-07-01

Despite the increased popularity of contracting-out of health services in developing countries, its effectiveness on overall health system performance is not yet conclusive. Except for substantial evidence of contracting-out's positive effect on access to health services and some evidence on improved equity in access, there is little evidence of contracting-out's impact on quality and efficiency. Most studies on the subject evaluate specific contracting-out projects against narrowly specified project objectives, not against more broadly defined health system goals. For this reason, conclusions of positive effects pertaining to project level may not hold at system level. This paper presents a conceptual framework that is expected to facilitate comprehensive, rigorous, and standardized evaluation of contracting-out at health system level. Specifically, this framework supports: full and standardized description of contracting-out interventions, study of the determinants of effectiveness, examination of provider and purchaser responses, assessment of the impact of contracting-out on all dimensions of health system performance, and cross-project analyses.

Did Equity of Reproductive and Maternal Health Service Coverage Increase during the MDG Era? An Analysis of Trends and Determinants across 74 Low- and Middle-Income Countries

PubMed Central

Sharma, Suneeta

2015-01-01

Introduction Despite widespread gains toward the 5th Millennium Development Goal (MDG), pro-rich inequalities in reproductive health (RH) and maternal health (MH) are pervasive throughout the world. As countries enter the post-MDG era and strive toward UHC, it will be important to monitor the extent to which countries are achieving equity of RH and MH service coverage. This study explores how equity of service coverage differs across countries, and explores what policy factors are associated with a country’s progress, or lack thereof, toward more equitable RH and MH service coverage. Methods We used RH and MH service coverage data from Demographic and Health Surveys (DHS) for 74 countries to examine trends in equity between countries and over time from 1990 to 2014. We examined trends in both relative and absolute equity, and measured relative equity using a concentration index of coverage data grouped by wealth quintile. Through multivariate analysis we examined the relative importance of policy factors, such as political commitment to health, governance, and the level of prepayment, in determining countries’ progress toward greater equity in RH and MH service coverage. Results Relative equity for the coverage of RH and MH services has continually increased across all countries over the past quarter century; however, inequities in coverage persist, in some countries more than others. Multivariate analysis shows that higher education and greater political commitment (measured as the share of government spending allocated to health) were significantly associated with higher equity of service coverage. Neither country income, i.e., GDP per capita, nor better governance were significantly associated with equity. Conclusion Equity in RH and MH service coverage has improved but varies considerably across countries and over time. Even among the subset of countries that are close to achieving the MDGs, progress made on equity varies considerably across countries. Enduring disparities in access and outcomes underpin mounting support for targeted reforms within the broader context of universal health coverage (UHC). PMID:26331846

Unrealized Promises: Unequal Access, Affordability, and Excellence at Community Colleges in Southern California

ERIC Educational Resources Information Center

Martinez-Wenzl, Mary; Marquez, Rigoberto

2012-01-01

California community colleges are, by design, the only entry point to four-year institutions for the majority of students in the state. Yet, many of these institutions perpetuate racial and class segregation, thus disrupting the California Master Plan for Higher Education's promise of access, equity, and excellence in higher education. This report…

Computer Mediated Communication, the Internet and Equity: Development in a Post-Colonial World

ERIC Educational Resources Information Center

Palmer, W. P.

1997-01-01

This paper relates to some thoughts about the very different access to communication that those living in developing countries have as compared with those living in developed countries. I advocate using information technology in within my own teaching in Australia, yet from my experiences in developing countries, I know how limited access to any…

Access and Equity Denied: Key Theories for School Psychologists to Consider When Assessing Black and Hispanic Students for Gifted Education

ERIC Educational Resources Information Center

Ford, Donna Y.; Wright, Brian L.; Washington, Ahmad; Henfield, Malik S.

2016-01-01

Black and Hispanic students are consistently underrepresented in gifted education. Several factors contribute to their low identification and lack of access to such programs and services. While teacher underreferral is a significant contributing factor, problematic also is testing and assessment, which is often administered by school…

Mobilizing Curriculum Studies in a (Virtual) World: Open Access, Edupunks, and the Public Good

ERIC Educational Resources Information Center

Corrigan, Julie Ann; Ng-A-Fook, Nicholas

2012-01-01

Despite societal imperatives for equity--whether espoused by nation states or transnational agencies like UNESCO--current models of higher education are unequivocally failing to provide universal access. This paper seeks to explore the (cyber)spaces (un)occupied by higher education, specifically in the area of curriculum studies, arguing that the…

Medical tourism in the Caribbean region: a call to consider environmental health equity.

PubMed

Johnston, R; Crooks, V A

2013-03-01

Medical tourism, which is the intentional travel by private-paying patients across international borders for medical treatment, is a sector that has been targeted for growth in many Caribbean countries. The international development of this industry has raised a core set of proposed health equity benefits and drawbacks for host countries. These benefits centre on the potential investment in health infrastructure and opportunities for health labour force development while drawbacks focus on the potential for reduced access to healthcare for locals and inefficient use of limited public resources to support the growth of the medical tourism industry. The development of the medical tourism sector in Caribbean countries raises additional health equity questions that have received little attention in existing international debates, specifically in regard to environmental health equity. In this viewpoint, we introduce questions of environmental health equity that clearly emerge in relation to the developing Caribbean medical tourism sector These questions acknowledge that the growth of this sector will have impacts on the social and physical environments, resources, and waste management infrastructure in countries. We contend that in addition to addressing the wider health equity concerns that have been consistently raised in existing debates surrounding the growth of medical tourism, planning for growth in this sector in the Caribbean must take environmental health equity into account in order to ensure that local populations, environments, and ecosystems are not harmed by facilities catering to international patients.

A web-based resource for promoting equity in midwifery education and training: Towards meaningful diversity and inclusion.

PubMed

Effland, Kristin J; Hays, Karen

2018-06-01

Increasing the midwifery workforce requires that aspiring midwives complete education and training, but structural racism and microaggressions impact the lives of underrepresented midwifery students and apprentices, adding stressors and disparities to the usual demanding educational challenges. In order to be resilient, students rely on preceptors, faculty, administrators and institutions to promote equity. Equity-focused learning environments improve student experiences and success rates, and better prepare all students to provide culturally humble and sensitive care to diverse childbearing persons and other essential competencies outlined by the International Confederation of Midwives. The comprehensive web-based resource, www.equitymidwifery.org, is designed to support midwifery educators in promoting equity and social justice in midwifery education and training. The website highlights examples and provides tools including original webinar content and encourages visitors to attend virtual strategy and collaboration calls. It offers a model of continuous professional development that is easily accessible. Copyright © 2018 Elsevier Ltd. All rights reserved.

Health sector reform in Brazil: a case study of inequity.

PubMed

Almeida, C; Travassos, C; Porto, S; Labra, M E

2000-01-01

Health sector reform in Brazil built the Unified Health System according to a dense body of administrative instruments for organizing decentralized service networks and institutionalizing a complex decision-making arena. This article focuses on the equity in health care services. Equity is defined as a principle governing distributive functions designed to reduce or offset socially unjust inequalities, and it is applied to evaluate the distribution of financial resources and the use of health services. Even though in the Constitution the term "equity" refers to equal opportunity of access for equal needs, the implemented policies have not guaranteed these rights. Underfunding, fiscal stress, and lack of priorities for the sector have contributed to a progressive deterioration of health care services, with continuing regressive tax collection and unequal distribution of financial resources among regions. The data suggest that despite regulatory measures to increase efficiency and reduce inequalities, delivery of health care services remains extremely unequal across the country. People in lower income groups experience more difficulties in getting access to health services. Utilization rates vary greatly by type of service among income groups, positions in the labor market, and levels of education.

Human Rights and the Political Economy of Universal Health Care: Designing Equitable Financing.

PubMed

Rudiger, Anja

2016-12-01

Health system financing is a critical factor in securing universal health care and achieving equity in access and payment. The human rights framework offers valuable guidance for designing a financing strategy that meets these goals. This article presents a rights-based approach to health care financing developed by the human right to health care movement in the United States. Grounded in a human rights analysis of private, market-based health insurance, advocates make the case for public financing through progressive taxation. Financing mechanisms are measured against the twin goals of guaranteeing access to care and advancing economic equity. The added focus on the redistributive potential of health care financing recasts health reform as an economic policy intervention that can help fulfill broader economic and social rights obligations. Based on a review of recent universal health care reform efforts in the state of Vermont, this article reports on a rights-based public financing plan and model, which includes a new business tax directed against wage disparities. The modeling results suggest that a health system financed through equitable taxation could produce significant redistributive effects, thus increasing economic equity while generating sufficient funds to provide comprehensive health care as a universal public good.

Human Rights and the Political Economy of Universal Health Care

PubMed Central

2016-01-01

Abstract Health system financing is a critical factor in securing universal health care and achieving equity in access and payment. The human rights framework offers valuable guidance for designing a financing strategy that meets these goals. This article presents a rights-based approach to health care financing developed by the human right to health care movement in the United States. Grounded in a human rights analysis of private, market-based health insurance, advocates make the case for public financing through progressive taxation. Financing mechanisms are measured against the twin goals of guaranteeing access to care and advancing economic equity. The added focus on the redistributive potential of health care financing recasts health reform as an economic policy intervention that can help fulfill broader economic and social rights obligations. Based on a review of recent universal health care reform efforts in the state of Vermont, this article reports on a rights-based public financing plan and model, which includes a new business tax directed against wage disparities. The modeling results suggest that a health system financed through equitable taxation could produce significant redistributive effects, thus increasing economic equity while generating sufficient funds to provide comprehensive health care as a universal public good. PMID:28559677

Analysis of government investment in primary healthcare institutions to promote equity during the three-year health reform program in China.

PubMed

Zhang, Xiaopeng; Xiong, Yuqi; Ye, Jing; Deng, Zhaohua; Zhang, Xinping

2013-03-25

The World Health Report 2000 stated that increased public financing for healthcare was an integral part of the efforts to achieve equity of access. In 2009, the Chinese government launched a three-year health reform program to achieve equity of access. Through this reform program, the government intended to increase its investment in primary healthcare institutions (PHIs). However, reports about the outcome and the improvement of the equity of access have yet to be presented. Stratified sampling was employed in this research. The samples used for the study comprised 34 community health service centers (CHSCs) and 92 township hospitals (THs) from six provinces of China. Collected data, which were publicly available, consisted of the total revenue, financial revenue, and the number of people for the periods covering January 2010 to September 2010 and January 2011 to September 2011. Revenue information for 2009 and 2010 was obtained from China's Health Statistics Yearbook.By using indicators such as government investment, government finance proportion and per capita revenue, t-tests for paired and independent samples were used to analyze the changes in government investment. Government invest large amount of money to the primary healthcare institutions. Government finance proportion in 2008 was 18.2%. This percentage increased to 38.84% in 2011, indicating statistical significance (p = 0.000) between 2010 and 2011. The per capita financial input was 20.92 yuan in 2010 and 31.10 yuan in 2011. Compared with the figures from 2008 to 2010, the gap in different health sectors narrowed in 2011, and differences emerged. The government finance proportion in CHSCs revenue was 6.9% higher than that of THs, while the per capita revenue of CHSCs was higher. In 2011, the highest and lowest government finance proportions were 48.80% (Shaanxi) and 19.36% (Shandong), respectively. In that same year, the per capita revenue of Shaanxi (40.69 Yuan) was higher than that of Liaoning (28.79 Yuan). Comparing the 2011 figures with those from 2008 to 2010, the gap in 2011 clearly narrowed. In the three-year health reform program, the Chinese government increased its investment to PHIs gradually and significantly. Thus promote equity to access and universal coverage. However, the increase in government investment stemmed from political desire and from the lack of institutionalization of practice and experience. Hence, a mode of financial allocation must be formulated to promote consistency in government input after the three-year health reform program.

Analysis of government investment in primary healthcare institutions to promote equity during the three-year health reform program in China

PubMed Central

2013-01-01

Background The World Health Report 2000 stated that increased public financing for healthcare was an integral part of the efforts to achieve equity of access. In 2009, the Chinese government launched a three-year health reform program to achieve equity of access. Through this reform program, the government intended to increase its investment in primary healthcare institutions (PHIs). However, reports about the outcome and the improvement of the equity of access have yet to be presented. Methods Stratified sampling was employed in this research. The samples used for the study comprised 34 community health service centers (CHSCs) and 92 township hospitals (THs) from six provinces of China. Collected data, which were publicly available, consisted of the total revenue, financial revenue, and the number of people for the periods covering January 2010 to September 2010 and January 2011 to September 2011. Revenue information for 2009 and 2010 was obtained from China’s Health Statistics Yearbook. By using indicators such as government investment, government finance proportion and per capita revenue, t-tests for paired and independent samples were used to analyze the changes in government investment. Results Government invest large amount of money to the primary healthcare institutions. Government finance proportion in 2008 was 18.2%. This percentage increased to 38.84% in 2011, indicating statistical significance (p = 0.000) between 2010 and 2011. The per capita financial input was 20.92 yuan in 2010 and 31.10 yuan in 2011. Compared with the figures from 2008 to 2010, the gap in different health sectors narrowed in 2011, and differences emerged. The government finance proportion in CHSCs revenue was 6.9% higher than that of THs, while the per capita revenue of CHSCs was higher. In 2011, the highest and lowest government finance proportions were 48.80% (Shaanxi) and 19.36% (Shandong), respectively. In that same year, the per capita revenue of Shaanxi (40.69 Yuan) was higher than that of Liaoning (28.79 Yuan). Comparing the 2011 figures with those from 2008 to 2010, the gap in 2011 clearly narrowed. Conclusion In the three-year health reform program, the Chinese government increased its investment to PHIs gradually and significantly. Thus promote equity to access and universal coverage. However, the increase in government investment stemmed from political desire and from the lack of institutionalization of practice and experience. Hence, a mode of financial allocation must be formulated to promote consistency in government input after the three-year health reform program. PMID:23530658

Creating the Business Case for Achieving Health Equity.

PubMed

Chin, Marshall H

2016-07-01

Health care organizations have increasingly acknowledged the presence of health care disparities across race/ethnicity and socioeconomic status, but significantly fewer have made health equity for diverse patients a true priority. Lack of financial incentives is a major barrier to achieving health equity. To create a business case for equity, governmental and private payors can: 1) Require health care organizations to report clinical performance data stratified by race, ethnicity, and socioeconomic status. 2) Incentivize preventive care and primary care. Implement more aggressive shared savings plans, update physician relative value unit fee schedules, and encourage partnerships across clinical and non-clinical sectors. 3) Incentivize the reduction of health disparities with equity accountability measures in payment programs. 4) Align equity accountability measures across public and private payors. 5) Assist safety-net organizations. Provide adequate Medicaid reimbursement, risk-adjust clinical performance scores for sociodemographic characteristics of patients, provide support for quality improvement efforts, and calibrate cuts to Disproportionate Share Hospital (DSH) payments to the pace of health insurance expansion. 6) Conduct demonstration projects to test payment and delivery system reform interventions to reduce disparities. Commitment to social justice is essential to achieve health equity, but insufficient without a strong business case that makes interventions financially feasible.

Beyond Equity: The New Politics of State Fiscal Constraints. State of the States: Florida.

ERIC Educational Resources Information Center

Herrington, Carolyn D.; Trimble, Susan

Public school funding in Florida differs from other states in a number of important ways. First, Florida has a highly equalized resource-distribution formula resulting in a high degree of interdistrict equity. Second, concerns for quality, while constant, have had to compete with the state's phenomenal growth. Third, the state exercises a much…

Inseparable Imperatives: Equity in Education and the Future of the American Economy

ERIC Educational Resources Information Center

DeBaun, Bill

2012-01-01

For most of the last sixty years, the United States has labored to provide a quality education to "all" children, regardless of their skin color or socioeconomic status. This struggle for equity in education has seldom been linked to America's position as the world's economic powerhouse and leading producer of college-educated individuals.…

Beyond the Equity Rhetoric in America's Teacher Education Programs: An African Immigrant Voice

ERIC Educational Resources Information Center

Obiakor, Festus E.

2010-01-01

Teacher education programs (TEPs) are consistently challenged to respond to individual and collective growth. In addition, current demographic changes have forced these programs to address issues of quality and equity in measurable ways. As an African immigrant to the United States, I have been fortunate to be involved in these programs,…

Race, Equity, and Public Schools in Post-Apartheid South Africa: Equal Opportunity for All Kids

ERIC Educational Resources Information Center

Yamauchi, F.

2005-01-01

This paper examines dynamic changes in educational quality and equity differences between Black and other population groups in post-Apartheid South African public schools, using the ratio of learners to educators in each school, available from the School Register of Needs, 1996 and 2000. The analysis incorporates school or community-level…

Disinvestment policy and the public funding of assisted reproductive technologies: outcomes of deliberative engagements with three key stakeholder groups.

PubMed

Hodgetts, Katherine; Hiller, Janet E; Street, Jackie M; Carter, Drew; Braunack-Mayer, Annette J; Watt, Amber M; Moss, John R; Elshaug, Adam G

2014-05-05

Measures to improve the quality and sustainability of healthcare practice and provision have become a policy concern. In addition, the involvement of stakeholders in health policy decision-making has been advocated, as complex questions arise around the structure of funding arrangements in a context of limited resources. Using a case study of assisted reproductive technologies (ART), deliberative engagements with a range of stakeholder groups were held on the topic of how best to structure the distribution of Australian public funding in this domain. Deliberative engagements were carried out with groups of ART consumers, clinicians and community members. The forums were informed by a systematic review of ART treatment safety and effectiveness (focusing, in particular, on maternal age and number of treatment cycles), as well as by international policy comparisons, and ethical and cost analyses. Forum discussions were transcribed and subject to thematic analysis. Each forum demonstrated stakeholders' capacity to understand concepts of choice under resource scarcity and disinvestment, and to countenance options for ART funding not always aligned with their interests. Deliberations in each engagement identified concerns around 'equity' and 'patient responsibility', culminating in a broad preference for (potential) ART subsidy restrictions to be based upon individual factors rather than maternal age or number of treatment cycles. Community participants were open to restrictions based upon measures of body mass index (BMI) and smoking status, while consumers and clinicians saw support to improve these factors as part of an ART treatment program, as distinct from a funding criterion. All groups advocated continued patient co-payments, with measures in place to provide treatment access to those unable to pay (namely, equity of access). Deliberations yielded qualitative, socially-negotiated evidence required to inform ethical, accountable policy decisions in the specific area of ART and health care more broadly. Notably, reductionist, deterministic characterizations of stakeholder 'self-interest' proved unfounded as each group sought to prioritise universal values (in particular, 'equity' and 'responsibility') over specific, within-group concerns. Our results--from an emotive case study in ART--highlight that evidence-informed disinvestment decision-making is feasible, and potentially less controversial than often presumed.

The rise and fall of dental therapy in Canada: a policy analysis and assessment of equity of access to oral health care for Inuit and First Nations communities.

PubMed

Leck, Victoria; Randall, Glen E

2017-07-20

Inequality between most Canadians and those from Inuit and First Nations communities, in terms of both access to oral health care services and related health outcomes, has been a long-standing problem. Efforts to close this equity gap led to the creation of dental therapy training programs. These programs were designed to produce graduates who would provide services in rural and northern communities. The closure of the last dental therapy program in late 2011 has ended the supply of dental therapists and governments do not appear to have any alternative solutions to the growing gap in access to oral health care services between most Canadians and those from Inuit and First Nations communities. A policy analysis of the rise and fall of the dental therapy profession in Canada was conducted using historical and policy documents. The analysis is framed within Kingdon's agenda-setting framework and considers why dental therapy was originally pursued as an option to ensure equitable access to oral health care for Inuit and First Nations communities and why this policy has now been abandoned with the closure of Canada's last dental therapy training school. The closure of the last dental therapy program in Canada has the potential to further reduce access to dental care in some Inuit and First Nations communities. Overlaps between federal and provincial jurisdiction have contributed to the absence of a coordinated policy approach to address the equity gap in access to dental care which will exacerbate the inequalities in comparison to the general population. The analysis suggests that while a technically feasible policy solution is available there continues to be no politically acceptable solution and thus it remains unlikely that a window of opportunity for policy change will open any time soon. In the absence of federal government leadership, the most viable option forward may be incremental policy change. Provincial governments could expand the scope of practice for dental hygienists in the hope that it may support enhanced access, consumer choice, and efficiency in the delivery of oral health care to Inuit and First Nations communities in Canada.

[Gender, equality, and health services access: an empirical approximation].

PubMed

Gómez Gómez, Elsa

2002-01-01

This piece describes the conceptual framework and the objectives that guided a research initiative in the Region of the Americas that was called "Gender, Equity, and Access to Health Services" and that was sponsored in 2001 by the Pan American Health Organization. The piece does not summarize the results of the six projects that were carried under the initiative, whose analyses have not all been completed. Instead, the piece discusses some of the foundations of the initiative and provides a general introduction to the country studies that were done. The six studies were done in Barbados/Jamaica, Brazil, Chile, Colombia, Ecuador, and Peru. The primary objective of the initiative was to stimulate the use of existing quantitative information in the countries, with the goal of starting a process of systematically documenting two things: 1) the unfair, unnecessary, and avoidable inequalities between men and women in their access to health care and 2) the linkages between those inequalities and other socioeconomic factors. The concept of gender equity that guided this examination of health care was not the usual one calling for the equal distribution of resources. Rather, it was the notion that resources should be allocated differentially, according to the particular needs of men and of women, and that persons should pay for health services according to their economic ability rather than their risk level. The starting point for the initiative was the premise that gender inequities in utilizing and paying for health care result from gender differences in the macroeconomic and microeconomic distribution of resources. The piece concludes that achieving equity in health care access will require a better understanding of the gender needs and gender barriers that are linked to social structures and health systems.

Social justice in Chinese higher education: Regional issues of equity and access

NASA Astrophysics Data System (ADS)

Jacob, W. James

2007-01-01

A topic of growing concern in Chinese higher education to policy-makers, scholars, and future student applicants is social justice. With the trend toward increasing enrollments in China's higher-education institutions, issues of equity and access have begun to surface, especially as they relate to China's minority population of over 100 million persons. The present contribution offers an overview of the regional boundaries of China, both geographic and historical. It then looks at the development of urbanicity in connection with higher education. Third, it describes the recent history of the gender gap in education both in general and in higher education in particular. Fourth, it examines the ethnic boundaries that exist in higher education. The final section analyzes related findings drawn from interviews and questionnaires administered to faculty members, administrators, and students at ten sample universities.

Patients' online access to their electronic health records and linked online services: a systematic interpretative review.

PubMed

de Lusignan, Simon; Mold, Freda; Sheikh, Aziz; Majeed, Azeem; Wyatt, Jeremy C; Quinn, Tom; Cavill, Mary; Gronlund, Toto Anne; Franco, Christina; Chauhan, Umesh; Blakey, Hannah; Kataria, Neha; Barker, Fiona; Ellis, Beverley; Koczan, Phil; Arvanitis, Theodoros N; McCarthy, Mary; Jones, Simon; Rafi, Imran

2014-09-08

To investigate the effect of providing patients online access to their electronic health record (EHR) and linked transactional services on the provision, quality and safety of healthcare. The objectives are also to identify and understand: barriers and facilitators for providing online access to their records and services for primary care workers; and their association with organisational/IT system issues. Primary care. A total of 143 studies were included. 17 were experimental in design and subject to risk of bias assessment, which is reported in a separate paper. Detailed inclusion and exclusion criteria have also been published elsewhere in the protocol. Our primary outcome measure was change in quality or safety as a result of implementation or utilisation of online records/transactional services. No studies reported changes in health outcomes; though eight detected medication errors and seven reported improved uptake of preventative care. Professional concerns over privacy were reported in 14 studies. 18 studies reported concern over potential increased workload; with some showing an increase workload in email or online messaging; telephone contact remaining unchanged, and face-to face contact staying the same or falling. Owing to heterogeneity in reporting overall workload change was hard to predict. 10 studies reported how online access offered convenience, primarily for more advantaged patients, who were largely highly satisfied with the process when clinician responses were prompt. Patient online access and services offer increased convenience and satisfaction. However, professionals were concerned about impact on workload and risk to privacy. Studies correcting medication errors may improve patient safety. There may need to be a redesign of the business process to engage health professionals in online access and of the EHR to make it friendlier and provide equity of access to a wider group of patients. A1 SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42012003091. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Patients’ online access to their electronic health records and linked online services: a systematic interpretative review

PubMed Central

de Lusignan, Simon; Mold, Freda; Sheikh, Aziz; Majeed, Azeem; Wyatt, Jeremy C; Quinn, Tom; Cavill, Mary; Gronlund, Toto Anne; Franco, Christina; Chauhan, Umesh; Blakey, Hannah; Kataria, Neha; Barker, Fiona; Ellis, Beverley; Koczan, Phil; Arvanitis, Theodoros N; McCarthy, Mary; Jones, Simon; Rafi, Imran

2014-01-01

Objectives To investigate the effect of providing patients online access to their electronic health record (EHR) and linked transactional services on the provision, quality and safety of healthcare. The objectives are also to identify and understand: barriers and facilitators for providing online access to their records and services for primary care workers; and their association with organisational/IT system issues. Setting Primary care. Participants A total of 143 studies were included. 17 were experimental in design and subject to risk of bias assessment, which is reported in a separate paper. Detailed inclusion and exclusion criteria have also been published elsewhere in the protocol. Primary and secondary outcome measures Our primary outcome measure was change in quality or safety as a result of implementation or utilisation of online records/transactional services. Results No studies reported changes in health outcomes; though eight detected medication errors and seven reported improved uptake of preventative care. Professional concerns over privacy were reported in 14 studies. 18 studies reported concern over potential increased workload; with some showing an increase workload in email or online messaging; telephone contact remaining unchanged, and face-to face contact staying the same or falling. Owing to heterogeneity in reporting overall workload change was hard to predict. 10 studies reported how online access offered convenience, primarily for more advantaged patients, who were largely highly satisfied with the process when clinician responses were prompt. Conclusions Patient online access and services offer increased convenience and satisfaction. However, professionals were concerned about impact on workload and risk to privacy. Studies correcting medication errors may improve patient safety. There may need to be a redesign of the business process to engage health professionals in online access and of the EHR to make it friendlier and provide equity of access to a wider group of patients. A1. Systematic review registration number PROSPERO CRD42012003091. PMID:25200561

[Inequality and erroneous social policy produce inequity in México].

PubMed

Eibenschutz, Catalina; Támez, Silvia; Camacho, Iliana

2008-12-01

The different conceptualizations regarding equity and inequality in health are discussed, concluding that inequity and inequality are not synonyms. It is suggested that inequality should be used for describing epidemiological profiles and equity in relationship to the distribution of and gaining access to health attention services. The situation in México is reviewed in greater detail, as there is great socioeconomic polarisation in this country, a privatizing sanitary reform which has increased inequity and incomplete citizenry as the main obstacles for gaining a reduction in inequity in health.

NGO facilitation of a government community-based maternal and neonatal health programme in rural India: improvements in equity.

PubMed

Baqui, Abdullah H; Rosecrans, Amanda M; Williams, Emma K; Agrawal, Praween K; Ahmed, Saifuddin; Darmstadt, Gary L; Kumar, Vishwajeet; Kiran, Usha; Panwar, Dharmendra; Ahuja, Ramesh C; Srivastava, Vinod K; Black, Robert E; Santosham, Mathuram

2008-07-01

Socio-economic disparities in health have been well documented around the world. This study examines whether NGO facilitation of the government's community-based health programme improved the equity of maternal and newborn health in rural Uttar Pradesh, India. A quasi-experimental study design included one intervention district and one comparison district of rural Uttar Pradesh. A household survey conducted between January and June 2003 established baseline rates of programme coverage, maternal and newborn care practices, and health care utilization during 2001-02. An endline household survey was conducted after 30 months of programme implementation between January and March 2006 to measure the same indicators during 2004-05. The changes in the indicators from baseline to endline in the intervention and comparison districts were calculated by socio-economic quintiles, and concentration indices were constructed to measure the equity of programme indicators. The equity of programme coverage and antenatal and newborn care practices improved from baseline to endline in the intervention district while showing little change in the comparison district. Equity in health care utilization for mothers and newborns also showed some improvements in the intervention district, but notable socio-economic differentials remained, with the poor demonstrating less ability to access health services. NGO facilitation of government programmes is a feasible strategy to improve equity of maternal and neonatal health programmes. Improvements in equity were most pronounced for household practices, and inequities were still apparent in health care utilization. Furthermore, overall programme coverage remained low, limiting the ability to address equity. Programmes need to identify and address barriers to universal coverage and care utilization, particularly in the poorest segments of the population.

Identification of publicly available data sources to inform the conduct of Health Technology Assessment in India

PubMed Central

Downey, Laura; Rao, Neethi; Guinness, Lorna; Asaria, Miqdad; Prinja, Shankar; Sinha, Anju; Kant, Rajni; Pandey, Arvind; Cluzeau, Francoise; Chalkidou, Kalipso

2018-01-01

Background: Health technology assessment (HTA) provides a globally-accepted and structured approach to synthesising evidence for cost and clinical effectiveness alongside ethical and equity considerations to inform evidence-based priorities. India is one of the most recent countries to formally commit to institutionalising HTA as an integral component of the heath resource allocation decision-making process. The effective conduct of HTA depends on the availability of reliable data.   Methods: We draw from our experience of collecting, synthesizing, and analysing health-related datasets in India and internationally, to highlight the complex requirements for undertaking HTA, and explore the availability of such data in India. We first outlined each of the core data components required for the conduct of HTA, and their availability in India, drawing attention to where data can be accessed, and different ways in which researchers can overcome the challenges of missing or low quality data. Results: We grouped data into the following categories: clinical efficacy; cost; epidemiology; quality of life; service use/consumption; and equity. We identified numerous large local data sources containing epidemiological information. There was a marked absence of other locally-collected data necessary for informing HTA, particularly data relating to cost, service use, and quality of life. Conclusions: The introduction of HTA into the health policy space in India provides an opportunity to comprehensively assess the availability and quality of health data capture across the country. While epidemiological information is routinely collected across India, other data inputs necessary for HTA are not readily available. This poses a significant bottleneck to the efficient generation and deployment of HTA into the health decision space. Overcoming these data gaps by strengthening the routine collection of comprehensive and verifiable health data will have important implications not only for embedding economic analyses into the priority setting process, but for strengthening the health system as a whole. PMID:29770210

Client/patient perceptions of achieving equity in primary health care: a mixed methods study.

PubMed

Akhavan, Sharareh; Tillgren, Per

2015-08-12

To provide health care on equal terms has become a challenge for the health system. As the front line in health services, primary care has a key role to play in developing equitable health care, responsive to the needs of different population groups. Reducing inequalities in care has been a central and recurring theme in Swedish health reforms. The aim of this study is to describe and assess client/patient experiences and perceptions of care in four primary health care units (PHCUs) involved in Sweden's national Care on Equal Terms project. Mixed Method Research (MMR) was chosen to describe and assess client/patient experiences and perceptions of health care with regard to equity. There was a focus group discussion, and individual interviews with 21 clients/patients and three representatives of patient associations. Data from the Swedish National Patient Survey (NPS), conducted in 2011 and followed up in 2013, were also used. The interview data were divided into two main categories and three subcategories. The first category "Perception of equitable health care" had two subcategories, namely "Health care providers' perceptions" and "Fairness and participation". The second category "To achieve more equitable health care" had four subcategories: "Encounter", "Access", "Interpreters and bilingual/diverse health care providers" and "Time pressure and continuity". Results from the NPS showed that two of the PHCUs improved in some aspects of patient perceived quality of care (PPQC) while two were not so successful. Clients/patients perceived health care providers' perceptions of their ethnic origin and mental health status as important for equitable health care. Discriminatory perceptions may lead to those in need of care refraining from seeking it. More equitable care means longer consultations, better accessibility in terms of longer opening hours, and ways of communicating other than just via voice mail. It also involves continuity in care and access to an interpreter if needed. Employing bilingual/diverse kinds of health providers is a way of providing more equitable primary health care.

Increasing equity of access to point-of-use water treatment products through social marketing and entrepreneurship: a case study in western Kenya.

PubMed

Freeman, Matthew C; Quick, Robert E; Abbott, Daniel P; Ogutu, Paul; Rheingans, Richard

2009-09-01

Point-of-use water chlorination reduces diarrhoea risk by 25-85%. Social marketing has expanded access to inexpensive sodium hypochlorite for water treatment, at a cost of less than US$0.01 per day, in Kenya. To increase product access, women's groups in western Kenya were trained to educate neighbours and sell health products to generate income. We evaluated this programme's impact on equity of access to water treatment products in a cross-sectional survey. We surveyed 487 randomly selected households in eight communities served by the women's groups. Overall, 20% (range 5-39%) of households in eight communities purchased and used chlorine, as confirmed by residual chlorine observed in stored water. Multivariate models using illiteracy and the poorest socioeconomic status as a referent showed that persons with at least some primary education (OR 2.5, 95% CI 1.8, 3.5) or secondary education (OR 5.4, 95% CI 1.6, 17.5) and persons in the four wealthiest quintiles (OR 2.5, 95% CI 1.0, 6.0) were more likely to chlorinate stored water. While this implementation model was associated with good product penetration and use, barriers to access to inexpensive water treatment remained among the very poor and less educated.

LGBT Cultural Competence and Interventions to Help Oncology Nurses and Other Health Care Providers.

PubMed

Radix, Asa; Maingi, Shail

2018-02-01

To define and give an overview of the importance of lesbian, gay, bisexual, and transgender (LGBT) cultural competency and offer some initial steps on how to improve the quality of care provided by oncology nurses and other health care professionals. A review of the existing literature on cultural competency. LGBT patients experience cancer and several other diseases at higher rates than the rest of the population. The reasons for these health care disparities are complex and include minority stress, fear of discrimination, lower rates of insurance, and lack of access to quality, culturally competent care. Addressing the health care disparities experienced by LGBT individuals and families requires attention to the actual needs, language, and support networks used by patients in these communities. Training on how to provide quality care in a welcoming and non-judgmental way is available and can improve health equity. Health care professionals and institutions that acquire cultural competency training can improve the overall health of LGBT patients who currently experience significant health care disparities. Copyright © 2017 Elsevier Inc. All rights reserved.

The Every Student Succeeds Act, State Efforts to Improve Access to Effective Educators, and the Importance of School Leadership

ERIC Educational Resources Information Center

Fuller, Edward J.; Hollingworth, Liz; Pendola, Andrew

2017-01-01

Purpose: Our primary purpose is to examine the degree to which state equity plans identify the distribution of principals and principal turnover as factors influencing three leadership mechanisms that affect student access to effective teachers--namely, hiring of teachers, building instructional capacity of teachers, and managing teacher turnover.…

Socio-Economic Segregation of Disadvantaged Children between Schools in Pakistan: Comparing the State and Private Sector

ERIC Educational Resources Information Center

Siddiqui, Nadia

2017-01-01

The distribution of children in different school-types and regions in Pakistan suggests that access and opportunities in education are not evenly accessible for many children. Segregation at school level is an important concern for equity and social justice because the adverse effects of segregation increase the pre-existing gap in opportunities…

Has Massification of Higher Education Led to More Equity? Clues to a Reflection on Portuguese Education Arena

ERIC Educational Resources Information Center

Dias, Diana

2015-01-01

Massification is an undeniable phenomenon in the higher education arena. However, there have been questions raised regarding the extent to which a mass system really corresponds to an effective democratisation not only of access, but also of success. With regards to access, this article intends, through a brief analysis of the expansion of higher…

Analysis of the Higher Education Act Reauthorizations: Financial Aid Policy Influencing College Access and Choice

ERIC Educational Resources Information Center

Capt, Robin L.

2013-01-01

The original goal of the Higher Education Act of 1965, the amendments to that act in 1972, and reauthorizations through 1998 was to increase accessibility of higher education to all. Initially these system-level efforts substantially enhanced equity, but recent enrollment trends raise the question: Is our system becoming more or less equitable? By…

Higher Education in Kenya: An Assessment of Current Responses to the Imperative of Widening Access

ERIC Educational Resources Information Center

Odhiambo, George

2016-01-01

Higher education is a key factor in a nation's effort to develop a highly skilled workforce for competing in the global economy. In this paper, current trends in accessibility, equity, participation and financing of higher education in Kenya are examined. The paper explores the challenges which need to be confronted and discusses the way forward…

Accessibility Evaluation of Top-Ranking University Websites in World, Oceania, and Arab Categories for Home, Admission, and Course Description Webpages

ERIC Educational Resources Information Center

Alahmadi, Tahani; Drew, Steve

2017-01-01

Evaluating accessibility is an important equity step in assessing the effectiveness and usefulness of online learning materials for students with disabilities such as visual or hearing impairments. Previous studies in this area have indicated that, over time, university websites have become gradually more inaccessible. This paper relates findings…

Leadership for Transformative Change: Lessons from Technology-Mediated Reform in Broad-Access Colleges. CCRC Working Paper No. 8

ERIC Educational Resources Information Center

Klempin, Serena; Karp, Melinda Mechur

2015-01-01

Community colleges and broad-access four-year institutions have a crucial role to play in increasing educational equity in the United States. In order to fulfill this role, however, institutions must engage in organizational change to address their low completion rates. Drawing on qualitative case studies of six colleges, this study explores the…

Dynamics of Inequalities in Access to Higher Education: Bulgaria in a Comparative Perspective

ERIC Educational Resources Information Center

Ilieva-Trichkova, Petya; Boyadjieva, Pepka

2014-01-01

This paper aims at studying the dynamics of inequalities in access to higher education (HE) both in a historical and a comparative perspective. It uses Bulgaria as a case study and places it among five other countries such as Estonia, Hungary, Poland, Slovakia and Slovenia. The adopted approach differentiates between equity in HE and inequalities…

Equality or Equity, Player or Guardian? The Dutch Government and Its Role in Providing Access Opportunities for Government Sponsored International Secondary Education, 1979-2009

ERIC Educational Resources Information Center

Prickarts, Boris

2010-01-01

This article focuses on the Dutch government's International Baccalaureate (IB) Diploma Programme (DP) Pilot, allowing Dutch pre-university students to take part in the IB DP. Is it likely to create "equal", or rather "equitable", access opportunities for government-sponsored Dutch international secondary schools? The article…

Learning Support for Students with Learning Difficulties in India and Australia: Similarities and Differences

ERIC Educational Resources Information Center

Thomas, Grace; Whitten, Janet

2012-01-01

In Australia, principles of inclusivity and access are explicit in education policies and are actively supported by government funding. In India, with a vast and diversely managed array of schools, limited resources and an absence of public funding, it cannot be assumed that official principles of access and equity apply. This small-scale study of…

Progress in the utilization of antenatal and delivery care services in Bangladesh: where does the equity gap lie?

PubMed

Pulok, Mohammad Habibullah; Sabah, Md Nasim-Us; Uddin, Jalal; Enemark, Ulrika

2016-07-29

Universal access to health care services does not automatically guarantee equity in the health system. In the post Millennium Development Goals (MDGs) era, the progress towards universal access to maternal health care services in a developing country, like Bangladesh requires an evaluation in terms of equity lens. This study, therefore, analysed the trend in inequity and identified the equity gap in the utilization of antenatal care (ANC) and delivery care services in Bangladesh between 2004 and 2011. The data of this study came from the Bangladesh Demographic and Health Survey. We employed rate ratio, concentration curve and concentration index to examine the trend in inequity of ANC and delivery care services. We also used logistic regression models to analyse the relationship between socioeconomic factors and maternal health care services. The concentration index for 4+ ANC visits dropped from 0.42 in 2004 to 0.31 in 2011 with a greater decline in urban area. There was almost no change in the concentration index for ANC services from medically trained providers during this period. We also found a decreasing trend in inequity in the utilization of both health facility delivery and skilled birth assistance but this trend was again more pronounced in urban area compared to rural area. The concentration index for C-section delivery decreased by about 33 % over 2004-2011 with a similar rate in both urban and rural areas. Women from the richest households were about 3 times more likely to have 4+ ANC visits, delivery at a health facility and skilled birth assistance compared to women from the poorest households. Women's and their husbands' education were significantly associated with greater use of maternal health care services. In addition, women's exposure to mass media, their involvement in microcredit programs and autonomy in healthcare decision-making appeared as significant predictors of using some of these health care services. Bangladesh faces not only a persistent pro-rich inequity but also a significant rural-urban equity gap in the uptake of maternal health care services. An equity perspective in policy interventions is much needed to ensure safe motherhood and childbirth in Bangladesh.

Using focus groups to design systems science models that promote oral health equity.

PubMed

Kum, Susan S; Northridge, Mary E; Metcalf, Sara S

2018-06-04

While the US population overall has experienced improvements in oral health over the past 60 years, oral diseases remain among the most common chronic conditions across the life course. Further, lack of access to oral health care contributes to profound and enduring oral health inequities worldwide. Vulnerable and underserved populations who commonly lack access to oral health care include racial/ethnic minority older adults living in urban environments. The aim of this study was to use a systematic approach to explicate cause and effect relationships in creating a causal map, a type of concept map in which the links between nodes represent causality or influence. To improve our mental models of the real world and devise strategies to promote oral health equity, methods including system dynamics, agent-based modeling, geographic information science, and social network simulation have been leveraged by the research team. The practice of systems science modeling is situated amidst an ongoing modeling process of observing the real world, formulating mental models of how it works, setting decision rules to guide behavior, and from these heuristics, making decisions that in turn affect the state of the real world. Qualitative data were obtained from focus groups conducted with community-dwelling older adults who self-identify as African American, Dominican, or Puerto Rican to elicit their lived experiences in accessing oral health care in their northern Manhattan neighborhoods. The findings of this study support the multi-dimensional and multi-level perspective of access to oral health care and affirm a theorized discrepancy in fit between available dental providers and patients. The lack of information about oral health at the community level may be compromising the use and quality of oral health care among racial/ethnic minority older adults. Well-informed community members may fill critical roles in oral health promotion, as they are viewed as highly credible sources of information and recommendations for dental providers. The next phase of this research will involve incorporating the knowledge gained from this study into simulation models that will be used to explore alternative paths toward improving oral health and health care for racial/ethnic minority older adults.

Using targeted vouchers and health equity funds to improve access to skilled birth attendants for poor women: a case study in three rural health districts in Cambodia.

PubMed

Ir, Por; Horemans, Dirk; Souk, Narin; Van Damme, Wim

2010-01-07

In many developing countries, the maternal mortality ratio remains high with huge poor-rich inequalities. Programmes aimed at improving maternal health and preventing maternal mortality often fail to reach poor women. Vouchers in health and Health Equity Funds (HEFs) constitute a financial mechanism to improve access to priority health services for the poor. We assess their effectiveness in improving access to skilled birth attendants for poor women in three rural health districts in Cambodia and draw lessons for further improvement and scaling-up. Data on utilisation of voucher and HEF schemes and on deliveries in public health facilities between 2006 and 2008 were extracted from the available database, reports and the routine health information system. Qualitative data were collected through focus group discussions and key informant interviews. We examined the trend of facility deliveries between 2006 and 2008 in the three health districts and compared this with the situation in other rural districts without voucher and HEF schemes. An operational analysis of the voucher scheme was carried out to assess its effectiveness at different stages of operation. Facility deliveries increased sharply from 16.3% of the expected number of births in 2006 to 44.9% in 2008 after the introduction of voucher and HEF schemes, not only for voucher and HEF beneficiaries, but also for self-paid deliveries. The increase was much more substantial than in comparable districts lacking voucher and HEF schemes. In 2008, voucher and HEF beneficiaries accounted for 40.6% of the expected number of births among the poor. We also outline several limitations of the voucher scheme. Vouchers plus HEFs, if carefully designed and implemented, have a strong potential for reducing financial barriers and hence improving access to skilled birth attendants for poor women. To achieve their full potential, vouchers and HEFs require other interventions to ensure the supply of sufficient quality maternity services and to address other non-financial barriers to demand. If these conditions are met, voucher and HEF schemes can be further scaled up under close monitoring and evaluation.

Using targeted vouchers and health equity funds to improve access to skilled birth attendants for poor women: a case study in three rural health districts in Cambodia

PubMed Central

2010-01-01

Background In many developing countries, the maternal mortality ratio remains high with huge poor-rich inequalities. Programmes aimed at improving maternal health and preventing maternal mortality often fail to reach poor women. Vouchers in health and Health Equity Funds (HEFs) constitute a financial mechanism to improve access to priority health services for the poor. We assess their effectiveness in improving access to skilled birth attendants for poor women in three rural health districts in Cambodia and draw lessons for further improvement and scaling-up. Methods Data on utilisation of voucher and HEF schemes and on deliveries in public health facilities between 2006 and 2008 were extracted from the available database, reports and the routine health information system. Qualitative data were collected through focus group discussions and key informant interviews. We examined the trend of facility deliveries between 2006 and 2008 in the three health districts and compared this with the situation in other rural districts without voucher and HEF schemes. An operational analysis of the voucher scheme was carried out to assess its effectiveness at different stages of operation. Results Facility deliveries increased sharply from 16.3% of the expected number of births in 2006 to 44.9% in 2008 after the introduction of voucher and HEF schemes, not only for voucher and HEF beneficiaries, but also for self-paid deliveries. The increase was much more substantial than in comparable districts lacking voucher and HEF schemes. In 2008, voucher and HEF beneficiaries accounted for 40.6% of the expected number of births among the poor. We also outline several limitations of the voucher scheme. Conclusions Vouchers plus HEFs, if carefully designed and implemented, have a strong potential for reducing financial barriers and hence improving access to skilled birth attendants for poor women. To achieve their full potential, vouchers and HEFs require other interventions to ensure the supply of sufficient quality maternity services and to address other non-financial barriers to demand. If these conditions are met, voucher and HEF schemes can be further scaled up under close monitoring and evaluation. PMID:20059767

African-American and white head and neck carcinoma patients in a university medical center setting. Are treatments provided and are outcomes similar or disparate?

PubMed

Murdock, J M; Gluckman, J L

2001-01-01

Racial and ethnic disparities occur in many areas of the health care management system in the United States. These disparities include disease incidence, access to health and medical services, treatments provided, and disease outcomes. Health care delivery organizations have limited resources. Encounters between patients and providers in health care delivery organizations typically are cross-cultural. Access to care, quality of care, and equity may be affected by limited resources and cross-cultural encounters. This impacts the diagnosis, treatments provided, and outcomes, with African-American patients faring poorly compared with white patients. African Americans are 15% more likely to develop cancer than whites and are about 34% more likely to die of cancer than whites in the United States. The purpose of this study was to determine and compare the characteristics of African-American patients and white patients with carcinoma of the head and neck at the University of Cincinnati Medical Center, an equal-access facility, reporting similarities and disparities in disease stage at the time of diagnosis, treatment received, and patient outcomes. Copyright 2001 American Cancer Society.

Resolving the tug-of-war between Medicare's national and local coverage.

PubMed

Foote, Susan Bartlett; Wholey, Douglas; Rockwood, Todd; Halpern, Rachel

2004-01-01

Medicare's decentralized local coverage policy process leads to policy variation, raising serious equity and quality issues. The policy debate resembles a tug-of-war, with advocates favoring nationalization of all local policies or arguing for the status quo. We extensively analyzed thousands of local policies and surveyed Medicare's contractors. We found that all local policies are not the same. We classified them based on where they fall on the diffusion curve. The classification by type allows for reallocation to the national or local process to improve the decisions and satisfy Medicare's equity and quality goals.

78 FR 68501 - Agency Information Collection Activity Under OMB Review

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-14

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Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-13

... consider the interdependent challenges of: (1) Economic competitiveness and revitalization; (2) social equity, inclusion, and access to opportunity; (3) energy use and climate change; and (4) public health...

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Federal Register 2010, 2011, 2012, 2013, 2014

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... provide additional narrative explaining their lack of access to loans, equity investments, or Financial... Narrative 10 Target Market Needs 10 Responsiveness to Target Market Needs 40 Delivery Capacity 40 TOTAL...

Associations Between Social Determinants of Health and Pregnancy Among Young People: A Systematic Review of Research Published During the Past 25 Years

PubMed Central

Buhi, Eric R.

2016-01-01

Objective Major health disparities exist in pregnancy among young people. Although social determinant of health (SDH) approaches in interventions are promoted to reduce these disparities, little research exists that synthesizes empirical links between SDHs and pregnancy among young people. This systematic literature review utilized the Healthy People 2020 SDH framework to analyze and synthesize the empirical associations between SDHs and pregnancy among young people. Methods We included studies that were published in the past 25 years from PubMed, PsycINFO®, and Academic Search” Premier databases. Twenty-two studies met all inclusion criteria and, following the Matrix Method, were assessed for methodological quality and empirical links between determinant areas and pregnancy. Results Seventeen studies reported an empirical association between at least one SDH and pregnancy among young people. Areas most represented were poverty and family structure. No studies examined the relationship between pregnancies among young people and quality of housing, access to healthy foods, access to health-care services and primary care, health technology, social cohesion, perceptions of discrimination/equity, access to employment, employment status, school policies that support health promotion, safe school environments, or higher education enrollment. Conclusion This research indicates a need to expand the range of SDHs that are analyzed with pregnancy among young people and to focus interventions on areas that have been determined to have an empirical link with pregnancy. PMID:26843674

The democratization of health in Mexico: financial innovations for universal coverage

PubMed Central

Frenk, Julio; Knaul, Felicia Marie

2009-01-01

Abstract In 2003, the Mexican Congress approved a reform establishing the Sistema de Protección Social en Salud [System of Social Protection in Health], whereby public funding for health is being increased by one percent of the 2003 gross domestic product over seven years to guarantee universal health insurance. Poor families that had been excluded from traditional social security can now enrol in a new public insurance scheme known as Seguro Popular [People’s Insurance], which assures legislated access to a comprehensive set of health-care entitlements. This paper describes the financial innovations behind the expansion of health-care coverage in Mexico to everyone and their effects. Evidence shows improvements in mobilization of additional public resources; availability of health infrastructure and drugs; service utilization; effective coverage; and financial protection. Future challenges are discussed, among them the need for additional public funding to extend access to costly interventions for non-communicable diseases not yet covered by the new insurance scheme, and to improve the technical quality of care and the responsiveness of the health system. Eventually, the progress achieved so far will have to be reflected in health outcomes, which will continue to be evaluated so that Mexico can meet the ultimate criterion of reform success: better health through equity, quality and fair financing. PMID:19649369

The democratization of health in Mexico: financial innovations for universal coverage.

PubMed

Frenk, Julio; Gómez-Dantés, Octavio; Knaul, Felicia Marie

2009-07-01

In 2003, the Mexican Congress approved a reform establishing the Sistema de Protección Social en Salud [System of Social Protection in Health], whereby public funding for health is being increased by one percent of the 2003 gross domestic product over seven years to guarantee universal health insurance. Poor families that had been excluded from traditional social security can now enrol in a new public insurance scheme known as Seguro Popular [People's Insurance], which assures legislated access to a comprehensive set of health-care entitlements. This paper describes the financial innovations behind the expansion of health-care coverage in Mexico to everyone and their effects. Evidence shows improvements in mobilization of additional public resources; availability of health infrastructure and drugs; service utilization; effective coverage; and financial protection. Future challenges are discussed, among them the need for additional public funding to extend access to costly interventions for non-communicable diseases not yet covered by the new insurance scheme, and to improve the technical quality of care and the responsiveness of the health system. Eventually, the progress achieved so far will have to be reflected in health outcomes, which will continue to be evaluated so that Mexico can meet the ultimate criterion of reform success: better health through equity, quality and fair financing.

The development of funding recommendations for health technologies at the state level: A South Australian case study.

PubMed

Lambert, Robyn; Carter, Drew; Burgess, Naomi; Haji Ali Afzali, Hossein

2018-04-20

State governments often face capped budgets that can restrict expenditure on health technologies and their evaluation, yet many technologies are introduced to practice through state-funded institutions such as hospitals, rather than through national evaluation mechanisms. This research aimed to identify the criteria, evidence, and standards used by South Australian committee members to recommend funding for high-cost health technologies. We undertook 8 semi-structured interviews and 2 meeting observations with members of state-wide committees that have a mandate to consider the safety, effectiveness, and cost-effectiveness of high-cost health technologies. Safety and effectiveness were fundamental criteria for decision makers, who were also concerned with increasing consistency in care and equitable access to technologies. Committee members often consider evidence that is limited in quantity and quality; however, they perceive evaluations to be rigorous and sufficient for decision making. Precise standards for safety, effective, and cost-effectiveness could not be identified. Consideration of new technologies at the state level is grounded in the desire to improve health outcomes and equity of access for patients. High quality evidence is often limited. The impact funding decisions have on population health is unclear due to limited use of cost-effectiveness analysis and unclear cost-effectiveness standards. Copyright © 2018 John Wiley & Sons, Ltd.

'Issues of equity are also issues of rights': Lessons from experiences in Southern Africa

PubMed Central

London, Leslie

2007-01-01

Background Human rights approaches to health have been criticized as antithetical to equity, principally because they are seen to prioritise rights of individuals at the expense of the interests of groups, a core tenet of public health. The objective of this study was to identify how human rights approaches can promote health equity. Methods The Network on Equity in Health in Southern Africa undertook an exploration of three regional case studies – antiretroviral access, patient rights charters and civic organization for health. A combination of archival reviews and stakeholder interviews were complemented with a literature review to provide a theoretical framework for the empirical evidence. Results Critical success factors for equity are the importance of rights approaches addressing the full spectrum from civil and political, through to socio-economic rights, as well as the need to locate rights in a group context. Human rights approaches succeed in achieving health equity when coupled with community engagement in ways that reinforce community capacity, particularly when strengthening the collective agency of its most vulnerable groups. Additionally, human rights approaches provide opportunities for mobilising resources outside the health sector, and must aim to address the public-private divide at local, national and international levels. Conclusion Where it is clear that rights approaches are predicated upon understanding the need to prioritize vulnerable groups and where the way rights are operationalised recognizes the role of agency on the part of those most affected in realising their socio-economic rights, human rights approaches appear to offer powerful tools to support social justice and health equity. PMID:17257421

Universal Health Insurance in India: Ensuring Equity, Efficiency, and Quality

PubMed Central

Prinja, Shankar; Kaur, Manmeet; Kumar, Rajesh

2012-01-01

Indian health system is characterized by a vast public health infrastructure which lies underutilized, and a largely unregulated private market which caters to greater need for curative treatment. High out-of-pocket (OOP) health expenditures poses barrier to access for healthcare. Among those who get hospitalized, nearly 25% are pushed below poverty line by catastrophic impact of OOP healthcare expenditure. Moreover, healthcare costs are spiraling due to epidemiologic, demographic, and social transition. Hence, the need for risk pooling is imperative. The present article applies economic theories to various possibilities for providing risk pooling mechanism with the objective of ensuring equity, efficiency, and quality care. Asymmetry of information leads to failure of actuarially administered private health insurance (PHI). Large proportion of informal sector labor in India's workforce prevents major upscaling of social health insurance (SHI). Community health insurance schemes are difficult to replicate on a large scale. We strongly recommend institutionalization of tax-funded Universal Health Insurance Scheme (UHIS), with complementary role of PHI. The contextual factors for development of UHIS are favorable. SHI schemes should be merged with UHIS. Benefit package of this scheme should include preventive and in-patient curative care to begin with, and gradually include out-patient care. State-specific priorities should be incorporated in benefit package. Application of such an insurance system besides being essential to the goals of an effective health system provides opportunity to regulate private market, negotiate costs, and plan health services efficiently. Purchaser-provider split provides an opportunity to strengthen public sector by allowing providers to compete. PMID:23112438

Trade in health services.

PubMed Central

Chanda, Rupa

2002-01-01

In light of the increasing globalization of the health sector, this article examines ways in which health services can be traded, using the mode-wise characterization of trade defined in the General Agreement on Trade in Services. The trade modes include cross- border delivery of health services via physical and electronic means, and cross-border movement of consumers, professionals, and capital. An examination of the positive and negative implications of trade in health services for equity, efficiency, quality, and access to health care indicates that health services trade has brought mixed benefits and that there is a clear role for policy measures to mitigate the adverse consequences and facilitate the gains. Some policy measures and priority areas for action are outlined, including steps to address the "brain drain"; increasing investment in the health sector and prioritizing this investment better; and promoting linkages between private and public health care services to ensure equity. Data collection, measures, and studies on health services trade all need to be improved, to assess better the magnitude and potential implications of this trade. In this context, the potential costs and benefits of trade in health services are shaped by the underlying structural conditions and existing regulatory, policy, and infrastructure in the health sector. Thus, appropriate policies and safeguard measures are required to take advantage of globalization in health services. PMID:11953795

[Epidemiology of cancer in Italy: from real data to the need for cancer networks.

PubMed

Pinto, Carmine; Mangone, Lucia

2016-10-01

The Italian Association of Medical Oncology (AIOM) and the Italian Association of Cancer Registries (AIRTUM) provide a reliable estimation of the incidence of cancer in Italy. The most outstanding data point to the steadily increasing efficacy of novel therapies, allowing patients to live longer and have a better quality of life, and the number of citizens being diagnosed with cancer - more than three million people, 4.9% of the population. Over the last years, a significant reduction in cancer incidence has been recorded among men with an opposite tendency among women. However, decreased mortality rates are observed in both sexes as a result of primary prevention measures and the promotion of large-scale national screening programs. In this scenario, cancer networks may play a key role. Quality of care could be substantially improved only if regional cancer networks are implemented on the basis of shared pathways, so as to guarantee equity of access in every phase of the disease.

The effects of socioeconomic status on stroke risk and outcomes.

PubMed

Marshall, Iain J; Wang, Yanzhong; Crichton, Siobhan; McKevitt, Christopher; Rudd, Anthony G; Wolfe, Charles D A

2015-12-01

The latest evidence on socioeconomic status and stroke shows that stroke not only disproportionately affects low-income and middle-income countries, but also socioeconomically deprived populations within high-income countries. These disparities are reflected not only in risk of stroke but also in short-term and long-term outcomes after stroke. Increased average levels of conventional risk factors (eg, hypertension, hyperlipidaemia, excessive alcohol intake, smoking, obesity, and sedentary lifestyle) in populations with low socioeconomic status account for about half of these effects. In many countries, evidence shows that people with lower socioeconomic status are less likely to receive good-quality acute hospital and rehabilitation care than people with higher socioeconomic status. For clinical practice, better implementation of well established treatments, effective management of risk factors, and equity of access to high-quality acute stroke care and rehabilitation will probably reduce inequality substantially. Overcoming barriers and adapting evidence-based interventions to different countries and health-care settings remains a research priority. Copyright © 2015 Elsevier Ltd. All rights reserved.

Understanding transformations in agriculture in south India through the quantification of productivity, equity, and resilience

NASA Astrophysics Data System (ADS)

Penny, G.; Srinivasan, V.; Thompson, S. E.

2017-12-01

Rapid acceleration of human-water interactions have been identified in many regions of the world, often resulting in reduced water security. In the Arkavathy watershed adjacent to Bangalore, India, environmental and human systems have collectively experienced major transformations since the initiation of sustainable agriculture near the beginning of the Holocene. We reconstruct a narrative history of water security in the Arkavathy, focusing on quantitative metrics of productivity, equity, and resilience. Over this time period, the system can be separated into multiple distinct eras characterized by the dominant practices of agriculture and water management, including the unmanaged (natural) plant ecology of the region, followed by subsistence farming, tank irrigation, construction of large reservoirs, groundwater depletion, and decentralized adaptation. Each of these eras was initiated by a combination of external drivers (e.g., climate, technology) and internal drivers (e.g., demand for food and water). The last fifty years have been characterized by rapid increase in productivity largely sustained by expansion of groundwater irrigation and increasing demand from the rapidly urbanizing Bangalore. Equity initially increased with the introduction of groundwater irrigation and the increased access to irrigation supply. As the water table declined and groundwater irrigation became less affordable, resilience of the system decreased and was followed by a decrease in equity and productivity, with wealthier farmers reaping the benefits and poorer farmers unable to afford access to groundwater. Absent meaningful changes to water rights policy, the system appears to be trending towards a new, undesirable equilibrium characterized by high inequality, moderate productivity (concentrated among the wealthiest farmers), and low resilience.

Civil Rights Laws as Tools to Advance Health in the Twenty-First Century.

PubMed

McGowan, Angela K; Lee, Mary M; Meneses, Cristina M; Perkins, Jane; Youdelman, Mara

2016-01-01

To improve health in the twenty-first century, to promote both access to and quality of health care services and delivery, and to address significant health disparities, legal and policy approaches, specifically those focused on civil rights, could be used more intentionally and strategically. This review describes how civil rights laws, and their implementation and enforcement, help to encourage health in the United States, and it provides examples for peers around the world. The review uses a broad lens to define health for both classes of individuals and their communities--places where people live, learn, work, and play. Suggestions are offered for improving health and equity broadly, especially within societal groups and marginalized populations. These recommendations include multisectorial approaches that focus on the social determinants of health.

Assessment of equity in healthcare financing in Fiji and Timor-Leste: a study protocol

PubMed Central

Asante, Augustine D; Price, Jennifer; Hayen, Andrew; Irava, Wayne; Martins, Joao; Guinness, Lorna; Ataguba, John E; Limwattananon, Supon; Mills, Anne; Jan, Stephen; Wiseman, Virginia

2014-01-01

Introduction Equitable health financing remains a key health policy objective worldwide. In low and middle-income countries (LMICs), there is evidence that many people are unable to access the health services they need due to financial and other barriers. There are growing calls for fairer health financing systems that will protect people from catastrophic and impoverishing health payments in times of illness. This study aims to assess equity in healthcare financing in Fiji and Timor-Leste in order to support government efforts to improve access to healthcare and move towards universal health coverage in the two countries. Methods and analysis The study employs two standard measures of equity in health financing increasingly being applied in LMICs—benefit incidence analysis (BIA) and financing incidence analysis (FIA). In Fiji, we will use a combination of secondary and primary data including a Household Income and Expenditure Survey, National Health Accounts, and data from a cross-sectional household survey on healthcare utilisation. In Timor-Leste, the World Bank recently completed a health equity and financial protection analysis that incorporates BIA and FIA, and found that the distribution of benefits from healthcare financing is pro-rich. Building on this work, we will explore the factors that influence the pro-rich distribution. Ethics and dissemination The study is approved by the Human Research Ethics Committee of University of New South Wales, Australia (Approval number: HC13269); the Fiji National Health Research Committee (Approval # 201371); and the Timor-Leste Ministry of Health (Ref MS/UNSW/VI/218). Results Study outcomes will be disseminated through stakeholder meetings, targeted multidisciplinary seminars, peer-reviewed journal publications, policy briefs and the use of other web-based technologies including social media. A user-friendly toolkit on how to analyse healthcare financing equity will be developed for use by policymakers and development partners in the region. PMID:25468509

Assessment of equity in healthcare financing in Fiji and Timor-Leste: a study protocol.

PubMed

Asante, Augustine D; Price, Jennifer; Hayen, Andrew; Irava, Wayne; Martins, Joao; Guinness, Lorna; Ataguba, John E; Limwattananon, Supon; Mills, Anne; Jan, Stephen; Wiseman, Virginia

2014-12-02

Equitable health financing remains a key health policy objective worldwide. In low and middle-income countries (LMICs), there is evidence that many people are unable to access the health services they need due to financial and other barriers. There are growing calls for fairer health financing systems that will protect people from catastrophic and impoverishing health payments in times of illness. This study aims to assess equity in healthcare financing in Fiji and Timor-Leste in order to support government efforts to improve access to healthcare and move towards universal health coverage in the two countries. The study employs two standard measures of equity in health financing increasingly being applied in LMICs-benefit incidence analysis (BIA) and financing incidence analysis (FIA). In Fiji, we will use a combination of secondary and primary data including a Household Income and Expenditure Survey, National Health Accounts, and data from a cross-sectional household survey on healthcare utilisation. In Timor-Leste, the World Bank recently completed a health equity and financial protection analysis that incorporates BIA and FIA, and found that the distribution of benefits from healthcare financing is pro-rich. Building on this work, we will explore the factors that influence the pro-rich distribution. The study is approved by the Human Research Ethics Committee of University of New South Wales, Australia (Approval number: HC13269); the Fiji National Health Research Committee (Approval # 201371); and the Timor-Leste Ministry of Health (Ref MS/UNSW/VI/218). Study outcomes will be disseminated through stakeholder meetings, targeted multidisciplinary seminars, peer-reviewed journal publications, policy briefs and the use of other web-based technologies including social media. A user-friendly toolkit on how to analyse healthcare financing equity will be developed for use by policymakers and development partners in the region. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Assessing the relevance of indicators in tracking social determinants and progress toward equitable population health in Brazil

PubMed Central

Rasella, Davide; Machado, Daiane Borges; Castellanos, Marcelo Eduardo Pfeirrer; Paim, Jairnilson; Szwarcwald, Celia Landmann; Lima, Diana; Magno, Laio; Pedrana, Leo; Medina, Maria Guadalupe; Penna, Gerson Oliveira; Barreto, Mauricio Lima

2016-01-01

Background The importance of the social determinants of health (SDH) and barriers to the access and utilization of healthcare have been widely recognized but not previously studied in the context of universal healthcare coverage (UHC) in Brazil and other developing countries. Objective To evaluate a set of proposed indicators of SDH and barriers to the access and utilization of healthcare – proposed by the SDH unit of the World Health Organization – with respect to their relevance in tracking progress in moving toward equitable population health and UHC in Brazil. Design This study had a mixed methodology, combining a quantitative analysis of secondary data from governmental sources with a qualitative study comprising two focus group discussions and six key informant interviews. The set of indicators tested covered a broad range of dimensions classified by three different domains: environment quality; accountability and inclusion; and livelihood and skills. Indicators were stratified according to income quintiles, urbanization, race, and geographical region. Results Overall, the indicators were adequate for tracking progress in terms of the SDH, equity, gender, and human rights in Brazil. Stratifications showed inequalities. The qualitative analysis revealed that many of the indicators were well known and already used by policymakers and health sector managers, whereas others were considered less useful in the Brazilian context. Conclusions Monitoring and evaluation practices have been developed in Brazil, and the set of indicators assessed in this study could further improve these practices, especially from a health equity perspective. Socioeconomic inequalities have been reduced in Brazil in the last decade, but there is still much work to be done in relation to addressing the SDH. PMID:26853898

A comparative study of financial data sources for critical access hospitals: audited financial statements, the Medicare cost report, and the Internal Revenue Service form 990.

PubMed

Ozmeral, Alisha Bhadelia; Reiter, Kristin L; Holmes, George M; Pink, George H

2012-01-01

Medicare cost reports (MCR), Internal Revenue Service form 990s (IRS 990), and audited financial statements (AFS) vary in their content, detail, purpose, timeliness, and certification. The purpose of this study was to compare selected financial data elements and characterize the extent of differences in financial data and ratios across the MCR, IRS 990, and AFS for a sample of nonprofit critical access hospitals (CAHs). Line items from AFS of 47 CAHs were compared to data reported in the hospitals' MCR and IRS 990s. Line items were based on 9 financial indicators commonly used to assess hospital financial performance. Of the indicators examined, the equity financing ratio most frequently matched between the 3 reports, while salaries and benefits to total expenses and debt service coverage were often different. Variances were driven by differences in individual account balances used to construct the ratios. Relative to AFS, cash was frequently lower on the IRS 990 while marketable securities and unrestricted investments were often higher. Other revenue and net income were consistently lower on the MCR and IRS 990, and depreciation was often higher on the MCR. The majority of total assets and fund balance (equity) values matched across the 3 reports, suggesting differences in classification among detailed accounts were more common than variances between the component totals (total assets, total liabilities, and fund balance). Health policy researchers should consider the impact of these variances on study results and consider ways to improve the availability and quality of financial accounting information. © 2012 National Rural Health Association.

Using shared goal setting to improve access and equity: a mixed methods study of the Good Goals intervention in children's occupational therapy.

PubMed

Kolehmainen, Niina; MacLennan, Graeme; Ternent, Laura; Duncan, Edward A S; Duncan, Eilidh M; Ryan, Stephen B; McKee, Lorna; Francis, Jill J

2012-08-16

Access and equity in children's therapy services may be improved by directing clinicians' use of resources toward specific goals that are important to patients. A practice-change intervention (titled 'Good Goals') was designed to achieve this. This study investigated uptake, adoption, and possible effects of that intervention in children's occupational therapy services. Mixed methods case studies (n = 3 services, including 46 therapists and 558 children) were conducted. The intervention was delivered over 25 weeks through face-to-face training, team workbooks, and 'tools for change'. Data were collected before, during, and after the intervention on a range of factors using interviews, a focus group, case note analysis, routine data, document analysis, and researchers' observations. Factors related to uptake and adoptions were: mode of intervention delivery, competing demands on therapists' time, and leadership by service manager. Service managers and therapists reported that the intervention: helped therapists establish a shared rationale for clinical decisions; increased clarity in service provision; and improved interactions with families and schools. During the study period, therapists' behaviours changed: identifying goals, odds ratio 2.4 (95% CI 1.5 to 3.8); agreeing goals, 3.5 (2.4 to 5.1); evaluating progress, 2.0 (1.1 to 3.5). Children's LoT decreased by two months [95% CI -8 to +4 months] across the services. Cost per therapist trained ranged from £1,003 to £1,277, depending upon service size and therapists' salary bands. Good Goals is a promising quality improvement intervention that can be delivered and adopted in practice and may have benefits. Further research is required to evaluate its: (i) impact on patient outcomes, effectiveness, cost-effectiveness, and (ii) transferability to other clinical contexts.

Racial and Ethnic Service Use Disparities Among Homeless Adults With Severe Mental Illnesses Receiving ACT

PubMed Central

Horvitz-Lennon, Marcela; Zhou, Dongli; Normand, Sharon-Lise T.; Alegría, Margarita; Thompson, Wes K.

2013-01-01

Objective Case management–based interventions aimed at improving quality of care have the potential to narrow racial and ethnic disparities among people with chronic illnesses. The aim of this study was to assess the equity effects of assertive community treatment (ACT), an evidence-based case management intervention, among homeless adults with severe mental illness. Methods This study used baseline, three-, and 12-month data for 6,829 black, Latino, and white adults who received ACT services through the ACCESS study (Access to Community Care and Effective Services and Support). Zero-inflated Poisson random regression models were used to estimate the adjusted probability of use of outpatient psychiatric services and, among service users, the intensity of use. Odds ratios and rate ratios (RRs) were computed to assess disparities at baseline and over time. Results No disparities were found in probability of use at baseline or over time. Compared with white users, baseline intensity of use was lower for black users (RR=.89; 95% confidence interval [CI]=.83–.96) and Latino users (RR=.65; CI=.52–.81]). Intensity did not change over time for whites, but it did for black and Latino users. Intensity increased for blacks between baseline and three months (RR=1.11, CI=1.06–1.17]) and baseline and 12 months (RR=1.17, CI=1.11–1.22]). Intensity of use dropped for Latinos between baseline and three months (RR=.83, CI=.70–.98). Conclusions Receipt of ACT was associated with a reduction in service use disparities for blacks but not for Latinos. Findings suggest that ACT’s equity effects differ depending on race-ethnicity. PMID:21632726

75 FR 37458 - Notice of Availability: Notice of Funding Availability (NOFA) for HUD's Fiscal Year 2010...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-29

...: (1) Economic competitiveness and revitalization; (2) social equity, inclusion, and access to opportunity; (3) energy use and climate change; and (4) public health and environmental impact. The notice...

Equity of access to primary care among older adults in Incheon, South Korea.

PubMed

Park, Ju Moon

2012-11-01

The present study examines the extent to which equity in the use of physician services for the elderly has been achieved in Incheon, Korea. It is based on the Aday and Andersen Access Framework. The results indicate that a universal health insurance system has not yielded a fully equitable distribution of services. The limitation of benefit coverage as well as high out-of-pocket payment can be a barrier to health care utilization, which results in inequity and differential medical care utilization between subgroups of older adults. Health policy reforms in South Korea must continue to concentrate on extending insurance coverage to the uninsured and establishing a financially separate insurance system for poor older adults. In addition, further research is needed to identify the nonfinancial barriers that persist for certain demographic subgroups, that is, those 80 years and older, men, those who lack a social network, and those who have no religion.

Equity of access under Korean universal health insurance.

PubMed

Park, Ju Moon

2015-03-01

This study examined the extent to which equity in the use of physician services has been achieved in the Republic of Korea. Descriptive and logistic regression analysis was performed examining the relationship between the dependent variable and the independent variables and the relative importance of factors. The results indicate that a universal health insurance system has not yielded a fully equitable distribution of services. Access differences arise from coverage limitation, as well as urban/rural variations in the distributions of providers. The policy options for expansion of coverage should be encouraged to ease the financial burden of out-of-pocket payments on patients and to limit the range of noninsured services. Urban/rural variations in the distributions of providers are caused by the government's "laissez-faire" policy for the private medical sector. To solve this geographic misdistribution, the attention of policy makers is required, with changing of the government's "laissez-faire" policy. © 2012 APJPH.

Who shall live when not all can live? Intellectual property in accessing and benefit-sharing influenza viruses through the World Health Organisation.

PubMed

Lawson, Charles

2011-03-01

This article addresses the development of the World Health Organisation's (WHO) arrangements for accessing viruses and the development of vaccines to respond to potential pandemics (and other lesser outbreaks). It examines the ongoing "conflict" between the United Nations' Convention on Biological Diversity (CBD) and the World Trade Organisation's Agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS) in the context of the debates about the paramountcy of intellectual property, and the potential for other (equity and development) imperatives to over-ride respect for intellectual property and TRIPS. The article concludes that the same intellectual property fault lines are evident in the WHO forum as those apparent at the CBD and the WTO fora, and an ongoing failure to properly address questions of equity and development. This poses a challenge for the Australian Government in guaranteeing a satisfactory pandemic influenza preparation and response.

Does consideration and assessment of effects on health equity affect the conclusions of systematic reviews? A methodology study.

PubMed

Welch, Vivian; Petticrew, Mark; Ueffing, Erin; Benkhalti Jandu, Maria; Brand, Kevin; Dhaliwal, Bharbhoor; Kristjansson, Elizabeth; Smylie, Janet; Wells, George Anthony; Tugwell, Peter

2012-01-01

Tackling health inequities both within and between countries remains high on the agenda of international organizations including the World Health Organization and local, regional and national governments. Systematic reviews can be a useful tool to assess effects on equity in health status because they include studies conducted in a variety of settings and populations. This study aims to describe the extent to which the impacts of health interventions on equity in health status are considered in systematic reviews, describe methods used, and assess the implications of their equity related findings for policy, practice and research. We conducted a methodology study of equity assessment in systematic reviews. Two independent reviewers extracted information on the reporting and analysis of impacts of health interventions on equity in health status in a group of 300 systematic reviews collected from all systematic reviews indexed in one month of MEDLINE, using a pre-tested data collection form. Any differences in data extraction were resolved by discussion. Of the 300 systematic reviews, 224 assessed the effectiveness of interventions on health outcomes. Of these 224 reviews, 29 systematic reviews assessed effects on equity in health status using subgroup analysis or targeted analyses of vulnerable populations. Of these, seven conducted subgroup analyses related to health equity which were reported in insufficient detail to judge their credibility. Of these 29 reviews, 18 described implications for policy and practice based on assessment of effects on health equity. The quality and completeness of reporting should be enhanced as a priority, because without this policymakers and practitioners will continue lack the evidence base they need to inform decision-making about health inequity. Furthermore, there is a need to develop methods to systematically consider impacts on equity in health status that is currently lacking in systematic reviews.

Infrastructure Supporting Teachers in the Country: Questions of Equity Arising from Downsizing and Restructuring

ERIC Educational Resources Information Center

Brennan, Marie

2006-01-01

Australia has long been of interest for its attention to educational equity by the relative quality of its state based provision of schooling in a country with a similar landmass to the 48 mainland states of the USA but a population of only 18 million. The six states and two territories had organised centralised systems of schooling which managed…

Examination of Access and Equity by Gender, Race, and Ethnicity in a Non-Traditional Leadership Development Programme in the United States

ERIC Educational Resources Information Center

Shields, Thomas; Cassada, Kate

2016-01-01

In developing the next generation of school leadership, school districts across the United States and internationally must consider who is being promoted, the training they are able to access beyond traditional university degree work, the schools in which these emerging leaders enter their first principalships, and how prepared these new leaders…

Potential of One-to-One Technology Uses and Pedagogical Practices: Student Agency and Participation in an Economically Disadvantaged Eighth Grade

ERIC Educational Resources Information Center

Andrade Johnson, Maria Dulce Silva

2017-01-01

The accelerated growth of 1:1 educational computing initiatives has challenged digital equity with a three-tiered, socioeconomic digital divide: (a) access, (b) higher order uses, and (c) user empowerment and personalization. As the access gap has been closing, the exponential increase of 1:1 devices threatens to widen the second and third digital…

Squeezing the funding you need from today's capital sources.

PubMed

Gordon, Deborah C

2010-04-01

Healthcare providers need to understand traditional and nontraditional financing options and other potential strategies for accessing capital. Common financing options include bonds, commercial lending, acquisition financing, and financing through the Department of Housing and Urban Development's Section 232 program. Alternative strategies for accessing capital include joint ventures, equity, sale of assets, fund-raising, capital leases, internal capital, public grants, and grants from foundations.

Gender Equity in Education: A Review of Trends and Factors. CREATE Pathways to Access. Research Monograph No. 18

ERIC Educational Resources Information Center

Bandyopadhyay, Madhumita; Subrahmanian, Ramya

2008-01-01

This review paper draws on recent data to map the access and participation rates of girls relative to boys. This paper offers a critical assessment of findings of different recent researches on school education in India identifying the areas that need further research. The paper reveals that while enrolment of girls has increased rapidly since the…

NEPC Review: "Tackling Gaps in Access to Strong Teachers: What State Leaders Can Do (The Education Trust, October 2017)

ERIC Educational Resources Information Center

Santoro, Doris A.

2017-01-01

The Every Students Succeeds Act (ESSA) directs states and districts to identify equity gaps in students' access to excellent educators and transformative school leaders. States are encouraged to use Title II funds strategically in order to identify and remedy these gaps. A new report from The Education Trust draws on ESSA documents and state…

Does hospital competition harm equity? Evidence from the English National Health Service.

PubMed

Cookson, Richard; Laudicella, Mauro; Li Donni, Paolo

2013-03-01

Increasing evidence shows that hospital competition under fixed prices can improve quality and reduce cost. Concerns remain, however, that competition may undermine socio-economic equity in the utilisation of care. We test this hypothesis in the context of the pro-competition reforms of the English National Health Service progressively introduced from 2004 to 2006. We use a panel of 32,482 English small areas followed from 2003 to 2008 and a difference in differences approach. The effect of competition on equity is identified by the interaction between market structure, small area income deprivation and year. We find a negative association between market competition and elective admissions in deprived areas. The effect of pro-competition reform was to reduce this negative association slightly, suggesting that competition did not undermine equity. Copyright © 2012 Elsevier B.V. All rights reserved.

How a universal health system reduces inequalities: lessons from England

PubMed Central

Ali, Shehzad; Doran, Tim; Ferguson, Brian; Fleetcroft, Robert; Goddard, Maria; Goldblatt, Peter; Laudicella, Mauro; Raine, Rosalind; Cookson, Richard

2016-01-01

Background Provision of universal coverage is essential for achieving equity in healthcare, but inequalities still exist in universal healthcare systems. Between 2004/2005 and 2011/2012, the National Health Service (NHS) in England, which has provided universal coverage since 1948, made sustained efforts to reduce health inequalities by strengthening primary care. We provide the first comprehensive assessment of trends in socioeconomic inequalities of primary care access, quality and outcomes during this period. Methods Whole-population small area longitudinal study based on 32 482 neighbourhoods of approximately 1500 people in England from 2004/2005 to 2011/2012. We measured slope indices of inequality in four indicators: (1) patients per family doctor, (2) primary care quality, (3) preventable emergency hospital admissions and (4) mortality from conditions considered amenable to healthcare. Results Between 2004/2005 and 2011/2012, there were larger absolute improvements on all indicators in more-deprived neighbourhoods. The modelled gap between the most-deprived and least-deprived neighbourhoods in England decreased by: 193 patients per family doctor (95% CI 173 to 213), 3.29 percentage points of primary care quality (3.13 to 3.45), 0.42 preventable hospitalisations per 1000 people (0.29 to 0.55) and 0.23 amenable deaths per 1000 people (0.15 to 0.31). By 2011/2012, inequalities in primary care supply and quality were almost eliminated, but socioeconomic inequality was still associated with 158 396 preventable hospitalisations and 37 983 deaths amenable to healthcare. Conclusions Between 2004/2005 and 2011/2012, the NHS succeeded in substantially reducing socioeconomic inequalities in primary care access and quality, but made only modest reductions in healthcare outcome inequalities. PMID:26787198

Equity weights in the allocation of health care: the rank-dependent QALY model.

PubMed

Bleichrodt, Han; Diecidue, Enrico; Quiggin, John

2004-01-01

This paper introduces the rank-dependent quality-adjusted life-years (QALY) model, a new method to aggregate QALYs in economic evaluations of health care. The rank-dependent QALY model permits the formalization of influential concepts of equity in the allocation of health care, such as the fair innings approach, and it includes as special cases many of the social welfare functions that have been proposed in the literature. An important advantage of the rank-dependent QALY model is that it offers a straightforward procedure to estimate equity weights for QALYs. We characterize the rank-dependent QALY model and argue that its central condition has normative appeal.

Toward a research and action agenda on urban planning/design and health equity in cities in low and middle-income countries.

PubMed

Smit, Warren; Hancock, Trevor; Kumaresen, Jacob; Santos-Burgoa, Carlos; Sánchez-Kobashi Meneses, Raúl; Friel, Sharon

2011-10-01

The importance of reestablishing the link between urban planning and public health has been recognized in recent decades; this paper focuses on the relationship between urban planning/design and health equity, especially in cities in low and middle-income countries (LMICs). The physical urban environment can be shaped through various planning and design processes including urban planning, urban design, landscape architecture, infrastructure design, architecture, and transport planning. The resultant urban environment has important impacts on the health of the people who live and work there. Urban planning and design processes can also affect health equity through shaping the extent to which the physical urban environments of different parts of cities facilitate the availability of adequate housing and basic infrastructure, equitable access to the other benefits of urban life, a safe living environment, a healthy natural environment, food security and healthy nutrition, and an urban environment conducive to outdoor physical activity. A new research and action agenda for the urban environment and health equity in LMICs should consist of four main components. We need to better understand intra-urban health inequities in LMICs; we need to better understand how changes in the built environment in LMICs affect health equity; we need to explore ways of successfully planning, designing, and implementing improved health/health equity; and we need to develop evidence-based recommendations for healthy urban planning/design in LMICs.

Translating Disparities Research to Policy: A Qualitative Study of State Mental Health Policymakers' Perceptions of Mental Health Care Disparities Report Cards

PubMed Central

Valentine, Anne; DeAngelo, Darcie; Alegría, Margarita; Cook, Benjamin L.

2014-01-01

Report cards have been used to increase accountability and quality of care in health care settings, and to improve state infrastructure for providing quality mental health care services. However, to date, report cards have not been used to compare states on racial/ethnic disparities in mental health care. This qualitative study examines reactions of mental health care policymakers to a proposed mental health care disparities report card generated from population-based survey data of mental health and mental health care utilization. We elicited feedback about the content, format, and salience of the report card. Interviews were conducted with nine senior advisors to state policymakers and one policy director of a national non-governmental organization from across the U.S. Four primary themes emerged: fairness in state-by-state comparisons; disconnect between the goals and language of policymakers and researchers; concerns about data quality and; targeted suggestions from policymakers. Participant responses provide important information that can contribute to making evidence-based research more accessible to policymakers. Further, policymakers suggested ways to improve the structure and presentation of report cards to make them more accessible to policymakers and to foster equity considerations during the implementation of new health care legislation. To reduce mental health care disparities, effort is required to facilitate understanding between researchers and relevant stakeholders about research methods, standards for interpretation of research-based evidence and its use in evaluating policies aimed at ameliorating disparities. PMID:25383993

Acceptability of quality reporting and pay for performance among primary health centers in Lebanon.

PubMed

Saleh, Shadi S; Alameddine, Mohamad S; Natafgi, Nabil M

2013-01-01

Primary health care (PHC) is emphasized as the cornerstone of any health care system. Enhancing PHC performance is considered a strategy to enhance effective and equitable access to care. This study assesses the acceptability of and factors associated with quality reporting among PHC centers (PHCCs) in Lebanon. The managers of 132 Lebanese Ministry of Health PHCCs were surveyed using a cross-sectional design. Managers' willingness to report quality, participate in comparative quality assessments, and endorse pay-for-performance schemes was evaluated. Collected data were matched to the infrastructural characteristics and services database. Seventy-six percent of managers responded to the questionnaire, 93 percent of whom were willing to report clinical performance. Most expressed strong support for peer-performance comparison and pay-for-performance schemes. Willingness to report was negatively associated with the religious affiliation of centers and presence of health care facilities in the catchment area and favorably associated with use of information systems and the size of population served. The great willingness of PHCC managers to employ quality-enhancing initiatives flags a policy priority for PHC stakeholders to strengthen PHCC infrastructure and to enable reporting in an easy, standardized, and systematic way. Enhancing equity necessitates education and empowerment of managers in remote areas and those managing religiously affiliated centers.

To expand coverage, or increase frequency: Quantifying the tradeoffs between equity and efficiency facing cervical cancer screening programs in low‐resource settings

PubMed Central

Tsu, Vivien; Jeronimo, Jose; Mvundura, Mercy; Lee, Kyueun; Kim, Jane J.

2017-01-01

Cervical cancer is a leading cause of cancer death worldwide, with 85% of the disease burden residing in less developed regions. To inform evidence‐based decision‐making as cervical cancer screening programs are planned, implemented, and scaled in low‐ and middle‐income countries, we used cost and test performance data from the START‐UP demonstration project in Uganda and a microsimulation model of HPV infection and cervical carcinogenesis to quantify the health benefits, distributional equity, cost‐effectiveness, and financial impact of either (1) improving access to cervical cancer screening or (2) increasing the number of lifetime screening opportunities for women who already have access. We found that when baseline screening coverage was low (i.e., 30%), expanding coverage of screening once in a lifetime to 50% can yield comparable reductions in cancer risk to screening two or three times in a lifetime at 30% coverage, lead to greater reductions in health disparities, and cost 150 international dollars (I$) per year of life saved (YLS). At higher baseline screening coverage levels (i.e., 70%), screening three times in a lifetime yielded greater health benefits than expanding screening once in a lifetime to 90% coverage, and would have a cost‐effectiveness ratio (I$590 per YLS) below Uganda's per capita GDP. Given very low baseline coverage at present, we conclude that a policy focus on increasing access for previously unscreened women appears to be more compatible with improving both equity and efficiency than a focus on increasing frequency for a small subset of women. PMID:27925175

Achieving Quality Integrated Education.

ERIC Educational Resources Information Center

Hawley, Willis D.; Rosenholtz, Susan J.

While desegregation is neither a necessary nor a sufficient condition for ensuring either equity or quality education for minorities, the evidence is convincing that it is "educationally more difficult" to improve student achievement in segregated schools. Desegregation offers the opportunity to enhance the quality of education, particularly when…

Quality Education: Cultural Competence and a Sustainability Worldview

ERIC Educational Resources Information Center

Nolet, Victor

2017-01-01

The United Nations Sustainable Development Goals tie together equity, justice, and a more inclusive society with ecological sustainability. This article offers teaching strategies for integrating the goal of quality education for sustainability and multicultural education.

Technostress and Library Values.

ERIC Educational Resources Information Center

Gorman, Michael

2001-01-01

Discusses information overload and society's and libraries' responses to technology. Considers eight values that libraries should focus on and how they relate to technology in libraries: democracy, stewardship, service, intellectual freedom, privacy, rationalism, equity of access, and building harmony and balance. (LRW)

76 FR 70535 - Notice of Funds Availability (NOFA) Inviting Applications for the Community Development Financial...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-14

... Populations is not required to provide additional narrative explaining their lack of access to loans, equity... Narrative 10 Target Market Needs 10 Responsiveness to Target Market Needs 40 Delivery Capacity 40 Total...

The balance of give and take in caregiver-partner relationships: An examination of self-perceived burden, relationship equity, and quality of life from the perspective of care recipients following stroke.

PubMed

McPherson, Christine J; Wilson, Keith G; Chyurlia, Livia; Leclerc, Charles

2010-05-01

We examined the sense of being a burden to others or self-perceived burden (SPB) in people with stroke. A mail survey was completed by 57 former inpatients and their partner caregivers. The care recipient survey included measures of functional status, quality of life, marital satisfaction, equity in the relationship, and psychological distress, as well as SPB using the Self-Perceived Burden Scale (SPBS; Cousineau, McDowell, Hotz, & Hébert, 2003). The caregiver survey included similar measures in addition to a caregiver burden measure. SPB was found to be a prevalent and distressing concern. SPBS scores correlated with measures of functional status and mood; however, the correlations were highest for measures of family roles and work/productivity. Using equity theory as a basis to examine the SPB construct, care recipients who perceived themselves as overbenefiting from the relationship had significantly higher SPB scores than those whose relationship was viewed as equitable or underbenefiting. For some receiving care from a partner after stroke is associated SPB. This sense of burden is related to changes in help-seeking behavior, quality of life, and distress.

Financialisation in health care: An analysis of private equity fund investments in Turkey.

PubMed

Eren Vural, Ipek

2017-08-01

The 2007-2008 global financial crisis revived interest in the impacts of financial markets and actors on our social and economic life. Nevertheless, research on health care financialisation remains scant. This article presents findings from research on one modality of financial investments in health care: global private equity funds' investments in private hospitals. Adopting a political economy approach, it analyses the drivers and impacts of the upsurge of global private equity investments in the Turkish private hospital sector amid the global financial crisis. The analysis derives from review of research and archival literature, as well as six in-depth interviews held with owners/executive board directors/general managers of the largest private hospital chains in Turkey and the general partners of their PE investors. The interviewing process took place between January and November 2016. All interviews were conducted by the author in Istanbul. The findings point to a mutually reinforcing relationship between neoliberal policies and financialisation processes in health care. The article shows that neoliberal healthcare reforms, introduced under consecutive Justice and Development Party (JDP) governments in Turkey, have been important precursors of private equity investments in healthcare services. These private equity investments, in turn, intensified and broadened the process of marketisation in health care services. Four impacts are identified, through which private equity investments hasten the marketisation of health care services. These relate to the impacts of private equity investments on a) advancing the process of chain formation by large hospital groups, b) spreading financial imperatives into the operations of private hospitals c) fostering internationalisation of capital, and d) augmenting inequities in access to health care services and standards. Copyright © 2017 Elsevier Ltd. All rights reserved.

Analysis Supporting Factors and Constraints LPMP Performance in Improving the Quality of Education in Jambi Province

ERIC Educational Resources Information Center

Rosadi, Kemas Imron

2015-01-01

Development of education in Indonesia is based on three aspects, namely equity and expansion, quality and relevance, as well as good governance. Quality education is influenced by several factors related to quality education managerial leaders, limited funds, facilities, educational facilities, media, learning resources, tools and training…

Equity and health services.

PubMed

Bayoumi, Ahmed M

2009-07-01

The Commission on Social Determinants of Health recognized the important role of health services as a determinant of health. While asserting that health was not a tradable commodity but rather a right, the Commission missed an opportunity to address how such a concept might remove a health care system from market forces. Examples include ensuring universal access to health care, not just universal insurance, severely limiting or eliminating profit-making in the delivery of health care services, and aggressive price regulations for the public good. While the Commission was appropriately sceptical of privileging efficiency as a principle for prioritization, it missed an opportunity to address how equity concerns can be incorporated into resources allocation decision making. A social justice orientation to the delivery of health care could serve as an important catalyst for equity-oriented health service change but the process is more complicated and political than that outlined in the Commission's report.

Immunization Equity.

PubMed

Hinman, Alan R; McKinlay, Mark A

2015-12-01

Health inequities are the unjust differences in health among different social groups. Unfortunately, inequities are the norm, both in terms of health status and access to, and use of, health services. Childhood immunizations reduce the incidence of vaccine-preventable diseases and represent a cost-effective way to foster health equity. This paper reflects a 2015 review of data from surveys conducted in developing countries from 2005 to 2011 that show significant inequities in immunization coverage and discusses several initiatives currently underway (including Gavi, the Vaccine Alliance) that are directed at increasing childhood immunizations or reducing or abolishing overall health inequities. These initiatives have already had a significant impact on disease burden and childhood mortality and give rise to optimism that health disparities may further be reduced and health equity achieved as a result of investments made in immunization. Copyright © 2015 2015 by American Journal of Preventive Medicine and Els. Published by Elsevier Inc. All rights reserved.

Urban Green Space and the Pursuit of Health Equity in Parts of the United States.

PubMed

Jennings, Viniece; Baptiste, April Karen; Osborne Jelks, Na'Taki; Skeete, Renée

2017-11-22

Research has demonstrated that inequitable access to green space can relate to health disparities or inequalities. This commentary aims to shift the dialogue to initiatives that have integrated green spaces in projects that may promote health equity in the United States. Specifically, we connect this topic to factors such as community revitalization, affordable housing, neighborhood walkability, food security, job creation, and youth engagement. We provide a synopsis of locations and initiatives in different phases of development along with characteristics to support effectiveness and strategies to overcome challenges. The projects cover locations such as Atlanta (GA), Los Angeles (CA), the District of Columbia (Washington D.C.), South Bronx (NY), and Utica (NY). Such insight can develop our understanding of green space projects that support health equity and inform the dialogue on this topic in ways that advance research and advocacy.

Urban Green Space and the Pursuit of Health Equity in Parts of the United States

PubMed Central

Jennings, Viniece; Baptiste, April Karen; Osborne Jelks, Na’Taki; Skeete, Renée

2017-01-01

Research has demonstrated that inequitable access to green space can relate to health disparities or inequalities. This commentary aims to shift the dialogue to initiatives that have integrated green spaces in projects that may promote health equity in the United States. Specifically, we connect this topic to factors such as community revitalization, affordable housing, neighborhood walkability, food security, job creation, and youth engagement. We provide a synopsis of locations and initiatives in different phases of development along with characteristics to support effectiveness and strategies to overcome challenges. The projects cover locations such as Atlanta (GA), Los Angeles (CA), the District of Columbia (Washington D.C.), South Bronx (NY), and Utica (NY). Such insight can develop our understanding of green space projects that support health equity and inform the dialogue on this topic in ways that advance research and advocacy. PMID:29165367

[Ethics, equity and social determinants of health].

PubMed

Puyol, Ángel

2012-01-01

The evidence shown by studies on the social determinants of health has changed the relationship between ethics and medicine. The evidence shown by studies on the social determinants of health has changed the relationship between ethics and medicine, and between a normative and a descriptive approach. Studies on the social determinants of health have also modified the traditional concept of equity, necessary health policies and the future of bioethics. More specifically: 1) the boundary between medicine and ethics has become much fuzzier, especially in the field of epidemiology, whose objectives are now inseparable from ethical considerations; 2) the concept of health equity traditionally defined as access to healthcare should be corrected or expanded to incorporate unfair health inequalities that occur before patients reach the healthcare system; and 3) the traditional autonomy bias of bioethics should be replaced by a primary concern for social justice and its relationship with health. Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.

Equity in access to maternal and child health services in five developing countries: what works.

PubMed

Talukder, M D Noorunnabi; Rob, Ubaidur

2010-01-01

People living in rural areas are yet to have equitable access to maternal and child health services in many developing countries. This article examines selected health service delivery models that improved access to services in five developing countries. The article is based on the review of background papers on Bangladesh, Pakistan, Cambodia, Ghana, and Tanzania, prepared as part of a multi-country study on health systems and maternal and child health. Findings suggest that equity in access to health services largely depends on a system that ensures a combination of facility-based service delivery and outreach services with a functioning referral network. A key factor is the availability of health workforce at the community level. Community-based deployment of service providers or recruitment and training of community health workers is critical in enhancing service coverage and linking local populations to a health facility. Incentive is necessary to keep community health workers' interest in providing services. However, health workforce alone cannot ensure good health outcomes. They must be embedded in a functioning service delivery network to transform structural inputs into outcomes. Moreover, local-level health systems should have the ability to allocate resources in strategic ways addressing the pressing health needs of the people.

Air Quality Strategies on Public Health and Health Equity in Europe-A Systematic Review.

PubMed

Wang, Li; Zhong, Buqing; Vardoulakis, Sotiris; Zhang, Fengying; Pilot, Eva; Li, Yonghua; Yang, Linsheng; Wang, Wuyi; Krafft, Thomas

2016-12-02

Air pollution is an important public health problem in Europe and there is evidence that it exacerbates health inequities. This calls for effective strategies and targeted interventions. In this study, we conducted a systematic review to evaluate the effectiveness of strategies relating to air pollution control on public health and health equity in Europe. Three databases, Web of Science, PubMed, and Trials Register of Promoting Health Interventions (TRoPHI), were searched for scientific publications investigating the effectiveness of strategies on outdoor air pollution control, public health and health equity in Europe from 1995 to 2015. A total of 15 scientific papers were included in the review after screening 1626 articles. Four groups of strategy types, namely, general regulations on air quality control, road traffic related emission control interventions, energy generation related emission control interventions and greenhouse gas emission control interventions for climate change mitigation were identified. All of the strategies reviewed reported some improvement in air quality and subsequently in public health. The reduction of the air pollutant concentrations and the reported subsequent health benefits were more significant within the geographic areas affected by traffic related interventions. Among the various traffic related interventions, low emission zones appeared to be more effective in reducing ambient nitrogen dioxide (NO₂) and particulate matter levels. Only few studies considered implications for health equity, three out of 15, and no consistent results were found indicating that these strategies could reduce health inequity associated with air pollution. Particulate matter (particularly fine particulate matter) and NO₂ were the dominant outdoor air pollutants examined in the studies in Europe in recent years. Health benefits were gained either as a direct, intended objective or as a co-benefit from all of the strategies examined, but no consistent impact on health equity from the strategies was found. The strategy types aiming to control air pollution in Europe and the health impact assessment methodology were also discussed in this review.

Air Quality Strategies on Public Health and Health Equity in Europe—A Systematic Review

PubMed Central

Wang, Li; Zhong, Buqing; Vardoulakis, Sotiris; Zhang, Fengying; Pilot, Eva; Li, Yonghua; Yang, Linsheng; Wang, Wuyi; Krafft, Thomas

2016-01-01

Air pollution is an important public health problem in Europe and there is evidence that it exacerbates health inequities. This calls for effective strategies and targeted interventions. In this study, we conducted a systematic review to evaluate the effectiveness of strategies relating to air pollution control on public health and health equity in Europe. Three databases, Web of Science, PubMed, and Trials Register of Promoting Health Interventions (TRoPHI), were searched for scientific publications investigating the effectiveness of strategies on outdoor air pollution control, public health and health equity in Europe from 1995 to 2015. A total of 15 scientific papers were included in the review after screening 1626 articles. Four groups of strategy types, namely, general regulations on air quality control, road traffic related emission control interventions, energy generation related emission control interventions and greenhouse gas emission control interventions for climate change mitigation were identified. All of the strategies reviewed reported some improvement in air quality and subsequently in public health. The reduction of the air pollutant concentrations and the reported subsequent health benefits were more significant within the geographic areas affected by traffic related interventions. Among the various traffic related interventions, low emission zones appeared to be more effective in reducing ambient nitrogen dioxide (NO2) and particulate matter levels. Only few studies considered implications for health equity, three out of 15, and no consistent results were found indicating that these strategies could reduce health inequity associated with air pollution. Particulate matter (particularly fine particulate matter) and NO2 were the dominant outdoor air pollutants examined in the studies in Europe in recent years. Health benefits were gained either as a direct, intended objective or as a co-benefit from all of the strategies examined, but no consistent impact on health equity from the strategies was found. The strategy types aiming to control air pollution in Europe and the health impact assessment methodology were also discussed in this review. PMID:27918457

Health inequalities by gradients of access to water and sanitation between countries in the Americas, 1990 and 2010.

PubMed

Mújica, Oscar J; Haeberer, Mariana; Teague, Jordan; Santos-Burgoa, Carlos; Galvão, Luiz Augusto Cassanha

2015-11-01

To explore distributional inequality of key health outcomes as determined by access coverage to water and sanitation (WS) between countries in the Region of the Americas. An ecological study was designed to explore the magnitude and change-over-time of standard gap and gradient metrics of environmental inequalities in health at the country level in 1990 and 2010 among the 35 countries of the Americas. Access to drinking water and access to improved sanitation facilities were selected as equity stratifiers. Five dependent variables were: total and healthy life expectancies at birth, and infant, under-5, and maternal mortality. Access to WS correlated with survival and mortality, and strong gradients were seen in both 1990 and 2010. Higher WS access corresponded to higher life expectancy and healthy life expectancy and lower infant, under-5, and maternal mortality risks. Burden of life lost was unequally distributed, steadily concentrated among the most environmentally disadvantaged, who carried up to twice the burden than they would if WS were fairly distributed. Population averages in life expectancy and specific mortality improved, but whereas absolute inequalities decreased, relative inequalities remained mostly invariant. Even with the Region on track to meet MDG 7 on water and sanitation, large environmental gradients and health inequities among countries remain hidden by Regional averages. As the post-2015 development agenda unfolds, policies and actions focused on health equity-mainly on the most socially and environmentally deprived-will be needed in order to secure the right for universal access to water and sanitation.

Ability to pay and equity in access to Italian and British National Health Services.

PubMed

Domenighetti, Gianfranco; Vineis, Paolo; De Pietro, Carlo; Tomada, Angelo

2010-10-01

Equity in delivery and distribution of health care is an important determinant of health and a cornerstone in the long way to social justice. We performed a comparative analysis of the prevalence of Italian and British residents who have fully paid out-of-pocket for health services which they could have obtained free of charge or at a lower cost from their respective National Health Services. Cross-sectional study based on a standardized questionnaire survey carried out in autumn 2006 among two representative samples (n = 1000) of the general population aged 20-74 years in each of the two countries. 78% (OR 19.9; 95% CI 15.5-25.6) of Italian residents have fully paid out-of-pocket for at least one access to health services in their lives, and 45% (OR 18.1; 95% CI 12.9-25.5) for more than five accesses. Considering only the last 2 years, 61% (OR 16.5; 95% CI 12.6-21.5) of Italians have fully paid out-of-pocket for at least one access. The corresponding pattern for British residents is 20 and 4% for lifelong prevalence, and 10% for the last 2 years. Opening the public health facilities to a privileged private access to all hospital physicians based on patient's ability to pay, as Italy does, could be a source of social inequality in access to care and could probably represent a major obstacle to decreasing waiting times for patients in the standard formal 'free of charge' way of access.

Gender equity and health sector reform in Colombia: mixed state-market model yields mixed results.

PubMed

Ewig, Christina; Bello, Amparo Hernández

2009-03-01

In 1993, Colombia carried out a sweeping health reform that sought to dramatically increase health insurance coverage and reduce state involvement in health provision by creating a unitary state-supervised health system in which private entities are the main insurers and health service providers. Using a quantitative comparison of household survey data and an analysis of the content of the reforms, we evaluate the effects of Colombia's health reforms on gender equity. We find that several aspects of these reforms hold promise for greater gender equity, such as the resulting increase in women's health insurance coverage. However, the reforms have not achieved gender equity due to the persistence of fees which discriminate against women and the introduction of a two-tier health system in which women heads of household and the poor are concentrated in a lower quality health system.

Students and Mobile Devices

ERIC Educational Resources Information Center

Traxler, John

2010-01-01

Many educators advocate, promote and encourage the dreams of agency, control, ownership and choice amongst students whilst educational institutions take the responsibility for provision, equity, access, participation and standards. The institutions traditionally procure, provide and control the technology for learning but now students are…

International Librarianship: Developing Professional, Intercultural, and Educational Leadership

ERIC Educational Resources Information Center

Constantinou, Constantia, Ed.; Miller, Michael J., Ed.; Schlesinger, Kenneth, Ed.

2017-01-01

International librarianship stems from a desire to bring about political change, transcultural understanding, collaboration, and mutual respect. Historically, librarians have been deeply involved with challenging issues of information sharing, equity in information access, and bridging the digital divide between different socioeconomic…

Equity in financing and use of health care in Ghana, South Africa, and Tanzania: implications for paths to universal coverage.

PubMed

Mills, Anne; Ataguba, John E; Akazili, James; Borghi, Jo; Garshong, Bertha; Makawia, Suzan; Mtei, Gemini; Harris, Bronwyn; Macha, Jane; Meheus, Filip; McIntyre, Di

2012-07-14

Universal coverage of health care is now receiving substantial worldwide and national attention, but debate continues on the best mix of financing mechanisms, especially to protect people outside the formal employment sector. Crucial issues are the equity implications of different financing mechanisms, and patterns of service use. We report a whole-system analysis--integrating both public and private sectors--of the equity of health-system financing and service use in Ghana, South Africa, and Tanzania. We used primary and secondary data to calculate the progressivity of each health-care financing mechanism, catastrophic spending on health care, and the distribution of health-care benefits. We collected qualitative data to inform interpretation. Overall health-care financing was progressive in all three countries, as were direct taxes. Indirect taxes were regressive in South Africa but progressive in Ghana and Tanzania. Out-of-pocket payments were regressive in all three countries. Health-insurance contributions by those outside the formal sector were regressive in both Ghana and Tanzania. The overall distribution of service benefits in all three countries favoured richer people, although the burden of illness was greater for lower-income groups. Access to needed, appropriate services was the biggest challenge to universal coverage in all three countries. Analyses of the equity of financing and service use provide guidance on which financing mechanisms to expand, and especially raise questions over the appropriate financing mechanism for the health care of people outside the formal sector. Physical and financial barriers to service access must be addressed if universal coverage is to become a reality. European Union and International Development Research Centre. Copyright © 2012 Elsevier Ltd. All rights reserved.

Caregiver satisfaction with paediatric HIV treatment and care in Nigeria and equity implications for children living with HIV.

PubMed

Chamla, Dick; Asadu, Chukwuemeka; Adejuyigbe, Ebun; Davies, Abiola; Ugochukwu, Ebele; Umar, Lawal; Oluwafunke, Ilesanmi; Hassan-Hanga, Fatimah; Onubogu, Chinyere; Tunde-Oremodu, Immaculata; Madubuike, Chinelo; Umeadi, Esther; Epundu, Obed; Omosun, Adenike; Anigilaje, Emmanuel; Adeyinka, Daniel

2016-03-01

Caregiver satisfaction has the potential to promote equity for children living with HIV, by influencing health-seeking behaviour. We measured dimensions of caregiver satisfaction with paediatric HIV treatment in Nigeria, and discuss its implications for equity by conducting facility-based exit interviews for caregivers of children receiving antiretroviral therapy in 20 purposively selected facilities within 5 geopolitical zones. Descriptive analysis and factor analysis were performed. Due to the hierarchical nature of the data, multilevel regression modelling was performed to investigate relationships between satisfaction factors and socio-demographic variables. Of 1550 caregivers interviewed, 63% (95% CI: 60.6-65.4) reported being very satisfied overall; however, satisfaction varied in some dimensions: only 55.6% (53.1-58.1) of caregivers could talk privately with health workers, 56.9% (54.4-59.3) reported that queues to see health workers were too long, and 89.9% (88.4-91.4) said that some health workers did not treat patients living with HIV with sufficient respect. Based on factor analysis, two underlying factors, labelled Availability and Attitude, were identified. In multilevel regression, the satisfaction with availability of services correlated with formal employment status (p < .01), whereas caregivers receiving care in private facilities were less likely satisfied with both availability (p < .01) and attitude of health workers (p < .05). State and facility levels influenced attitudes of the health workers (p < .01), but not availability of services. We conclude that high levels of overall satisfaction among caregivers masked dissatisfaction with some aspects of services. The two underlying satisfaction factors are part of access typology critical for closing equity gaps in access to HIV treatment between adults and children, and across socio-economic groups.

Caregiver satisfaction with paediatric HIV treatment and care in Nigeria and equity implications for children living with HIV

PubMed Central

Chamla, Dick; Asadu, Chukwuemeka; Adejuyigbe, Ebun; Davies, Abiola; Ugochukwu, Ebele; Umar, Lawal; Oluwafunke, Ilesanmi; Hassan-Hanga, Fatimah; Onubogu, Chinyere; Tunde-Oremodu, Immaculata; Madubuike, Chinelo; Umeadi, Esther; Epundu, Obed; Omosun, Adenike; Anigilaje, Emmanuel; Adeyinka, Daniel

2016-01-01

ABSTRACT Caregiver satisfaction has the potential to promote equity for children living with HIV, by influencing health-seeking behaviour. We measured dimensions of caregiver satisfaction with paediatric HIV treatment in Nigeria, and discuss its implications for equity by conducting facility-based exit interviews for caregivers of children receiving antiretroviral therapy in 20 purposively selected facilities within 5 geopolitical zones. Descriptive analysis and factor analysis were performed. Due to the hierarchical nature of the data, multilevel regression modelling was performed to investigate relationships between satisfaction factors and socio-demographic variables. Of 1550 caregivers interviewed, 63% (95% CI: 60.6–65.4) reported being very satisfied overall; however, satisfaction varied in some dimensions: only 55.6% (53.1–58.1) of caregivers could talk privately with health workers, 56.9% (54.4–59.3) reported that queues to see health workers were too long, and 89.9% (88.4–91.4) said that some health workers did not treat patients living with HIV with sufficient respect. Based on factor analysis, two underlying factors, labelled Availability and Attitude, were identified. In multilevel regression, the satisfaction with availability of services correlated with formal employment status (p < .01), whereas caregivers receiving care in private facilities were less likely satisfied with both availability (p < .01) and attitude of health workers (p < .05). State and facility levels influenced attitudes of the health workers (p < .01), but not availability of services. We conclude that high levels of overall satisfaction among caregivers masked dissatisfaction with some aspects of services. The two underlying satisfaction factors are part of access typology critical for closing equity gaps in access to HIV treatment between adults and children, and across socio-economic groups. PMID:27392010

Sustainable Development in Surgery: The Health, Poverty, and Equity Impacts of Charitable Surgery in Uganda

PubMed Central

Shrime, Mark G.; Sekidde, Serufusa; Linden, Allison; Cohen, Jessica L.; Weinstein, Milton C.; Salomon, Joshua A.

2016-01-01

Background The recently adopted Sustainable Development Goals call for the end of poverty and the equitable provision of healthcare. These goals are often at odds, however: health seeking can lead to catastrophic spending, an outcome for which cancer patients and the poor in resource-limited settings are at particularly high risk. How various health policies affect the additional aims of financial wellbeing and equity is poorly understood. This paper evaluates the health, financial, and equity impacts of governmental and charitable policies for surgical oncology in a resource-limited setting. Methods Three charitable platforms for surgical oncology delivery in Uganda were compared to six governmental policies aimed at improving healthcare access. An extended cost-effectiveness analysis using an agent-based simulation model examined the numbers of lives saved, catastrophic expenditure averted, impoverishment averted, costs, and the distribution of benefits across the wealth spectrum. Findings Of the nine policies and platforms evaluated, two were able to provide simultaneous health and financial benefits efficiently and equitably: mobile surgical units and governmental policies that simultaneously address surgical scaleup, the cost of surgery, and the cost of transportation. Policies that only remove user fees are dominated, as is the commonly employed short-term “surgical mission trip”. These results are robust to scenario and sensitivity analyses. Interpretation The most common platforms for increasing access to surgical care appear unable to provide health and financial risk protection equitably. On the other hand, mobile surgical units, to date an underutilized delivery platform, are able to deliver surgical oncology in a manner that meets sustainable development goals by improving health, financial solvency, and equity. These platforms compare favorably with policies that holistically address surgical delivery and should be considered as countries strengthen health systems. PMID:28036357

Sustainable Development in Surgery: The Health, Poverty, and Equity Impacts of Charitable Surgery in Uganda.

PubMed

Shrime, Mark G; Sekidde, Serufusa; Linden, Allison; Cohen, Jessica L; Weinstein, Milton C; Salomon, Joshua A

2016-01-01

The recently adopted Sustainable Development Goals call for the end of poverty and the equitable provision of healthcare. These goals are often at odds, however: health seeking can lead to catastrophic spending, an outcome for which cancer patients and the poor in resource-limited settings are at particularly high risk. How various health policies affect the additional aims of financial wellbeing and equity is poorly understood. This paper evaluates the health, financial, and equity impacts of governmental and charitable policies for surgical oncology in a resource-limited setting. Three charitable platforms for surgical oncology delivery in Uganda were compared to six governmental policies aimed at improving healthcare access. An extended cost-effectiveness analysis using an agent-based simulation model examined the numbers of lives saved, catastrophic expenditure averted, impoverishment averted, costs, and the distribution of benefits across the wealth spectrum. Of the nine policies and platforms evaluated, two were able to provide simultaneous health and financial benefits efficiently and equitably: mobile surgical units and governmental policies that simultaneously address surgical scaleup, the cost of surgery, and the cost of transportation. Policies that only remove user fees are dominated, as is the commonly employed short-term "surgical mission trip". These results are robust to scenario and sensitivity analyses. The most common platforms for increasing access to surgical care appear unable to provide health and financial risk protection equitably. On the other hand, mobile surgical units, to date an underutilized delivery platform, are able to deliver surgical oncology in a manner that meets sustainable development goals by improving health, financial solvency, and equity. These platforms compare favorably with policies that holistically address surgical delivery and should be considered as countries strengthen health systems.

Kidney Transplant Access in the Southeast: View From the Bottom

PubMed Central

Patzer, R. E.; Pastan, S. O.

2014-01-01

The Southeastern region of the United States has the highest burden of end-stage renal disease (ESRD) but the lowest rates of kidney transplantation in the nation. There are many patient-, dialysis facility–, ESRD Network– and health system–level barriers that contribute to this regional disparity. Compared to the rest of the nation, the Southeast has a larger population of African-Americans and higher poverty, as well as more prevalent ESRD risk factors including hypertension, obesity and diabetes. Dialysis facilities—where ESRD patients receive the majority of their healthcare—play an important role in transplant access. Identifying characteristics of individual dialysis units with low rates of kidney transplantation, such as understaffing or for-profit status, can help identify targets for quality improvement initiatives. Geographic differences across the country can identify opportunities to increase funding for healthcare resources in proportion to patient and disease burden. Focusing interventions among dialysis facilities with the lowest transplant rates within the Southeast, such as provider and patient education, has the potential to increase referrals for kidney transplantation, leading to higher rates of kidney transplants in this region. Referral for transplantation should be measured on a national level to monitor disparities in early access to transplantation. Transplant centers have an obligation to assist under-served populations in ensuring equity in access to services. Policies that improve access to care for patients, such as the Affordable Care Act and Medicaid expansion, are particularly important for Southern states and may alleviate geographic disparities. PMID:24891223

Health equity in Lebanon: a microeconomic analysis

PubMed Central

2010-01-01

Background The health sector in Lebanon suffers from high levels of spending and is acknowledged to be a source of fiscal waste. Lebanon initiated a series of health sector reforms which aim at containing the fiscal waste caused by high and inefficient public health expenditures. Yet these reforms do not address the issues of health equity in use and coverage of healthcare services, which appear to be acute. This paper takes a closer look at the micro-level inequities in the use of healthcare, in access, in ability to pay, and in some health outcomes. Methods We use data from the 2004/2005 Multi Purpose Survey of Households in Lebanon to conduct health equity analysis, including equity in need, access and outcomes. We briefly describe the data and explain some of its limitations. We examine, in turn, and using standardization techniques, the equity in health care utilization, the impact of catastrophic health payments on household wellbeing, the effect of health payment on household impoverishment, the equity implications of existing health financing methods, and health characteristics by geographical region. Results We find that the incidence of disability decreases steadily across expenditure quintiles, whereas the incidence of chronic disease shows the opposite pattern, which may be an indication of better diagnostics for higher quintiles. The presence of any health-related expenditure is regressive while the magnitude of out-of-pocket expenditures on health is progressive. Spending on health is found to be "normal" and income-elastic. Catastrophic health payments are likelier among disadvantaged groups (in terms of income, geography and gender). However, the cash amounts of catastrophic payments are progressive. Poverty is associated with lower insurance coverage for both private and public insurance. While the insured seem to spend an average of almost LL93,000 ($62) on health a year in excess of the uninsured, they devote a smaller proportion of their expenditures to health. Conclusions The lowest quintiles of expenditures per adult have less of an ability to pay out-of-pocket for healthcare, and yet incur healthcare expenditures more often than the wealthy. They have lower rates of insurance coverage, causing them to spend a larger proportion of their expenditures on health, and further confirming our results on the vulnerability of the bottom quintiles. PMID:20398278

Assessing evidence of inequalities in access to medication for diabetic populations in low- and middle-income countries: a systematic review

PubMed Central

Christiani, Yodi; Dhippayom, Teerapon; Chaiyakunapruk, Nathorn

2016-01-01

Background Inequalities in access to medications among people diagnosed with diabetes inlow- and middle-income countries (LMICs) is a public health concern since untreated diabetes can lead to severe complications and premature death. Objective To assess evidence of inequalities in access to medication for diabetes in adult populations of people with diagnosed diabetes in LMICs. Design We conducted a systematic review of the literature using the PRISMA-Equity guidelines. A search of five databases – PubMed, Cochrane, CINAHL, PsycINFO, and EMBASE – was conducted from inception to November 2015. Using deductive content analysis, information extracted from the selected articles was analysed according to the PRISMA-Equity guidelines, based on exposure variables (place of residence, race/ethnicity, occupation, gender, religion, education, socio-economic status, social capital, and others). Results Fifteen articles (seven quantitative and eight qualitative studies) are included in this review. There were inconsistent findings between studies conducted in different countries and regions although financial and geographic barriers generally contributed to inequalities in access to diabetes medications. The poor, those with relatively low education, and people living in remote areas had less access to diabetes medications. Furthermore, we found that the level of government political commitment through primary health care and in the provision of essential medicines was an important factor in promoting access to medications. Conclusions The review indicates that inequalities exist in accessing medication among diabetic populations, although this was not evident in all LMICs. Further research is needed to assess the social determinants of health and medication access for people with diabetes in LMICs. PMID:27938647

Investigating the management of diabetes in nursing homes using a mixed methods approach.

PubMed

Hurley, L; O'Donnell, M; O'Caoimh, R; Dinneen, S F

2017-05-01

As populations age there is an increased demand for nursing home (NH) care and a parallel increase in the prevalence of diabetes. Despite this, there is growing evidence that the management of diabetes in NHs is suboptimal. The reasons for this are complex and poorly understood. This study aimed to identify the current level of diabetes care in NHs using a mixed methods approach. The nursing managers at all 44 NHs in County Galway in the West of Ireland were invited to participate. A mixed methods approach involved a postal survey, focus group and telephone interviews. The survey response rate was 75% (33/44) and 27% (9/33) of nursing managers participated in the qualitative research. The reported prevalence of diagnosed diabetes was 14% with 80% of NHs treating residents with insulin. Hypoglycaemia was reported as 'frequent' in 19% of NHs. A total of 36% of NHs have staff who have received diabetes education or training and 56% have access to diabetes care guidelines. Staff education was the most cited opportunity for improving diabetes care. Focus group and interview findings highlight variations in the level of support provided by GPs and access to dietetic, podiatry and retinal screening services. There is a need for national clinical guidelines and standards of care for diabetes management in nursing homes, improved access to quality diabetes education for NH staff, and greater integration between healthcare services and NHs to ensure equity, continuity and quality in diabetes care delivery. Copyright © 2017 Elsevier B.V. All rights reserved.

Towards a framework for business model innovation in health care delivery in developing countries.

PubMed

Castano, Ramon

2014-12-02

Uncertainty and information asymmetries in health care are the basis for a supply-sided mindset in the health care industry and for a business model for hospitals and doctor's practices; these two models have to be challenged with business model innovation. The three elements which ensure this are standardizability, separability, and patient-centeredness. As scientific evidence advances and outcomes are more predictable, standardization is more feasible. If a standardized process can also be separated from the hospital and doctor's practice, it is more likely that innovative business models emerge. Regarding patient centeredness, it has to go beyond the oversimplifying approach to patient satisfaction with amenities and interpersonal skills of staff, to include the design of structure and processes starting from patients' needs, expectations, and preferences. Six business models are proposed in this article, including those of hospitals and doctor's practices. Unravelling standardized and separable processes from the traditional hospital setting will increase hospital expenditure, however, the new business models would reduce expenses. The net effect on efficiency could be argued to be positive. Regarding equity in access to high-quality care, most of the innovations described along these business models have emerged in developing countries; it is therefore reasonable to be optimistic regarding their impact on access by the poor. These models provide a promising route to achieve sustainable universal access to high quality care by the poor. Business model innovation is a necessary step to guarantee sustainability of health care systems; standardizability, separability, and patient-centeredness are key elements underlying the six business model innovations proposed in this article.

Resource and Technology: A beacon for change in the reform of Jamaica's secondary education system - or a "pipedream"?

NASA Astrophysics Data System (ADS)

Jennings, Zellynne

2012-04-01

Different strategies are being employed worldwide to prepare school-leavers for the world of work. Central to the Reform of Secondary Education (ROSE) in Jamaica in the 1990s was the achievement of goals of access, equity and quality through the implementation of a common curriculum in all schools. Within this reform, Resource and Technology (R&T) was an innovation designed to develop the creative potential in technology and to transform pedagogical practices from being teacher-centred to being student-centred. This paper examines how teachers and principals involved in the implementation of R&T perceive its attributes, such as need and relevance and observability. The findings reveal how the achievement of goals was frustrated and which challenges the users faced, including a lack of clarity of the means for implementing R&T.

Primary care priorities in addressing health equity: summary of the WONCA 2013 health equity workshop.

PubMed

Shadmi, Efrat; Wong, William C W; Kinder, Karen; Heath, Iona; Kidd, Michael

2014-11-07

Research consistently shows that gaps in health and health care persist, and are even widening. While the strength of a country's primary health care system and its primary care attributes significantly improves populations' health and reduces inequity (differences in health and health care that are unfair and unjust), many areas, such as inequity reduction through the provision of health promotion and preventive services, are not explicitly addressed by general practice. Substantiating the role of primary care in reducing inequity as well as establishing educational training programs geared towards health inequity reduction and improvement of the health and health care of underserved populations are needed. This paper summarizes the work performed at the World WONCA (World Organization of National Colleges and Academies of Family Medicine) 2013 Meetings' Health Equity Workshop which aimed to explore how a better understanding of health inequities could enable primary care providers (PCPs)/general practitioners (GPs) to adopt strategies that could improve health outcomes through the delivery of primary health care. It explored the development of a health equity curriculum and opened a discussion on the future and potential impact of health equity training among GPs. A survey completed by workshop participants on the current and expected levels of primary care participation in various inequity reduction activities showed that promoting access (availability and coverage) to primary care services was the most important priority. Assessment of the gaps between current and preferred priorities showed that to bridge expectations and actual performance, the following should be the focus of governments and health care systems: forming cross-national collaborations; incorporating health equity and cultural competency training in medical education; and, engaging in initiation of advocacy programs that involve major stakeholders in equity promotion policy making as well as promoting research on health equity. This workshop formed the basis for the establishment of WONCA's Health Equity Special Interest Group, set up in early 2014, aiming to bring the essential experience, skills and perspective of interested GPs around the world to address differences in health that are unfair, unjust, unnecessary but avoidable.