34 CFR 280.1 - What is the Magnet Schools Assistance Program?

Code of Federal Regulations, 2013 CFR

2013-07-01

... schools; (e) Improvement of the capacity of LEAs, including through professional development, to continue... terminated; and (f) Ensuring that all students enrolled in the magnet school programs have equitable access... 34 Education 1 2013-07-01 2013-07-01 false What is the Magnet Schools Assistance Program? 280.1...

Mentoring, Gender, and Publication among Social, Natural, and Physical Scientists. Final Report.

ERIC Educational Resources Information Center

Grant, Linda; Ward, Kathryn B.

Research has identified mentoring as a critical factor in the entry and survival of women and minorities in the social, natural, and physical sciences where they are underrepresented. Much research and many change-oriented programs in higher education have assumed that the presence of mentors is sufficient to ensure equitable access to scientific…

Expected Annual Emergency Miles per Ambulance: An Indicator for Measuring Availability of Emergency Medical Services Resources

ERIC Educational Resources Information Center

Patterson, P. Daniel; Probst, Janice C.; Moore, Charity G.

2006-01-01

Context: To ensure equitable access to prehospital care, as recommended by the Rural and Frontier Emergency Medical Services (EMS) Agenda for the Future, policymakers will need a uniform measure of EMS infrastructure. Purpose and Methods: This paper proposes a county-level indicator of EMS resource availability that takes into consideration…

State School Finance Inequities and the Limits of Pursuing Teacher Equity through Departmental Regulation

ERIC Educational Resources Information Center

Baker, Bruce D.; Weber, Mark

2016-01-01

New federal regulations (State Plans to Ensure Equitable Access to Excellent Educators)1 place increased pressure on states and local public school districts to improve their measurement and reporting of gaps in teacher qualifications across schools and the children they serve. Yet a sole focus on resource disparities between schools within a…

Ecological Aspects Influencing the Implementation of Inclusive Education in Mainstream Primary Schools in the Eastern Cape, South Africa

ERIC Educational Resources Information Center

Geldenhuys, J. L.; Wevers, N. E. J.

2013-01-01

Despite efforts worldwide to ensure quality education for all learners through inclusive education, indications are that many learners, especially those that experience barriers to learning, are still excluded from full access to quality and equitable education opportunities in mainstream primary schools. This article uses a qualitative approach…

Planning for Food Systems: Community-University Partnerships for Food-Systems Transformation

ERIC Educational Resources Information Center

Whittaker, Jennifer; Clark, Jill K.; SanGiovannni, Sarah; Raja, Samina

2017-01-01

The United Nations estimates that by 2050, more than 66% of the world's population will live in urban areas. In the face of continuing urbanization, how will communities meet the fundamental need for good food? What kinds of public policies, structures, and systems will ensure equitable and just access to food? We argue that urban universities…

Linking research to global health equity: the contribution of product development partnerships to access to medicines and research capacity building.

PubMed

Pratt, Bridget; Loff, Bebe

2013-11-01

Certain product development partnerships (PDPs) recognize that to promote the reduction of global health disparities they must create access to their products and strengthen research capacity in developing countries. We evaluated the contribution of 3 PDPs--Medicines for Malaria Venture, Drugs for Neglected Diseases Initiative, and Institute for One World Health--according to Frost and Reich's access framework. We also evaluated PDPs' capacity building in low- and middle-income countries at the individual, institutional, and system levels. We found that these PDPs advance public health by ensuring their products' registration, distribution, and adoption into national treatment policies in disease-endemic countries. Nonetheless, ensuring broad, equitable access for these populations--high distribution coverage; affordability, particularly for the poor; and adoption at provider and end-user levels--remains a challenge.

Practice variation in the Dutch long-term care and the role of supply-sensitive care: Is access to the Dutch long-term care equitable?

PubMed

Duell, Daisy; Koolman, Xander; Portrait, France

2017-12-01

Universal access and generous coverage are important goals of the Dutch long-term care (LTC) system. It is a legal requirement that everyone eligible for LTC should be able to receive it. Institutional care (IC) made up for 90% of Dutch LTC spending. To investigate whether access to IC is as equitable as the Dutch government aspires, we explored practice variation in entitlements to IC across Dutch regions. We used a unique dataset that included all individual applications for Dutch LTC in January 2010-December 2013 (N = 3,373,358). This dataset enabled an accurate identification of the need for care. We examined the local variation in the probability of being granted long-term IC and in the intensity of the care granted given that individuals have applied for LTC. We also investigated whether the variation observed was related to differences in the local availability of care facilities. Although our analyses indicated the presence of some practice variation, its magnitude was very small by national and international standards (up to 3%). Only a minor part of the practice variation could be accounted for by local supply differences in care facilities. Overall, we conclude that, unlike many other developed countries, the Dutch system ensured equitable access to long-term IC. © 2017 The Authors. Health Economics Published by John Wiley & Sons Ltd.

Emergency response vaccines--a challenge for the public sector and the vaccine industry.

PubMed

Milstien, Julie; Lambert, Scott

2002-11-22

In partnership with industry, WHO has developed a number of strategies to facilitate access to vaccines recommended for use in national immunization programs. These strategies have been necessitated by the increasing fragility of vaccine supply for developing markets. The potential global spread of epidemic disease has made it imperative to expand these efforts. A new concept is proposed, that of essential vaccines, defined as "vaccines of public health importance that should be accessible to all people at risk". Essential vaccines will include emergency response vaccines that have become important due to resurgent outbreaks, threatening global pandemics, and situations where a global emergency immunization response may be needed. While some of the approaches already developed will be applicable to emergency response vaccines, other novel approaches requiring public sector intervention will be necessary. Procurement, financing and allocation of these emergency response vaccines, if left to governments or private individuals based on ability to pay, will threaten equitable access. The challenge will be to ensure development of and equitable access to these vaccines while not threatening the already fragile supply of other essential vaccines.

Vocational Qualifications and Progression to Higher Education: The Case of the 14-19 Diplomas in the English System

ERIC Educational Resources Information Center

Hodgson, Ann; Spours, Ken

2010-01-01

Ensuring effective progression from vocational qualifications to higher education has become an important issue internationally as a part of government strategies to raise skill levels and to provide more equitable access to tertiary level study. From September 2008, the Government in England has begun to introduce a new set of qualifications for…

Gender Norms and Access to Extension Services and Training among Potato Farmers in Dedza and Ntcheu in Malawi

ERIC Educational Resources Information Center

Mudege, Netsayi N.; Chevo, Tafadzwa; Nyekanyeka, Ted; Kapalasa, Eliya; Demo, Paul

2016-01-01

Purpose: This paper explores the interaction between extension services and gender relations in order to suggest ways and strategies that can be useful in ensuring that extension services are gender-equitable and empowering for women. Design/Methodology/Approach: In total, 35 sex-disaggregated focus group discussions with farmers, and 4 interviews…

Missionary Zeal: Some Problems with the Rhetoric, Vision and Approach of the AHELO Project

ERIC Educational Resources Information Center

Ashwin, Paul

2015-01-01

The OECD's Assessment of Higher Education Learning Outcomes (AHELO) project is an important contribution to discussions of how to define and measure the quality of global higher education. There is a genuine need for quality measures that can help to ensure students have equitable access to high-quality higher education wherever they study but do…

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…

Ensuring Equitable Access to Strong Teachers: Important Elements of an Effective State Action Plan

ERIC Educational Resources Information Center

Metz, Rachel

2015-01-01

Every community has strong teachers who help their students learn to high levels. But far too often low-income students and students of color are short-changed when it comes to teacher quality. Federal law requires states to end these disparities. But states, recognizing that most hiring, compensation, and promotional decisions, not to mention…

Standardization or Localization: A Study of Online Learning Programmes by Tertiary Institutions in Ghana

ERIC Educational Resources Information Center

Djan, Josephine; George, Babu

2016-01-01

Many universities in Ghana have had a desire to ensure equitable access to formal tertiary education for the growing number of the working public who have sought to improve or better their educational status in tertiary institutions. For many of these working public or individuals, it is almost impossible to stay off work to enrol in these…

How Should Organizations Promote Equitable Distribution of Benefits from Technological Innovation in Health Care?

PubMed

Nambisan, Satish; Nambisan, Priya

2017-11-01

Technological innovations typically benefit those who have good access to and an understanding of the underlying technologies. As such, technology-centered health care innovations are likely to preferentially benefit users of privileged socioeconomic backgrounds. Which policies and strategies should health care organizations adopt to promote equitable distribution of the benefits from technological innovations? In this essay, we draw on two important concepts-co-creation (the joint creation of value by multiple parties such as a company and its customers) and digitalization (the application of new digital technologies and the ensuing changes in sociotechnical structures and relationships)-and propose a set of policies and strategies that health care organizations could adopt to ensure that benefits from technological innovations are more equitably distributed among all target populations, including resource-poor communities and individuals. © 2017 American Medical Association. All Rights Reserved.

Towards ensuring gender equity.

PubMed

Basu, A

1996-01-01

All people should participate in the development process. Many, however, remain excluded from the benefits of development. For example, women are privy to only a small share of developmental opportunities. The goals of equality, development, and peace were stated during the Fourth World Conference on Women held in Beijing in September 1995. The author considers whether women truly have equitable access to literacy, education, food, nutrition, health, employment, and the political and economic decision making process. She stresses that the goals pronounced at the Fourth World Conference on Women must be backed up with the necessary resources, including institutions established at the local, state, and national levels to ensure that the objectives are implemented and the implementation is monitored. The author further argues that in order for women to achieve equality with men, all girls must have access to primary and secondary schools; basic literacy is inadequate. Moreover, gender stereotyping must be avoided and gender sensitization ensured at all levels.

What are the determinants of food security among regional and remote Western Australian children?

PubMed

Godrich, Stephanie L; Davies, Christina R; Darby, Jill; Devine, Amanda

2017-01-22

To explore how determinants of food security affect children in regional and remote Western Australia (WA), across food availability, access and utilisation dimensions. The Determinants of Food Security framework guided the thematic analysis (using NVivo 10) of semi-structured interviews with 20 key informants. Food availability factors included availability, price, promotion, quality, location of outlets and variety. Food access factors included social support, financial resources, transport to food outlets, distance to food outlets and mobility. Food utilisation factors included nutrition knowledge and skills, children's food preferences, storage facilities, preparation and cooking facilities and time to purchase food. Key food availability recommendations include increasing local food supply options. Food access recommendations include ensuring equitable formal social support and empowering informal support options. Food utilisation recommendations include prioritising food literacy programs focusing on quick, healthy food preparation and budgeting skills. Implications for public health: Policymakers should invest in local food supply options, equitable social support services and experiential food literacy programs. Practitioners should focus child/parent programs on improving attitude, knowledge and skills. © 2017 Public Health Association of Australia.

Synthesizing qualitative and quantitative evidence on non-financial access barriers: implications for assessment at the district level.

PubMed

O'Connell, Thomas S; Bedford, K Juliet A; Thiede, Michael; McIntyre, Di

2015-06-09

A key element of the global drive to universal health coverage is ensuring access to needed health services for everyone, and to pursue this goal in an equitable way. This requires concerted efforts to reduce disparities in access through understanding and acting on barriers facing communities with the lowest utilisation levels. Financial barriers dominate the empirical literature on health service access. Unless the full range of access barriers are investigated, efforts to promote equitable access to health care are unlikely to succeed. This paper therefore focuses on exploring the nature and extent of non-financial access barriers. We draw upon two structured literature reviews on barriers to access and utilization of maternal, newborn and child health services in Ghana, Bangladesh, Vietnam and Rwanda. One review analyses access barriers identified in published literature using qualitative research methods; the other in published literature using quantitative analysis of household survey data. We then synthesised the key qualitative and quantitative findings through a conjoint iterative analysis. Five dominant themes on non-financial access barriers were identified: ethnicity; religion; physical accessibility; decision-making, gender and autonomy; and knowledge, information and education. The analysis highlighted that non-financial factors pose considerable barriers to access, many of which relate to the acceptability dimension of access and are challenging to address. Another key finding is that quantitative research methods, while yielding important findings, are inadequate for understanding non-financial access barriers in sufficient detail to develop effective responses. Qualitative research is critical in filling this gap. The analysis also indicates that the nature of non-financial access barriers vary considerably, not only between countries but also between different communities within individual countries. To adequately understand access barriers as a basis for developing effective strategies to address them, mixed-methods approaches are required. From an equity perspective, communities with the lowest utilisation levels should be prioritised and the access barriers specific to that community identified. It is, therefore, critical to develop approaches that can be used at the district level to diagnose and act upon access barriers if we are to pursue an equitable path to universal health coverage.

Towards regulation of similar biotherapeutic products: Thailand's perspective.

PubMed

Thanaphollert, Prapassorn; Tungsanga, Kriang

2011-09-01

The implementation of universal health coverage scheme in Thailand allows quality, equitable and accessible health care for all. Patients with life threatening and chronic diseases can get access to biotherapeutic products to treat their ailments. This triggered a major impact on the need for specific guidelines in evaluation of similar biotherapeutic products in order to standardize the regulatory pathway to license this class of products ensuring that the products meet acceptable levels of quality, safety and efficacy. The development of similar biotherapeutic products (SBP) should be considered to ensure therapeutic equivalence of biotherapeutics products at more affordable prices. This will lead to greater ease and speed of approval and assurance of the quality, safety and efficacy of these products. Therefore, we report herein the SBP situation in Thailand. Copyright © 2011. Published by Elsevier Ltd.

Illinois State Plan: Adult Education and Family Literacy. Under Title II of the Workforce Investment Act of 1998, Adult Education and Family Literacy Act

ERIC Educational Resources Information Center

Illinois Community College Board, 2014

2014-01-01

This document contains Illinois' State Plan for Adult Education and Family Literacy under Title II of the Workforce Investment Act of 1998 for July 1, 1999, through June 30, 2015. The plan is comprised of the following sections: (1) Eligible agency certifications and assurances; (2) Description of the steps to ensure direct and equitable access;…

Challenges and strategies for sustaining youth-friendly health services - a qualitative study from the perspective of professionals at youth clinics in northern Sweden.

PubMed

Thomée, Suzanne; Malm, Desiré; Christianson, Monica; Hurtig, Anna-Karin; Wiklund, Maria; Waenerlund, Anna-Karin; Goicolea, Isabel

2016-12-21

Youth-friendly health-care services - those that are accessible, acceptable, equitable, appropriate and effective for different youth subpopulations - are beneficial for youth health, but not easy to implement and sustain. Sweden is among the few countries where youth-friendly health-care services have been integrated within the public health system and sustained for a long time. This study explores the challenges and strategies in providing sustainable youth-friendly health-care services, from the perspective of professionals working in youth clinics in northern Sweden. Eleven semi-structured interviews with various health-care professionals working in youth clinics in northern Sweden were conducted. The interviews were transcribed verbatim, and analysed using thematic analysis in relation to the World Health Organization domains of youth friendliness. Four themes emerged from the analysis of the data: 1) 'Meeting youths on their own terms - the key to ensuring a holistic and youth-centred care' was related to the acceptability and appropriateness of the services; 2) 'Organizational challenges and strategies in keeping professionals' expertise on youth updated' referred to the domain of effectiveness; 3) 'Youth clinics are accessible for those who know and can reach them' was related to the domains of accessibility and equity, and 4) 'The challenge of combining strong directions and flexibility in diverse local realities' focused on the struggle to sustain the youth clinics organization and their goals within the broader health system. Professionals working in youth clinics are perceived as motivated, interested and knowledgeable about youth, and the clinics ensure confidentiality and a youth-centred and holistic approach. Challenges remain, especially in terms of ensuring equitable access to different youth subpopulations, improving monitoring routines and ensuring training and competence for all professionals, independently of the location and characteristics of the clinic. Youth clinics are perceived as an indisputable part of the Swedish health system, but organizational challenges are also pointed out in terms of weak clear directives and leadership, heavy workload, local/regional diversity and unequitable distribution of resources.

The Purpose of the Cataloging for Matters of Equitable Access: Spanish-Language Cataloging and "Everyday" Approaches of Non-Native English Speakers

ERIC Educational Resources Information Center

Adamich, Tom

2009-01-01

While teacher-librarians embrace the concept of equitable access when they select "multicultural" materials to include in their collections, plan special programs, and teach lessons on a variety of topics, what do they do to make equitable access a part of their online catalogs? Have they achieved (or nearly achieved) a consistent level of…

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

Affordable antiretroviral drugs for the under-served markets: how to expand equitable access against the backdrop of challenging scenarios?

PubMed

Dionisio, Daniele; Cao, Yunzhen; Hongzhou, Lu; Kraisintu, Krisana; Messeri, Daniela

2006-01-01

Threats by enforced Intellectual Property (IP) rights to equitable HIV treatment access by poor populations are impending. India and China's policy directions in the field will be crucial in ultimately affecting the affordability and accessibility of antiretroviral (ARV) therapy in the under-served markets. These directions, together with the exploitation level of IP-bound flexibilities and the evolutionary modelling in partnerships and trade agreements between research-based and generic pharmaceutical industry, will also affect the outcomes of self-sufficiency efforts now at their beginning in the developing world as far as domestic manufacturing of generic ARV drugs is concerned. This paper explores key issues, implications and interaction dynamics across these challenging scenarios while attempting to provide equitable solution glimpses into the near future. Access-oriented long-term drug policy strategies entitled to pass muster of governments, research-based as well as generic industries in both developed and developing countries are needed if equitable access to affordable ARV treatments by poor people has to be achieved despite enforced IP rights. Predictable dynamics between western multinationals and transitional country generic corporations let regard IP-bound Voluntary License flexibilities as a fitting measure into just mentioned needs especially if substantial incentives to generic corporations are concurrently secured. Efforts to equitably expand ARV drug access through exploiting IP opportunities should encompass attainment of self-sufficiency in domestic drug manufacturing whenever basic requirements are in place in the developing world as a whole. A credible industrial potential would act, indeed, as a boosting factor for drawing branded drug producers into technology transfer agreements, the terms of which would let all contractors enjoy substantial advantages. These perspectives consistently bind up with the foreseeable long-term trade and drug policy directions of India and China according to frontier crossing implications of their key IP management trends as well as their multifaceted penetration strategies of both the wealthy and under-served markets worldwide. As coherent with these perspectives, more disbursement by wealthy country governments and donors to basic infrastructure development in sub-Saharan African nations with stable governments in place is urged both as a priority for improving Africa's economy and a prerequisite for allowing domestic industrial plants to take off. Aiming at the targets just underscored, WHO's brokering role in negotiated agreements between wealthy and developing country-based firms as well as its technical guidance in setting international standards have always to be sought if equitable and appropriate end results are to be attained. Overall insights in this paper would mean that, while research-based corporations are to be praised whenever waiving, on humanitarian purposes, part of their profits, the trade and profit rules cannot basically be given up if long-term sustainable results are the goal to look for. Only negotiated agreements securing all contracting parties lasting advantages may ensure shifting of such a goal from mere vision to a really sustainable attainment.

Examining Deaf Students' Equitable Access to Science vis-a-vis Contemporary Pedagogical Practices

NASA Astrophysics Data System (ADS)

Ross, Annemarie D.

As a Deaf individual, it is important to ensure the growth of the Deaf community as science-literate members of society. While many predecessors have contributed to the body of research in Deaf pedagogy, there is still much to be done in safeguarding Deaf learners' equitable access to science education. One area of concern is in narrowing the statistically significant gap in Climate Change knowledge between Deaf students' and Hearing students' at the Rochester Institute of Technology. It is within this topic that the writing-to-learn-science framework is practiced and Deaf students in the Laboratory Science Technology program at the National Technical Institute for the Deaf participate in a study to assess whether or not the use of writing-to-learn-science strategies help them become better scientists, writers and learners. In this study, the social constructivist framework (Vygotsky, 1987) is used to study the impact of the use of the Berland and Reiser (2009) argumentation framework, so that they write-to-learn-science through the steps of sense-making, articulation and persuasion.

[Equal Opportunities for Care in Obstetrics - A Quantitative Survey of Accessibility in Obstetric Departments in Austria].

PubMed

Schildberger, B; Ortner, N; Zenzmaier, C; König-Bachmann, M

2016-04-01

In everyday life women with disabilities are facing different challenges and discriminatory aspects. Especially the issue of pregnancy and motherhood is still critically discussed and subject to taboo. The aim of the present study is to survey the extent of structural measures on the one hand and additional specific service offers on the other hand that have been implemented in order to ensure accessibility and equitable care for women with disabilities in the obstetric departments in Austria. Data were collected by a self-developed non-standardised questionnaire, evaluating existing or implemented structural measures and specific service offerings that ensure accessibility. Data collection and analysis were performed using the online survey application "LimeSurvey" and SPSS, respectively. The survey data reveal that the obstetric departments largely conform to the requirements of the different building regulations. Additional measures or adaptations of the inventory for women with mobility or sensory impairments are at the discretion of the institution and thus are hardly implemented. Despite the small sample size it becomes obvious that the obstetric departments in Austria lack in many regards structures that ensure accessibility to care, nursing, counselling and support for women with sensory impairments or limited mobility. © Georg Thieme Verlag KG Stuttgart · New York.

Hospitalization among migrants in Italy: Access to health care as an opportunity for integration and inclusion.

PubMed

Barsanti, Sara

2018-03-30

This paper analyzes migrant access to health care by comparing hospitalizations of native and immigrant population with respect the Tuscany Region (Italy). In the analyses, a critical gap both for legal and undocumented migrant population is highlighted. Indeed, we found some key differences between the migrant and native populations related to the use of specific hospital services in Tuscany and, indirectly, of community and primary care services. Moreover, especially for undocumented migrants, hospitals seem to be the only point of access to the health-care system for migrant populations. The results suggest that the Italian health-care system is unable to ensure an equitable access to health services. In this context, maternity care could be a key point of access to the welfare system that allows participation in the health system not only for mothers but also for all migrant family members. Copyright © 2018 John Wiley & Sons, Ltd.

Equitable Access to Healthcare Services and Income Replacement for Cancer: Is Critical Illness Insurance a Help or a Hindrance?

PubMed Central

Longo, Christopher J.

2010-01-01

Canada's publicly funded healthcare system ensures that medically necessary hospital and physician services are available without financial barriers, but not all community-based care is covered. Consequently, many patients experience financial shocks (FS) related to community-based healthcare services not funded by government, and perhaps also from lost income, a situation that may be difficult for patients to avoid. Critical illness insurance (CII) offers a patient-funded alternative to those who qualify and desire protection against FS, leaving those without CII exposed. The author discusses the benefits and limitations of CII to mitigate financially derived healthcare access inequities, using cancer as an example. PMID:21532761

Is outpatient care benefit distribution of government healthcare subsidies equitable in rural ethnic minority areas of China? Results from cross-sectional studies in 2010 and 2013

PubMed Central

Chen, Mingsheng; Qian, Dongfu; Feng, Zhanchun; Si, Lei

2018-01-01

Objectives Government healthcare subsidies for healthcare facilities play a significant role in providing more extensive healthcare access to patients, especially poor ones. However, equitable distribution of these subsidies continues to pose a challenge in rural ethnic minority areas of China. This study aimed to evaluate the benefits distribution of outpatient services across different socioeconomic populations in China’s rural ethnic minority areas. Setting Inner Mongolia Autonomous Region, Xinjiang Autonomous Region and Qinghai Province. Design Two rounds of cross-sectional study. Participants One thousand and seventy patients in 2010 and 907 patients in 2013, who sought outpatient services prior to completing the household surveys, were interviewed. Methods Benefits incidence analysis was performed to measure the benefits distribution of government healthcare subsidies across socioeconomic groups. The concentration index (CI) for outpatient care at different healthcare facility levels in rural ethnic minority areas was calculated. Two rounds of household surveys using multistage stratified samples were conducted. Findings The overall CI for outpatient care was –0.0146 (P>0.05) in 2010 and –0.0992 (P<0.01) in 2013. In 2010, the CI was –0.0537 (P<0.01), –0.0085 (P>0.05) and −0.0034 (P>0.05) at levels of village clinics (VCs), township health centres (THCs) and county hospitals (CHs), respectively. In 2013, the CI was –0.1353 (P<0.05), –0.0695 (P>0.05) and –0.1633 (P<0.01) at the levels of VCs, THCs and CHs, respectively. Conclusion Implementation of the gatekeeper mechanism helped improve the benefits distribution of government healthcare subsidies in rural Chinese ethnic minority areas. Equitable distribution of government healthcare subsidies for VCs was improved by increasing financial input and ensuring the performance of primary healthcare facilities. Equitable distribution of subsidies for CHs was improved by policies that rationally guided patients’ care-seeking behaviour. In addition, highly qualified physicians were also a key factor in ensuring equitable benefits distribution. PMID:29431138

Improving regional and rural cancer services in Western Australia.

PubMed

Platt, Violet; O'Connor, Kathleen; Coleman, Rhonda

2015-02-01

This paper examines health reform which has been designed to improve cancer services across Western Australia. Western Australia is a large state divided into nine regions each with differing demographics. The diversity of the state and the distribution of the population over a large area of land create significant challenge in ensuring equality in service delivery. A comparison was conducted looking at cancer services in Western Australia pre-2005 and service delivery in 2014. A review of the partnership initiatives and programs provides a clear discussion on the need for coordination of care between service providers. The approach undertaken in Western Australia has seen an increase in the delivery of cancer services closer to the patient's home as well as greater involvement of primary care professionals in cancer care. This work has resulted in demonstrated improvements in patient care and support. Services for cancer patients need to be accessible closer to home with distance being an appreciable barrier to treatment access.A statewide approach needs to be developed to ensure all people have equitable access to service delivery. © 2015 National Rural Health Alliance Inc.

Making stem cells count for global health.

PubMed

McMahon, Dominique S; Thorsteinsdóttir, Halla

2011-11-01

Developing countries such as China, India and Brazil are making large investments in the stem cell field. Here we argue that hands-on involvement in the field by these countries is essential if the products developed are going to be locally relevant, affordable and appropriate. However, stem cells are a high-risk investment and any global health impacts are still likely to be far off. Even if they are eventually successful, better clinical oversight and measures to ensure access are required for stem cells to have a substantial and equitable impact.

Equitable access to elective hospital services: the introduction of patient choice in a decentralised healthcare system.

PubMed

Ringard, Ånen

2012-02-01

During the 1980s and 1990s, increased waiting times for elective surgery was perceived to be a major accessibility problem in many countries. In an attempt to improve access, hospital choice reforms were introduced in a number of countries. In Norway, a nationwide reform to improve access came into effect in 2001. At the same time, renewed support was expressed for the long-standing political aim of ensuring equal access to healthcare services for all citizens regardless of their social position. The current aim is to analyse the relationship of the hospital choice reform and the goal of equitable access to hospital services. A survey conducted among Norwegian patients in 2004 provided information about whether a choice of hospital had been made. Information from the survey was merged with administrative data from the hospital that performed the treatment. The survey provided data on patients' socioeconomic position. Demographics, medical need, and prior use of healthcare services were controlled for to determine the effect of socioeconomic position on hospital choice. The patient's socioeconomic position, measured by education, was found to be significantly associated with hospital choice. The relationship resembled that of a social gradient. Patients with a primary education were less likely to have made a choice, followed by those with secondary education or a lower university degree. Patients with higher university education were most likely to have chosen. Hospital selection is a demanding task for many patients. Policymakers should therefore focus on crafting and implementing tools necessary for supporting uptake of choice in disadvantaged groups.

Managing the changing burden of cancer in Asia.

PubMed

Sankaranarayanan, Rengaswamy; Ramadas, Kunnambath; Qiao, You-lin

2014-01-08

Asia accounts for 60% of the world population and half the global burden of cancer. The incidence of cancer cases is estimated to increase from 6.1 million in 2008 to 10.6 million in 2030, due to ageing and growing populations, lifestyle and socioeconomic changes. Striking variations in ethnicity, sociocultural practices, human development index, habits and dietary patterns are reflected in the burden and pattern of cancer in different regions. The existing and emerging cancer patterns and burden in different regions of Asia call for political recognition of cancer as an important public health problem and for balanced investments in public and professional awareness. Prevention as well as early detection of cancers leads to both better health outcomes and considerable savings in treatment costs. Cancer health services are still evolving, and require substantial investment to ensure equitable access to cancer care for all sections of the population. In this review, we discuss the changing burden of cancer in Asia, along with appropriate management strategies. Strategies should promote healthy ageing via healthy lifestyles, tobacco and alcohol control measures, hepatitis B virus (HBV) and human papillomavirus (HPV) vaccination, cancer screening services, and vertical investments in strengthening cancer healthcare infrastructure to improve equitable access to services.

Managing the changing burden of cancer in Asia

PubMed Central

2014-01-01

Asia accounts for 60% of the world population and half the global burden of cancer. The incidence of cancer cases is estimated to increase from 6.1 million in 2008 to 10.6 million in 2030, due to ageing and growing populations, lifestyle and socioeconomic changes. Striking variations in ethnicity, sociocultural practices, human development index, habits and dietary patterns are reflected in the burden and pattern of cancer in different regions. The existing and emerging cancer patterns and burden in different regions of Asia call for political recognition of cancer as an important public health problem and for balanced investments in public and professional awareness. Prevention as well as early detection of cancers leads to both better health outcomes and considerable savings in treatment costs. Cancer health services are still evolving, and require substantial investment to ensure equitable access to cancer care for all sections of the population. In this review, we discuss the changing burden of cancer in Asia, along with appropriate management strategies. Strategies should promote healthy ageing via healthy lifestyles, tobacco and alcohol control measures, hepatitis B virus (HBV) and human papillomavirus (HPV) vaccination, cancer screening services, and vertical investments in strengthening cancer healthcare infrastructure to improve equitable access to services. PMID:24400922

Water access, water scarcity, and climate change.

PubMed

Mukheibir, Pierre

2010-05-01

This article investigates the approaches of the various discourses operating in the water sector and how they address the issues of scarcity and equitable access under projected climate change impacts. Little synergy exists between the different approaches dealing with these issues. Whilst being a sustainable development and water resources management issue, a holistic view of access, scarcity and the projected impacts of climate change is not prevalent in these discourses. The climate change discourse too does not adequately bridge the gap between these issues. The projected impacts of climate change are likely to exacerbate the problems of scarcity and equitable access unless appropriate adaptation strategies are adopted and resilience is built. The successful delivery of accessible water services under projected climate change impacts therefore lies with an extension of the adaptive water management approach to include equitable access as a key driver.

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.

Strong Collaborative Relationships for Strong Community Schools

ERIC Educational Resources Information Center

Daniel, Julia

2017-01-01

Community schools have gained attention as mechanisms to bring about equitable access to high-quality educational resources, extended learning time and opportunities, integrated student supports, and collaborative engaging relationships with parents and communities. In order to effectively create conditions that provide equitable access to such…

Access to genetic testing and genetic counseling in vulnerable populations: the d/Deaf and hard of hearing population.

PubMed

Cooke-Hubley, Sandra; Maddalena, Victor

2011-09-01

Genetic testing holds great potential for preventing morbidities and mortalities for a number of diseases through early detection and effective intervention. As the number of genetic tests expand, so will public demand for these services. Therefore, it is essential to evaluate access to genetic testing and genetic services to ensure that all Canadians, including vulnerable groups, have equitable access to all forms of health care, in keeping with the mandate of the Canadian Health Act. The purpose of this paper is to examine the literature to determine if and how the Deaf community, as a vulnerable group, is at an increased risk of inequitable access to genetic services in Canada and to discuss how those who are deaf and hard of hearing are subject to the same risks. First, we define vulnerability and describe why the Deaf community, as a social group, can be considered a vulnerable group, followed by a description of the benefits of genetic testing. Second, we describe the barriers to accessing genetic testing, and how the d/Deaf and hard of hearing population experience additional barriers. Third, we examine the difficulties incorporating genetic testing into medical practice, and how this creates additional barriers to those already at risk. Finally, we discuss the steps necessary to promote equitable access to genetic testing among the d/Deaf and hard of hearing populations within Canada, and provide recommendations for further research in this topic area. Lastly, we comment on how barriers to genetic testing vary among the d/Deaf and hard of hearing is dependent upon the type of health care system available (whether public or private).

Patents or patients? Global access to pharmaceuticals and social justice.

PubMed

de Wildt, Gilles; Khoon, Chan Chee

2008-01-01

Innovation, vaccine development, and world-wide equitable access to necessary pharmaceuticals are hindered by current patenting arrangements and the orientation of pharmaceutical research. Plausible alternatives exist, including instituting the right of national or international agencies to act in the public interest and to buy patents selectively with a view to innovation and equitable access. Alternatives could partly or wholly finance themselves and lower pharmaceutical prices globally. Countries, individuals or groups of patients could help promote alternatives by calling into question the current emphasis on commercialization and profit, and by demanding globally equitable arrangements when sharing data that are important for research or when individuals or communities volunteer as research participants.

Right to health: (in) congruence between the legal framework and the health system.

PubMed

Mitano, Fernando; Ventura, Carla Aparecida Arena; de Lima, Mônica Cristina Ribeiro Alexandre d'Auria; Balegamire, Juvenal Bazilashe; Palha, Pedro Fredemir

2016-01-01

to discuss the right to health, incorporation into the legal instruments and the deployment in practice in the National Health System in Mozambique. this is a documentary analysis of a qualitative nature, which after thorough and interpretative reading of the legal instruments and articles that deal with the right to health, access and universal coverage, resulted in the construction of three empirical categories: instruments of humans rights and their interrelationship with the development of the right to health; the national health system in Mozambique; gaps between theory and practice in the consolidation of the right to health in the country. Mozambique ratified several international and regional legal instruments (of Africa) that deal with the right to health and which are ensured in its Constitution. However, their incorporation into the National Health Service have been limited because it can not provide access and universal coverage to health services in an equitable manner throughout its territorial extension and in the different levels of care. the implementation of the right to health is complex and will require mobilization of the state and political financial, educational, technological, housing, sanitation and management actions, as well as ensuring access to health, and universal coverage.

School Practices for Equitable Discipline of African American Students. ERIC Digest Number 166.

ERIC Educational Resources Information Center

Schwartz, Wendy, Ed.

Many schools employ varied strategies to ensure equitable treatment of African American students and fair and educative disciplinary procedures. This digest reviews successful disciplinary practices. Cross-cultural competence has a role in student-school relationships. Many negative perceptions of difference exist in today's society. Schools can…

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.

Equitable Access by Design. A Conceptual Framework for Integrated Student Supports within Linked Learning Pathways

ERIC Educational Resources Information Center

de Velasco, Jorge Ruiz; Newman, Elizabeth; Borsato, Graciela

2016-01-01

This report proposes a conceptual framework for defining and implementing a system of integrated student supports that provides equitable access to college and career readiness via Linked Learning pathways in high schools. The framework emphasizes the central commitment of the Linked Learning approach to challenge prevailing norms of…

When Choice Fosters Inequality: Can Research Help?

ERIC Educational Resources Information Center

Ayscue, Jennifer B.; Siegel-Hawley, Genevieve; Woodward, Brian; Orfield, Gary

2017-01-01

The Civil Rights Project was hired to identify barriers to equitable access in Buffalo (New York) Public Schools' criteria schools and propose solutions, which, if accepted by both parties, could resolve the civil rights violations and create more equitable access to those schools. The researchers found that students of color, low-income students,…

Cost-Effective, Equitable and Flexible Higher Education through Open and Distance Learning in Bangladesh

ERIC Educational Resources Information Center

Islam, Tofazzal

2011-01-01

This paper examines how this mega-university offers increasing access to cost-effective, equitable and flexible higher education by analyzing data from primary and secondary sources, identifies challenges impacting the continued growth of enrollment in distance education, and outlines opportunities for increasing access to higher education through…

Gender Equity in Middle School Science Teaching: Being "Equitable" Should Be the Goal.

ERIC Educational Resources Information Center

Subrahmanyan, Lalita; Bozonie, Heath

1996-01-01

Examines level at which gender issues are addressed in middle school science classes. Argues that in the crucial area of science education, particularly for girls at the middle school level, "equal" rather than "equitable" as a dominant teacher attitude may be inadequate to ensure that gender imbalances are rectified. (SD)

Rural health care support mechanism. Final rule; denial of petition for reconsideration.

PubMed

2003-12-24

In this document, the Commission modifies its rules to improve the effectiveness of the rural health care support mechanism, which provides discounts to rural health care providers to access modern telecommunications for medical and health maintenance purposes. Because participation in the rural health care support mechanism has not met the Commission's initial projections, the Commission amends its rules to improve the program, increase participation by rural health care providers, and ensure that the benefits of the program continue to be distributed in a fair and equitable manner. In addition, the Commission denies Mobile Satellite Ventures Subsidiary's petition for reconsideration of the 1997 Universal Service Order.

National health financing policy in Eritrea: a survey of preliminary considerations

PubMed Central

2012-01-01

Background The 58th World Health Assembly and 56th WHO Regional Committee for Africa adopted resolutions urging Member States to ensure that health financing systems included a method for prepayment to foster financial risk sharing among the population and avoid catastrophic health-care expenditure. The Regional Committee asked countries to strengthen or develop comprehensive health financing policies. This paper presents the findings of a survey conducted among senior staff of selected Eritrean ministries and agencies to elicit views on some of the elements likely to be part of a national health financing policy. Methods This is a descriptive study. A questionnaire was prepared and sent to 19 senior staff (Directors) in the Ministry of Health, Labour Department, Civil Service Administration, Eritrean Confederation of Workers, National Insurance Corporation of Eritrea and Ministry of Local Government. The respondents were selected by the Ministry of Health as key informants. Results The key findings were as follows: the response rate was 84.2% (16/19); 37.5% (6/16) and 18.8% said that the vision of Eritrean National Health Financing Policy (NHFP) should include the phrases ‘equitable and accessible quality health services’ and ‘improve efficiency or reduce waste’ respectively; over 68% indicated that NHFP should include securing adequate funding, ensuring efficiency, ensuring equitable financial access, protection from financial catastrophe, and ensuring provider payment mechanisms create positive incentives to service providers; over 80% mentioned community participation, efficiency, transparency, country ownership, equity in access, and evidence-based decision making as core values of NHFP; over 62.5% confirmed that NHFP components should consist of stewardship (oversight), revenue collection, revenue pooling and risk management, resource allocation and purchasing of health services, health economics research, and development of human resources for health; over 68.8% indicated cost-sharing, taxation and social health insurance as preferred revenue collection mechanisms; and 68.75% indicated their preferred provider payment mechanism to be a global (lump sum) budget. Conclusion This study succeeded in gathering the preliminary views of senior staff of selected Eritrean ministries and agencies regarding the likely elements of the NHFP, i.e. the vision, objectives, components, provider payment mechanisms, and health financing agency and its governance. In addition to stakeholder surveys, it would be helpful to inform the development of the NHFP with other pieces of evidence, including cost-effectiveness analysis of health services and interventions, financial feasibility analysis of financing options, a survey of the political and professional acceptability of financing options, national health accounts, and equity analyses. PMID:22929308

National health financing policy in Eritrea: a survey of preliminary considerations.

PubMed

Kirigia, Joses Muthuri; Zere, Eyob; Akazili, James

2012-08-28

The 58th World Health Assembly and 56th WHO Regional Committee for Africa adopted resolutions urging Member States to ensure that health financing systems included a method for prepayment to foster financial risk sharing among the population and avoid catastrophic health-care expenditure. The Regional Committee asked countries to strengthen or develop comprehensive health financing policies. This paper presents the findings of a survey conducted among senior staff of selected Eritrean ministries and agencies to elicit views on some of the elements likely to be part of a national health financing policy. This is a descriptive study. A questionnaire was prepared and sent to 19 senior staff (Directors) in the Ministry of Health, Labour Department, Civil Service Administration, Eritrean Confederation of Workers, National Insurance Corporation of Eritrea and Ministry of Local Government. The respondents were selected by the Ministry of Health as key informants. The key findings were as follows: the response rate was 84.2% (16/19); 37.5% (6/16) and 18.8% said that the vision of Eritrean National Health Financing Policy (NHFP) should include the phrases 'equitable and accessible quality health services' and 'improve efficiency or reduce waste' respectively; over 68% indicated that NHFP should include securing adequate funding, ensuring efficiency, ensuring equitable financial access, protection from financial catastrophe, and ensuring provider payment mechanisms create positive incentives to service providers; over 80% mentioned community participation, efficiency, transparency, country ownership, equity in access, and evidence-based decision making as core values of NHFP; over 62.5% confirmed that NHFP components should consist of stewardship (oversight), revenue collection, revenue pooling and risk management, resource allocation and purchasing of health services, health economics research, and development of human resources for health; over 68.8% indicated cost-sharing, taxation and social health insurance as preferred revenue collection mechanisms; and 68.75% indicated their preferred provider payment mechanism to be a global (lump sum) budget. This study succeeded in gathering the preliminary views of senior staff of selected Eritrean ministries and agencies regarding the likely elements of the NHFP, i.e. the vision, objectives, components, provider payment mechanisms, and health financing agency and its governance. In addition to stakeholder surveys, it would be helpful to inform the development of the NHFP with other pieces of evidence, including cost-effectiveness analysis of health services and interventions, financial feasibility analysis of financing options, a survey of the political and professional acceptability of financing options, national health accounts, and equity analyses.

Dementia Home Care Resources: How Are We Managing?

PubMed Central

Ward-Griffin, Catherine; Hall, Jodi; DeForge, Ryan; St-Amant, Oona; McWilliam, Carol; Oudshoorn, Abram; Forbes, Dorothy; Klosek, Marita

2012-01-01

With the number of people living with dementia expected to more than double within the next 25 years, the demand for dementia home care services will increase. In this critical ethnographic study, we drew upon interview and participant data with persons with dementia, family caregivers, in-home providers, and case managers in nine dementia care networks to examine the management of dementia home care resources. Three interrelated, dialectical themes were identified: (1) finite formal care-inexhaustible familial care, (2) accessible resources rhetoric-Iinaccessible resources reality, and (3) diminishing care resources-increasing care needs. The development of policies and practices that provide available, accessible, and appropriate resources, ensuring equitable, not necessarily equal, distribution of dementia care resources is required if we are to meet the goal of aging in place now and in the future. PMID:22132332

A new paradigm for teaching histology laboratories in Canada's first distributed medical school.

PubMed

Pinder, Karen E; Ford, Jason C; Ovalle, William K

2008-01-01

To address the critical problem of inadequate physician supply in rural British Columbia, The University of British Columbia (UBC) launched an innovative, expanded and distributed medical program in 2004-2005. Medical students engage in a common curriculum at three geographically distinct sites across B.C.: in Vancouver, Prince George and Victoria. The distribution of the core Histology course required a thorough revision of our instructional methodology. We here report our progress and address the question "How does one successfully distribute Histology teaching to remote sites while maintaining the highest of educational standards?" The experience at UBC points to three specific challenges in developing a distributed Histology curriculum: (i) ensuring equitable student access to high quality histological images, (ii) designing and implementing a reliable, state-of-the-art technological infrastructure that allows for real-time teaching and interactivity across geographically separate sites and (iii) ensuring continued student access to faculty content expertise. High quality images--available through any internet connection--are provided within a new virtual slide box library of 300 light microscopic and 190 electron microscopic images. Our technological needs are met through a robust and reliable videoconference system that allows for live, simultaneous communication of audio/visual materials across the three sites. This system also ensures student access to faculty content expertise during all didactic teaching sessions. Student examination results and surveys demonstrate that the distribution of our Histology curriculum has been successful. (c) 2008 American Association of Anatomists.

Right to health: (in) congruence between the legal framework and the health system

PubMed Central

Mitano, Fernando; Ventura, Carla Aparecida Arena; de Lima, Mônica Cristina Ribeiro Alexandre d'Auria; Balegamire, Juvenal Bazilashe; Palha, Pedro Fredemir

2016-01-01

Objective to discuss the right to health, incorporation into the legal instruments and the deployment in practice in the National Health System in Mozambique. Method this is a documentary analysis of a qualitative nature, which after thorough and interpretative reading of the legal instruments and articles that deal with the right to health, access and universal coverage, resulted in the construction of three empirical categories: instruments of humans rights and their interrelationship with the development of the right to health; the national health system in Mozambique; gaps between theory and practice in the consolidation of the right to health in the country. Results Mozambique ratified several international and regional legal instruments (of Africa) that deal with the right to health and which are ensured in its Constitution. However, their incorporation into the National Health Service have been limited because it can not provide access and universal coverage to health services in an equitable manner throughout its territorial extension and in the different levels of care. Conclusions the implementation of the right to health is complex and will require mobilization of the state and political financial, educational, technological, housing, sanitation and management actions, as well as ensuring access to health, and universal coverage. PMID:27027677

Improving equitable access to imaging under universal-access medicine: the ontario wait time information program and its impact on hospital policy and process.

PubMed

Kielar, Ania Z; El-Maraghi, Robert H; Schweitzer, Mark E

2010-08-01

In Canada, equal access to health care is the goal, but this is associated with wait times. Wait times should be fair rather than uniform, taking into account the urgency of the problem as well as the time an individual has already waited. In November 2004, the Ontario government began addressing this issue. One of the first steps was to institute benchmarks reflecting "acceptable" wait times for CT and MRI. A public Web site was developed indicating wait times at each Local Health Integration Network. Since starting the Wait Time Information Program, there has been a sustained reduction in wait times for Ontarians requiring CT and MRI. The average wait time for a CT scan went from 81 days in September 2005 to 47 days in September 2009. For MRI, the resulting wait time was reduced from 120 to 105 days. Increased patient scans have been achieved by purchasing new CT and MRI scanners, expanding hours of operation, and improving patient throughput using strategies learned from the Lean initiative, based on Toyota's manufacturing philosophy for car production. Institution-specific changes in booking procedures have been implemented. Concurrently, government guidelines have been developed to ensure accountability for monies received. The Ontario Wait Time Information Program is an innovative first step in improving fair and equitable access to publicly funded imaging services. There have been reductions in wait times for both CT and MRI. As various new processes are implemented, further review will be necessary for each step to determine their individual efficacy. Copyright 2010 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Access to New Zealand Sign Language interpreters and quality of life for the deaf: a pilot study.

PubMed

Henning, Marcus A; Krägeloh, Christian U; Sameshima, Shizue; Shepherd, Daniel; Shepherd, Gregory; Billington, Rex

2011-01-01

This paper aims to: (1) explore usage and accessibility of sign language interpreters, (2) appraise the levels of quality of life (QOL) of deaf adults residing in New Zealand, and (3) consider the impact of access to and usage of sign language interpreters on QOL. Sixty-eight deaf adults living in New Zealand participated in this study. Two questionnaires were employed: a 12-item instrument about access and use of New Zealand sign language interpreters and the abbreviated version of the World Health Organization Quality of Life questionnaire (WHOQOL-BREF). The results showed that 39% of this sample felt that they were unable to adequately access interpreting services. Moreover, this group scored significantly lower than a comparable hearing sample on all four WHOQOL-BREF domains. Finally, the findings revealed that access to good quality interpreters were associated with access to health services, transport issues, engagement in leisure activities, gaining more information, mobility and living in a healthy environment. These findings have consequences for policy makers and agencies interested in ensuring that there is an equitable distribution of essential services for all groups within New Zealand which inevitably has an impact on the health of the individual.

[Debate and challenges on the topic of free medical care in Africa: "Back to the Future"?].

PubMed

Ridde, Valéry; Blanchet, Karl

2009-01-01

In its 2008 annual report, WHO affirmed the importance of resisting the temptation to depend on direct payment for primary health care. Members of the WHO committee on the social determinants of health as well as of those at the conference on primary health care in Ouagadougou in 2008 reaffirmed the need to make access to health care systems more equitable. Several decades after imposition of direct payment began, convincing data clearly demonstrate its harmful effects on the basic fairness of access to care. Accordingly, the current debate in the field of financial support for health involves the elimination of payments. More precisely, we can finally say that this is a debate about a return to the free care that existed before the widespread implementation of "cost recovery" systems. Here we want to review these discussions and prepare the ground for a debate on possible effective strategies for making health care systems more equitable from the perspective of universal coverage. We will thus note that analyses today must certainly focus more on how to eliminate direct payments than on the reasons to do so, already amply demonstrated. The international community must now undertake to support governments that want to move in this direction and ensure that the process is thoroughly documented so that it can also produce useful knowledge for the formulation of fair public policies.

Technical Education as a Tool for Ensuring Sustainable Development: A Case of India

ERIC Educational Resources Information Center

Sharma, Gagan Deep; Uppal, Raminder Singh; Mahendru, Mandeep

2016-01-01

This paper notes that education needs to essentially lead to sustainable development serving two-fold purpose--eradicating the problems of unemployment and poverty; and ensuring equitable distribution of wealth while ensuring the right understanding leading to a peaceful, prosperous and developed world. In its current state, technical education…

Community Science: creating equitable partnerships for the advancement of scientific knowledge for action.

NASA Astrophysics Data System (ADS)

Lewis, E. S.; Gehrke, G. E.

2017-12-01

In a historical moment where the legitimacy of science is being questioned, it is essential to make science more accessible to the public. Active participation increases the legitimacy of projects within communities (Sidaway 2009). Creating collaborations in research strengthens not only the work by adding new dimensions, but also the social capital of communities through increased knowledge, connections, and decision making power. In this talk, Lewis will discuss how engagement at different stages of the scientific process is possible, and how researchers can actively develop opportunities that are open and inviting. Genuine co-production in research pushes scientists to work in new ways, and with people from different backgrounds, expertise, and lived experiences. This approach requires a flexible and dynamic balance of learning, sharing, and creating for all parties involved to ensure more meaningful and equitable participation. For example, in community science such as that by Public Lab, the community is at the center of scientific exploration. The research is place-based and is grounded in the desired outcomes of community members. Researchers are able to see themselves as active participants in this work alongside community members. Participating in active listening, developing plans together, and using a shared language built through learning can be helpful tools in all co-production processes. Generating knowledge is powerful. Through genuine collaboration and co-creation, science becomes more relevant. When community members are equitable stakeholders in the scientific process, they are better able to engage and advocate for the changes they want to see in their communities. Through this talk, session attendees will learn about practices that promote equitable participation in science, and hear examples of how the community science process engages people in both the knowledge production, and in the application of science.

Food security: the challenge of feeding 9 billion people.

PubMed

Godfray, H Charles J; Beddington, John R; Crute, Ian R; Haddad, Lawrence; Lawrence, David; Muir, James F; Pretty, Jules; Robinson, Sherman; Thomas, Sandy M; Toulmin, Camilla

2010-02-12

Continuing population and consumption growth will mean that the global demand for food will increase for at least another 40 years. Growing competition for land, water, and energy, in addition to the overexploitation of fisheries, will affect our ability to produce food, as will the urgent requirement to reduce the impact of the food system on the environment. The effects of climate change are a further threat. But the world can produce more food and can ensure that it is used more efficiently and equitably. A multifaceted and linked global strategy is needed to ensure sustainable and equitable food security, different components of which are explored here.

Physical, Social, and Political Inequities Constraining Girls' Menstrual Management at Schools in Informal Settlements of Nairobi, Kenya.

PubMed

Girod, Candace; Ellis, Anna; Andes, Karen L; Freeman, Matthew C; Caruso, Bethany A

2017-12-01

Access to adequate water and sanitation is limited in informal settlements, contributing to girls' challenges managing menstruation at school, especially when they cannot access materials to absorb menstrual blood and appropriate facilities for hygiene. This study documents differences between girls' experience of menstruation at public schools (where the Kenyan government provides menstrual pads) and private schools (where pads are not provided) in two informal settlements of Nairobi, Kenya. Results showed that supply chains to public schools were not reliable, and equitable pad provision was not assured. Girls in private schools struggled to access pads because they were not provided. Sanitation facilities were physically available, but Muslim girls were unable to practice ablution due to the design of toilets in our study schools. Girls experienced fear and anxiety due to harassment from male peers and had incomplete information about menstruation from teachers. Findings suggest that practitioners and policy-makers should acknowledge the diversity of school populations and monitor programs to ensure efforts do not contribute to inequity.

Neighborhood Socioeconomic Status and Primary Health Care: Usual Points of Access and Temporal Trends in a Major US Urban Area.

PubMed

Hussein, Mustafa; Diez Roux, Ana V; Field, Robert I

2016-12-01

Neighborhood socioeconomic status (SES), an overall marker of neighborhood conditions, may determine residents' access to health care, independently of their own individual characteristics. It remains unclear, however, how the distinct settings where individuals seek care vary by neighborhood SES, particularly in US urban areas. With existing literature being relatively old, revealing how these associations might have changed in recent years is also timely in this US health care reform era. Using data on the Philadelphia region from 2002 to 2012, we performed multilevel analysis to examine the associations of neighborhood SES (measured as census tract median household income) with access to usual sources of primary care (physician offices, community health centers, and hospital outpatient clinics). We found no evidence that residence in a low-income (versus high-income) neighborhood was associated with poorer overall access. However, low-income neighborhood residence was associated with less reliance on physician offices [-4.40 percentage points; 95 % confidence intervals (CI) -5.80, -3.00] and greater reliance on the safety net provided by health centers [2.08; 95 % CI 1.42, 2.75] and outpatient clinics [1.61; 95 % CI 0.97, 2.26]. These patterns largely persisted over the 10 years investigated. These findings suggest that safety-net providers have continued to play an important role in ensuring access to primary care in urban, low-income communities, further underscoring the importance of supporting a strong safety net to ensure equitable access to care regardless of place of residence.

[Better rights for sick children].

PubMed

Lie, Sverre O; Rø, Otto Christian

2012-02-21

Recognizing that healthy children are the future of Europe and the rights of every child to equitable access to health care which is appropriate, child-oriented and of good quality must be respected; The health and well-being of children are priority goals shared by all member states within the general context of human rights and the specific framework of children's rights; Investments in children's health and wellbeing ensures better outcome for the entire lifespan and may reduce the burden on health and welfare systems, since a significant number of avoidable physical and socio-psychological problems in adult life have their origin in infancy and childhood Effective and efficient child-friendly healthcare contributes to social cohesion

Beyond equality: Providing equitable care for persons with disabilities

PubMed Central

Wakeham, Scott; Heung, Sally; Lee, Janet; Sadowski, Cheryl A.

2017-01-01

Background: Almost 14% of Canadians have a disability, and older adults are most commonly affected. People living with disabilities have challenges accessing health care services, including medications and other services provided in pharmacies. Methods: A literature review was conducted regarding disability and pharmacy services. Resources regarding accessibility were also incorporated. Results: A number of organizations provide guidance on caring for those with disabilities. A primary concern for these vulnerable individuals relates to being invisible or overlooked by the health care system. There are also the stresses of physical, communication and attitudinal barriers. Pharmacists may be unaware of these barriers and may actually be contributing to them. To understand their patients’ accessibility needs, pharmacists can consider physical and nonphysical barriers and engage in education, advocacy and communications training to improve their patient-centred care for individuals with disabilities. Discussion and Conclusion: Pharmacists can improve the care of individuals with disabilities by learning more about accessibility. Within the community pharmacy environment, there are physical and nonphysical interventions that pharmacists can implement to ensure that patient-centred care is prioritized. PMID:29163726

A market-based approach to share water and benefits in transboundary river basins

NASA Astrophysics Data System (ADS)

Arjoon, Diane; Tilmant, Amaury; Herrmann, Markus

2016-04-01

The equitable sharing of benefits in transboundary river basins is necessary to reach a consensus on basin-wide development and management activities. Benefit sharing arrangements must be collaboratively developed to be perceived as efficient, as well as equitable, in order to be considered acceptable to all riparian countries. The current literature falls short of providing practical, institutional arrangements that ensure maximum economic welfare as well as collaboratively developed methods for encouraging the equitable sharing of benefits. In this study we define an institutional arrangement that distributes welfare in a river basin by maximizing the economic benefits of water use and then sharing these benefits in an equitable manner using a method developed through stakeholder involvement. In this methodology (i) a hydro-economic model is used to efficiently allocate scarce water resources to water users in a transboundary basin, (ii) water users are obliged to pay for water, and (iii) the total of these water charges are equitably redistributed as monetary compensation to users. The amount of monetary compensation, for each water user, is determined through the application of a sharing method developed by stakeholder input, based on a stakeholder vision of fairness, using an axiomatic approach. The whole system is overseen by a river basin authority. The methodology is applied to the Eastern Nile River basin as a case study. The technique ensures economic efficiency and may lead to more equitable solutions in the sharing of benefits in transboundary river basins because the definition of the sharing rule is not in question, as would be the case if existing methods, such as game theory, were applied, with their inherent definitions of fairness.

The future of the New Zealand plastic surgery workforce.

PubMed

Adams, Brandon M; Klaassen, Michael F; Tan, Swee T

2013-04-05

The New Zealand (NZ) plastic and reconstructive surgery (PRS) workforce provides reconstructive plastic surgery (RPS) public services from six centres. There has been little analysis on whether the workforce is adequate to meet the needs of the NZ population currently or in the future. This study analysed the current workforce, its distribution and future requirements. PRS manpower data, workforce activities, population statistics, and population modelling were analysed to determine current needs and predict future needs for the PRS workforce. The NZ PRS workforce is compared with international benchmarks. Regional variation of the workforce was analysed with respect to the population's access to PRS services. Future supply of specialist plastic surgeons is analysed. NZ has a lower number of plastic surgeons per capita than comparable countries. The current NZ PRS workforce is mal-distributed. Areas of current and emerging future need are identified. The current workforce mal-distribution will worsen with future population growth and distribution. Up to 60% of the NZ population will be at risk of inadequate access to PRS services by 2027. Development of PRS services must be coordinated to ensure that equitable and sustainable services are available throughout NZ. Strategies for ensuring satisfactory future workforce are discussed.

Essential Medicine Utilization and Situation in Selected Ten Developing Countries: A Compendious Audit

PubMed Central

Haque, Mainul

2017-01-01

Medicine improves the quality of life and increases mean age of human beings as it fights against diseases. Accessibility to medicines is the fundamental right of every person. The principle of the essential medicines (EMs) is that a limited number of availability of medicine will promote to a better supply chain and rational prescribing to the rural and remote health centers for any developing countries. Furthermore, it was also expected that this concept will also ensure better procurement policy at lower costs, more in amount, with easier storage. Thereby, EMs will safeguard and improve distribution and dispensing of medicine. Correspondingly, motivational and dedicated training program regarding drug information and adverse drug reactions will boost up access to medicine and health-care. In addition, the selection of medicine from EM is the first step in the direction of the rational use of medicine and progress and ensuring the quality of health care. Thereafter, selection needs to be followed by appropriate use. Everyone should receive the right medicine, in an adequate dose for an adequate duration, with appropriate information and follow-up treatment, and at an affordable cost. The acceptance and implementation of World Health Organization-promoted EM policies in deferent countries have improved quality use of medicine in terms of accessibility and affordability, predominantly in developing countries. The corporations and teamwork among various participants of health care are instantly obligatory to progress equitable access to medicines in low- and middle-income countries. PMID:28852629

Canada's northern food subsidy Nutrition North Canada: a comprehensive program evaluation.

PubMed

Galloway, Tracey

2017-01-01

Nutrition North Canada (NNC) is a retail subsidy program implemented in 2012 and designed to reduce the cost of nutritious food for residents living in Canada's remote, northern communities. The present study evaluates the extent to which NNC provides access to perishable, nutritious food for residents of remote northern communities. Program documents, including fiscal and food cost reports for the period 2011-2015, retailer compliance reports, audits of the program, and the program's performance measurement strategy are examined for evidence that the subsidy is meeting its objectives in a manner both comprehensive and equitable across regions and communities. NNC lacks price caps or other means of ensuring food is affordable and equitably priced in communities. Gaps in food cost reporting constrain the program's accountability. From 2011-15, no adjustments were made to community eligibility, subsidy rates, or the list of eligible foods in response to information provided by community members, critics, the Auditor General of Canada, and the program's own Advisory Board. Measures to increase program accountability, such as increasing subsidy information on point-of-sale receipts, make NNC more visible but do nothing to address underlying accountability issues Conclusions: The current structure and regulatory framework of NNC are insufficient to ensure the program meets its goal. Both the volume and cost of nutritious food delivered to communities is highly variable and dependent on factors such as retailers' pricing practices, over which the program has no control. It may be necessary to consider alternative forms of policy in order to produce sustainable improvements to food security in remote, northern communities.

Prevention for those who can pay: insurance reimbursement of genetic-based preventive interventions in the liminal state between health and disease

PubMed Central

Prince, Anya E.R.

2015-01-01

Clinical use of genetic testing to predict adult onset conditions allows individuals to minimize or circumvent disease when preventive medical interventions are available. Recent policy recommendations and changes expand patient access to information about asymptomatic genetic conditions and create mechanisms for expanded insurance coverage for genetic tests. The American College of Medical Genetics and Genomics (ACMG) recommends that laboratories provide incidental findings of medically actionable genetic variants after whole genome sequencing. The Patient Protection and Affordable Care Act (ACA) established mechanisms to mandate coverage for genetic tests, such as BRCA. The ACA and ACMG, however, do not address insurance coverage for preventive interventions. These policies equate access to testing as access to prevention, without exploring the accessibility and affordability of interventions. In reality, insurance coverage for preventive interventions in asymptomatic adults is variable given the US health insurance system's focus on treatment. Health disparities will be exacerbated if only privileged segments of society can access preventive interventions, such as prophylactic surgeries, screenings, or medication. To ensure equitable access to interventions, federal or state legislatures should mandate insurance coverage for both predictive genetic testing and recommended follow-up interventions included in a list established by an expert panel or regulatory body. PMID:26339500

Prevention for those who can pay: insurance reimbursement of genetic-based preventive interventions in the liminal state between health and disease.

PubMed

Prince, Anya E R

2015-07-01

Clinical use of genetic testing to predict adult onset conditions allows individuals to minimize or circumvent disease when preventive medical interventions are available. Recent policy recommendations and changes expand patient access to information about asymptomatic genetic conditions and create mechanisms for expanded insurance coverage for genetic tests. The American College of Medical Genetics and Genomics (ACMG) recommends that laboratories provide incidental findings of medically actionable genetic variants after whole genome sequencing. The Patient Protection and Affordable Care Act (ACA) established mechanisms to mandate coverage for genetic tests, such as BRCA. The ACA and ACMG, however, do not address insurance coverage for preventive interventions. These policies equate access to testing as access to prevention, without exploring the accessibility and affordability of interventions. In reality, insurance coverage for preventive interventions in asymptomatic adults is variable given the US health insurance system's focus on treatment. Health disparities will be exacerbated if only privileged segments of society can access preventive interventions, such as prophylactic surgeries, screenings, or medication. To ensure equitable access to interventions, federal or state legislatures should mandate insurance coverage for both predictive genetic testing and recommended follow-up interventions included in a list established by an expert panel or regulatory body.

Providing Elementary Students Equitable Access to Notebook Computers by Empowering Three School Communities in Shared Decision Making.

ERIC Educational Resources Information Center

Despot, Paula C.

This practicum was designed to provide elementary students from low-socioeconomic school communities equitable opportunities to use notebook computer technology in the communication process. A multi-dimensional staff development program was designed and conducted to integrate computer technology in the classroom. Students and their families were…

Equitable access to health insurance for socially excluded children? The case of the National Health Insurance Scheme (NHIS) in Ghana.

PubMed

Williams, Gemma A; Parmar, Divya; Dkhimi, Fahdi; Asante, Felix; Arhinful, Daniel; Mladovsky, Philipa

2017-08-01

To help reduce child mortality and reach universal health coverage, Ghana extended free membership of the National Health Insurance Scheme (NHIS) to children (under-18s) in 2008. However, despite the introduction of premium waivers, a substantial proportion of children remain uninsured. Thus far, few studies have explored why enrolment of children in NHIS may remain low, despite the absence of significant financial barriers to membership. In this paper we therefore look beyond economic explanations of access to health insurance to explore additional wider determinants of enrolment in the NHIS. In particular, we investigate whether social exclusion, as measured through a sociocultural, political and economic lens, can explain poor enrolment rates of children. Data were collected from a cross-sectional survey of 4050 representative households conducted in Ghana in 2012. Household indices were created to measure sociocultural, political and economic exclusion, and logistic regressions were conducted to study determinants of enrolment at the individual and household levels. Our results indicate that socioculturally, economically and politically excluded children are less likely to enrol in the NHIS. Furthermore, households excluded in all dimensions were more likely to be non-enrolled or partially-enrolled (i.e. not all children enrolled within the household) than fully-enrolled. These results suggest that equity in access for socially excluded children has not yet been achieved. Efforts should be taken to improve coverage by removing the remaining small, annually renewable registration fee, implementing and publicising the new clause that de-links premium waivers from parental membership, establishing additional scheme administrative offices in remote areas, holding regular registration sessions in schools and conducting outreach sessions and providing registration support to female guardians of children. Ensuring equitable access to NHIS will contribute substantially to improving child health and reducing child mortality in Ghana. Copyright © 2017 Elsevier Ltd. All rights reserved.

Patients’ Online Access to Their Primary Care Electronic Health Records and Linked Online Services: Implications for Research and Practice

PubMed Central

Mold, Freda; de Lusignan, Simon

2015-01-01

Online access to medical records and linked services, including requesting repeat prescriptions and booking appointments, enables patients to personalize their access to care. However, online access creates opportunities and challenges for both health professionals and their patients, in practices and in research. The challenges for practice are the impact of online services on workload and the quality and safety of health care. Health professionals are concerned about the impact on workload, especially from email or other online enquiry systems, as well as risks to privacy. Patients report how online access provides a convenient means through which to access their health provider and may offer greater satisfaction if they get a timely response from a clinician. Online access and services may also result in unforeseen consequences and may change the nature of the patient-clinician interaction. Research challenges include: (1) Ensuring privacy, including how to control inappropriate carer and guardian access to medical records; (2) Whether online access to records improves patient safety and health outcomes; (3) Whether record access increases disparities across social classes and between genders; and (4) Improving efficiency. The challenges for practice are: (1) How to incorporate online access into clinical workflow; (2) The need for a business model to fund the additional time taken. Creating a sustainable business model for a safe, private, informative, more equitable online service is needed if online access to records is to be provided outside of pay-for-service systems. PMID:26690225

Patients' Online Access to Their Primary Care Electronic Health Records and Linked Online Services: Implications for Research and Practice.

PubMed

Mold, Freda; de Lusignan, Simon

2015-12-04

Online access to medical records and linked services, including requesting repeat prescriptions and booking appointments, enables patients to personalize their access to care. However, online access creates opportunities and challenges for both health professionals and their patients, in practices and in research. The challenges for practice are the impact of online services on workload and the quality and safety of health care. Health professionals are concerned about the impact on workload, especially from email or other online enquiry systems, as well as risks to privacy. Patients report how online access provides a convenient means through which to access their health provider and may offer greater satisfaction if they get a timely response from a clinician. Online access and services may also result in unforeseen consequences and may change the nature of the patient-clinician interaction. Research challenges include: (1) Ensuring privacy, including how to control inappropriate carer and guardian access to medical records; (2) Whether online access to records improves patient safety and health outcomes; (3) Whether record access increases disparities across social classes and between genders; and (4) Improving efficiency. The challenges for practice are: (1) How to incorporate online access into clinical workflow; (2) The need for a business model to fund the additional time taken. Creating a sustainable business model for a safe, private, informative, more equitable online service is needed if online access to records is to be provided outside of pay-for-service systems.

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.

Changing the paradigm: planning for ambulatory care expansion in Los Angeles County using a community-based and evidence-based model.

PubMed

Fielding, J E; Lamirault, I; Nolan, B; Bobrowsky, J

2000-07-01

In 1998, Los Angeles County's Department of Health Services (DHS) embarked on a planning process to expand ambulatory care services for the county's 2.7 million uninsured and otherwise medically indigent residents. This planning process was novel in two ways. First, it used a quantitative, needs-based approach for resource allocation to ensure an equitable distribution of safety-net ambulatory care services across the county. Second, it used a new community-based planning paradigm that took into consideration the specific needs of each of the county's eight geographic service planning areas. Together, the evidence-based approach to planning and the community-based decision-making will ensure that DHS can more equitably provide for the needs of Los Angeles County's medically indigent residents.

Barriers to free antiretroviral treatment access for female sex workers in Chennai, India.

PubMed

Chakrapani, Venkatesan; Newman, Peter A; Shunmugam, Murali; Kurian, Abraham K; Dubrow, Robert

2009-11-01

India's National AIDS Control Organization (NACO) provides free first-line antiretroviral treatment (ART) at government centers for people living with HIV. To assist in developing policies and programs to ensure equity in ART access, we explored barriers to ART access among female sex workers (FSWs) living with HIV in Chennai. Between August and November 2007, we conducted three focus group discussions and two key informant interviews. Data were explored using framework analysis to identify categories and derive themes. We found interrelated barriers at the family/social, health care system/programmatic, and individual levels. Major barriers included fear of adverse consequences of disclosure of HIV status due to stigma and discrimination associated with HIV and sex work, lack of family support, negative experiences with health care providers, lack of adequate counseling services at government centers and by outreach workers employed by nongovernmental organizations (NGOs), perceived biased treatment of FSWs who are not referred by NGOs, lack of adequate knowledge about ART, and fatalism. Barriers can be addressed by: creating effective measures to reduce stigma associated with HIV/AIDS and sex work at the familial, societal, and health care system levels; incorporating information about ART into targeted interventions among FSWs; training counselors at government hospitals and NGO outreach workers on treatment issues; improving infrastructure and staffing levels at government centers to allow adequate time and privacy for counseling; and implementing government mass media campaigns on ART availability. Finally, it is crucial that NACO begin monitoring ART coverage of FSWs and other marginalized populations to ensure equitable ART access.

7 CFR 22.205 - Allocation of loan and grant funds.

Code of Federal Regulations, 2012 CFR

2012-01-01

... approved loan funding levels will be allocated among States by a formula designed to ensure equitable... allocations may be shifted from one State to another so as to enable the obligation of all available funds prior to the end of the fiscal year. (c) The formula used for fund allocation will ensure that a minimum...

7 CFR 22.205 - Allocation of loan and grant funds.

Code of Federal Regulations, 2011 CFR

2011-01-01

... approved loan funding levels will be allocated among States by a formula designed to ensure equitable... allocations may be shifted from one State to another so as to enable the obligation of all available funds prior to the end of the fiscal year. (c) The formula used for fund allocation will ensure that a minimum...

7 CFR 22.205 - Allocation of loan and grant funds.

Code of Federal Regulations, 2014 CFR

2014-01-01

... approved loan funding levels will be allocated among States by a formula designed to ensure equitable... allocations may be shifted from one State to another so as to enable the obligation of all available funds prior to the end of the fiscal year. (c) The formula used for fund allocation will ensure that a minimum...

7 CFR 22.205 - Allocation of loan and grant funds.

Code of Federal Regulations, 2013 CFR

2013-01-01

... approved loan funding levels will be allocated among States by a formula designed to ensure equitable... allocations may be shifted from one State to another so as to enable the obligation of all available funds prior to the end of the fiscal year. (c) The formula used for fund allocation will ensure that a minimum...

Contextual Problem Defining: Learning to Think and Act from the Standpoint of Equity

ERIC Educational Resources Information Center

Pena, Edlyn Vallejo; Bensimon, Estela Mara; Colyar, Julia

2006-01-01

One of the most critical challenges facing institutions of higher education in the twenty-first century is the need to be more accountable for producing equitable educational outcomes for students of color. Although access to higher education has increased significantly over the past two decades, it has not translated into equitable educational…

"Assessment as Discourse": A Pre-Service Physics Teacher's Evolving Capacity to Support an Equitable Pedagogy

ERIC Educational Resources Information Center

Lyon, Edward G.

2013-01-01

One way to view "equitable pedagogy" is through an opportunity to learn (OTL) lens, meaning that regardless of race, class, or culture, a student has access to rigorous and meaningful content, as well as appropriate resources and instruction necessary to learn and demonstrate understanding of that content. Assessment holds a unique…

Does deregulation in community pharmacy impact accessibility of medicines, quality of pharmacy services and costs? Evidence from nine European countries.

PubMed

Vogler, Sabine; Habimana, Katharina; Arts, Danielle

2014-09-01

To analyse the impact of deregulation in community pharmacy on accessibility of medicines, quality of pharmacy services and costs. We analysed and compared community pharmacy systems in five rather deregulated countries (England, Ireland, the Netherlands, Norway, Sweden) and four rather regulated countries (Austria, Denmark, Finland, Spain). Data were collected by literature review, a questionnaire survey and interviews. Following a deregulation, several new pharmacies and dispensaries of Over-the-Counter (OTC) medicines tended to be established, predominantly in urban areas. Unless prevented by regulation, specific stakeholders, e.g. wholesalers, were seen to gain market dominance which limited envisaged competition. There were indications for an increased workload for pharmacists in some deregulated countries. Economic pressure to increase the pharmacy turnover through the sale of OTC medicines and non-pharmaceuticals was observed in deregulated and regulated countries. Prices of OTC medicines were not found to decrease after a deregulation in pharmacy. Access to pharmacies usually increases after a deregulation but this is likely to favour urban populations with already good accessibility. Policy-makers are recommended to take action to ensure equitable accessibility and sustainable competition in a more deregulated environment. No association between pharmaceutical expenditure and the extent of regulation/deregulation appears to exist. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

5 CFR 537.103 - Agency student loan repayment plans.

Code of Federal Regulations, 2010 CFR

2010-01-01

... recruitment, relocation, and retention incentives); (b) The situations in which the student loan repayment... employees (or job candidates) to receive student loan repayment benefits that ensures fair and equitable...

30 CFR 250.101 - Authority and applicability.

Code of Federal Regulations, 2014 CFR

2014-07-01

... energy needs; (2) Balance orderly energy resource development with protection of the human, marine, and coastal environments; (3) Ensure the public receives a fair and equitable return on the resources of the...

30 CFR 250.101 - Authority and applicability.

Code of Federal Regulations, 2013 CFR

2013-07-01

... energy needs; (2) Balance orderly energy resource development with protection of the human, marine, and coastal environments; (3) Ensure the public receives a fair and equitable return on the resources of the...

30 CFR 250.101 - Authority and applicability.

Code of Federal Regulations, 2012 CFR

2012-07-01

... energy needs; (2) Balance orderly energy resource development with protection of the human, marine, and coastal environments; (3) Ensure the public receives a fair and equitable return on the resources of the...

Canada’s northern food subsidy Nutrition North Canada: a comprehensive program evaluation

PubMed Central

Galloway, Tracey

2017-01-01

ABSTRACT Background: Nutrition North Canada (NNC) is a retail subsidy program implemented in 2012 and designed to reduce the cost of nutritious food for residents living in Canada’s remote, northern communities. The present study evaluates the extent to which NNC provides access to perishable, nutritious food for residents of remote northern communities. Design: Program documents, including fiscal and food cost reports for the period 2011–2015, retailer compliance reports, audits of the program, and the program’s performance measurement strategy are examined for evidence that the subsidy is meeting its objectives in a manner both comprehensive and equitable across regions and communities. Results: NNC lacks price caps or other means of ensuring food is affordable and equitably priced in communities. Gaps in food cost reporting constrain the program’s accountability. From 2011–15, no adjustments were made to community eligibility, subsidy rates, or the list of eligible foods in response to information provided by community members, critics, the Auditor General of Canada, and the program’s own Advisory Board. Measures to increase program accountability, such as increasing subsidy information on point-of-sale receipts, make NNC more visible but do nothing to address underlying accountability issues Conclusions: The current structure and regulatory framework of NNC are insufficient to ensure the program meets its goal. Both the volume and cost of nutritious food delivered to communities is highly variable and dependent on factors such as retailers’ pricing practices, over which the program has no control. It may be necessary to consider alternative forms of policy in order to produce sustainable improvements to food security in remote, northern communities. PMID:28151097

The views of stakeholders on controlled access schemes for high-cost antirheumatic biological medicines in Australia

PubMed Central

Lu, Christine Y; Ritchie, Jan; Williams, Ken; Day, Ric

2007-01-01

Background In Australia, government-subsidised access to high-cost medicines is "targeted" to particular sub-sets of patients under the Pharmaceutical Benefits Scheme to achieve cost-effective use. In order to determine how this access system could be improved, the opinions of key stakeholders on access to biological agents for rheumatoid arthritis were explored. Methods Thirty-six semi-structured interviews were conducted with persons from relevant stakeholder groups. These were transcribed verbatim, and analysed thematically. Results Controlled access to expensive medicines was considered to be equitable and practical; however, there was disagreement as to the method of defining the target patient populations. Other concerns included timeliness of access, excessive bureaucracy, and the need for additional resources to facilitate the scheme. Collaboration between stakeholders was deemed important because it allows more equitable distribution of limited resources. The majority considered that stakeholder consultation should have been broader. Most wanted increased transparency of the decision-making process, ongoing and timely review of access criteria, and an increased provision of information for patients. More structured communication between stakeholders was proposed. Conclusion The Pharmaceutical Benefit Scheme is adapting to meet the changing needs of patients. Provision of subsidised access to high-cost medicines in a manner that is affordable for individuals and society, and that is equitable and efficiently managed is challenging. The views of stakeholders on targeted access to anti-rheumatic biological medicines in Australia acknowledged this challenge and provided a number of suggestions for modifications. These could serve as a basis to inform the debate on how to change the processes and policies so as to improve the scheme. PMID:18096055

Investigating socio-economic inequity in access to and expenditures on routine immunization services in Anambra state.

PubMed

Sibeudu, Florence T; Uzochukwu, Benjamin S C; Onwujekwe, Obinna E

2017-02-01

Addressing existing inequities in the utilization of priority health services such as routine immunization is a current public health priority. Increasing access to routine immunization from the current low levels amongst all socio-economic status groups in Nigeria is challenging. However, little is known on the level of SES inequity in utilization of routine immunization services and such information which will inform the development of strategies for ensuring equitable provision of routine immunization services in the country. The study was a cross sectional household survey, which was undertaken in two randomly selected communities in Anambra State, southeast Nigeria. A pre-tested interviewer administered questionnaire was used to collect data on levels of access to RI by children under-2 years from randomly selected households. In each household, data was collected from the primary care givers or their representative (in their absence). The relationship between access to routine immunization and socio-economic status of households and other key variables was explored in data analysis. Households from high socio-economic status (well-off) groups utilized routine immunization services more than those that belong to low socio-economic status (poor) groups (X 2  = 9.97, p < 0.002). It was found that higher percentage of low socio-economic status households compared to the high socio-economic status households received routine immunization services at public health facilities. Households that belong to low socio-economic status groups had to travel longer distance to get to health facilities consequently incurring some transportation cost. The mean expenditures on service charge for routine immunization services (mostly informal payments) and transportation were US$1.84 and US$1.27 respectively. Logistic regression showed that access to routine immunization was positively related to socio-economic status and negatively related to distant of a household to a health facility. Ability to pay affects access to services, even when such services are free at point of consumption with lower socio-economic status groups having less access to services and also having other constraints such as transportation. Hence, innovative provision methods that will bring routine immunization services closer to the people and eliminate all formal and informal user fees for routine immunization will help to increase and improve equitable coverage with routine immunization services.

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…

Ensuring Quality Cancer Care: A Follow-Up Review of the Institute of Medicine’s Ten Recommendations for Improving the Quality of Cancer Care in America

PubMed Central

Spinks, Tracy; Albright, Heidi W.; Feeley, Thomas W.; Walters, Ron; Burke, Thomas W.; Aloia, Thomas; Bruera, Eduardo; Buzdar, Aman; Foxhall, Lewis; Hui, David; Summers, Barbara; Rodriguez, Alma; DuBois, Raymond; Shine, Kenneth I.

2011-01-01

Responding to growing concerns regarding the safety, quality, and efficacy of cancer care in the United States, the Institute of Medicine (IOM) of the National Academy of Sciences commissioned a comprehensive review of cancer care delivery in the US healthcare system in the late 1990s. The National Cancer Policy Board (NCPB), a twenty-member board with broad representation, performed this review. In its review, the NCPB focused on the state of cancer care delivery at that time, its shortcomings, and ways to measure and improve the quality of cancer care. The NCPB described an ideal cancer care system, where patients would have equitable access to coordinated, guideline-based care and novel therapies throughout the course of their disease. In 1999, the IOM published the results of this review in its influential report, Ensuring Quality Cancer Care. This report outlined ten recommendations, which, when implemented, would: 1) improve the quality of cancer care; 2) increase our understanding of quality cancer care; and, 3) reduce or eliminate access barriers to quality cancer care. Despite the fervor generated by this report, there are lingering doubts regarding the safety and quality of cancer care in the United States today. Increased awareness of medical errors and barriers to quality care, coupled with escalating healthcare costs, has prompted national efforts to reform the healthcare system. These efforts by healthcare providers and policymakers should bridge the gap between the ideal state described in Ensuring Quality Cancer Care and the current state of cancer care in the United States. PMID:22045610

Sharing water and benefits in transboundary river basins

NASA Astrophysics Data System (ADS)

Arjoon, Diane; Tilmant, Amaury; Herrmann, Markus

2016-06-01

The equitable sharing of benefits in transboundary river basins is necessary to solve disputes among riparian countries and to reach a consensus on basin-wide development and management activities. Benefit-sharing arrangements must be collaboratively developed to be perceived not only as efficient, but also as equitable in order to be considered acceptable to all riparian countries. The current literature mainly describes what is meant by the term benefit sharing in the context of transboundary river basins and discusses this from a conceptual point of view, but falls short of providing practical, institutional arrangements that ensure maximum economic welfare as well as collaboratively developed methods for encouraging the equitable sharing of benefits. In this study, we define an institutional arrangement that distributes welfare in a river basin by maximizing the economic benefits of water use and then sharing these benefits in an equitable manner using a method developed through stakeholder involvement. We describe a methodology in which (i) a hydrological model is used to allocate scarce water resources, in an economically efficient manner, to water users in a transboundary basin, (ii) water users are obliged to pay for water, and (iii) the total of these water charges is equitably redistributed as monetary compensation to users in an amount determined through the application of a sharing method developed by stakeholder input, thus based on a stakeholder vision of fairness, using an axiomatic approach. With the proposed benefit-sharing mechanism, the efficiency-equity trade-off still exists, but the extent of the imbalance is reduced because benefits are maximized and redistributed according to a key that has been collectively agreed upon by the participants. The whole system is overseen by a river basin authority. The methodology is applied to the Eastern Nile River basin as a case study. The described technique not only ensures economic efficiency, but may also lead to more equitable solutions in the sharing of benefits in transboundary river basins because the definition of the sharing rule is not in question, as would be the case if existing methods, such as game theory, were applied, with their inherent definitions of fairness.

Freeing data through The Polar Information Commons

NASA Astrophysics Data System (ADS)

de Bruin, Taco; Chen, Robert; Parsons, Mark; Carlson, David

2010-05-01

The polar regions are changing rapidly with dramatic global effect. Wise management of resources, improved decision support, and effective international cooperation on resource and geopolitical issues require deeper understanding and better prediction of these changes. Unfortunately, polar data and information remain scattered, scarce, and sporadic. Inspired by the Antarctic Treaty of 1959 that established the Antarctic as a global commons to be used only for peaceful purposes and scientific research, we assert that data and information about the polar regions are themselves "public goods" that should be shared ethically and with minimal constraint. We therefore envision the Polar Information Commons (PIC) as an open, virtual repository for vital scientific data and information that would provide a shared, community-based cyber-infrastructure fostering innovation, improving scientific efficiency, and encouraging participation in polar research, education, planning, and management. The PIC will build on the legacy of the International Polar Year (IPY), providing a long-term framework for access to and preservation of both existing and future data and information about the polar regions. Rapid change demands rapid data access. The PIC system will enable scientists to quickly expose their data to the world and share them through open protocols on the Internet. A PIC digital label will alert users and data centers to new polar data and ensure that usage rights are clear. The PIC will utilize the Science Commons Protocol for Implementing Open Access Data, which promotes open data access through the public domain coupled with community norms of practice to ensure use of data in a fair and equitable manner. A set of PIC norms is currently being developed in consultation with key polar data organizations and other stakeholders. We welcome inputs from the broad science community as we further develop and refine the PIC approach and move ahead with implementation.

Freeing data through The Polar Information Commons

NASA Astrophysics Data System (ADS)

de Bruin, T.; Chen, R. S.; Parsons, M. A.; Carlson, D. J.

2009-12-01

The polar regions are changing rapidly with dramatic global effect. Wise management of resources, improved decision support, and effective international cooperation on resource and geopolitical issues require deeper understanding and better prediction of these changes. Unfortunately, polar data and information remain scattered, scarce, and sporadic. Inspired by the Antarctic Treaty of 1959 that established the Antarctic as a global commons to be used only for peaceful purposes and scientific research, we assert that data and information about the polar regions are themselves “public goods” that should be shared ethically and with minimal constraint. We therefore envision the Polar Information Commons (PIC) as an open, virtual repository for vital scientific data and information that would provide a shared, community-based cyber-infrastructure fostering innovation, improving scientific efficiency, and encouraging participation in polar research, education, planning, and management. The PIC will build on the legacy of the International Polar Year (IPY), providing a long-term framework for access to and preservation of both existing and future data and information about the polar regions. Rapid change demands rapid data access. The PIC system will enable scientists to quickly expose their data to the world and share them through open protocols on the Internet. A PIC digital label will alert users and data centers to new polar data and ensure that usage rights are clear. The PIC will utilize the Science Commons Protocol for Implementing Open Access Data, which promotes open data access through the public domain coupled with community norms of practice to ensure use of data in a fair and equitable manner. A set of PIC norms is currently being developed in consultation with key polar data organizations and other stakeholders. We welcome inputs from the broad science community as we further develop and refine the PIC approach and move ahead with implementation.

Freeing data through The Polar Information Commons

NASA Astrophysics Data System (ADS)

de Bruin, T.; Chen, R. S.; Parsons, M. A.; Carlson, D. J.; Cass, K.; Finney, K.; Wilbanks, J.; Jochum, K.

2010-12-01

The polar regions are changing rapidly with dramatic global effect. Wise management of resources, improved decision support, and effective international cooperation on resource and geopolitical issues require deeper understanding and better prediction of these changes. Unfortunately, polar data and information remain scattered, scarce, and sporadic. Inspired by the Antarctic Treaty of 1959 that established the Antarctic as a global commons to be used only for peaceful purposes and scientific research, we assert that data and information about the polar regions are themselves “public goods” that should be shared ethically and with minimal constraint. ICSU’s Committee on Data (CODATA) therefore started the Polar Information Commons (PIC) as an open, virtual repository for vital scientific data and information. The PIC provides a shared, community-based cyber-infrastructure fostering innovation, improving scientific efficiency, and encouraging participation in polar research, education, planning, and management. The PIC builds on the legacy of the International Polar Year (IPY), providing a long-term framework for access to and preservation of both existing and future data and information about the polar regions. Rapid change demands rapid data access. The PIC system enables scientists to quickly expose their data to the world and share them through open protocols on the Internet. A PIC digital label will alert users and data centers to new polar data and ensure that usage rights are clear. The PIC utilizes the Science Commons Protocol for Implementing Open Access Data, which promotes open data access through the public domain coupled with community norms of practice to ensure use of data in a fair and equitable manner. A set of PIC norms has been developed in consultation with key polar data organizations and other stakeholders. We welcome inputs from the broad science community as we further develop and refine the PIC approach and move ahead with implementation.

New dialogue for the way forward in maternal health: addressing market inefficiencies.

PubMed

McCarthy, Katharine; Ramarao, Saumya; Taboada, Hannah

2015-06-01

Despite notable progress in Millennium Development Goal (MDG) five, to reduce maternal deaths three-quarters by 2015, deaths due to treatable conditions during pregnancy and childbirth continue to concentrate in the developing world. Expanding access to three effective and low-cost maternal health drugs can reduce preventable maternal deaths, if available to all women. However, current failures in markets for maternal health drugs limit access to lifesaving medicines among those most in need. In effort to stimulate renewed action planning in the post-MDG era, we present three case examples from other global health initiatives to illustrate how market shaping strategies can scale-up access to essential maternal health drugs. Such strategies include: sharing intelligence among suppliers and users to better approximate and address unmet need for maternal health drugs, introducing innovative financial strategies to catalyze otherwise unattractive markets for drug manufacturers, and employing market segmentation to create a viable and sustainable market. By building on lessons learned from other market shaping interventions and capitalizing on opportunities for renewed action planning and partnership, the maternal health field can utilize market dynamics to better ensure sustainable and equitable distribution of essential maternal health drugs to all women, including the most marginalized.

Challenges of using new and repurposed drugs for the treatment of multidrug-resistant tuberculosis in children.

PubMed

Schaaf, H Simon; Garcia-Prats, Anthony J; McKenna, Lindsay; Seddon, James A

2018-03-01

New and repurposed antituberculosis drugs are urgently needed to more safely and effectively treat multidrug-resistant (MDR) tuberculosis (TB) in children. Multiple challenges limit timely access to new MDR-TB treatments in children. Areas covered: Diagnosis of MDR-TB in children remains a barrier, with few children with MDR-TB diagnosed and treated. Other barriers to timely access to new and repurposed drugs are discussed, and include delayed initiation of paediatric trials, limited funding for paediatric drug development, fragmented regulatory systems and operational challenges. The status of access to current repurposed and novel drugs is presented. Expert commentary: More timely initiation of paediatric trials is needed and paediatric work should happen and be funded in parallel with each phase of adult trials. Better quality data, increased regulator resources and expertise, harmonization of regulatory requirements across borders/organisations and registration fee waivers would improve registration timelines. Improved diagnosis, recording and reporting will establish better demand. Improved systems for procurement and supply chain management would reduce in-country operational barriers to getting medications to children. The challenges must be addressed to ensure timely and equitable access to new drugs and regimens that are urgently needed for effective, safe and shorter treatment of children with MDR-TB.

Differential effects on socioeconomic groups of modelling the location of mammography screening clinics using Geographic Information Systems.

PubMed

Hyndman, J C; Holman, C D

2000-06-01

To evaluate spatial access to mammography clinics and to investigate whether relocating clinics can improve global access. To determine whether any change in access is distributed equitably between different social groups. The study was undertaken in Perth, Western Australia in 1996. It was an analysis of travel distances to mammography clinics, comparing distances to the pattern of existing clinics and modelled relocated clinics. The study population was the 151,162 women aged 40-64 years resident in Perth in 1991. Overall travel distances to the existing clinics was reduced by 14% when a GIS system was used to relocate them so as to minimise the travel distance for all women. The travel distance of the most disadvantaged groups fell by 2% and by 24% for the least disadvantaged group. GIS modelling can be used to advantage to evaluate potential locations for screening clinics that improve the access for the target population, however global analysis should be supplemented by analysis of special groups to ensure that no group is disadvantaged by the proposal. If new technology is not used to evaluate the placement of health services, population travel distances may be greater than necessary, with possible impacts on attendance rates.

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

25 CFR 39.401 - What is the purpose of this subpart?

Code of Federal Regulations, 2010 CFR

2010-04-01

....401 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR EDUCATION THE INDIAN SCHOOL... is to ensure accountability of administrative officials by creating procedures that are systematic... the equitable distribution of funds among schools. ...

Trade in health services in the ASEAN region.

PubMed

Arunanondchai, Jutamas; Fink, Carsten

2006-12-01

Promoting quality health services to large population segments is a key ingredient to human and economic development. At its core, healthcare policymaking involves complex trade-offs between promoting equitable and affordable access to a basic set of health services, creating incentives for efficiencies in the healthcare system and managing constraints in government budgets. International trade in health services influences these trade-offs. It presents opportunities for cost savings and access to better quality care, but it also raises challenges in promoting equitable and affordable access. This paper offers a discussion of trade policy in health services for the ASEAN region. It reviews the existing patterns of trade and identifies policy measures that could further harness the benefits from trade in health services and address potential pitfalls that deeper integration may bring about.

Neighborhood disparities in access to healthy foods and their effects on environmental justice

USDA-ARS?s Scientific Manuscript database

Environmental justice is concerned with an equitable distribution of environmental burdens. These burdens comprise immediate health hazards as well as subtle inequities, such as limited access to healthy foods. We reviewed the literature on neighborhood disparities in access to fast-food outlets and...

Bridging the Communication Divide: CMC and Deaf Individuals' Literacy Skills

ERIC Educational Resources Information Center

Garberoglio, Carrie Lou; Dickson, Duncan; Cawthon, Stephanie; Bond, Mark

2015-01-01

Deaf individuals frequently capitalize upon communication technologies that increase equitable access to communication in an ongoing, effortless manner. Those communication technologies create conditions that increase direct access to language and literacy. It is the lack of direct access to language that has been historically problematic for deaf…

Thoughts on Access, Differentiation, and Implementation of a Multicultural Curriculum

ERIC Educational Resources Information Center

Cavilla, Derek

2014-01-01

Identification of gifted students from diverse and underserved communities is traditionally low; however, there are ways to expand identification methods in order to make access to gifted education programs more equitable. Creation and implementation of multi-faceted and multi-dimensional assessments as well as tiered access into gifted education…

We Can Get There From Here : New Perspectives on Transportation Equity

DOT National Transportation Integrated Search

2016-09-01

Achieving transportation equity is a transportation system goal that is becoming increasingly important in both the public sector and academia. An equitable transportation system would ensure that the benefits and burdens created by transportation pr...

The identification and management of substance use disorders in anesthesiologists.

PubMed

Lefebvre, Lisa G; Kaufmann, I Michael

2017-02-01

The purpose of this article is to review current evidence for the identification and management of substance use disorders in anesthesiologists and to describe an approach to return to practice. Anesthesiologists experience substance use disorders at a rate reported to be 2.7 times that of other physicians. Effective evidence-based treatment is available for physicians with substance use disorders, including anesthesiologists. Significant barriers preventing access to such treatment still exist, some of which are specific to the physician cohort. Standard of care should involve ongoing monitoring of substance use disorders in a chronic disease management paradigm. The outcomes for anesthesiologists treated and monitored for a substance use disorder are similar to those for other physicians and significantly superior to those for the general population. Return to work is possible and is most effectively managed in an occupational health risk management model. The treatment of substance use disorders in anesthesiologists is effective, and a safe return to practice is possible in a majority of cases. National guidelines are needed to ensure equitable access to high-quality treatment and recovery monitoring for all Canadian physicians.

Learning from Recruitment Challenges: Barriers to Diagnosis, Treatment, and Research Participation for Latinos with Symptoms of Alzheimer's Disease

PubMed Central

Gelman, Caroline Rosenthal

2014-01-01

This paper discusses barriers to diagnosis and treatment of Alzheimer's disease (AD) and concomitantly to participation in AD research as elicited from 29 potential Latino participants who ultimately did not enroll in a study evaluating a caregiver intervention. Nearly half of all individuals contacting the researcher about the intervention study failed to meet criteria stipulating an existing AD diagnosis. Barriers to obtaining a diagnosis include lack of knowledge about AD, perceptions of memory loss as normal aging, and structural barriers to accessing care. A quarter of caregivers contacting the researcher felt too overwhelmed to participate. Many of these barriers have been previously identified as challenges to treatment, suggesting this is not just a methodological research problem but inextricably tied to larger issues of AD knowledge and service accessibility. Engaging Latino communities equitably in the assessment of needs and the process of addressing them, thus ensuring the validity and applicability of the research and findings, is important both for increasing this group's participation in relevant studies and for addressing existing health disparities. PMID:20029704

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…

From Access to Success: An Integrated Approach to Quality Higher Education Informed by Social Inclusion Theory and Practice

ERIC Educational Resources Information Center

Gidley, Jennifer M.; Hampson, Gary P.; Wheeler, Leone; Bereded-Samuel, Elleni

2010-01-01

Equitable access, success and quality in higher education are examined from a variety of ideological perspectives. "Quality" is positioned as a complex generic concept while "access" and "success" are identified as key concepts in the social inclusion domain, supplemented by the concept of "participation."…

Open Access to Scientific Literature: An Assessment of Awareness Support and Usage among Academic Librarians at Historically Black Colleges and Universities

ERIC Educational Resources Information Center

Evans, Marsha Ann Johnson

2012-01-01

Open Access (OA) to scholarly communications is a critical component in providing equitable admission to scholarly information and a key vehicle toward the achievement of global access to research in the knowledge building process. A standard and universally accepted process for guaranteeing OA permits complimentary access to knowledge, research…

Measurement and analysis of inequality of opportunity in access of maternal and child health care in Togo.

PubMed

Sanoussi, Yacobou

2017-12-04

Access to maternal and child health care in low- and middle-income countries such as Togo is characterized by significant inequalities. Most studies in the Togolese context have examined the total inequality of health and the determinants of individuals' health. Few empirical studies in Togo have focused on inequalities of opportunity in maternal and child health. To fill this gap, we estimated changes in inequality of opportunity in access to maternal and child health services between 1998 and 2013 using data from Togo Demographic and Health Surveys (DHS). We computed the Human Opportunity Index (HOI)-a measure of how individual, household, and geographic characteristics like sex and place of residence can affect individuals' access to services or goods that should be universal-using five indicators of access to healthcare and one composite indicator of access to adequate care for children. The five indicators of access were: birth in a public or private health facility; whether the child had received any vaccinations; access to prenatal care; prenatal care given by qualified staff; and having at least four antenatal visits. We then examined differences across the two years. Between 1998 and 2013, inequality of opportunities decreased for four out of six indicators. However, inequalities increased in access to antenatal care provided by qualified staff (5.9% to 12.5%) and access to adequate care (27.7% to 28.6%). Although inequality of opportunities reduced between 1998 and 2013 for some of the key maternal and child health indicators, the average coverage and access rates underscore the need for sustained efforts to ensure equitable access to primary health care for mothers and children.

Strategies for moving towards equity in recruitment of rural and Aboriginal research participants.

PubMed

Wong, Sabrina T; Wu, Leena; Boswell, Brooke; Housden, Laura; Lavoie, Josee

2013-01-01

Equitable recruitment strategies, designed to ensure improved opportunities to participate in the research, are needed to include First Nations (FN) communities. The purpose of this article is to report on a set of successful strategies trialed with rural and FN communities in Canada. The strategies discussed were designed as part of a larger mixed-method study examining the effectiveness of Group Medical Visits (GMVs) on the quality of primary healthcare (PHC) in both FN reserve and northern communities in British Columbia (BC). Community partners and the study's decision-maker partners helped to identify and recruit primary care practices and reserve communities who were offering GMVs. Eleven communities (6 rural and 5 FN reserve) within the Northern Health Authority, BC participated in the study. Participants completed a survey either in person or via telephone. Content analysis was conducted on team meeting and field notes, focusing on issues related to the data collection process. Financial analysis was conducted on monetary resources spent on recruitment efforts in the various communities. Data were recorded regarding the number of times potential participants were contacted and mode of interview. Descriptive statistics were used to examine whether there were differences by mode of data collection, gender, and FN status. Logistic regression was used to examine whether FN status remained statistically significant after controlling for sex, education, employment status, age and health status. Once people were contacted, participation rate was 68% with 269 (n=90 men, n=179 women) people. Of those who participated in the survey, 42% were from FN communities. Content analysis revealed two overarching categories: (1) communication and coordination of the geographically dispersed research team and participating communities was maintained using synchronous and asynchronous methods; and (2) flexibility was needed to tailor recruitment strategies. Financial resources required to achieve equitable recruitment across these communities can cost up to 17 times more than travel to sites accessible by a direct flight or car. The farther away from Prince George (BC's capital in the north), the more resources were needed to ensure equitable recruitment from a community. Community partners played a critical role in recruiting potential participants. Team members, particularly those from urban areas, require support to successfully navigate working in small northern communities. Achieving equity in recruitment requires flexibility, trusting partnerships within each community and regular communication among the research team. A significant portion of time and resources needs to be allocated towards travel to these communities. While achieving equity in recruiting research participants poses a number of challenges, including greater costs, research that ensures participation opportunities for rural and FN communities is likely to better inform effective strategies to meet the needs of these communities.

Montana Faxnet Project. Final Report.

ERIC Educational Resources Information Center

Brander, Linda L.

This report summarizes the activities and accomplishments of the Montana Faxnet Project, which was created to design and demonstrate a statewide document delivery network utilizing telefacsimile equipment that would create equitable access for all Montanans accessing and retrieving information, and reduce the waiting time for requested materials…

Coverage and equitability of interventions to prevent child mortality in rural Jimma and West Hararghe Zones, Oromia Region, Ethiopia.

PubMed

Miller, Nathan P; Degefie, Tedbabe; Hazel, Elizabeth; Legesse, Hailemariam; Tolera, Taye; Amouzou, Agbessi

2014-10-01

Interventions to prevent childhood illnesses are important components of the Ethiopian Health Extension Program (HEP). Although the HEP was designed to reduce inequities in access to health care, there is little evidence on equitability of preventive interventions in Ethiopia. This article describes coverage of preventive interventions and how many interventions individual children received We also examined which factors were associated with the number of preventive interventions received, and assessed the extent to which interventions were equitably distributed. We conducted a cross-sectional survey in 3,200 randomly selected households in the rural Jimma and West Hararghe Zones of Ethiopia's Oromia Region. We calculated coverage of 10 preventive interventions and a composite of eight interventions (co-coverage) representing the number of interventions received by children. Mul- tiple linear regressions were used to assess associations between co-coverage and explanatory variables. Finally, we assessed the equitability of preventive interventions by comparing coverage among children in the poorest and the least poor wealth quintiles. Coverage was less than 50% for six of the 10 interventions. Children received on average only three of the eight interventions included in the co-coverage calculation. Zone, gender, caretaker age, religion, and household wealth were all significantly associated with co-coverage, controlling for key covariates. Exclusive breastfeeding, vaccine uptake, and vitamin A supplementation were all relatively equitable. On the other hand, coverage of insecticide-treated nets or indoor residual spraying (ITN/IRS) and access to safe water were significantly higher among the least poor children compared to children in the poorest quintile. Coverage of key interventions to prevent childhood illnesses is generally low in Jimma and West Hararghe. Although a number of interventions were equitably distributed, there were marked wealth-based inequities for interventions that are possessed at the household level, even among relatively homogeneous rural communities.

Competency-Based Objectives in Global Underserved Women's Health for Medical Trainees.

PubMed

Chen, Chi Chiung Grace; Dougherty, Anne; Whetstone, Sara; Mama, Saifuddin T; Larkins-Pettigrew, Margaret; Raine, Susan P; Autry, Amy M

2017-10-01

The Association of Professors of Gynecology and Obstetrics Committee on Global Health developed an inclusive definition of global women's health and competency-based objectives that reflected work internationally, as well as with U.S. vulnerable and underserved populations, such as refugee and immigrant populations or those who would otherwise have compromised access to health care. The knowledge, skill, and attitude-based competencies required to fulfill each learning objective were mapped to the Accreditation Council for Graduate Medical Education Outcomes Project's educational domains and the Consortium of Universities for Global Health competency domains. The proposed global women's health definition and competency-based learning objective framework is a first step in ensuring quality standards for educating trainees to address global women's health needs. By proposing these objectives, we hope to guide future program development and spark a broader conversation that will improve health for vulnerable women and shape educational, ethical, and equitable global health experiences for medical trainees.

Emerging issues in public health genomics

PubMed Central

Roberts, J. Scott

2014-01-01

This review highlights emerging areas of interest in public health genomics. First, recent advances in newborn screening (NBS) are described, with a focus on practice and policy implications of current and future efforts to expand NBS programs (e.g., via next-generation sequencing). Next, research findings from the rapidly progressing field of epigenetics and epigenomics are detailed, highlighting ways in which our emerging understanding in these areas could guide future intervention and research efforts in public health. We close by considering various ethical, legal and social issues posed by recent developments in public health genomics; these include policies to regulate access to personal genomic information; the need to enhance genetic literacy in both health professionals and the public; and challenges in ensuring that the benefits (and burdens) from genomic discoveries and applications are equitably distributed. Needs for future genomics research that integrates across basic and social sciences are also noted. PMID:25184533

Evidence-based decision-making within Australia's pharmaceutical benefits scheme.

PubMed

Lopert, Ruth

2009-07-01

In Australia, most prescription drugs are subsidized through the Pharmaceutical Benefits Scheme (PBS), one of several government programs in which evidence-based decision making is applied to the funding of health technologies. PBS processes are intended to ensure "value for money" for the Australian taxpayer and to support affordable, equitable access to prescription medicines; they are not intended as a mechanism for cost containment. The inclusion of a drug on the national formulary depends on the recommendation of the Pharmaceutical Benefits Advisory Committee (PBAC), which considers not only the comparative effectiveness but also the comparative cost-effectiveness of drugs proposed for listing. While some decisions have been controversial, the PBS retains strong public support. Moreover, evidence does not suggest that the consideration of cost-effectiveness has created a negative environment for the drug industry: Australia has a high penetration of patented medicines, with prices for some recently approved drugs at U.S. levels.

Healthcare in Asia: a perspective from primary care at the gateway to a continent.

PubMed

Jiwa, Moyez; Othman, Sajaratulnisah; Hanafi, Nik Sherina; Ng, Chirk Jenn; Khoo, Ee Ming; Chia, Yook Chin

2012-01-01

Malaysia has achieved reasonable health outcomes even though the country spends a modest amount of Gross Domestic Product on healthcare. However, the country is now experiencing a rising incidence of both infectious diseases and chronic lifestyle conditions that reflect growing wealth in a vibrant and successful economy. With an eye on an ageing population, reform of the health sector is a government priority. As in other many parts of the world, general practitioners are the first healthcare professional consulted by patients. The Malaysian health system is served by public and private care providers. The integration of the two sectors is a key target for reform. However, the future health of the nation will depend on leadership in the primary care sector. This leadership will need to be informed by research to integrate care providers, empower patients, bridge cultural gaps and ensure equitable access to scarce health resources.

Vaccines to prevent pneumonia in children - a developing country perspective.

PubMed

Oliwa, Jacquie N; Marais, Ben J

2017-03-01

Pneumonia accounted for 15% of the 6.3 million deaths among children younger than five years in 2013, a total of approximately 935,000 deaths worldwide. Routine vaccination against common childhood illnesses has been identified as one of the most cost-effective strategies to prevent death from pneumonia. Vaccine-preventable or potentially preventable diseases commonly linked with respiratory tract infections include Streptococcus pneumoniae, Haemophilus influenza type-b (Hib), pertussis, influenza, measles, and tuberculosis. Although here have been great strides in the development and administration of effective vaccines, the countries that carry the largest disease burdens still struggle to vaccinate their children and newer conjugated vaccines remain out of reach for many. The Global Vaccine Action Plan (GVAP) has identified priority areas for innovation in research in all aspects of immunisation development and delivery to ensure equitable access to vaccines for all. Copyright © 2015 Elsevier Ltd. All rights reserved.

Litigation and Community Advocacy to Ensure Health Access for Micronesian Migrants in Hawai'i.

PubMed

Hagiwara, Megan Kiyomi; Yamada, Seiji; Tanaka, Wayne; Ostrowski, Deja Marie

2015-05-01

The Federated States of Micronesia and the Republics of Palau and the Marshall Islands signed a series of treaties known as the Compacts of Free Association (COFA) with the United States (U.S.). While the islands became independent nations, certain rights and responsibilities were assigned to the U.S. However since the signing of the treaties, U.S. federal and Hawai'i state policies have reduced health care coverage for COFA migrants living in the U.S. and its territories. This commentary reports the ongoing efforts of the Micronesian community and its allies to rectify a legacy of unjust policies. We outline the need for sound policies that support appropriate health care to all members of society, and highlight the community's strength and ability to mobilize for political action. If health is a human right, providing adequate, equitable health care to all members of society is not up for debate.

Comprehensive evaluation system of intelligent urban growth

NASA Astrophysics Data System (ADS)

Li, Lian-Yan; Ren, Xiao-Bin

2017-06-01

With the rapid urbanization of the world, urban planning has become increasingly important and necessary to ensure people have access to equitable and sustainable homes, resources and jobs.This article is to talk about building an intelligent city evaluation system.First,using System Analysis Model(SAM) which concludes literature data analysis and stepwise regression analysis to describe intelligent growth scientifically and obtain the evaluation index. Then,using the improved entropy method to obtain the weight of the evaluation index.Afterwards, establishing a complete Smart Growth Comprehensive Evaluation Model(SGCEM).Finally,testing the correctness of the model.Choosing Otago(New Zealand )and Yumen(China) as research object by data mining and SGCEM model,then we get Yumen and Otago’s rational degree’s values are 0.3485 and 0.5376 respectively. It’s believed that the Otago’s smart level is higher,and it is found that the estimated value of rationality is consistent with the reality.

Exploration of instruction, assessment, and equity in the middle school science classroom

NASA Astrophysics Data System (ADS)

Szpyrka, Donna A.

2001-07-01

In order to determine equitable practices of middle school science teachers questionnaire responses, classroom observations, teacher interviews, and assessment artifacts were examined to discover relationships between classroom instruction, assessment practices, and equity. Teachers in middle school science classrooms in six different schools completed a National Center for Education Statistics questionnaire, offered assessment artifacts, and participated in interviews. Observers using a classroom observation protocol and an equity profile rated 22 lessons. The study found that a distinction could be made between teachers who were more equitable and those who were less equitable. Careful planning and organization; the incorporation of tasks, roles, and interactions consistent with investigative science; a collaborative approach to learning; and instruction that takes into account what transpired in previous lessons---appear to be characteristics of lesson design of the more equitable teachers. In addition, instructional strategies and activities that addressed access, equity, and diversity as well as, a classroom climate that was respectful of students' contributions were found to a greater extent in the more equitable teachers' classrooms. While all teachers used multiple methods of assessment, the more equitable teachers used assessment differently. They also provided written feedback to students, relied on more than one aspect of student performance for determining grades, and explicated clear and specific assessment practices.

Tripartite Governance: Enabling Successful Implementations with Vulnerable Populations.

PubMed

Kennedy, Margaret Ann

2016-01-01

Vulnerable populations are often at a distinct disadvantage when it comes to the implementation of health information systems in an equitable, appropriate, and timely manner. The disadvantages experienced by vulnerable populations are innumerable and include lack of representation, lack of appropriate levels of funding, lack of resources and capacity, and lack of representation. Increasingly, models of representation for complex implementations involve a tripartite project governance model. This tripartite partnership distributes accountability across all partners, and ensures that vulnerable populations have an equitable contribution to the direction of implementation according to their needs. This article shares lessons learned and best practices from complex tripartite partnerships supporting implementations with vulnerable populations in Canada.

Did Tanzania Achieve the Second Millennium Development Goal? Statistical Analysis

ERIC Educational Resources Information Center

Magoti, Edwin

2016-01-01

Development Goal "Achieve universal primary education", the challenges faced, along with the way forward towards achieving the fourth Sustainable Development Goal "Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all". Statistics show that Tanzania has made very promising steps…

The Relationship Between Education and Prostate-Specific Antigen Testing Among Urban African American Medicare Beneficiaries

PubMed Central

Pollack, Craig Evan; Garza, Mary A.; Yeh, Hsin-Chieh; Markakis, Diane; Phelan-Emrick, Darcy F.; Wenzel, Jennifer; Shapiro, Gary R.; Bone, Lee; Johnson, Lawrence

2017-01-01

Purpose We examined the association between socioeconomic status (SES) and prostate-specific antigen (PSA) cancer screening among older African American men. Methods We analyzed baseline data from a sample of 485 community-dwelling African American men who participated in the Cancer Prevention and Treatment Demonstration Trial. The outcome was receipt of PSA screening within the past year. SES was measured using income and educational attainment. Sequential multivariate logistic regression models were performed to study whether health care access, patient–provider relationship, and cancer fatalism mediated the relationship between SES and PSA screening. Results Higher educational attainment was significantly associated with higher odds of PSA screening in the past year (odds ratio (OR) 2.08 for college graduate compared to less than high school graduate, 95 % confidence interval (CI) 1.03–4.24); income was not. Health care access and patient–provider communication did not alter the relationship between education and screening; however, beliefs regarding cancer fatalism partially mediated the observed relationship. Conclusion Rates of prostate cancer screening among African American men vary by level of educational attainment; beliefs concerning cancer fatalism help explain this gradient. Understanding the determinants of cancer fatalism is a critical next step in building interventions that seek to ensure equitable access to prostate cancer screening. PMID:26863336

The Relationship Between Education and Prostate-Specific Antigen Testing Among Urban African American Medicare Beneficiaries.

PubMed

Hararah, Mohammad Khalid; Pollack, Craig Evan; Garza, Mary A; Yeh, Hsin-Chieh; Markakis, Diane; Phelan-Emrick, Darcy F; Wenzel, Jennifer; Shapiro, Gary R; Bone, Lee; Johnson, Lawrence; Ford, Jean G

2015-06-01

We examined the association between socioeconomic status (SES) and prostate-specific antigen (PSA) cancer screening among older African American men. We analyzed baseline data from a sample of 485 community-dwelling African American men who participated in the Cancer Prevention and Treatment Demonstration Trial. The outcome was receipt of PSA screening within the past year. SES was measured using income and educational attainment. Sequential multivariate logistic regression models were performed to study whether health care access, patient-provider relationship, and cancer fatalism mediated the relationship between SES and PSA screening. Higher educational attainment was significantly associated with higher odds of PSA screening in the past year (odds ratio (OR) 2.08 for college graduate compared to less than high school graduate, 95 % confidence interval (CI) 1.03-4.24); income was not. Health care access and patient-provider communication did not alter the relationship between education and screening; however, beliefs regarding cancer fatalism partially mediated the observed relationship. Rates of prostate cancer screening among African American men vary by level of educational attainment; beliefs concerning cancer fatalism help explain this gradient. Understanding the determinants of cancer fatalism is a critical next step in building interventions that seek to ensure equitable access to prostate cancer screening.

Millennium Development Goal 5 and adolescents: looking back, moving forward

PubMed Central

Vogel, Joshua P; Pileggi-Castro, Cynthia; Chandra-Mouli, Venkatraman; Pileggi, Vicky Nogueira; Souza, João Paulo; Chou, Doris; Say, Lale

2015-01-01

Since the Millennium Declaration in 2000, unprecedented progress has been made in the reduction of global maternal mortality. Millennium Development Goal 5 (MDG 5; improving maternal health) includes two primary targets, 5A and 5B. Target 5A aimed for a 75% reduction in the global maternal mortality ratio (MMR), and 5B aimed to achieve universal access to reproductive health. Globally, maternal mortality since 1990 has nearly halved and access to reproductive health services in developing countries has substantially improved. In setting goals and targets for the post-MDG era, the global maternal health community has recognised that ultimate goal of ending preventable maternal mortality is now within reach. The new target of a global MMR of <70 deaths per 100 000 live births by 2030 is ambitious, yet achievable and to reach this target a significantly increased effort to promote and ensure universal, equitable access to reproductive, maternal and newborn services for all women and adolescents will be required. In this article, as we reflect on patterns, trends and determinants of maternal mortality, morbidity and other key MDG5 indicators among adolescents, we aim to highlight the importance of promoting and protecting the sexual and reproductive health and rights of adolescents as part of renewed global efforts to end preventable maternal mortality. PMID:25613967

Essential drugs in the new international economic environment.

PubMed Central

Velásquez, G.; Boulet, P.

1999-01-01

Recent global developments in the regulation of trade and intellectual property rights threaten to hinder the access of populations in developing countries to essential drugs. The authors argue for state intervention in the health and pharmaceutical markets in order to guarantee equitable access to these products. PMID:10212525

Digital Exclusion: Coming out from behind Closed Doors

ERIC Educational Resources Information Center

Watling, Sue

2011-01-01

Government visions of a digital future show little indication of how disabled people, reliant on access technology, will participate. Access technology has the potential to offer independent use of the Internet but many disabled people already face barriers that prevent them having equitable digital experiences. Multiple obstacles include high…

Strategies for Supporting Inclusive Education for Students with Disabilities

ERIC Educational Resources Information Center

Mumford, Vincent E.; Chandler, Judy Potter

2009-01-01

The Individuals with Disabilities Education Improvement Act (IDEA) of 2004 supports equitable access to educational opportunities for all children who have disabilities. IDEA requires that students who receive services for special needs receive a free appropriate public education, and have access to the general education curriculum, which includes…

Making "cents" of the business side of nurse practitioner practice.

PubMed

Luster-Tucker, AtNena

2016-03-15

Nurse practitioners produce excellent patient outcomes and should be allowed to practice to the full extent of their education and training. In addition to clinical skills, nurse practitioners need to understand the business side of practice in order to ensure fair and equitable compensation.

A bill to ensure the equitable treatment of swimming pool enclosures outside of hurricane season under the National Flood Insurance Program.

THOMAS, 112th Congress

Sen. Graham, Lindsey [R-SC

2011-05-23

Senate - 05/23/2011 Read twice and referred to the Committee on Banking, Housing, and Urban Affairs. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

Working Classes? Preparing for Employability

ERIC Educational Resources Information Center

Harney, John O.

2017-01-01

On June 28, the New England Board of Higher Education (NEBHE) convened members of the Commission on Higher Education and Employability (CHEE) in Providence to discuss concrete ways New England employers, education leaders and policymakers can work together to ensure a successful, equitable workforce future. The Commission comprises high-powered…

Assessing the Legality of State Tournament Bans in Interscholastic Athletics

ERIC Educational Resources Information Center

Scott, Beau

2017-01-01

State high school athletic associations are tasked with facilitating equitable athletic opportunities for all member schools. To accomplish this task, state associations implement rules designed to ensure competitive balance (Johnson, Tracy, & Pierce, 2015). With over 7.8 million participants, interscholastic athletics are extremely popular…

Effect of comprehensive breast care on breast cancer outcomes: a community hospital based study from Mumbai, India.

PubMed

Gadgil, Anita; Roy, Nobhojit; Sankaranarayanan, Rengaswamy; Muwonge, Richard; Sauvaget, Catherine

2012-01-01

Breast cancer is the second most common cancer in women in India and the disease burden is increasing annually. The lack of awareness initiatives, structured screening, and affordable treatment facilities continue to result in poor survival. We present a breast cancer survival scenario, in urban population in India, where standardised care is distributed equitably and free of charge through an employees' healthcare scheme. We studied 99 patients who were treated at our hospital during the period 2005 to 2010 and our follow-up rates were 95.95%. Patients received evidence-based standardised care in line with the tertiary cancer centre in Mumbai. One-, three- and five-year survival rates were calculated using Kaplan-Meier method. Socio-demographic, reproductive and tumor factors, relevant to survival, were analysed. Mortality hazard ratios (HR) were calculated using Cox proportional hazard method. Survival in this series was compared to that in registries across India and discrepancies were discussed. Patients mean age was 56 years, mean tumor size was 3.2 cms, 85% of the tumors belonged to T1 and T2 stages, and 45% of the patients belonged to the composite stages I and IIA. Overall 5-year survival was 74.9%. Patients who presented with large-sized tumors (HR 3.06; 95% CI 0.4-9.0), higher composite stage (HR 1.91; 0.55-6.58) and undergone mastectomy (HR 2.94; 0.63- 13.62) had a higher risk of mortality than women who had higher levels of education (HR 0.25; 0.05-1.16), although none of these results reached the significant statistical level. We observed 25% better survival compared to other Indian populations. Our results are comparable to those from the European Union and North America, owing to early presentation, equitable access to standardised free healthcare and complete follow-up ensured under the scheme. This emphasises that equitable and affordable delivery of standardised healthcare can translate into early presentation and better survival in India.

Making Sense of Mathematics

ERIC Educational Resources Information Center

Umphrey, Jan

2011-01-01

The National Council of Teachers of Mathematics (NCTM) is a voice and advocate for mathematics educators, working to ensure that all students receive equitable mathematics learning of the highest quality. To help teachers and school leaders understand the Common Core State Standards for Mathematics (CCSSM) and to point out how the CCSSM can be…

12 CFR 360.9 - Large-bank deposit insurance determination modernization.

Code of Federal Regulations, 2010 CFR

2010-01-01

... market discipline, ensure equitable treatment of depositors at different institutions and reduce the FDIC... section for a covered institution that: Has a composite rating of 3, 4, or 5 under the Uniform Financial... operations of a large insured depository institution (defined as a “Covered Institution”) to continue...

A Case Study of a Highly Effective, Inclusive Elementary School

ERIC Educational Resources Information Center

McLeskey, James; Waldron, Nancy L.; Redd, Lacy

2014-01-01

Current federal legislation holds schools accountable for ensuring that all students, including those with disabilities, make adequate yearly progress on academic achievement measures, while also including students with disabilities in general education settings whenever possible. Schools are thus expected to be both excellent and equitable in…

75 FR 59274 - Medicare and Medicaid Programs; Announcement of Application from Hospital Requesting Waiver for...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-27

...--(1) is expected to increase organ donations; and (2) will ensure equitable treatment of patients...] Medicare and Medicaid Programs; Announcement of Application from Hospital Requesting Waiver for Organ... require the hospital to enter into an agreement with its designated Organ Procurement Organization (OPO...

77 FR 24495 - Medicare and Medicaid Programs; Announcement of Application From a Hospital Requesting Waiver for...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-24

... increase organ donations; and (2) will ensure equitable treatment of patients referred for transplants...] Medicare and Medicaid Programs; Announcement of Application From a Hospital Requesting Waiver for Organ... require the hospital to enter into an agreement with its designated Organ Procurement Organization (OPO...

77 FR 60703 - Medicare and Medicaid Programs; Announcement of Application From Hospital Requesting Waiver for...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-04

... waiver--(1) is expected to increase organ donations; and (2) will ensure equitable treatment of patients...] Medicare and Medicaid Programs; Announcement of Application From Hospital Requesting Waiver for Organ... the requirement to have an agreement with its designated Organ Procurement Organization (OPO). The...

77 FR 51539 - Medicare and Medicaid Programs; Announcement of Application From a Hospital Requesting Waiver for...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-24

... expected to increase organ donations; and (2) will ensure equitable treatment of patients referred for...] Medicare and Medicaid Programs; Announcement of Application From a Hospital Requesting Waiver for Organ... the requirement to have an agreement with its designated Organ Procurement Organization (OPO). The...

75 FR 5599 - Medicare and Medicaid Programs; Announcement of Applications From Hospitals Requesting Waiver for...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-03

...--(1) is expected to increase organ donations; and (2) will ensure equitable treatment of patients...] Medicare and Medicaid Programs; Announcement of Applications From Hospitals Requesting Waiver for Organ... otherwise require the hospitals to enter into an agreement with their designated Organ Procurement...

Intelligibility Is Equity: Can International Students Read Undergraduate Admissions Materials?

ERIC Educational Resources Information Center

Taylor, Zachary W.

2018-01-01

Fewer international students have applied to and enrolled in US institutions, as 40 per cent of US institutions reported a drop in international applications since 2016. Subsequently, US institutions must ensure that their international admissions materials are as equitable and transparent as possible. Expanding previous work, this study examines…

Principals: Instructional Leaders to Support All Students

ERIC Educational Resources Information Center

Kroener, Julienne Patricia

2017-01-01

As principals work towards meeting the educational needs of all students, including students with disabilities, in an inclusive environment it is essential to understand the challenges that may occur throughout this process. This study examined the barriers that exist for principals as instructional leaders when ensuring equitable education for…

Promoting Creativity in the Middle Grades Language Arts Classroom

ERIC Educational Resources Information Center

Batchelor, Katherine E.; Bintz, William P.

2013-01-01

Middle level educators around the country aim to create a classroom environment and a way of teaching that is developmentally responsive, challenging, empowering, and equitable for every student. One way to ensure this is to include instruction that promotes creativity. This article offers guiding principles and shares instructional lessons that…

Ensuring Equitable Opportunities for Delaware's Undocumented Career and Technical School Population

ERIC Educational Resources Information Center

Vieni-Vento, Sarah R.

2012-01-01

This executive position paper proposes a legal process by which undocumented students enrolled in career and technical schools can obtain cooperative employment and pursue post-secondary opportunities. The recommended process is based on the current plight of undocumented students who are caught between harsh federal immigration policies and…

Perspectives of North American Postsecondary Students with Learning Disabilities: A Scoping Review

ERIC Educational Resources Information Center

Lightfoot, Amy; Janemi, Roya; Rudman, Debbie Laliberte

2018-01-01

Despite the existence of policies aimed at ensuring equitable opportunities for individuals with disabilities, at the postsecondary level, students with learning disabilities and/or attention deficit/hyperactivity disorder have lower enrollment and completion rates than those without disabilities. To optimize policies and practices to support…

Bariatric surgery: an IDF statement for obese Type 2 diabetes

PubMed Central

Dixon, J B; Zimmet, P; Alberti, K G; Rubino, F

2011-01-01

The International Diabetes Federation Taskforce on Epidemiology and Prevention of Diabetes convened a consensus working group of diabetologists, endocrinologists, surgeons and public health experts to review the appropriate role of surgery and other gastrointestinal interventions in the treatment and prevention of Type 2 diabetes. The specific goals were: to develop practical recommendations for clinicians on patient selection; to identify barriers to surgical access and suggest interventions for health policy changes that ensure equitable access to surgery when indicated; and to identify priorities for research. Bariatric surgery can significantly improve glycaemic control in severely obese patients with Type 2 diabetes. It is an effective, safe and cost-effective therapy for obese Type 2 diabetes. Surgery can be considered an appropriate treatment for people with Type 2 diabetes and obesity not achieving recommended treatment targets with medical therapies, especially in the presence of other major co-morbidities. The procedures must be performed within accepted guidelines and require appropriate multidisciplinary assessment for the procedure, comprehensive patient education and ongoing care, as well as safe and standardized surgical procedures. National guidelines for bariatric surgery need to be developed for people with Type 2 diabetes and a BMI of 35 kg/m2 or more. PMID:21480973

Virtual Tutoring and Student Support Systems

ERIC Educational Resources Information Center

Geary, Jennifer Lee

2005-01-01

Virtual tutoring and student support systems may be pivotal in developing opportunities of equality and of outcome for students who study at a distance. Cookson (2002) mentions that it is important to assist students to have access to study programs. Cookson (2002) elaborates upon this and states, "If access is to be equitable, once they are…

Climate Change: Providing Equitable Access to a Rigorous and Engaging Curriculum

ERIC Educational Resources Information Center

Cardichon, Jessica; Roc, Martens

2013-01-01

This report examines how implementing rigorous and engaging curriculum aligned with college- and career-ready standards fosters positive school climates in which students are motivated to succeed, achievement gaps narrow, and learning and outcomes improve. It includes federal, state, and local recommendations for increasing access to high-quality,…

Access and benefit sharing: Best practices for the use and exchange of invertebrate biological control agents

USDA-ARS?s Scientific Manuscript database

The Convention on Biological Diversity (CBD) acknowledges the sovereign rights that countries have over their ‘genetic resources’. The Nagoya Protocol that came into force in 2014 provides a framework for implementation of and equitable process by which access to, and sharing of benefits between don...

Research into Telecommunications Options for People with Physical Disabilities

ERIC Educational Resources Information Center

Nguyen, Toan; Garrett, Rob; Downing, Andrew; Walker, Lloyd; Hobbs, David

2007-01-01

People with a disability do not have equitable access to the modern telecommunication medium. Many experience difficulty typing, handling the phone, dialing, or answering calls. For those who are unable to speak, the only option is to type messages using whatever functional control site exists on their body. The provision of accessible mobile…

Engaging Youth of Color in Applied Science Education and Public Health Promotion

ERIC Educational Resources Information Center

Sprague Martinez, Linda; Bowers, Edmond; Reich, Amanda J.; Ndulue, Uchenna J.; Le, Albert An; Peréa, Flavia C.

2016-01-01

Participation in inquiry-based science education, which focuses on student-constructed learning, has been linked to academic success. Whereas the benefits of this type of science education are evident, access to such high-quality science curriculum and programming is not equitable. Black and Latino students in particular have less access to…

Improving Information Access through Technology: A Plan for Louisiana's Public Libraries.

ERIC Educational Resources Information Center

Jaques, Thomas F.

Strengthening technology in Louisiana's public libraries will support equitable and convenient access to electronic information resources for all citizens at library sites, in homes, and in business. The plan presented in this document is intended to enhance and expand technology in the state's public libraries. After discussion of the crucial…

Investigations in the Science of Sports.

ERIC Educational Resources Information Center

Hammrich, Penny L.; Fadigan, Kathleen

2003-01-01

Describes the Sisters in Sport Science (SISS) program which provides equitable access for girls to science and mathematics through sports. Includes a sample SISS activity that integrates track and physical sciences. (YDS)

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.

Is community-based health insurance an equitable strategy for paying for healthcare? Experiences from southeast Nigeria.

PubMed

Onwujekwe, Obinna; Onoka, Chima; Uzochukwu, Benjamin; Okoli, Chijioke; Obikeze, Eric; Eze, Soludo

2009-09-01

To determine how equitable enrolment and utilization of community-based health insurance is in two communities with varying levels of success in implementing the scheme. The study was undertaken in two communities in Anambra state, southeast Nigeria. Data was collected using a questionnaire that was administered to 971 respondents in two communities selected by simple random sampling. Data analysis examined socio-economic status (SES) differences in enrolment levels, utilization, willingness to renew registration and payments. Enrolment level was 15.5% in the non-successful community and 48.4% in the successful community (p<0.0001). However, there was no inequity in enrolment, willingness to renew registration and utilization of services. Equal amounts of money were paid as registration fee and premium by all SES quartiles. There were no exemptions and no subsidies. Enrolment was generally low and contributions were retrogressive. The average premiums were also small. However, there was equitable enrolment and utilization of services. Efforts need to be made to increase the number of enrolees, so as to increase the pool of funds and risks. Payments by enrolees especially in poor and rural communities should be supplemented by subsidies from government and donors in order to ensure equitable financial risk protection.

Corporatization of pain medicine: implications for widening pain care disparities.

PubMed

Meghani, Salimah H

2011-04-01

The current health care system in the United States is structured in a way that ensures that more opportunity and resources flow to the wealthy and socially advantaged. The values intrinsic to the current profit-oriented culture are directly antithetical to the idea of equitable access. A large body of literature points to disparities in pain treatment and pain outcomes among vulnerable groups. These disparities range from the presence of disproportionately higher numbers and magnitude of risk factors for developing disabling pain, lack of access to primary care providers, analgesics and interventions, lack of referral to pain specialists, longer wait times to receive care, receipt of poor quality of pain care, and lack of geographical access to pharmacies that carry opioids. This article examines the manner in which the profit-oriented culture in medicine has directly and indirectly structured access to pain care, thereby widening pain treatment disparities among vulnerable groups. Specifically, the author argues that the corporatization of pain medicine amplifies disparities in pain outcomes in two ways: 1) directly through driving up the cost of pain care, rendering it inaccessible to the financially vulnerable; and 2) indirectly through an interface with corporate loss-aversion/risk management culture that draws upon irrelevant social characteristics, thus worsening disparities for certain populations. Thus, while financial vulnerability is the core reason for lack of access, it does not fully explain the implications of corporate microculture regarding access. The effect of corporatization on pain medicine must be conceptualized in terms of overt access to facilities, providers, pharmaceuticals, specialty services, and interventions, but also in terms of the indirect or covert effect of corporate culture in shaping clinical interactions and outcomes. Wiley Periodicals, Inc.

Global health equity in United Kingdom university research: a landscape of current policies and practices.

PubMed

Gotham, Dzintars; Meldrum, Jonathan; Nageshwaran, Vaitehi; Counts, Christopher; Kumari, Nina; Martin, Manuel; Beattie, Ben; Post, Nathan

2016-10-10

Universities are significant contributors to research and technologies in health; however, the health needs of the world's poor are historically neglected in research. Medical discoveries are frequently licensed exclusively to one producer, allowing a monopoly and inequitable pricing. Similarly, research is often published in ways that make it inaccessible. Universities can adopt policies and practices to overcome neglect and ensure equitable access to research and its products. For 25 United Kingdom universities, data on health research funding were extracted from the top five United Kingdom funders' databases and coded as research on neglected diseases (NDs) and/or health in low- and lower-middle-income countries (hLLMIC). Data on intellectual property licensing policies and practices and open-access policies were obtained from publicly available sources and by direct contact with universities. Proportions of research articles published as open-access were extracted from PubMed and PubMed Central. Across United Kingdom universities, the median proportion of 2011-2014 health research funds attributable to ND research was 2.6% and for hLLMIC it was 1.7%. Overall, 79% of all ND funding and 74% of hLLMIC funding were granted to the top four institutions within each category. Seven institutions had policies to ensure that technologies developed from their research are affordable globally. Mostly, universities licensed their inventions to third parties in a way that confers monopoly rights. Fifteen institutions had an institutional open-access publishing policy; three had an institutional open-access publishing fund. The proportion of health-related articles with full-text versions freely available online ranged from 58% to 100% across universities (2012-2013); 23% of articles also had a creative commons CC-BY license. There is wide variation in the amount of global health research undertaken by United Kingdom universities, with a large proportion of total research funding awarded to a few institutions. To meet a level of research commitment in line with the global burden of disease, most universities should seek to expand their research activity. Most universities do not license their intellectual property in a way that is likely to encourage access in resource-poor settings, and lack policies to do so. The majority of recent research publications are published open-access, but not as gold standard (CC-BY) open-access.

Reducing Inequities in Neonatal Mortality through Adequate Supply of Health Workers: Evidence from Newborn Health in Brazil

PubMed Central

Sousa, Angelica; Dal Poz, Mario R.; Boschi-Pinto, Cynthia

2013-01-01

Introduction Progress towards the MDG targets on maternal and child mortality is hindered worldwide by large differentials between poor and rich populations. Using the case of Brazil, we investigate the extent to which policies and interventions seeking to increase the accessibility of health services among the poor have been effective in decreasing neonatal mortality. Methods With a panel data set for the 4,267 Minimum Comparable Areas (MCA) in Brazil in 1991 and 2000, we use a fixed effect regression model to evaluate the effect of the provision of physicians, nurse professionals, nurse associates and community health workers on neonatal mortality for poor and non-poor areas. We additionally forecasted the neonatal mortality rate in 2005. Results We find that the provision of health workers is particularly important for neonatal mortality in poor areas. Physicians and especially nurse professionals have been essential in decreasing neonatal mortality: an increase of one nurse professional per 1000 population is associated with a 3.8% reduction in neonatal mortality while an increase of one physician per 1000 population is associated with a 2.3% reduction in neonatal mortality. We also find that nurse associates are less important for neonatal mortality (estimated reduction effect of 1.2% ) and that community health workers are not important particularly among the poor. Differences in the provision of health workers explain a large proportion of neonatal mortality. Discussion In this paper, we show new evidence to inform decision making on maternal and newborn health. Reductions in neonatal mortality in Brazil have been hampered by the unequal distribution of health workers between poor and non-poor areas. Thus, special attention to a more equitable health system is required to allocate the resources in order to improve the health of poor and ensure equitable access to health services to the entire population. PMID:24073222

Reducing inequities in neonatal mortality through adequate supply of health workers: evidence from newborn health in Brazil.

PubMed

Sousa, Angelica; Dal Poz, Mario R; Boschi-Pinto, Cynthia

2013-01-01

Progress towards the MDG targets on maternal and child mortality is hindered worldwide by large differentials between poor and rich populations. Using the case of Brazil, we investigate the extent to which policies and interventions seeking to increase the accessibility of health services among the poor have been effective in decreasing neonatal mortality. With a panel data set for the 4,267 Minimum Comparable Areas (MCA) in Brazil in 1991 and 2000, we use a fixed effect regression model to evaluate the effect of the provision of physicians, nurse professionals, nurse associates and community health workers on neonatal mortality for poor and non-poor areas. We additionally forecasted the neonatal mortality rate in 2005. We find that the provision of health workers is particularly important for neonatal mortality in poor areas. Physicians and especially nurse professionals have been essential in decreasing neonatal mortality: an increase of one nurse professional per 1000 population is associated with a 3.8% reduction in neonatal mortality while an increase of one physician per 1000 population is associated with a 2.3% reduction in neonatal mortality. We also find that nurse associates are less important for neonatal mortality (estimated reduction effect of 1.2% ) and that community health workers are not important particularly among the poor. Differences in the provision of health workers explain a large proportion of neonatal mortality. In this paper, we show new evidence to inform decision making on maternal and newborn health. Reductions in neonatal mortality in Brazil have been hampered by the unequal distribution of health workers between poor and non-poor areas. Thus, special attention to a more equitable health system is required to allocate the resources in order to improve the health of poor and ensure equitable access to health services to the entire population.

Unfinished Business: Addressing Unequal Opportunities in Education

ERIC Educational Resources Information Center

Cookson, Peter W., Jr.

2015-01-01

In October 2014, the US Department of Education's Office of Civil Rights issued a clarion call to school districts and states to review their policies and practices in order to ensure they are equitably providing educational resources to their schools. The quality of classroom instruction and the quality of the organizational systems supporting…

Managing and Collecting Student Accounts and Loans: A Desk Reference for Educational Receivables Stewardship

ERIC Educational Resources Information Center

Glezerman, David R.; DeSantis, Dennis

2008-01-01

This handy desk reference will help readers and their institutions develop and maintain a professional environment that will maximize efficiencies and provide the necessary skills to properly manage operations and portfolios while ensuring that students receive fair and equitable service and opportunities. Written for business officers, financial…

Is Racial and Ethnic Equity Possible in Juvenile Justice?

ERIC Educational Resources Information Center

Bilchik, Shay

2008-01-01

Promising approaches in both policy and practice have emerged that should serve as beacons to guide professionals as they renew their determination to ensure fairness for all races and ethnicities in child serving systems. Indeed, when those systems are equitably treating children of color, then all children will benefit. The Center for Juvenile…

NCAA[R] Drug-Testing Program, 1999-2000.

ERIC Educational Resources Information Center

Halpin, Ty, Ed.

The drug testing program supports NCAA's goal to protect the health and safety of student-athletes competing for their institutions, while reaffirming the organization's commitment to fair and equitable competition. Proposal Nos. 30 and 52-54 provide a program for the NCAA's members to ensure that no one athlete has a chemically-induced advantage…

An Evaluation of Virtual Home Visits in Early Intervention: Feasibility of "Virtual Intervention"

ERIC Educational Resources Information Center

Olsen, Sue; Fiechtl, Barbara; Rule, Sarah

2012-01-01

The provision of consistent high quality home- and community-based services to children with disabilities living in rural and frontier areas is a challenge. Distance, weather, geographic terrain (mountains, canyons), and shortages of pediatric early interventionists are among the challenges to ensuring appropriate and equitable services.…

State Financial Aid: Policies to Enhance Articulation and Transfer

ERIC Educational Resources Information Center

Long, Bridget Terry

2005-01-01

Financing and financial aid issues in higher education continue to plague state policymakers and higher education leaders. Every year, they struggle with questions of how to meet growing needs through state allocations, how best to ensure shared and equitable responsibility for paying for higher education, and how best to use subsidies such as…

75 FR 59272 - Medicare and Medicaid Programs; Announcement of an Application from a Hospital Requesting Waiver...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-27

... waiver--(1) is expected to increase organ donations; and (2) will ensure equitable treatment of patients...] Medicare and Medicaid Programs; Announcement of an Application from a Hospital Requesting Waiver for Organ... require the hospital to enter into an agreement with its designated Organ Procurement Organization (OPO...

75 FR 21337 - Medicare and Medicaid Programs; Announcement of an Application From a Hospital Requesting Waiver...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-23

... waiver--(1) Is expected to increase organ donations; and (2) will ensure equitable treatment of patients...] Medicare and Medicaid Programs; Announcement of an Application From a Hospital Requesting Waiver for Organ... require the hospital to enter into an agreement with its designated Organ Procurement Organization (OPO...

Preparing Transformative Leaders for Diversity, Immigration, and Equitable Expectations for School-Wide Excellence

ERIC Educational Resources Information Center

Liou, Daniel D.; Hermanns, Carl

2017-01-01

Purpose: The purpose of this paper is to describe and analyze an Arizona university's educational leadership program and the revisioning/restructuring process that program faculty have engaged in to ensure that the program provides aspiring school leaders with the conceptual knowledge, dispositions, and skills necessary to transform their schools…

GPE's Engagement on Domestic Financing for Education. Policy Brief

ERIC Educational Resources Information Center

Martinez, Raphaelle; Terway, Arushi

2016-01-01

The Global Partnership for Education (GPE) is a global, multi-stakeholder partnership that seeks to strengthen education systems in low- and lower-middle-income countries and in countries affected by fragility and conflict to ensure equitable, quality education for all. GPE plays a unique role in helping governments to develop and finance the…

How to Educate Children for Sustainable Learning and for a Sustainable World

ERIC Educational Resources Information Center

Samuelsson, Ingrid Pramling; Park, Eunhye

2017-01-01

This article discusses how early learning might be made sustainable for children. It considers the application of Goal 4 of the Sustainable Development Goals to early childhood education to ensure that inclusive and equitable quality education that promotes lifelong learning opportunities is available to all children. Early childhood practitioners…

75 FR 15718 - MMS Information Collection Activity: 1010-0086, Sulphur Operations, Extension of a Collection...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-30

... under a lease. Operations on the OCS must preserve, protect, and develop oil and natural gas resources... human, marine, and coastal environments; to ensure the public a fair and equitable return on the...; provide for safety and protection of the environment; and result in diligent exploration, development, and...

Open Education and the Sustainable Development Goals: Making Change Happen

ERIC Educational Resources Information Center

Lane, Andy

2017-01-01

Education for All has been a concept at the heart of international development since 1990 and has found its latest instantiation within the Sustainable Development Goals (SDGs) as SDG 4, "Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all". Open education, in the form of resources and…

Gender Play and Good Governance

ERIC Educational Resources Information Center

Powell, Mark

2008-01-01

Like good government, thoughtful care of children requires those in power, whether teachers or parents, to recognize when it is appropriate for them to step back from day-to-day decision-making while still working behind the scenes to ensure an organizational structure that supports the independence and equitable development of those they serve.…

"Does It Answer the Question or Is It French Fries?": An Exploration of Language Supports for Scientific Argumentation

ERIC Educational Resources Information Center

González-Howard, María; McNeill, Katherine L.; Marco-Bujosa, Lisa M.; Proctor, C. Patrick

2017-01-01

Reform initiatives around the world are reconceptualising science education by stressing student engagement in science practices. Yet, science practices are language-intensive, requiring students to have strong receptive and productive language proficiencies. It is critical to address these rigorous language demands to ensure equitable learning…

78 FR 69118 - Information Collection Activities: General; Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-18

... human, marine, and coastal environments; to ensure the public a fair and equitable return on the... ``operations in the [O]uter Continental Shelf should be conducted in a safe manner by well trained personnel... subsoil and seabed, or other occurrences which may cause damage to the environment or to property or...

Whose Parallellingualism? Overt and Covert Ideologies in Danish University Language Policies

ERIC Educational Resources Information Center

Hultgren, Anna Kristina

2014-01-01

This paper aims to contribute to the study of multilingualism in the workplace by analysing top-down language policies advocating parallellingualism at Denmark's eight universities. Parallellingualism, a key concept in Nordic language policy, has been suggested as a way to ensure an equitable balance between English and the Nordic language(s)…

Making reasonable and achievable adjustments: the contributions of learning disability liaison nurses in 'Getting it right' for people with learning disabilities receiving general hospitals care.

PubMed

MacArthur, Juliet; Brown, Michael; McKechanie, Andrew; Mack, Siobhan; Hayes, Matthew; Fletcher, Joan

2015-07-01

To examine the role of learning disability liaison nurses in facilitating reasonable and achievable adjustments to support access to general hospital services for people with learning disabilities. Mixed methods study involving four health boards in Scotland with established Learning Disability Liaison Nurses (LDLN) Services. Quantitative data of all liaison nursing referrals over 18 months and qualitative data collected from stakeholders with experience of using the liaison services within the previous 3-6 months. Six liaison nurses collected quantitative data of 323 referrals and activity between September 2008-March 2010. Interviews and focus groups were held with 85 participants included adults with learning disabilities (n = 5), carers (n = 16), primary care (n = 39), general hospital (n = 19) and liaison nurses (n = 6). Facilitating reasonable and achievable adjustments was an important element of the LDLNs' role and focussed on access to information; adjustments to care; appropriate environment of care; ensuring equitable care; identifying patient need; meeting patient needs; and specialist tools/resources. Ensuring that reasonable adjustments are made in the general hospital setting promotes person-centred care and equal health outcomes for people with a learning disability. This view accords with 'Getting it right' charter produced by the UK Charity Mencap which argues that healthcare professionals need support, encouragement and guidance to make reasonable adjustments for this group. LDLNs have an important and increasing role to play in advising on and establishing adjustments that are both reasonable and achievable. © 2015 John Wiley & Sons Ltd.

Helping Children to Learn at Home: A Family Project to Support Young English-Language Learners

ERIC Educational Resources Information Center

Jasinski, Mary-Anne

2012-01-01

The Coalition for Equal Access to Education (CEAE) is a Calgary-based nonprofit organization committed to working with community, education, and government stakeholders to promote access to quality, equitable education and services for K-12 English-as-a-second-language (ESL) learners. CEAE is active in developing innovative projects, research…

Faculty-Librarian Collaboration for Library Services in the Online Classroom: Student Evaluation Results and Recommended Practices for Implementation

ERIC Educational Resources Information Center

Figa, Elizabeth; Bone, Tonda; Macpherson, Janet R.

2009-01-01

Student success is influenced by their ability to access, evaluate, and use resources. Traditionally, academic librarianship has provided students with these information literacy skills. The increase in distance learning options has created the need for libraries to provide both reference services equitable to those available onsite and access to…

Digital Revolution or Digital Divide: Will Rural Teachers Get a Piece of the Professional Development Pie?

ERIC Educational Resources Information Center

Broadley, Tania

2010-01-01

In order to sustain the rural education community, access to high quality professional development opportunities must become a priority. Teachers in rural areas face many challenges in order to access professional learning equitable to their city counterparts. In the current climate, the Federal government of Australia is committed to initiatives…

The US Culture Collection Network responding to the requirements of the Nagoya Protocol on Access and Benefit Sharing

USDA-ARS?s Scientific Manuscript database

The US Culture Collection Network held a meeting to share information about how collections are responding to the requirements of the recently enacted Nagoya Protocol on Access to Genetic Resources and the Fair and Equitable Sharing of Benefits Arising from their Utilization to the Convention on Bio...

Can local people also gain from benefit sharing in water resources development? Experiences from dam development in the Orange-Senqu River Basin

NASA Astrophysics Data System (ADS)

Mokorosi, Palesa Selloane; van der Zaag, Pieter

The concept of sharing benefits derived from beneficial uses of water is increasingly embraced in numerous international discourses in place of sharing water in volumes among nations riparian to common water bodies. Many benefit-sharing efforts involve building of dams and inter-basin transfer schemes. These infrastructures have been blamed to be posing environmental and social costs and directly affecting local people ( Gupta and van der Zaag, 2007) [Gupta, J., van der Zaag, P., 2007. Inter-basin water transfers and integrated water resources management: Where engineering, science and politics interlock. Physics and Chemistry of the Earth doi:10.1016/j.pce.2007.04.003]. This paper attempts to find attributes that lead towards recognising the rights of affected people and the mechanisms that may ensure access of direct benefits to them. Four theoretical factors are identified as key in recognising the rights of the affected people and were adopted as the analytical framework: a. Appropriate legal and policy framework, b. Public participation, c. Sustainable compensation measures, and d. Equitable access of derived benefits. In order to complement these theoretical factors, the study compared two large water development projects in the Orange-Senqu river basin: the Orange River Development Project and the Lesotho Highlands Water Project. In both projects, several large dams were constructed and water was transferred from one river into another. The following are the findings of the paper: a) the political environment through the legal and institutional framework plays a major role in protecting or marginalising the affected people; b) compensation measures for lost properties left many affected people destitute and food insecure; c) affected people mainly benefited from the indirect benefits of the projects instead of direct benefits. In order to ensure access to direct benefits for the affected people it is recommended that a) the national legislation must support the concept, b) mechanisms for allocating benefits to the affected people must be defined at project planning stage and should aim at long-term development goals, and c) local authorities must have sufficient capacity to ensure smooth operation.

Challenges in immunisation service delivery for refugees in Australia: A health system perspective.

PubMed

Mahimbo, A; Seale, H; Smith, M; Heywood, A

2017-09-12

Refugees are at risk of being under-immunised in their countries of origin, in transit and post-resettlement in Australia. Whilst studies have focused on identifying barriers to accessibility of health services among refugees, few focus on providers' perspectives on immunisation service delivery to this group. Health service providers are well placed to provide insights into the pragmatic challenges associated with refugee health service delivery, which can be useful in identifying strategies aimed at improving immunisation coverage among this group. A qualitative study involving 30 semi-structured interviews was undertaken with key stakeholders in immunisation service delivery across all States and Territories in Australia between December 2014 and December 2015. Thematic analysis was undertaken. Variability in accessing program funding and vaccines, lack of a national policy for catch-up vaccination, unclear roles and responsibilities for catch-up, a lack of a central immunisation register and insufficient training among general practitioners were seen as the main challenges impacting on immunisation service delivery for refugees. This study provides insight into the challenges that impact on effective immunisation service delivery for refugees. Deliberate strategies such as national funding for relevant vaccines, improved data collection nationally and increased guidance for general practitioners on catch-up immunisation for refugees would help to ensure equitable access across all age groups. Copyright © 2017 Elsevier Ltd. All rights reserved.

Strategies for gender-equitable HIV services in rural India.

PubMed

Sinha, Gita; Peters, David H; Bollinger, Robert C

2009-05-01

The emergence of HIV in rural India has the potential to heighten gender inequity in a context where women already suffer significant health disparities. Recent Indian health policies provide new opportunities to identify and implement gender-equitable rural HIV services. In this review, we adapt Mosley and Chen's conceptual framework of health to outline determinants for HIV health services utilization and outcomes. Examining the framework through a gender lens, we conduct a comprehensive literature review for gender-related gaps in HIV clinical services in rural India, focusing on patient access and outcomes, provider practices, and institutional partnerships. Contextualizing findings from rural India in the broader international literature, we describe potential strategies for gender-equitable HIV services in rural India, as responses to the following three questions: (1) What gender-specific patient needs should be addressed for gender-equitable HIV testing and care? (2) What do health care providers need to deliver HIV services with gender equity? (3) How should institutions enforce and sustain gender-equitable HIV services? Data at this early stage indicate substantial gender-related differences in HIV services in rural India, reflecting prevailing gender norms. Strategies including gender-specific HIV testing and care services would directly address current gender-specific patient needs. Rural care providers urgently need training in gender sensitivity and HIV-related communication and clinical skills. To enforce and sustain gender equity, multi-sectoral institutions must establish gender-equitable medical workplaces, interdisciplinary HIV services partnerships, and oversight methods, including analysis of gender-disaggregated data. A gender-equitable approach to rural India's rapidly evolving HIV services programmes could serve as a foundation for gender equity in the overall health care system.

Strategies for gender-equitable HIV services in rural India

PubMed Central

Sinha, Gita; Peters, David H; Bollinger, Robert C

2009-01-01

The emergence of HIV in rural India has the potential to heighten gender inequity in a context where women already suffer significant health disparities. Recent Indian health policies provide new opportunities to identify and implement gender-equitable rural HIV services. In this review, we adapt Mosley and Chen's conceptual framework of health to outline determinants for HIV health services utilization and outcomes. Examining the framework through a gender lens, we conduct a comprehensive literature review for gender-related gaps in HIV clinical services in rural India, focusing on patient access and outcomes, provider practices, and institutional partnerships. Contextualizing findings from rural India in the broader international literature, we describe potential strategies for gender-equitable HIV services in rural India, as responses to the following three questions: (1) What gender-specific patient needs should be addressed for gender-equitable HIV testing and care? (2) What do health care providers need to deliver HIV services with gender equity? (3) How should institutions enforce and sustain gender-equitable HIV services? Data at this early stage indicate substantial gender-related differences in HIV services in rural India, reflecting prevailing gender norms. Strategies including gender-specific HIV testing and care services would directly address current gender-specific patient needs. Rural care providers urgently need training in gender sensitivity and HIV-related communication and clinical skills. To enforce and sustain gender equity, multi-sectoral institutions must establish gender-equitable medical workplaces, interdisciplinary HIV services partnerships, and oversight methods, including analysis of gender-disaggregated data. A gender-equitable approach to rural India's rapidly evolving HIV services programmes could serve as a foundation for gender equity in the overall health care system. PMID:19244284

Getting Data Right - and Righteous to Improve Hispanic or Latino Health.

PubMed

Rodríguez-Lainz, Alfonso; McDonald, Mariana; Penman-Aguilar, Ana; Barrett, Drue H

2016-01-01

Hispanics or Latinos constitute the largest racial/ethnic minority in the United States. They are also a very diverse population. Latino/Hispanic's health varies significantly for subgroups defined by national origin, race, primary language, and migration-related factors (place of birth, immigration status, years of residence in the United States). Most Hispanics speak Spanish at home, and one-third have limited English proficiency (LEP). There is growing awareness on the importance for population health monitoring programs to collect those data elements (Hispanic subgroup, primary language, and migration-related factors) that better capture Hispanics' diversity, and to provide language assistance (translation of data collection forms, interpreters) to ensure meaningful inclusion of all Latinos/Hispanics in national health monitoring. There are strong ethical and scientific reasons for such expansion of data collection by public health entities. First, expand data elements can help identify otherwise hidden Hispanic subpopulations' health disparities. This may promote a more just and equitable distribution of health resources to underserved populations. Second, language access is needed to ensure fair and legal treatment of LEP individuals in federally supported data collection activities. Finally, these strategies are likely to improve the quality and representativeness of data needed to monitor and address the health of all Latino/Hispanic populations in the United States.

Getting Data Right — and Righteous to Improve Hispanic or Latino Health

PubMed Central

Rodríguez-Lainz, Alfonso; McDonald, Mariana; Penman-Aguilar, Ana; Barrett, Drue H.

2017-01-01

Hispanics or Latinos constitute the largest racial/ethnic minority in the United States. They are also a very diverse population. Latino/Hispanic’s health varies significantly for subgroups defined by national origin, race, primary language, and migration-related factors (place of birth, immigration status, years of residence in the United States). Most Hispanics speak Spanish at home, and one-third have limited English proficiency (LEP). There is growing awareness on the importance for population health monitoring programs to collect those data elements (Hispanic subgroup, primary language, and migration-related factors) that better capture Hispanics’ diversity, and to provide language assistance (translation of data collection forms, interpreters) to ensure meaningful inclusion of all Latinos/Hispanics in national health monitoring. There are strong ethical and scientific reasons for such expansion of data collection by public health entities. First, expand data elements can help identify otherwise hidden Hispanic subpopulations’ health disparities. This may promote a more just and equitable distribution of health resources to underserved populations. Second, language access is needed to ensure fair and legal treatment of LEP individuals in federally supported data collection activities. Finally, these strategies are likely to improve the quality and representativeness of data needed to monitor and address the health of all Latino/Hispanic populations in the United States. PMID:29416934

Fair and Equitable Postal Service Access Act

THOMAS, 112th Congress

Rep. Moore, Gwen [D-WI-4

2011-09-15

House - 10/03/2011 Referred to the Subcommittee on Federal Workforce, U.S. Postal Service, and Labor Policy . (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

Noninvasive Prenatal Genetic Testing: Current and Emerging Ethical, Legal, and Social Issues.

PubMed

Minear, Mollie A; Alessi, Stephanie; Allyse, Megan; Michie, Marsha; Chandrasekharan, Subhashini

2015-01-01

Noninvasive prenatal genetic testing (NIPT) for chromosomal aneuploidy involving the analysis of cell-free fetal DNA became commercially available in 2011. The low false-positive rate of NIPT, which reduces unnecessary prenatal invasive diagnostic procedures, has led to broad clinician and patient adoption. We discuss the ethical, legal, and social issues raised by rapid and global dissemination of NIPT. The number of women using NIPT is anticipated to expand, and the number of conditions being tested for will continue to increase as well, raising concerns about the routinization of testing and negative impacts on informed decision making. Ensuring that accurate and balanced information is available to all pregnant women and that access to NIPT is equitable will require policy guidance from regulators, professional societies, and payers. Empirical evidence about stakeholders' perspectives and experiences will continue to be essential in guiding policy development so that advances in NIPT can be used effectively and appropriately to improve prenatal care.

The Affordable Care Act and genetic testing for inheritable cancer syndromes: impact on high-risk underserved minorities.

PubMed

Walcott, Farzana L; Dunn, Barbara K; DeShields, Mary; Baquet, Claudia

2014-02-01

Genetic testing for inheritable cancer syndromes is becoming a critical part of preventive health services. The Patient Protection and Affordable Care Act (PPACA) Essential Health Benefits package addresses breast cancer susceptibility-gene testing for women who are unaffected by cancer. The absence of provisions for 1) men, 2) cancer patients, 3) other inheritable cancer syndromes, and 4) risk-reducing interventions are limitations of PPACA. We discuss provisions and limitations of PPACA pertaining to genetic testing and effects on high-risk populations, in particular minorities. The PPACA is the beginning of an ongoing process of incorporating genetic testing in the armamentarium of cancer prevention. Future efforts should focus on ensuring equitable access to genetic testing as a preventive service under PPACA to high-risk populations other than women. Consideration should also be given to provisions for risk-reducing interventions, especially in underserved minority populations, who are known to underutilize genetic testing and may have limited financial resources for medical intervention.

National logistics working groups: A landscape analysis study.

PubMed

Leab, Dorothy; Schreiber, Benjamin; Kasonde, Musonda; Bessat, Olivia; Bui, Son; Loisel, Carine

2017-04-19

Several countries have acknowledged the contributions made by national logistics working groups (NLWG) to ensure equitable access to the expanded program on immunization's (EPI) vaccines against preventable diseases. In order to provide key insights to the United Nations Children's Fund (UNICEF) and the World Health Organization (WHO) supply chain hub - as well as other players, including national EPI - a landscape analysis study was conducted from September 2015 to February 2016. This is a cross-sectional survey taken by 43 countries that combines qualitative and quantitative approaches. Data was collected through a desk review, consultation, interviews, and distance questioning. References and guidance were used to determine and specify the underlying mechanisms of NLWGs. The key findings are:This study has provided a general overview of the status of NLWGs for immunization in various countries. Based on the key insights of the study, technical assistance needs have been identified, and immunization partners will be required to help countries create and reinforce their NLWGs. Copyright © 2017. Published by Elsevier Ltd.

Introduction of Sequential Inactivated Polio Vaccine–Oral Polio Vaccine Schedule for Routine Infant Immunization in Brazil’s National Immunization Program

PubMed Central

Domingues, Carla Magda Allan S.; de Fátima Pereira, Sirlene; Marreiros, Ana Carolina Cunha; Menezes, Nair; Flannery, Brendan

2015-01-01

In August 2012, the Brazilian Ministry of Health introduced inactivated polio vaccine (IPV) as part of sequential polio vaccination schedule for all infants beginning their primary vaccination series. The revised childhood immunization schedule included 2 doses of IPV at 2 and 4 months of age followed by 2 doses of oral polio vaccine (OPV) at 6 and 15 months of age. One annual national polio immunization day was maintained to provide OPV to all children aged 6 to 59 months. The decision to introduce IPV was based on preventing rare cases of vaccine-associated paralytic polio, financially sustaining IPV introduction, ensuring equitable access to IPV, and preparing for future OPV cessation following global eradication. Introducing IPV during a national multivaccination campaign led to rapid uptake, despite challenges with local vaccine supply due to high wastage rates. Continuous monitoring is required to achieve high coverage with the sequential polio vaccine schedule. PMID:25316829

Intergenerational Efforts to Develop a Healthy Environment for Everyone: Sustainability as a Human Rights Issue.

PubMed

Kruger, Tina M; Savage, Caroline E; Newsham, Patrick

2014-12-01

As climate change proceeds at an unprecedented rate, concern for the natural environment has increased. The world's population aging also continues to rise at an unprecedented rate, giving greater attention to the implications of an older population. The two trends are linked through the fact that changes to the environment affect older adults, and older adults affect the environment. Sustainability is, therefore, an intergenerational phenomenon, and protecting resources today leaves a positive legacy and enhances quality of life for future generations. Older adults have much to share with younger generations about behaviors that promote sustainable living, yet few sustainability efforts are intergenerational in nature. As large numbers of people currently subsist without secure access to basic needs, ensuring equitable resource consumption for all generations is urgent and aligns with the Universal Declaration of Human Rights. Through exploring linkages between aging and sustainability, we identify intergenerational strategies to protect the environment and promote human rights and quality of life for older adults. © The Author(s) 2015.

Prevalence and Correlates of Lifetime Suicide Attempts Among Transgender Persons in Argentina.

PubMed

Marshall, Brandon D L; Socías, María Eugenia; Kerr, Thomas; Zalazar, Virginia; Sued, Omar; Arístegui, Inés

2016-07-01

This study examined the lifetime prevalence and correlates of attempted suicide among transgender persons in Argentina. Data were derived from a nation-wide, cross-sectional survey conducted in 2013. We assessed individual, social, and structural correlates of reporting a history of attempting suicide using logistic regression. Among 482 participants, the median age was 30, 91% identified as transwomen, and 32% resided in the Buenos Aires metropolitan area. A lifetime suicide attempt was reported by 159 (33%), among whom the median age at first attempt was 17. In a multivariate model, internalized stigma was positively associated with a history of suicidal behavior, while participants with stable housing had reduced odds of prior suicide attempt(s). These findings suggest that reducing stigma and mitigating structural vulnerabilities (through, for example, the enactment and enforcement of laws that prohibit discrimination based on gender identity to ensure equitable access to housing) could be effective targets for intervention to reduce suicide attempts among transgender individuals in Argentina.

Accessibility and spatial distribution of general practice services in an Australian city by levels of social disadvantage.

PubMed

Hyndman, J C; Holman, C D

2001-12-01

The accessibility and spatial distribution of health services provided by the main source of primary medical care in Australia--the general practice surgery--was investigated by level of social disadvantage of local catchment areas. All 459 general practice surgeries in Perth, an Australian city of 1.2 million residents, were surveyed with a 94% response. Amount of service provision was measured using weekly doctor-hours, available from consulting rooms during opening hours, and associated nurse-hours of service. Access factors were defined as the distance to the nearest surgery, provision of Sunday and evening services, ease of making a same day appointment, bulk-billing, and whether the surgery offered a choice of gender of doctor. There were relatively more surgeries in disadvantaged areas and doctor-hours of service provision were also greater (41.0 h/1,000 most disadvantaged vs. 37.9 h/1000 least disadvantaged). Bulk-billing care, at no direct cost to the patient, was more likely to be provided in most disadvantaged areas compared with least disadvantaged areas (61 vs. 38%). However, populations living in the most disadvantaged areas were less likely to be able to see the local GP at short notice (91 vs. 95%), to have access to a local female GP (56 vs. 62%) or a local service in the evenings (42 vs. 51%). While the overall picture of accessibility was favourable, there was considerable variation in the type of services provided to different socioeconomic groups. Health care planners should investigate the reasons for these differences and advise Government to ensure that access factors affecting publicly funded services are equitably distributed.

Recommendations for Ensuring Long-Term Engagement of Communities if Gulf Coast Ecosystem Restoration

EPA Pesticide Factsheets

This report contains advice and recommendations about how the Agency can best engage minority, low-income, and tribal/indigenous communities for input on decisions about Gulf Coast restoration plans, particularly with respect to the impacts of such plans on permitting (such as wetlands restoration, equitable development, revitalization, cleanups, and sustainable energy).

PISA for Development and the Sustainable Development Goals. PISA for Development Brief 17

ERIC Educational Resources Information Center

OECD Publishing, 2017

2017-01-01

The PISA for Development brief series is a set of concise monthly education policy-oriented notes published by the OECD which are designed to describe a specific PISA for Development topic. In this brief, PISA's role in monitoring the fourth United Nations Sustainable Development Goal--to "ensure inclusive and equitable quality education and…

Youth Rising: Centering Youth Voice in the Quest for Equitable and Inclusive Schools. Equity by Design

ERIC Educational Resources Information Center

Gonzalez, Taucia; Love, Larry D.; Johnson, Mary L.; Picón, Ninoska; Velázquez, Josué

2017-01-01

This Equity Brief focuses on disrupting the dominant narratives around inclusion by asking the question, "Whose Voice Matters" in creating inclusive schools. Ensuring that youth from historically marginalized groups have leadership opportunities and have their voices heard is one way to support and empower them. Supporting students of…

Considering Accreditation in Gerontology: The Importance of Interprofessional Collaborative Competencies to Ensure Quality Health Care for Older Adults

ERIC Educational Resources Information Center

Goldberg, Lynette R.; Koontz, Jennifer Scott; Rogers, Nicole; Brickell, Jean

2012-01-01

The health care needs of older adults can be complex and multifaceted. Safe, effective, equitable, and person-centered service provision relies on skilled interprofessional, team-based practice. Too often, students seeking a career specializing in gerontology are not exposed to such interprofessional, team-based learning and practice during their…

76 FR 38410 - BOEMRE Information Collection Activity: 1010-0057, Pollution Prevention and Control, Extension of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-30

..., and pipeline right-of-way. Operations on the OCS must preserve, protect, and develop oil and natural... protection of human, marine, and coastal environments; to ensure the public a fair and equitable return on... waters or subsoil and seabed, or other occurrences which may cause damage to the environment or to...

A Mixed-Methods Study Examining the Postgraduate Career Choices of Student-Athletes on 12 NCAA Women's Basketball Teams

ERIC Educational Resources Information Center

Beverly, Sharon R.

2010-01-01

Title IX, a federal law that was passed in 1972, ensured equitable treatment for women in any federally funded program. It affected educational institutions at every level (elementary, high school, higher education) and included areas such as admissions, facilities, financial assistance, and, most notably, athletics programs within those…

77 FR 26588 - Self-Regulatory Organizations; NASDAQ OMX BX, Inc.; Notice of Filing and Immediate Effectiveness...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-04

... they deem fee levels at a particular venue to be excessive. In such an environment, BX must continually... excessive extent, it will lose customers to its competitors. Accordingly, BX believes that competitive market forces help to ensure that the fees it charges for execution and routing are reasonable, equitably...

Prevalence of People Who Could Benefit from Augmentative and Alternative Communication (AAC) in the UK: Determining the Need

ERIC Educational Resources Information Center

Creer, Sarah; Enderby, Pamela; Judge, Simon; John, Alex

2016-01-01

Background: Commissioners and providers require information relating to the number of people requiring a service in order to ensure provision is appropriate and equitable for the population they serve. There is little epidemiological evidence available regarding the prevalence of people who could benefit from augmentative and alternative…

Getting beyond the Facts: Reforming California School Finance. Issue Brief

ERIC Educational Resources Information Center

Bersin, Alan; Kirst, Michael W.; Liu, Goodwin

2008-01-01

California's school finance system is long overdue for reform. The authors propose a new system that is more rational, more equitable, and, they believe, politically feasible. At its core, their proposal aims to link district revenue to student needs and regional costs while ensuring that all districts are held harmless at current funding levels.…

Expressions of Liberal Justice? Examining the Aims of the UN's Sustainable Development Goals for Education

ERIC Educational Resources Information Center

VanderDussen Toukan, Elena

2017-01-01

This paper analyzes the United Nations' Sustainable Development Goals (SDGs) for education, which sets benchmarks for member states to "ensure inclusive and equitable quality education and promote lifelong opportunities for all" by the year 2030. I examine ways in which the underlying philosophical rationale for the targets invokes a…

For Function or Transformation? A Critical Discourse Analysis of Education under the Sustainable Development Goals

ERIC Educational Resources Information Center

Brissett, Nigel; Mitter, Radhika

2017-01-01

We conduct a critical discourse analysis of the extent to which Sustainable Development Goal 4, "to ensure inclusive and equitable quality education for all and promote lifelong learning," promotes a utilitarian and/or transformative approach to education. Our findings show that despite transformative language used throughout the Agenda,…

The Impact of Federally Tax Exempt Property Ownership on National County Poverty Rank and Student Achievement

ERIC Educational Resources Information Center

Kuessner, Sonia Shedd

2016-01-01

Education in the 21st century is subject to standardized testing with financial implications associated with testing. Under continued focus at the federal level to close the socioeconomic achievement gap, equitable distribution of funding is critical to ensure all schools have resources available to offset impacts of low socioeconomic status on…

Attaining Equitable Distribution of Effective Teachers in Public Schools

ERIC Educational Resources Information Center

Partee, Glenda L.

2014-01-01

Since Congress passed the No Child Left Behind Act of 2001, or NCLB, much has transpired in K-12 public education. NCLB, the most recent iteration of the Elementary and Secondary Education Act of 1965, or ESEA, sought to ensure that all children have the equal opportunity for a high-quality education, established criteria for highly qualified…

Diffusion across the Digital Divide: Assessing Use of the Connecticut Digital Library (ICONN) in K-12 Schools in Connecticut

ERIC Educational Resources Information Center

Bogel, Gayle

2008-01-01

State digital libraries are manifestations of the diffusion of technology that has provided both "access to" and "delivery of" digital content. Whether the content is being accessed and used equitably in K-12 schools has not been assessed. Determining patterns of the diffusion of use across socioeconomic groups in K-12 schools…

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…

Understanding the Complex Dimensions of the Digital Divide: Lessons Learned in the Alaskan Arctic

ERIC Educational Resources Information Center

Subramony, Deepak Prem

2007-01-01

An ethnographic case study of Inupiat Eskimo in the Alaskan Arctic has provided insights into the complex nature of the sociological issues surrounding equitable access to technology tools and skills, which are referred to as the digital divide. These people can overcome the digital divide if they get the basic ready access to hardware and…

Quality Ratings and Improvement Systems in Early Childhood Education: Promising Approaches for Pennsylvania. A PACER Policy Brief

ERIC Educational Resources Information Center

Jenkins, Della; Englander, Katie

2016-01-01

Policymakers are recognizing that Pennsylvania has fallen behind in providing equitable access to high quality early childhood education. Governor Tom Wolf ran on a campaign promise of universal pre-k access and proposed an unprecedented budget increase for early childhood programs in 2016. In Philadelphia, Mayor Jim Kenney has made pre-k a…

To Play or Not to Play: Equitable Access to Afterschool Programs for Students with Disabilities

ERIC Educational Resources Information Center

Meade, Whitney W.; O'Brien, Jason

2018-01-01

In this case, a child with a spinal cord injury was denied access to an afterschool care program that her nondisabled siblings were allowed to attend because she did not meet "eligibility requirements." Specifically, the independent contractor who ran the program mandated that students be able to function in an environment with a student…

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…

The impact of health service variables on healthcare access in a low resourced urban setting in the Western Cape, South Africa.

PubMed

Scheffler, Elsje; Visagie, Surona; Schneider, Marguerite

2015-06-19

Health care access is complex and multi-faceted and, as a basic right, equitable access and services should be available to all user groups. The aim of this article is to explore how service delivery impacts on access to healthcare for vulnerable groups in an urban primary health care setting in South Africa. A descriptive qualitative study design was used. Data were collected through semi-structured interviews with purposively sampled participants and analysed through thematic content analysis. Service delivery factors are presented against five dimensions of access according to the ACCESS Framework. From a supplier perspective, the organisation of care in the study setting resulted in available, accessible, affordable and adequate services as measured against the DistrictHealth System policies and guidelines. However, service providers experienced significant barriers in provision of services, which impacted on the quality of care, resulting in poor client and provider satisfaction and ultimately compromising acceptability of service delivery. Although users found services to be accessible, the organisation of services presented them with challenges in the domains of availability, affordability and adequacy, resulting in unmet needs, low levels of satisfaction and loss of trust. These challenges fuelled perceptions of unacceptable services. Well developed systems and organisation of services can create accessible, affordable and available primary healthcare services, but do not automatically translate into adequate and acceptable services. Focussing attention on how services are delivered might restore the balance between supply (services) and demand (user needs) and promote universal and equitable access.

What strategies to boost production of affordable fixed-dose anti-retroviral drug combinations for children in the developing world?

PubMed

Dionisio, Daniele; Gass, Robert; McDermott, Peter; Racalbuto, Vincenzo; Madeo, Marina; Braghieri, Giuseppe; Crowley, Siobhan; Pinheiro, Eloan Dos Santos; Graaff, Peter; Vasan, Ashwin; Eksaengsri, Achara; Moller, Helene; Khanna, Arun Kumar; Kraisintu, Krisana; Juneja, Sandeep; Nicolaou, Stavros; Sengupta, Aloka; Esperti, Francesco; Messeri, Daniela

2007-03-01

No more than 8% of HIV positive children needing treatment in low- and middle-income countries have access to antiretroviral drugs (ARVs). Children presently account for about 4% of all treated patients, while for equitable access they should make up at least 13%. This study explores key issues, implications and interaction dynamics to boost production of easy-to-use and affordable fixed-dose combination (FDC) ARVs for children in the developing world. Potentials for equitable solutions are examined including priority steps and actions, appropriate treatment options and reliable forecasting methods for paediatric ARVs, as well as combination incentives to generic companies against market unattractiveness and enforced intellectual property (IP) rights. Moreover, implementation strategies to enhance the development and production of affordable ARV paediatric formulations and appropriate supply systems to ensure availability are investigated. The current market for FDC paediatric ARVs is already substantial and will only grow with improved and scaled up diagnosis and monitoring of children. This provides an argument for immediate increase of production and development of FDC ARVs for children. These formulations must be low cost and included in the list of Essential Medicines to avoid children continuing to lag behind in access to treatment. Access-oriented, long-term drug policy strategies with the ability to pass muster of governments, the UN system, as well as generic and research-based enterprises are needed to let children gain expanded and sustained access to FDC ARVs. Under the requirements listed above, IP-bound Voluntary License (VL) flexibilities do appear, if coupled with substantial combination incentives to generic firms, as a fitting tool into the needs. Policies must consider enhancing human resource capacity in the area of caregivers and social and health workers aiming to spread correct information and awareness on effectiveness and rationale of FDC ARVs for children. Policies should urge that paediatric ARV treatment programmes entwine with extant interventions on prevention of mother-to-child transmission, as well as with HIV treatment initiatives focused on mothers and household members. Policies, again, should consider centralising functions and pooling resources to help overcome drug supply barriers. WHO's brokering role in VL-based agreements between wealthy and developing country industries, as well as its technical guidance in setting international standards should not be waived while looking for sustained access to optimised ARV treatments for children. Strategies discussed in this paper, while taking unavoidability of marketing and profit rules into account, look closely into the trade and drug policy directions of China and India according to frontier crossing implications of their IP management trends as well as their multi-faceted penetration strategies of both the wealthy and under-served markets the world over.

Climate Change and Global Food Systems: Potential Impacts on Food Security and Undernutrition.

PubMed

Myers, Samuel S; Smith, Matthew R; Guth, Sarah; Golden, Christopher D; Vaitla, Bapu; Mueller, Nathaniel D; Dangour, Alan D; Huybers, Peter

2017-03-20

Great progress has been made in addressing global undernutrition over the past several decades, in part because of large increases in food production from agricultural expansion and intensification. Food systems, however, face continued increases in demand and growing environmental pressures. Most prominently, human-caused climate change will influence the quality and quantity of food we produce and our ability to distribute it equitably. Our capacity to ensure food security and nutritional adequacy in the face of rapidly changing biophysical conditions will be a major determinant of the next century's global burden of disease. In this article, we review the main pathways by which climate change may affect our food production systems-agriculture, fisheries, and livestock-as well as the socioeconomic forces that may influence equitable distribution.

A Balanced Investment Portfolio For Equitable Health And Well-Being Is An Imperative, And Within Reach.

PubMed

Kindig, David A; Milstein, Bobby

2018-04-01

Health investments, defined as formal expenditures to either produce or care for health, in the US are extremely inefficient and have yet to unlock the country's full potential for equitable health and well-being. A major reason for such poor performance is that the US health investment portfolio is out of balance, with too much spent on certain aspects of health care and not enough spent to ensure social, economic, and environmental conditions that are vital to maintaining health and well-being. This commentary summarizes the evidence for this assertion, along with the opportunities and challenges involved in rebalancing investments in ways that would improve overall population health, reduce health gaps, and help build a culture of health for all Americans.

75 FR 77022 - Self-Regulatory Organizations; The NASDAQ Stock Market LLC; Notice of Filing and Immediate...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-10

... evolution of technologies and systems through which data may be accessed. NASDAQ, like other data providers... just and equitable principles of trade, to foster cooperation and coordination with persons engaged in...

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.

Fees-for-services, cost recovery, and equity in a district of Burkina Faso operating the Bamako Initiative.

PubMed Central

Ridde, Valéry

2003-01-01

OBJECTIVE: To gauge the effects of operating the Bamako Initiative in Kongoussi district, Burkina Faso. METHODS: Qualitative and quasi-experimental quantitative methodologies were used. FINDINGS: Following the introduction of fees-for-services in July 1997, the number of consultations for curative care fell over a period of three years by an average of 15.4% at "case" health centres but increased by 30.5% at "control" health centres. Moreover, although the operational results for essential drugs depots were not known, expenditure increased on average 2.7 times more than income and did not keep pace with the decline in the utilization of services. Persons in charge of the management committees had difficulties in releasing funds to ensure access to care for the poor. CONCLUSION: The introduction of fees-for-services had an adverse effect on service utilization. The study district is in a position to bear the financial cost of taking care of the poor and the community is able to identify such people. Incentives must be introduced by the state and be swiftly applied so that the communities agree to a more equitable system and thereby allow access to care for those excluded from services because they are unable to pay. PMID:12973646

Global surgery: current evidence for improving surgical care.

PubMed

Fuller, Jennifer C; Shaye, David A

2017-08-01

The field of global surgery is undergoing rapid transformation, owing to several recent prominent reports positioning it as a cost-effective means of relieving global disease burden. The purpose of this article is to review the recent advances in the field of global surgery. Efforts to grow the global surgical workforce and procedural capacity have focused on innovative methods to increase surgeon training, enhance international collaboration, leverage technology, optimize existing health systems, and safely implement task-sharing. Computer modeling offers a novel means of informing policy to optimize timely access to care, equitably promote health and financial protection, and efficiently grow infrastructure. Tools and checklists have recently been developed to enhance data collection and ensure methodologically rigorous publications to inform planning, benchmark surgical systems, promote accurate modeling, track key health indicators, and promote safety. Creation of institutional partnerships and trainee exchanges can enrich training, stimulate commitment to humanitarian work, and promote the equal exchange of ideas and expertise. The recent body of work creates a strong foundation upon which work toward the goal of universal access to safe, affordable surgical care can be built; however, further collection and analysis of country-specific data is necessary for accurate modeling and outcomes research into the efficacy of policies such as task-sharing is greatly needed.

Comparison of examination fees and availability of routine vision care by optometrists and ophthalmologists.

PubMed Central

Soroka, M

1991-01-01

A national telephone survey of eye care practitioners shows that the average fee for routine eye examinations was less among optometrists than ophthalmologists. The average wait for the earliest appointment was 5 days for optometrists and 20 days for ophthalmologists. Weekend and evening appointments were also more obtainable among optometrists. The study did not determine what tests were included in the routine examination of each practitioner. Optometrists are licensed to use diagnostic drugs in all 50 States and prescribe therapeutic drugs for the treatment of ocular diseases in 25 States. Legislation that would update State laws permitting doctors of optometry to prescribe and use pharmaceutical agents for the treatment of eye diseases has been introduced in many of the remaining States. Supporters of bills permitting therapeutic pharmaceutical optometry contend that these changes would ensure the availability of quality eye care at significant savings, since optometric fees are generally lower than ophthalmological fees. In addition, it has been argued that optometrists are equitably distributed geographically and are more likely to have weekend and evening office hours, thus enabling increased patient access to eye care. When considering cost-effectiveness and accessibility, this study may provide information to those States considering changes in the scope of optometric licensure. PMID:1908597

Deregulation, Distrust, and Democracy: State and Local Action to Ensure Equitable Access to Healthy, Sustainably Produced Food.

PubMed

Wiley, Lindsay F

2015-01-01

Environmental, public health, alternative food, and food justice advocates are working together to achieve incremental agricultural subsidy and nutrition assistance reforms that increase access to fresh fruits and vegetables. When it comes to targeting food and beverage products for increased regulation and decreased consumption, however, the priorities of various food reform movements diverge. This article argues that foundational legal issues, including preemption of state and local authority to protect the public's health and welfare, increasing First Amendment protection for commercial speech, and eroding judicial deference to legislative policy judgments, present a more promising avenue for collaboration across movements than discrete food reform priorities around issues like sugary drinks, genetic modification, or organics. Using the Vermont Genetically Modified Organism (GMO) Labeling Act litigation, the Kauai GMO Cultivation Ordinance litigation, the New York City Sugary Drinks Portion Rule litigation, and the Cleveland Trans Fat Ban litigation as case studies, I discuss the foundational legal challenges faced by diverse food reformers, even when their discrete reform priorities diverge. I also 'explore the broader implications of cooperation among groups that respond differently to the "irrationalities" (from the public health perspective) or "values" (from the environmental and alternative food perspective) that permeate public risk perception for democratic governance in the face of scientific uncertainty.

The U.S. Culture Collection Network Responding to the Requirements of the Nagoya Protocol on Access and Benefit Sharing

Treesearch

Kevin McCluskey; Katharine B. Barker; Hazel A. Barton; Kyria Boundy-Mills; Daniel R. Brown; Jonathan A. Coddington; Kevin Cook; Philippe Desmeth; David Geiser; Jessie A. Glaeser; Stephanie Greene; Seogchan Kang; Michael W. Lomas; Ulrich Melcher; Scott E. Miller; David R. Nobles; Kristina J. Owens; Jerome H. Reichman; Manuela da Silva; John Wertz; Cale Whitworth; David Smith; Steven E. Lindow

2017-01-01

The U.S. Culture Collection Network held a meeting to share information about how culture collections are responding to the requirements of the recently enacted Nagoya Protocol on Access to Genetic Resources and the Fair and Equitable Sharing of Benefits Arising from their Utilization to the Convention on Biological Diversity (CBD). The meeting included representatives...

Innovative Approaches Address Aging and Mental Health Needs in LGBTQ Communities.

PubMed

Hoy-Ellis, Charles P; Ator, Michael; Kerr, Christopher; Milford, Jessica

2016-01-01

LGBTQ older adults have higher levels of psychological distress as compared to older adults in general. They also experience multiple barriers to accessing equitable, culturally competent mental health and aging services because of their distinct histories and particular social contexts. This article discusses this lack of access to services, and highlights an innovative way mental health services are being delivered in LGBTQ communities.

A mobile school-based HCT service - is it youth friendly?

PubMed

Lawrence, Estelle; Struthers, Patricia; Van Hove, Geert

2016-12-01

Despite an increase in HIV Counselling and Testing (HCT), few young people have been tested. It has been suggested that they do not test because formal health services (where HCT is provided) are often not youth friendly. The World Health Organisation describes a youth-friendly health service (YFHS) as one which is accessible, equitable, acceptable, appropriate, and effective. A mobile school-based model has been implemented by a non-governmental organisation in Cape Town in an attempt to make HCT more youth friendly and accessible to young people. The objective of this study was to explore whether this mobile school-based HCT service is youth friendly. The study was descriptive, using three qualitative data collection methods: observation of the HCT site at two secondary schools; interviews with six service providers; and direct observation of 21 HCT counselling sessions. The mobile school-based HCT service fulfilled some of the criteria for being a YFHS. The service was equitable in that all students, irrespective of race, gender, age, or socio-economic status, were free to use the service. It was accessible in terms of location and cost, but students were not well informed to make decisions about using the service. The service was acceptable in that confidentiality was guaranteed and the service providers were friendly and non-judgemental, but it was not considered acceptable in that there was limited privacy. The service was appropriate in that HCT is recommended as an intervention for decreasing the transmission of HIV, based on evidence and expert opinion; however, in this case, HCT was provided as a stand-alone service rather than part of a full package of services. Moreover, studies have suggested that young people want to know their HIV status. The service was ineffective in that it identified students who are HIV positive; however, these students were not assisted to access care. Providing HCT in the school setting may make HCT more accessible for students, but it needs to be provided in an equitable, accessible, acceptable, and effective way.

A mobile school-based HCT service – is it youth friendly?

PubMed Central

Lawrence, Estelle; Struthers, Patricia; Van Hove, Geert

2016-01-01

Abstract Background: Despite an increase in HIV Counselling and Testing (HCT), few young people have been tested. It has been suggested that they do not test because formal health services (where HCT is provided) are often not youth friendly. The World Health Organisation describes a youth-friendly health service (YFHS) as one which is accessible, equitable, acceptable, appropriate, and effective. A mobile school-based model has been implemented by a non-governmental organisation in Cape Town in an attempt to make HCT more youth friendly and accessible to young people. The objective of this study was to explore whether this mobile school-based HCT service is youth friendly. Methods: The study was descriptive, using three qualitative data collection methods: observation of the HCT site at two secondary schools; interviews with six service providers; and direct observation of 21 HCT counselling sessions. Key Results: The mobile school-based HCT service fulfilled some of the criteria for being a YFHS. The service was equitable in that all students, irrespective of race, gender, age, or socio-economic status, were free to use the service. It was accessible in terms of location and cost, but students were not well informed to make decisions about using the service. The service was acceptable in that confidentiality was guaranteed and the service providers were friendly and non-judgemental, but it was not considered acceptable in that there was limited privacy. The service was appropriate in that HCT is recommended as an intervention for decreasing the transmission of HIV, based on evidence and expert opinion; however, in this case, HCT was provided as a stand-alone service rather than part of a full package of services. Moreover, studies have suggested that young people want to know their HIV status. The service was ineffective in that it identified students who are HIV positive; however, these students were not assisted to access care. Conclusion: Providing HCT in the school setting may make HCT more accessible for students, but it needs to be provided in an equitable, accessible, acceptable, and effective way. PMID:27576352

The Customer Comes First: Implementing a Customer Service Program at the University of Minnesota, Twin Cities Libraries

ERIC Educational Resources Information Center

Bayer, Jerrie; Llewellyn, Steven

2011-01-01

Library customers have more remote information choices than ever before, so we must ensure that when they do come to the library, they experience a welcoming environment, a high standard of service, and receive equitable levels of service across campus. Developing a customer service program was a logical next step to reinforce the ongoing…

Teacher Preparation in the Central Valley: What Do Pre-Service Single-Subject Teachers Need to Ensure Equitable and Excellent Classrooms?

ERIC Educational Resources Information Center

Zambo, Janeen-Marie Harvey

2017-01-01

Educational equity is a major component to solving the achievement gap in public education. Prior research on educational equity has largely centered on the development of multicultural education and critical race theoretical approaches, with some studies considering how these theories are best incorporated into teacher preparation programs.…

An "Acción" Approach to Affirmative Action: Hispanic-Serving Institutions as Spaces for Fostering Epistemic Justice

ERIC Educational Resources Information Center

Gonzales, Leslie D.

2015-01-01

In this article, readers are asked to suspend conventional notions of affirmative action as a policy that ensures equitable admissions practices to the nation's most elite post secondary institutions, and instead to consider how affirmative action might be understood as a way to challenge the relations of power that govern the legitimation of…

Measuring the Return on Investment in TVET. Report of the UNESCO-UNEVOC Virtual Conference, 9-16 May 2016

ERIC Educational Resources Information Center

UNESCO-UNEVOC International Centre for Technical and Vocational Education and Training, 2016

2016-01-01

Sustainable Development Goals call on Members States to "ensure inclusive and equitable quality education and promote lifelong learning opportunities for all" and sets a number of targets related to technical and vocational education and training (TVET). In order to collect input from the global TVET community, UNESCO-UNEVOC organized a…

Dynamics of Low-Fee Private Schools in Kenya: Governmental Legitimation, School-Community Dependence, and Resource Uncertainty

ERIC Educational Resources Information Center

Edwards, Brent, Jr.; Klees, Steven J.; Wildish, Janet L.

2017-01-01

Background/Context: The UN Sustainable Development Goals include a renewed commitment to inclusive and equitable education for all and will maintain pressure on governments in low-income countries to ensure this provision. A range of prominent researchers and institutional actors continue to explore and to promote low-fee private schools (LFPSs)…

What Makes a Quality Curriculum? In-Progress Reflection No. 2 on "Current and Critical Issues in Curriculum and Learning"

ERIC Educational Resources Information Center

Stabback, Philip

2016-01-01

Sustainable Development Goal Four has to do with education in the post-2015 development agenda. It aims to "ensure inclusive and equitable quality education and promote lifelong learning opportunities for all". Given the essential role of curriculum in enabling quality learning and in articulating and supporting education that is…

Water and Benefit Sharing in Transboundary River Basins

NASA Astrophysics Data System (ADS)

Arjoon, D.; Tilmant, A.; Herrmann, M.

2015-12-01

Growing water scarcity underlies the importance of cooperation for the effective management of river basins, particularly in the context of international rivers in which unidirectional externalities can lead to asymmetric relationships between riparian countries. Studies have shown that significant economic benefits can be expected through basin-wide cooperation, however, the equitable partitioning of these benefits over the basin is less well studied and tends to overlook the importance of stakeholder input in the definition of equitability. In this study, an institutional arrangement to maximize welfare and then share the scarcity cost in a river basin is proposed. A river basin authority plays the role of a bulk water market operator, efficiently allocating bulk water to the users and collecting bulk water charges which are then equitably redistributed among water users. This highly regulated market restrains the behaviour of water users to control externalities and to ensure basin-wide coordination, enhanced efficiency, and the equitable redistribution of the scarcity cost. The institutional arrangement is implemented using the Eastern Nile River basin as a case study. The importance of this arrangement is that it can be adopted for application in negotiations to cooperate in trans-boundary river basins. The benefit sharing solution proposed is more likely to be perceived as equitable because water users help define the sharing rule. As a result, the definition of the sharing rule is not in question, as it would be if existing rules, such as bankruptcy rules or cooperative game theory solutions, are applied, with their inherent definitions of fairness. Results of the case study show that the sharing rule is predictable. Water users can expect to receive between 93.5% and 95% of their uncontested benefits (benefits that they expect to receive if water was not rationed), depending on the hydrologic scenario.

Increased access to palliative care and hospice services: opportunities to improve value in health care.

PubMed

Meier, Diane E

2011-09-01

A small proportion of patients with serious illness or multiple chronic conditions account for the majority of health care spending. Despite the high cost, evidence demonstrates that these patients receive health care of inadequate quality, characterized by fragmentation, overuse, medical errors, and poor quality of life. This article examines data demonstrating the impact of the U.S. health care system on clinical care outcomes and costs for the sickest and most vulnerable patients. It also defines palliative care and hospice, synthesizes studies of the outcomes of palliative care and hospice services, reviews variables predicting access to palliative care and hospice services, and identifies those policy priorities necessary to strengthen access to high-quality palliative care. Palliative care and hospice services improve patient-centered outcomes such as pain, depression, and other symptoms; patient and family satisfaction; and the receipt of care in the place that the patient chooses. Some data suggest that, compared with the usual care, palliative care prolongs life. By helping patients get the care they need to avoid unnecessary emergency department and hospital stays and shifting the locus of care to the home or community, palliative care and hospice reduce health care spending for America's sickest and most costly patient populations. Policies focused on enhancing the palliative care workforce, investing in the field's science base, and increasing the availability of services in U.S. hospitals and nursing homes are needed to ensure equitable access to optimal care for seriously ill patients and those with multiple chronic conditions. © 2011 Milbank Memorial Fund. Published by Wiley Periodicals Inc.

Increased Access to Palliative Care and Hospice Services: Opportunities to Improve Value in Health Care

PubMed Central

Meier, Diane E

2011-01-01

Context: A small proportion of patients with serious illness or multiple chronic conditions account for the majority of health care spending. Despite the high cost, evidence demonstrates that these patients receive health care of inadequate quality, characterized by fragmentation, overuse, medical errors, and poor quality of life. Methods: This article examines data demonstrating the impact of the U.S. health care system on clinical care outcomes and costs for the sickest and most vulnerable patients. It also defines palliative care and hospice, synthesizes studies of the outcomes of palliative care and hospice services, reviews variables predicting access to palliative care and hospice services, and identifies those policy priorities necessary to strengthen access to high-quality palliative care. Findings: Palliative care and hospice services improve patient-centered outcomes such as pain, depression, and other symptoms; patient and family satisfaction; and the receipt of care in the place that the patient chooses. Some data suggest that, compared with the usual care, palliative care prolongs life. By helping patients get the care they need to avoid unnecessary emergency department and hospital stays and shifting the locus of care to the home or community, palliative care and hospice reduce health care spending for America's sickest and most costly patient populations. Conclusions: Policies focused on enhancing the palliative care workforce, investing in the field's science base, and increasing the availability of services in U.S. hospitals and nursing homes are needed to ensure equitable access to optimal care for seriously ill patients and those with multiple chronic conditions. PMID:21933272

Improving pathology and laboratory medicine in low-income and middle-income countries: roadmap to solutions.

PubMed

Sayed, Shahin; Cherniak, William; Lawler, Mark; Tan, Soo Yong; El Sadr, Wafaa; Wolf, Nicholas; Silkensen, Shannon; Brand, Nathan; Looi, Lai Meng; Pai, Sanjay A; Wilson, Michael L; Milner, Danny; Flanigan, John; Fleming, Kenneth A

2018-05-12

Insufficient awareness of the centrality of pathology and laboratory medicine (PALM) to a functioning health-care system at policy and governmental level, with the resultant inadequate investment, has meant that efforts to enhance PALM in low-income and middle-income countries have been local, fragmented, and mostly unsustainable. Responding to the four major barriers in PALM service delivery that were identified in the first paper of this Series (workforce, infrastructure, education and training, and quality assurance), this second paper identifies potential solutions that can be applied in low-income and middle-income countries (LMICs). Increasing and retaining a quality PALM workforce requires access to mentorship and continuing professional development, task sharing, and the development of short-term visitor programmes. Opportunities to enhance the training of pathologists and allied PALM personnel by increasing and improving education provision must be explored and implemented. PALM infrastructure must be strengthened by addressing supply chain barriers, and ensuring laboratory information systems are in place. New technologies, including telepathology and point-of-care testing, can have a substantial role in PALM service delivery, if used appropriately. We emphasise the crucial importance of maintaining PALM quality and posit that all laboratories in LMICs should participate in quality assurance and accreditation programmes. A potential role for public-private partnerships in filling PALM services gaps should also be investigated. Finally, to deliver these solutions and ensure equitable access to essential services in LMICs, we propose a PALM package focused on these countries, integrated within a nationally tiered laboratory system, as part of an overarching national laboratory strategic plan. Copyright © 2018 Elsevier Ltd. All rights reserved.

The Relationship Between Geographic Access to Plastic Surgeons and Breast Reconstruction Rates Among Women Undergoing Mastectomy for Cancer.

PubMed

Bauder, Andrew R; Gross, Cary P; Killelea, Brigid K; Butler, Paris D; Kovach, Stephen J; Fox, Justin P

2017-03-01

Despite a national health care policy requiring payers to cover breast reconstruction, rates of postmastectomy reconstruction are low, particularly among minority populations. We conducted this study to determine if geographic access to a plastic surgeon impacts breast reconstruction rates. Using 2010 inpatient and ambulatory surgery data from 10 states, we identified adult women who underwent mastectomy for breast cancer. Data were aggregated to the health service area (HSA) level and hierarchical generalized linear models were used to risk-standardize breast reconstruction rates (RSRR) across HSAs. The relationship between an HSA's RSRR and plastic surgeon density (surgeons/100,000 population) was quantified using correlation coefficients. The final cohort included 22,997 patients across 134 HSAs. There was substantial variation in plastic surgeon density (median, 1.4 surgeons/100,000; interquartile range, [0.0-2.6]/100,000) and the use of breast reconstruction (median RSRR, 43.0%; interquartile range, [29.9%-62.8%]) across HSAs. Higher plastic surgeon density was positively correlated with breast reconstruction rates (correlation coefficient = 0.66, P < 0.001) and inversely related to time between mastectomy and reconstruction (correlation coefficient = -0.19, P < 0.001). Non-white and publicly insured women were least likely to undergo breast reconstruction overall. Among privately insured patients, racial disparities were noted in high surgeon density areas (white = 79.0% vs. non-white = 63.3%; P < 0.001) but not in low surgeon density areas (34.4% vs 36.5%; P = 0.70). The lack of geographic access to a plastic surgeon serves as a barrier to breast reconstruction and may compound disparities in care associated with race and insurance status. Future efforts to improve equitable access should consider strategies to ensure access to appropriate clinical expertise.

What core primary health care services should be available to Australians living in rural and remote communities?

PubMed

Thomas, Susan L; Wakerman, John; Humphreys, John S

2014-08-21

Australians living in rural and remote areas experience poorer access to primary health care (PHC) and poorer health outcomes compared to metropolitan populations. Current health reform in Australia aims to ensure all Australians, regardless of where they live, have access to essential PHC services. However, at a national level policy makers and health planners lack an evidence-based set of core PHC services to assist in implementing this goal. A Delphi method was used to reach consensus on an evidence-based list of core PHC services to which all Australians should have access and their necessary support functions. Experts in rural and remote and/or Indigenous PHC, including policy-makers, academics, clinicians and consumers, were invited to consider a list of core services derived from the literature. Thirty nine experts agreed to participate. After three survey rounds there was a strong consensus (≥80% agreement) on core PHC services namely; 'care of the sick and injured', 'mental health', 'maternal/child health', 'allied health', 'sexual/reproductive health', 'rehabilitation', 'oral/dental health' and 'public health/illness prevention'; and on the PHC support functions of; 'management/governance/leadership', 'coordination', 'health infrastructure', 'quality systems', 'data systems', 'professional development' and 'community participation'. Themes emerging from qualitative data included challenges in providing equitable PHC in rural and remote areas, the importance of service coordination and diverse strategies to overcome access barriers. This study identifies a basket of PHC services that consumers in rural and remote communities can expect to access. It provides rigorously derived evidence that will contribute to a more systematic approach to PHC service planning and availability and will assist policy makers in the allocation of scarce resources necessary to improve the health outcomes of residents of rural and remote areas.

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

How equitable are community health worker programmes and which programme features influence equity of community health worker services? A systematic review.

PubMed

McCollum, Rosalind; Gomez, Woedem; Theobald, Sally; Taegtmeyer, Miriam

2016-05-20

Community health workers (CHWs) are uniquely placed to link communities with the health system, playing a role in improving the reach of health systems and bringing health services closer to hard-to-reach and marginalised groups. A systematic review was conducted to determine the extent of equity of CHW programmes and to identify intervention design factors which influence equity of health outcomes. In accordance with our published protocol, we systematically searched eight databases from 2004 to 2014 for quantitative and qualitative studies which assessed access, utilisation, quality or community empowerment following introduction of a CHW programme according to equity stratifiers (place of residence, gender, socio-economic position and disability). Thirty four papers met inclusion criteria. A thematic framework was applied and data extracted and managed, prior to charting and thematic analysis. To our knowledge this is the first systematic review that describes the extent of equity within CHW programmes and identifies CHW intervention design features which influence equity. CHW programmes were found to promote equity of access and utilisation for community health by reducing inequities relating to place of residence, gender, education and socio-economic position. CHWs can also contribute towards more equitable uptake of referrals at health facility level. There was no clear evidence for equitable quality of services provided by CHWs and limited information regarding the role of the CHW in generating community empowerment to respond to social determinants of health. Factors promoting greater equity of CHW services include recruitment of most poor community members as CHWs, close proximity of services to households, pre-existing social relationship with CHW, provision of home-based services, free service delivery, targeting of poor households, strengthened referral to facility, sensitisation and mobilisation of community. However, if CHW programmes are not well planned some of the barriers faced by clients at health facility level can replicate at community level. CHWs promote equitable access to health promotion, disease prevention and use of curative services at household level. However, care must be taken by policymakers and implementers to take into account factors which can influence the equity of services during planning and implementation of CHW programmes.

Primary health care service delivery networks for the prevention and management of type 2 diabetes: using social network methods to describe interorganisational collaboration in a rural setting.

PubMed

McDonald, Julie; Jayasuriya, Rohan; Harris, Mark Fort

2011-01-01

Adults with type 2 diabetes or with behavioural risk factors require comprehensive and well coordinated responses from a range of health care providers who often work in different organisational settings. This study examines three types of collaborative links between organisations involved in a rural setting. Social network methods were employed using survey data on three types of links, and data was collected from a purposive sample of 17 organisations representing the major provider types. The analysis included a mix of unconfirmed and confirmed links, and network measures. General practices were the most influential provider group in initiating referrals, and they referred to the broadest range of organisations in the network. Team care arrangements formed a small part of the general practice referral network. They were used more for access to private sector allied health care providers and less for sharing care with public sector health services. Involvement in joint programs/activities was limited to public and non-government sector services, with no participation from the private sector. The patterns of interactions suggest that informal referral networks provide access to services and coordination of care for individual patients with diabetes. Two population subgroups would benefit from more proactive approaches to ensure equitable access to services and coordination of care across organisational boundaries: people with more complex health care needs and people at risk of developing diabetes.

Ten Principles to Guide Health Reform.

PubMed

Gerald, Joe K

2017-03-01

Americans face inevitable trade-offs between health care affordability, accessibility, and innovation. Although numerous reforms have been proposed, universal principles to guide decision-making are lacking. Solving the challenges that confront us will be difficult, owing to intense partisan divisions and a dysfunctional political process. Nevertheless, we must engage in reasoned debate that respects deeply held differences of opinion regarding our individual and collective obligations to promote healthy living and ensure affordable access to health care. Otherwise, our decisions will be expressed through political processes that reflect the preferences of narrow interests rather than the general public. Our health care system can be made more efficient and equitable by incentivizing consumers and providers to utilize high-value care and avoid low-value care. To accomplish this, we must understand the determinants of consumer and provider behavior and implement policies that encourage, but do not force, optimal decision-making. Although distinguishing between low- and high-value treatments will invariably threaten established interests, we must expand our capacity to make such judgements. Throughout this process, consumers, taxpayers, and policy makers must maintain realistic expectations. Although realigning incentives to promote high-value care will improve efficiency, it is unlikely to control increasing medical expenditures because they are not primarily caused by inefficiency. Rather, rising medical expenditures are driven by medical innovation made possible by increasing incomes and expanding health insurance coverage. Failure to recognize these linkages risks adopting indiscriminate policies that will reduce spending but slow innovation and impair access to needed care.

Aboriginal prisoners and cognitive impairment: the impact of dual disadvantage on Social and Emotional Wellbeing.

PubMed

Shepherd, S M; Ogloff, J R P; Shea, D; Pfeifer, J E; Paradies, Y

2017-04-01

Negligible information is available regarding the Social and Emotional Wellbeing (SEWB) needs of Aboriginal Australian individuals in custody with cognitive impairment. This is problematic given that Aboriginal people with cognitive impairment often experience dual disadvantage in the context of the justice system. This study sought to ascertain the relationship between cognitive impairment and mental health/cultural needs (SEWB) Aboriginal and Torres Strait Islander people in custody. A sample of 122 Aboriginal and Torres Strait Islander people were administered a culturally themed semi-structured questionnaire in custodial settings in Victoria, Australia. The questionnaire included measures of cognitive impairment, SEWB and forensic needs. Analyses were performed to determine differences in the presence of SEWB and unmet custodial needs by level of cognitive impairment. Findings revealed a diminished level of wellbeing for cognitively impaired participants across several factors. Cognitive impairment was associated with poorer coping mechanisms, additional experiences of racism, difficulties handling emotions, discomfort around non-Aboriginal people and reduced access to meaningful activities in custody. All participants regardless of their level of impairment recognised the importance of cultural engagement; however, cognitively impaired participants had greater difficulty accessing/practicing cultural activities. Culturally responsive disability assistance should be available at all phases of the justice system for Indigenous people with cognitive impairment to ensure that equitable care is accessible and needs are addressed. © 2017 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

Implications of prosthesis funding structures on the use of prostheses: experiences of individuals with upper limb absence.

PubMed

Biddiss, Elaine; McKeever, Patricia; Lindsay, Sally; Chau, Tom

2011-06-01

While sparsely researched, funding structures may play an important role in use of and satisfaction with prostheses and related health services. The objectives of this study were to (1) quantify the direct costs of prosthesis wear, (2) explore variations in funding distribution, and (3) describe the role of affordability in prosthesis selection and wear. An anonymous, online cross-sectional descriptive survey was administered. Analyses were conducted of qualitative and quantitative data extracted from an international sample of 242 individuals with upper limb absence. Access to prosthesis funding was variable and fluctuated with age, level of limb absence and country of care. Of individuals who gave details on prosthetic costs, 63% (n = 69) were fully reimbursed for their prosthetic expenses, while 37% (n = 40) were financially disadvantaged by the cost of components (mean [SD] US$9,574 [$9,986]) and their ongoing maintenance (US$1,936 [$3,179]). Of the 71 non-wearers in this study, 48% considered cost an influential factor in their decision not to adopt prosthesis use. Prosthesis funding is neither homogeneous nor transparent and can be influential in both the selection and use of a prosthetic device. Inequitable access to prosthesis funding is evident in industrialized nations and may lead to prosthesis abandonment and/or diminished quality of life for individuals with upper limb absences. Increased efforts are required to ensure equitable access to upper limb prosthetics and related services in line with individuals' needs.

Insiders' Insight: Discrimination against Indigenous Peoples through the Eyes of Health Care Professionals.

PubMed

Wylie, Lloy; McConkey, Stephanie

2018-05-07

Discrimination in the health care system has a direct negative impact on health and wellbeing. Experiences of discrimination are considered a root cause for the health inequalities that exist among Indigenous peoples. Experiences of discrimination are commonplace, with patients noting abusive treatment, stereotyping, and a lack of quality in the care provided, which discourage Indigenous people from accessing care. This research project examined the perspectives of health care providers and decision-makers to identify what challenges they see facing Indigenous patients and families when accessing health services in a large city in southern Ontario. Discrimination against Indigenous people was identified as major challenges by respondents, noting that it is widespread. This paper discusses the three key discrimination subthemes that were identified, including an unwelcoming environment, stereotyping and stigma, and practice informed by racism. These findings point to the conclusion that in order to improve health care access for Indigenous peoples, we need to go beyond simply making health services more welcoming and inclusive. Practice norms shaped by biases informed by discrimination against Indigenous people are widespread and compromise standards of care. Therefore, the problem needs to be addressed throughout the health care system as part of a quality improvement strategy. This will require not only a significant shift in the attitudes, knowledge, and skills of health care providers, but also the establishment of accountabilities for health care organizations to ensure equitable health services for Indigenous peoples.

Innovative Approaches Address Aging and Mental Health Needs in LGBTQ Communities

PubMed Central

Hoy-Ellis, Charles P.; Ator, Michael; Kerr, Christopher; Milford, Jessica

2016-01-01

LGBTQ older adults have higher levels of psychological distress as compared to older adults in general. They also experience multiple barriers to accessing equitable, culturally competent mental health and aging services because of their distinct histories and particular social contexts. This article discusses this lack of access to services, and highlights an innovative way mental health services are being delivered in LGBTQ communities. PMID:28366982

Exploring barriers to and enablers of adequate healthcare for Indigenous Australian prisoners with cancer: a scoping review drawing on evidence from Australia, Canada and the United States.

PubMed

Olds, Jessica; Reilly, Rachel; Yerrell, Paul; Stajic, Janet; Micklem, Jasmine; Morey, Kim; Brown, Alex

International frameworks supported by national principles in Australia stipulate that prisoners should be provided with health services equivalent to those provided in the general community. However, a number of barriers unique to the prison system may hinder the provision of equitable healthcare for this population. In Australia, Indigenous people carry a greater burden of cancer mortality, which the Cancer Data and Aboriginal Disparities (CanDAD) project is seeking to address. During the course of recruiting participants to the CanDAD study, Indigenous Australian prisoners with cancer emerged as an important, under-researched but difficult to access sub-group. This scoping review sought to identify barriers and facilitators of access to adequate and equitable healthcare for Indigenous Australian prisoners with cancer in Australia. This review demonstrated a lack of research and, as such, the scoping review was extended to prisoners with cancer in Australia, New Zealand, the United States and Canada. This approach was taken in order to summarise the existing body of evidence regarding the barriers and facilitators of access to adequate and equitable healthcare for those who are incarcerated and suffering from cancer, and highlight areas that may require further investigation. Eight studies or commentaries were found to meet the inclusion criteria. This limited set of findings pointed to a range of possible barriers faced by prisoners with cancer, including a tension between the prisons' concern with security versus the need for timely access to medical care. Findings identified here offer potential starting points for research and policy development. Further research is needed to better elucidate how barriers to adequate cancer care for prisoners may be identified and overcome, in Australia and internationally. Furthermore, given Indigenous Australians' over-burden of cancer mortality and over-representation in the prison system, further research is needed to identify whether there are a unique set of barriers for this group.

Contribution of Complementary Elementary Education towards Transition of Nomadic Pupils from Non-Formal to Middle School Education in Habero Sub-Zone, Eritrea

ERIC Educational Resources Information Center

Tekle, Tesfu; Njihia, Mukirae; Ogeta, Norbert; Habtu, Michael

2015-01-01

Background: Education in Eritrea is a fundamental right of every person. Therefore, ensuring equal and equitable educational opportunities for every citizen is essential for upward mobility. However, enrolment in areas inhabited by the nomadic groups is far less from the national average. To boost enrolment among the nomads and to meet the…

The No Child Left Behind Comparability Provision and Within-District Resource Distribution: An Examination of One Florida School District

ERIC Educational Resources Information Center

Chaprnka, Danielle L.

2012-01-01

The intent of Title I of the No Child Left Behind Act of 2001 is to ensure that all students, regardless of their socioeconomic status, are provided a fair and equitable opportunity to meet challenging academic performance standards. Given such, Title I legislation provides for federal funding to be administered to school districts and schools…

75 FR 44972 - Medicare and Medicaid Programs; Announcement of an Application From a Hospital Seeking To Enter...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-30

... waiver under section 1138(a)(2) of the Social Security Act (the Act), has requested to enter into an... change is likely to increase organ donation and will ensure equitable treatment for patients in both...)(1)(C) of the Social Security Act (the Act) and our regulations at Sec. 482.45. Section 1138(a)(1)(A...

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.

Inequities in accessibility to and utilisation of maternal health services in Ghana after user-fee exemption: a descriptive study.

PubMed

Ganle, John K; Parker, Michael; Fitzpatrick, Raymond; Otupiri, Easmon

2014-11-01

Inequities in accessibility to, and utilisation of maternal healthcare services impede progress towards attainment of the maternal health-related Millennium Development Goals. The objective of this study is to examine the extent to which maternal health services are utilised in Ghana, and whether inequities in accessibility to and utilization of services have been eliminated following the implementation of a user-fee exemption policy, that aims to reduce financial barriers to access, reduce inequities in access, and improve access to and use of birthing services. We analyzed data from the 2007 Ghana Maternal Health Survey for inequities in access to and utilization of maternal health services. In measuring the inequities, frequency tables and cross-tabulations were used to compare rates of service utilization by region, residence and selected socio-demographic variables. Findings show marginal increases in accessibility to and utilisation of skilled antenatal, delivery and postnatal care services following the policy implementation (2003-2007). However, large gradients of inequities exist between geographic regions, urban and rural areas, and different socio-demographic, religious and ethnic groupings. More urban women (40%) than rural, 53% more women in the highest wealth quintile than women in the lowest, 38% more women in the best performing region (Central Region) than the worst (Upper East Region), and 48% more women with at least secondary education than those with no formal education, accessed and used all components of skilled maternal health services in the five years preceding the survey. Our findings raise questions about the potential equity and distributional benefits of Ghana's user-fee exemption policy, and the role of non-financial barriers or considerations. Exempting user-fees for maternal health services is a promising policy option for improving access to maternal health care, but might be insufficient on its own to secure equitable access to maternal health services in Ghana. Ensuring equity in access will require moving beyond user-fee exemption to addressing wider issues of supply and demand factors and the social determinants of health, including redistributing healthcare resources and services, and redressing the positional vulnerability of women in their communities.

Technology in Education. IDRA Focus.

ERIC Educational Resources Information Center

IDRA Newsletter, 1995

1995-01-01

This theme issue includes four articles on the effective use of computers and electronic technology in education, and on equitable access to educational technologies for Hispanics and other minority groups. "Teachers and Instructional Technology: Wise or Foolish Choices" (Laura Chris Green) describes three unproductive roles for computer…

Community Collaboration, Use of Universal Design in the Classroom

ERIC Educational Resources Information Center

Smith, Rachel E.; Buchannan, Tara

2012-01-01

Barriers to classroom participation for postsecondary students with disabilities are often addressed through accommodations via disability resource offices. However, the use of individualized accommodations as the sole method for resolving access barriers in the classroom is neither sustainable nor equitable. Furthermore, this somewhat flawed…

Ethnicity, Inequality, and Higher Education in Malaysia.

ERIC Educational Resources Information Center

Selvaratnam, Viswanathan

1988-01-01

Traces the development since 1957 of Malaysian education policies aimed at providing equitable access to higher education. Suggests that these policies have increased representation of the Malay underclass in tertiary institutions and the professions, but have had little effect on intraethnic class inequalities. 46 references. (SV)

The Pearl of Great Price: Achieving Equitable Access to Primary and Secondary Education and Enhancing Learning in Sri Lanka. CREATE Pathways to Access. Research Monograph No. 29

ERIC Educational Resources Information Center

Aturupane, Harsha

2009-01-01

The experience of public policy in Sri Lanka has had a profound impact on the thinking of the global development community in relation to the role of education in economic development. In particular, the example of Sri Lanka helped to persuade policy makers around the world that governments can successfully develop a general education system to…

IJEPA: Gray Area for Health Policy and International Nurse Migration.

PubMed

Efendi, Ferry; Mackey, Timothy Ken; Huang, Mei-Chih; Chen, Ching-Min

2017-05-01

Indonesia is recognized as a nurse exporting country, with policies that encourage nursing professionals to emigrate abroad. This includes the country's adoption of international principles attempting to protect Indonesian nurses that emigrate as well as the country's own participation in a bilateral trade and investment agreement, known as the Indonesia-Japan Economic Partnership Agreement that facilitates Indonesian nurse migration to Japan. Despite the potential trade and employment benefits from sending nurses abroad under the Indonesia-Japan Economic Partnership Agreement, Indonesia itself is suffering from a crisis in nursing capacity and ensuring adequate healthcare access for its own populations. This represents a distinct challenge for Indonesia in appropriately balancing domestic health workforce needs, employment, and training opportunities for Indonesian nurses, and the need to acknowledge the rights of nurses to freely migrate abroad. Hence, this article reviews the complex operational and ethical issues associated with Indonesian health worker migration under the Indonesia-Japan Economic Partnership Agreement. It also introduces a policy proposal to improve performance of the Indonesia-Japan Economic Partnership Agreement and better align it with international principles focused on equitable health worker migration.

A State Policymaker's STEM Playbook. Promising Practices

ERIC Educational Resources Information Center

Zinth, Jennifer; Goetz, Tami

2016-01-01

Science, technology, engineering and mathematics (STEM) has captured the attention of state policymakers who are concerned about equitable access to high-quality educational experiences and preparing and inspiring students to pursue STEM careers. Yet in many states, STEM policymaking efforts have not achieved their intended return on investment…

77 FR 21547 - Proposed Priorities; Disability and Rehabilitation Research Projects and Centers Program

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-10

... impeding more engagement in physical activity among this population is limited knowledge about safe and.... Inaccessibility of recreational equipment and environments remains a primary barrier to participation in physical... will facilitate equitable access to, and safe use of, recreational equipment, facilities, and...

Teaching: In Light of Noel Gough's and Ajay Sharma's Articles

ERIC Educational Resources Information Center

Pouliot, Chantal

2017-01-01

In their articles, Ajay Sharma (Cult Stud Sci Educ, doi:10.1007/s11422-017-9835-z, 2017) and Noel Gough (Cult Stud Sci Educ, doi:10.1007/s11422-017-9834-0, 2017) shed light on the impact neoliberalism has on the teaching of science and suggest ways to ensure that science education remains critical and socially equitable. In this paper, I…

Changes in Federal Water Project Repayment Policies Can Reduce Federal Costs.

DTIC Science & Technology

1981-08-07

a reimburs - able purpose, the users should share in cost recovery. RECOMMENDATIONS To provide for equitable cost reimbursement on underutilized...Department of the Interior’s Bureau of Reclamation that do not ensure fair and timely recovery of water projects’ reimbursable costs. We made this...such costs for reimbursable project purposes and considering them in future water price determinations, agencies often reas- signed them to

Achieving Aichi Biodiversity Target 11 to improve the performance of protected areas and conserve freshwater biodiversity

Treesearch

Diego Juffe-Bignoli; Ian Harrison; Stuart HM Butchart; Rebecca Flitcroft; Virgilio Hermoso; Harry Jonas; Anna Lukasiewicz; Michele Thieme; Eren Turak; Heather Bingham; James Dalton; William Darwall; Marine Deguignet; Nigel Dudley; Royal Gardner; Jonathan Higgins; Ritesh Kumar; Simon Linke; G Randy Milton; Jamie Pittock; Kevin G Smith; Arnout van Soesbergen

2016-01-01

1. The Strategic Plan for Biodiversity (2011–2020), adopted at the 10th meeting of the Conference of the Parties to the Convention on Biological Diversity, sets 20 Aichi Biodiversity Targets to be met by 2020 to address biodiversity loss and ensure its sustainable and equitable use. Aichi Biodiversity Target 11 describes what an improved conservation network would look...

Peer engagement in harm reduction strategies and services: a critical case study and evaluation framework from British Columbia, Canada.

PubMed

Greer, Alissa M; Luchenski, Serena A; Amlani, Ashraf A; Lacroix, Katie; Burmeister, Charlene; Buxton, Jane A

2016-05-27

Engaging people with drug use experience, or 'peers,' in decision-making helps to ensure harm reduction services reflect current need. There is little published on the implementation, evaluation, and effectiveness of meaningful peer engagement. This paper aims to describe and evaluate peer engagement in British Columbia from 2010-2014. A process evaluation framework specific to peer engagement was developed and used to assess progress made, lessons learned, and future opportunities under four domains: supportive environment, equitable participation, capacity building and empowerment, and improved programming and policy. The evaluation was conducted by reviewing primary and secondary qualitative data including focus groups, formal documents, and meeting minutes. Peer engagement was an iterative process that increased and improved over time as a consequence of reflexive learning. Practical ways to develop trust, redress power imbalances, and improve relationships were crosscutting themes. Lack of support, coordination, and building on existing capacity were factors that could undermine peer engagement. Peers involved across the province reviewed and provided feedback on these results. Recommendations from this evaluation can be applied to other peer engagement initiatives in decision-making settings to improve relationships between peers and professionals and to ensure programs and policies are relevant and equitable.

Does the universal health insurance program affect urban-rural differences in health service utilization among the elderly? Evidence from a longitudinal study in taiwan.

PubMed

Liao, Pei-An; Chang, Hung-Hao; Yang, Fang-An

2012-01-01

To assess the impact of the introduction of Taiwan's National Health Insurance (NHI) on urban-rural inequality in health service utilization among the elderly. A longitudinal data set of 1,504 individuals aged 65 and older was constructed from the Survey of Health and Living Status of the Elderly. A difference-in-differences model was employed and estimated by the random-effect probit method. The introduction of universal NHI in Taiwan heterogeneously affected outpatient and inpatient health service utilization among the elderly in urban and rural areas. The introduction of NHI reduced the disparity of outpatient (inpatient) utilization between the previously uninsured and insured older urban residents by 12.9 (22.0) percentage points. However, there was no significant reduction in the utilization disparity between the previously uninsured and insured elderly among rural residents. Our study on Taiwan's experience should provide a valuable lesson to countries that are in an initial stage of proposing a universal health insurance system. Although NHI is designed to ensure the equitable right to access health care, it may result in differential impacts on health service utilization among the elderly across areas. The rural elderly tend to confront more challenges in accessing health care associated with spatial distance, transportation, social isolation, poverty, and a lack of health care providers, especially medical specialists. © 2011 National Rural Health Association.

[Personalized medicine: equity and access].

PubMed

Joly, Yann; Knoppers, Bartha M

2014-11-01

Personalized medicine has seen a recent increase in popularity amongst medical researchers and policymakers. Nevertheless, there are persistent legal, ethical, and social questions that need to be explored, particularly related to the criticism that personalized medicine constitutes an elitist model of healthcare. Investigating this critique the current manuscript argues that personalized medicine has the potential to become a positive force for equitable access to better healthcare at a national and international level. © 2014 médecine/sciences – Inserm.

Lecturers' Experiences of Teaching STEM to Students with Disabilities

ERIC Educational Resources Information Center

Ngubane-Mokiwa, S. A.; Khoza, S. B.

2016-01-01

Innovative teaching is a concept based on student-centred teaching strategies. Access to Science, Technology, Engineering and Mathematics (STEM) subjects has not been equitable due to use of traditional teaching strategies. These strategies tend to exclude students with disabilities who can effectively learn in environments that appropriately and…

The Others: Equitable Access, International Students, and the Community College

ERIC Educational Resources Information Center

Viggiano, Tiffany; López Damián, Ariadna I.; Morales Vázquez, Evelyn; Levin, John S.

2018-01-01

This qualitative investigation explains the ways in which community college decision makers justify the inclusion of international students at three community colleges in the United States. We identify and explain the ways in which decision makers rationalize institutional policy--particularly recruitment strategies and motivations--related to…

Student Discipline and Access to Equal Educational Opportunities in the United States

ERIC Educational Resources Information Center

Cambron-McCabe, Nelda; McCarthy, Martha

2004-01-01

Courts and legislatures in the United States have looked closely at governmental practices that threaten students' educational opportunities. One area that has raised concerns is whether student discipline policies and procedures are equitable, fair, and effective. Substantial litigation has established that disciplinary actions must be…

Mexico's "Telesecundaria" Program and Equitable Access to Resources

ERIC Educational Resources Information Center

Craig, Dana; Etcheverry, Jose; Ferris, Stefan

2016-01-01

This Note provides an analysis of Mexico's "Telesecundaria" program within the context of Mexico's new education reform framework offering a succinct background of the project, as well as key policy lessons that can be useful for other jurisdictions interested in the development of distance education programs. This Note uses a literature…

Share the Sky: Concepts and Technologies That Will Shape Future Airspace Use

NASA Technical Reports Server (NTRS)

Ballin, Mark G.; Cotton, William; Kopardekar, Parimal

2011-01-01

The airspace challenge for the United States is to protect national sovereignty and ensure the safety and security of those on the ground and in the air, while at the same time ensuring the efficiency of flight, reducing the costs involved, protecting the environment, and protecting the freedom of access to the airspace. Many visions of the future NAS hold a relatively near-term perspective, focusing on existing uses of the airspace and assuming that new uses will make up a small fraction of total use. In the longer term, the skies will be filled with diverse and amazing new air vehicles filling our societal needs. Anticipated new vehicles include autonomous air vehicles acting both independently and in coordinated groups, unpiloted cargo carriers, and large numbers of personal air vehicles and small-scale point-to-point transports. These vehicles will enable new capabilities that have the potential to increase societal mobility, transport freight at lower cost and with lower environmental impact, improve the study of the Earth s atmosphere and ecosystem, and increase societal safety and security by improving or drastically lowering the cost of critical services such as firefighting, emergency medical evacuation, search and rescue, border and neighborhood surveillance, and the inspection of our infrastructure. To ensure that uses of the airspace can continue to grow for the benefit of all, a new paradigm for operations is needed: equitably and safely sharing the airspace. This paper is an examination of such a vision, concentrating on the operations of all types of air vehicles and future uses of the National Airspace. Attributes of a long-term future airspace system are provided, emerging operations technologies are described, and initial steps in research and development are recommended.

Competition among pharmacies and the typology of services delivered: The Portuguese case.

PubMed

Martins, Lurdes; Queirós, Sónia

2015-05-01

To analyze the impact of individual and market characteristics (such as competition) on the typology of services delivered by a community pharmacy after a recent Portuguese pro-competitive regulatory change. In this paper, market concentration indices are used to identify market competition groups in the sample. These competition groups are then described with regard to the typology of services on offer by pharmacies within the group. Finally, a system of structural equations is estimated to verify if the decision of a pharmacy to offer or not to offer each of the studied pharmaceutical services is affected by local market regulated competition. In some cases, pharmacies belonging to different competition groups do not present significant differences in terms of the typology of services on offer, but according to our regressions, it seems that vaccines and medicines administration services, pharmaceutical care programmes and medicines management programmes are more likely to be offered in pharmacies located in higher competitive markets. These are also urban areas, in which there is already easy access to products sold in pharmacies, and to health services in general. Access to additional pharmacy services may in some cases increase as market competition increases. Thus, pro-competitive regulatory measures may have led to an asymmetric distribution of pharmacy services across the country, favouring more competitive urban marketplaces. If policy-makers are interested in a more symmetrical distribution of pharmacies services all over the country, they are recommended to take action to ensure equitable access to these services. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

A review of promoting access to medicines in China - problems and recommendations.

PubMed

Sun, Jing; Hu, Cecile Jia; Stuntz, Mark; Hogerzeil, Hans; Liu, Yuanli

2018-02-20

Despite recent reforms, distorting funding mechanisms and over-prescribing still maintain severe financial barriers to medicines access in China. Complicated and interrelated problems in the pharmaceutical sector require a common framework to be resolved as fragmented solutions do not work. We present a preliminary assessment of the impact of the national healthcare reforms on access to medicines, and propose policy recommendations for promoting universal access to medicines in China. Drawing on multiple sources of information, including a review of published literatures and official national data, field investigations in six provinces and interviews with key opinion leaders, this paper presents a preliminary assessment of the impact of the national healthcare reforms on access to medicines, and proposes policy recommendations for promoting universal access to medicines in China. Public expenditure on medicines has been strictly controlled since the national healthcare reforms of 2009. Yet total pharmaceutical expenditure (TPE) and total health expenditure growth rates continuously outpaced the growth of gross domestic product (GDP). With 2.4% of GDP, TPE now exceeds that of most high income countries. The distorted provider and consumer incentives in the Chinese health system have not fundamentally changed. Price-setting and reimbursement mechanisms do not promote cost-effective use of medicines. Inappropriate price controls and perverse financial incentives are the un-resolved root causes of preference of originator brands for some major diseases and shortages of low-cost and low-consumption medicines. In addition, access to expensive life-saving medicines is yet systematically addressed. The complicated and interdependent problems interact in a way that leads to significant system problems in China, which create dual challenges that both the developing country and the developed countries are facing. To further promote access to medicines, China should speed up the re-assessment of the quality and efficacy of domestically produced generic medicines; coordinate various reforms of price determination, insurance payments, and procurement policies; address medicine shortages through comprehensive policies and legislation; establish specific mechanisms to achieve sustainable equitable access to expensive essential medicines with health technology assessment as a tool to ensure that policy and priority setting are created in a coherent and evidence-based way.

HIV Programs for Sex Workers: Lessons and Challenges for Developing and Delivering Programs

PubMed Central

Wilson, David

2015-01-01

There is evidence that HIV prevention programs for sex workers, especially female sex workers, are cost-effective in several contexts, including many western countries, Thailand, India, the Democratic Republic of Congo, Kenya, and Zimbabwe. The evidence that sex worker HIV prevention programs work must not inspire complacency but rather a renewed effort to expand, intensify, and maximize their impact. The PLOS Collection “Focus on Delivery and Scale: Achieving HIV Impact with Sex Workers” highlights major challenges to scaling-up sex worker HIV prevention programs, noting the following: sex worker HIV prevention programs are insufficiently guided by understanding of epidemic transmission dynamics, situation analyses, and programmatic mapping; sex worker HIV and sexually transmitted infection services receive limited domestic financing in many countries; many sex worker HIV prevention programs are inadequately codified to ensure consistency and quality; and many sex worker HIV prevention programs have not evolved adequately to address informal sex workers, male and transgender sex workers, and mobile- and internet-based sex workers. Based on the wider collection of papers, this article presents three major clusters of recommendations: (i) HIV programs focused on sex workers should be prioritized, developed, and implemented based on robust evidence; (ii) national political will and increased funding are needed to increase coverage of effective sex worker HIV prevention programs in low and middle income countries; and (iii) comprehensive, integrated, and rapidly evolving HIV programs are needed to ensure equitable access to health services for individuals involved in all forms of sex work. PMID:26079267

Catalyzing a Reproductive Health and Social Justice Movement.

PubMed

Verbiest, Sarah; Malin, Christina Kiko; Drummonds, Mario; Kotelchuck, Milton

2016-04-01

The maternal and child health (MCH) community, partnering with women and their families, has the potential to play a critical role in advancing a new multi-sector social movement focused on creating a women's reproductive and economic justice agenda. Since the turn of the twenty-first century, the MCH field has been planting seeds for change. The time has come for this work to bear fruit as many states are facing stagnant or slow progress in reducing infant mortality, increasing maternal death rates, and growing health inequities. This paper synthesizes three current, interrelated approaches to addressing MCH challenges-life course theory, preconception health, and social justice/reproductive equity. Based on these core constructs, the authors offer four directions for advancing efforts to improve MCH outcomes. The first is to ensure access to quality health care for all. The second is to facilitate change through critical conversations about challenging issues such as poverty, racism, sexism, and immigration; the relevance of evidence-based practice in disenfranchised communities; and how we might be perpetuating inequities in our institutions. The third is to develop collaborative spaces in which leaders across diverse sectors can see their roles in creating equitable neighborhood conditions that ensure optimal reproductive choices and outcomes for women and their families. Last, the authors suggest that leaders engage the MCH workforce and its consumers in dialogue and action about local and national policies that address the social determinants of health and how these policies influence reproductive and early childhood outcomes.

HIV Programs for Sex Workers: Lessons and Challenges for Developing and Delivering Programs.

PubMed

Wilson, David

2015-06-01

There is evidence that HIV prevention programs for sex workers, especially female sex workers, are cost-effective in several contexts, including many western countries, Thailand, India, the Democratic Republic of Congo, Kenya, and Zimbabwe. The evidence that sex worker HIV prevention programs work must not inspire complacency but rather a renewed effort to expand, intensify, and maximize their impact. The PLOS Collection "Focus on Delivery and Scale: Achieving HIV Impact with Sex Workers" highlights major challenges to scaling-up sex worker HIV prevention programs, noting the following: sex worker HIV prevention programs are insufficiently guided by understanding of epidemic transmission dynamics, situation analyses, and programmatic mapping; sex worker HIV and sexually transmitted infection services receive limited domestic financing in many countries; many sex worker HIV prevention programs are inadequately codified to ensure consistency and quality; and many sex worker HIV prevention programs have not evolved adequately to address informal sex workers, male and transgender sex workers, and mobile- and internet-based sex workers. Based on the wider collection of papers, this article presents three major clusters of recommendations: (i) HIV programs focused on sex workers should be prioritized, developed, and implemented based on robust evidence; (ii) national political will and increased funding are needed to increase coverage of effective sex worker HIV prevention programs in low and middle income countries; and (iii) comprehensive, integrated, and rapidly evolving HIV programs are needed to ensure equitable access to health services for individuals involved in all forms of sex work.

Utilizing the Experience of Consumers in Consultation to Develop the Australasian Oncofertility Consortium Charter.

PubMed

Anazodo, Antoinette C; Gerstl, Brigitte; Stern, Catharyn J; McLachlan, Robert I; Agresta, Franca; Jayasinghe, Yasmin; Cohn, Richard J; Wakefield, Claire E; Chapman, Michael; Ledger, William; Sullivan, Elizabeth A

2016-09-01

In Australia and New Zealand, there has not been a national systematic development of oncofertility services for cancer patients of reproductive age although many cancer and fertility centers have independently developed services. A number of barriers exist to the development of these services, including a lack of clear referral pathways, a lack of communication between clinicians and patients about fertility preservation, differences in the knowledge base of clinicians about the risk of cancer treatment causing infertility and fertility preservation options, a lack of national health insurance funding covering all aspects of fertility preservation, and storage costs and cultural, religious, and ethical barriers. The development of strategies to overcome these barriers is a high priority for oncofertility care to ensure that equitable access to the best standard of care is available for all patients. The FUTuRE Fertility Research Group led a collaborative consultation process with the Australasian Oncofertility Consumer group and oncofertility specialists to explore consumers' experiences of oncofertility care. Consumers participated in qualitative focus group meetings to define and develop a model of consumer driven or informed "gold standard oncofertility care" with the aim of putting together a Charter that specifically described this. The finalized Australasian Oncofertility Consortium Charter documents eight key elements of gold standard oncofertility care that will be used to monitor the implementation of oncofertility services nationally, to ensure that these key elements are incorporated into standard practice over time.

Fundraising and Corporate Donations in Schools: The Beginning of a Two-Tier Public Education System.

ERIC Educational Resources Information Center

Kidder, Annie

2002-01-01

As Canadian provinces cut funding for education, the shortfall is made up by parent fundraising, donations, or private partnerships. Equitable access to education is undermined because schools with better parent fundraisers, more effective principal wheeler-dealers, and more-advantaged populations have more resources, while disadvantaged children…

An Analysis of Specific Learning Disability Exclusionary Clause

ERIC Educational Resources Information Center

Lybarger, Pamela A.

2017-01-01

The purpose of Individuals with Disabilities Education Improvement Act (IDEIA) is to protect the rights of students with disabilities and to assure that all students receive equitable access to a free and appropriate public education; yet there are explicit exclusions written in the law for students who may have experienced environmental,…

The Potentials of Student Initiated Netspeak in a Middle Primary Science-Inspired Multiliteracies Project

ERIC Educational Resources Information Center

Ridgewell, Jay; Exley, Beryl

2011-01-01

There is no denying that the information technology revolution of the late twentieth century has arrived. Whilst not equitably accessible for many, others hold high expectations for the contributions online activity will make to student learning outcomes. Concurrently, and not necessarily consequentially, the number of science and technology…

Education for All: National Plan of Action, 2003-2015

ERIC Educational Resources Information Center

Online Submission, 2005

2005-01-01

Background: The Lao People's Democratic Republic (PDR) Education for All National Plan of Action (EFA NPA) for 2003-2015 seeks to accomplish three major tasks: equitable access, improved quality and relevance and strengthened education management. Purpose: To design a National Education For All Action Plan for basic education in Lao PDR which…

Routes towards Portuguese Higher Education: Students' Preferred or Feasible Choices?

ERIC Educational Resources Information Center

Tavares, Orlanda

2013-01-01

Background: An equitable and democratised higher education system should, in principle, be permeable to the flow of populations with different social and/or cultural backgrounds, allowing access to any parts of the system. However, despite the democratisation efforts that took place in Portugal after the 1974 revolution, and although the student…

78 FR 33886 - Identification of Ukraine as a Priority Foreign Country and Initiation of Section 301 Investigation

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-05

... Representative) identified Ukraine as a priority foreign country due to Ukraine's denial of adequate and effective protection of intellectual property rights and its denial of fair and equitable market access to... system for collecting societies, which are responsible for collecting and distributing royalties to U.S...

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…

Effectiveness of Asynchronous Reference Services for Distance Learning Students within Florida's Community College System

ERIC Educational Resources Information Center

Profeta, Patricia C.

2007-01-01

The provision of equitable library services to distance learning students emerged as a critical area during the 1990s. Library services available to distance learning students included digital reference and instructional services, remote access to online research tools, database and research tutorials, interlibrary loan, and document delivery.…

Sketching Up New Geographies: Open Sourcing and Curriculum Development

ERIC Educational Resources Information Center

Boyd, William; Ellis, David

2013-01-01

The functionality of web 2.0 technologies has caused academics to rethink their development of teaching and learning methods and approaches. The editable, open access nature of web 2.0 encourages the innovative collaboration of ideas, the creation of equitable visual and tactile learning environments, and opportunity for academics to develop…

Communities and School Ratings: Examining Geography of Opportunity in an Urban School District Located in a Resource-Rich City

ERIC Educational Resources Information Center

Green, Terrance L.; Sánchez, Joanna; Germain, Emily

2017-01-01

Research on geography of opportunity documents how residential patterns influence students' access to equitable educational opportunities and resources. This scholarship often highlights how geography reinforces educational inequity in urban school districts located in resource-constrained cities. Yet, less research has explored how the geography…

Perspectives in Early Childhood Education: Belize, Brazil, Mexico, El Salvador and Peru

ERIC Educational Resources Information Center

McConnell-Farmer, Judith Lynne; Cook, Pamela R.; Farmer, M. W.

2012-01-01

Early childhood education (ECE) provision is becoming a growing priority. During the past twenty years, Latin America has shown a growing recognition in the provision of educational programs for young children, birth to age eight, is essential. Urban and rural populations intimated in 2009, that many countries utilizing equitable access to…

Government Funding as Leverage for Quality Teaching and Learning: A South African Perspective

ERIC Educational Resources Information Center

Essack, Sabiha Y.; Naidoo, Indirani; Barnes, Glen

2010-01-01

The South African Higher Education Funding Framework uses funding as a lever to achieve equitable student access, quality teaching and research, and improved student retention and success. Maximising a university subsidy from the national Department of Education necessitates innovative strategies at the pre- and post-student admission stages. This…

Leading against the Grain: Lessons for Creating Just and Equitable Schools

ERIC Educational Resources Information Center

Brooks, Jeffrey S., Ed.; Normore, Anthony H., Ed.

2017-01-01

What new ideas and ways of thinking can educational leaders learn from great world leaders who have moved their societies to greater equity and expanded educational opportunity? In this lively, accessible volume, the editors have brought together an impressive group of senior and early-career educational scholars to study the lives and…

Inquiry-Based Practical Work in Physical Sciences: Equitable Access and Social Justice Issues

ERIC Educational Resources Information Center

Tsakeni, Maria

2018-01-01

Physical sciences education comes with high expectations for learners to be successfully placed in tertiary institutions in related fields, and developing countries' aspirations to develop advanced and specialised skills to drive economies. However, some of the prevailing instructional strategies in science classrooms work to marginalise learners.…

Redefining School Health Services: Comprehensive Child Health Care as the Framework.

ERIC Educational Resources Information Center

Silver, George A.

Recognizing the needs, deficiencies, and diversity of school health services is prerequisite to any analysis of need. More uniform programs and more equitable access for all school children to whatever minimal standard of health services should be provided: periodic examination, some limited medical care on the school grounds, intensive health…

Research and Policy Considerations for English Learner Equity

ERIC Educational Resources Information Center

Robinson-Cimpian, Joseph P.; Thompson, Karen D.; Umansky, Ilana M.

2016-01-01

English learners (ELs), students from a home where a language other than English is spoken and who are in the process of developing English proficiency themselves, represent over 10% of the US student population. Oftentimes education policies and practices create barriers for ELs to achieve access and outcomes that are equitable to those of their…

Data-Based Decision Making: The Road to AP Equity

ERIC Educational Resources Information Center

Edwards, Kelcey; Duggan, Odette

2012-01-01

Presented at the Advanced Placement Annual Conference (APAC) in Lake Buena Vista, FL in July 2012. This presentation reviews concepts central to achieving equitable AP access and success for all willing and academically prepared students. We analyze trends in participation and performance by race/ethnicity from the AP Report to the Nation and…

Collaborating for Equity: A Scan of the Los Angeles Educational Ecosystem. Summary

ERIC Educational Resources Information Center

Potochnik, Tracie; Romans, Angela N.

2016-01-01

Los Angeles has an educational ecosystem that is rich with partners committed to providing equitable access to learning opportunities for students. Throughout the 2014-2015 school year, the "Annenberg Institute for School Reform at Brown University" (AISR) spent time meeting with a range of partners, including the Los Angeles Unified…

Collaborating for Equity: A Scan of the Los Angeles Educational Ecosystem. Full Report

ERIC Educational Resources Information Center

Potochnik, Tracie; Romans, Angela N.

2015-01-01

Los Angeles has an educational ecosystem that is rich with partners committed to providing equitable access to learning opportunities for students. Throughout the 2014-2015 school year, the "Annenberg Institute for School Reform at Brown University" (AISR) spent time meeting with a range of partners, including the Los Angeles Unified…

Recognizing and Accommodating Employees with PTSD: The Intersection of Human Resource Development, Rehabilitation, and Psychology

ERIC Educational Resources Information Center

Hughes, Claretha; Lusk, Stephanie L.; Strause, Stephanie

2016-01-01

All employees within the workplace must be treated fairly and equitably including those with disabilities who may require accommodations that serve to increase access to and maintenance of competitive employment. Human Resource Development (HRD) researchers and practitioners have experience in accommodating employees with disabilities but are now…

School Choice and Competitive Incentives: Mapping the Distribution of Educational Opportunities across Local Education Markets

ERIC Educational Resources Information Center

Lubienski, Christopher; Gulosino, Charisse; Weitzel, Peter

2009-01-01

Competition sparked by school choice is expected to generate greater educational opportunities, particularly for disadvantaged students. The premise is that competitive incentives will change the organizational behavior of schools (and districts, dioceses, etc.) in ways that will lead to more equitable access for students across varied and often…

Transforming a Teacher Community of Practice for Underserved Students

ERIC Educational Resources Information Center

Hollins, Etta R.

2009-01-01

Migration has shifted the world's population such that hardly a monocultural society still exists. These demographic changes have brought about changes in the strategies used to maintain national unity and in the distribution of benefits, goods, and services within the society. Providing equitable access to high-quality education has been among…

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"…

Equity, autonomy, and efficiency: what health care system should we have?

PubMed

Menzel, Paul T

1992-02-01

The U.S. has a wide range of options in choosing a health care system. Rational choice of a system depends on analysis and prioritization of the basic moral goals of equitable access to all citizens, the just sharing of financial costs between well and ill, respect for the values and choices of subscribers and patients, and efficiency in the delivery of costworthy care. These moral goals themselves, however, tell us little about what health care system the United States should have. Equitable access does not demand a level and scope of care for the poor equal to that rationally chosen by the middle class, and there are ways within mixed systems, though not easy ways, to achieve a fair distribution of costs between well and ill. Despite pluralistic systems' apparent advantage in allowing subscribers to choose their own forms of rationing, problems in translating serious long-term subscriber choices into actual medical practice may be greater in pluralistic than in unitary systems. Final choice of a system hinges primarily on peculiar historical facts about U.S. political culture, not on moral principle.

Equality, autonomy, and efficiency: what health care system should we have?

PubMed

Menzel, P T

1992-02-01

The U.S. has a wide range of options in choosing a health care system. Rational choice of a system depends on analysis and prioritization of the basis moral goals of equitable access to all citizens, the just sharing of financial costs between well and ill, respect for the values and choices of subscribers and patients, and efficiency in the delivery of costworthy care. These moral goals themselves, however, tell us little about what health care system the United States should have. Equitable access does not demand a level and scope of care for the poor equal to that rationally chosen by the middle class, and there are ways within mixed systems, though not easy ways, to achieve a fair distribution of costs between well and ill. Despite pluralistic systems' apparent advantage in allowing subscribers to choose their own forms of rationing, problems in translating serious long-term subscriber choices into actual medical practice may be greater in pluralistic than in unitary systems. Final choice of a system hinges primarily on peculiar historical facts about U.S. political culture, not on moral principle.

[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.

Welfarism versus 'free enterprise': considerations of power and justice in the Philippine healthcare system.

PubMed

Sy, Peter A

2003-10-01

The just distribution of benefits and burdens of healthcare, at least in the contemporary Philippine context, is an issue that gravitates towards two opposing doctrines of welfarism and 'free enterprise.' Supported largely by popular opinion, welfarism maintains that social welfare and healthcare are primarily the responsibility of the government. Free enterprise (FE) doctrine, on the other hand, maintains that social welfare is basically a market function and that healthcare should be a private industry that operates under competitive conditions with minimal government control. I will examine the ethical implications of these two doctrines as they inform healthcare programmes by business and government, namely: (a) the Devolution of Health Services and (b) the Philippine Health Maintenance Organization (HMO). I will argue that these doctrines and the health programmes they inform are deficient in following respects: (1) equitable access to healthcare, (2) individual needs for premium healthcare, (3) optimal utilisation of health resources, and (4) the equitable assignment of burdens that healthcare entails. These respects, as considerations of justice, are consistent with an operational definition of 'power' proposed here as 'access to and control of resources.'

Neighborhood Disparities in Access to Healthy Foods and Their Effects on Environmental Justice

PubMed Central

Dave, Jayna

2012-01-01

Environmental justice is concerned with an equitable distribution of environmental burdens. These burdens comprise immediate health hazards as well as subtle inequities, such as limited access to healthy foods. We reviewed the literature on neighborhood disparities in access to fast-food outlets and convenience stores. Low-income neighborhoods offered greater access to food sources that promote unhealthy eating. The distribution of fast-food outlets and convenience stores differed by the racial/ethnic characteristics of the neighborhood. Further research is needed to address the limitations of current studies, identify effective policy actions to achieve environmental justice, and evaluate intervention strategies to promote lifelong healthy eating habits, optimum health, and vibrant communities. PMID:22813465

Task-sharing or public finance for the expansion of surgical access in rural Ethiopia: an extended cost-effectiveness analysis.

PubMed

Shrime, Mark G; Verguet, Stéphane; Johansson, Kjell Arne; Desalegn, Dawit; Jamison, Dean T; Kruk, Margaret E

2016-07-01

Despite a high burden of surgical disease, access to surgical services in low- and middle-income countries is often limited. In line with the World Health Organization's current focus on universal health coverage and equitable access to care, we examined how policies to expand access to surgery in rural Ethiopia would impact health, impoverishment and equity. An extended cost-effectiveness analysis was performed. Deterministic and stochastic models of surgery in rural Ethiopia were constructed, utilizing pooled estimates of costs and probabilities from national surveys and published literature. Model calibration and validation were performed against published estimates, with sensitivity analyses on model assumptions to check for robustness. Outcomes of interest were the number of deaths averted, the number of cases of poverty averted and the number of cases of catastrophic expenditure averted for each policy, divided across wealth quintiles. Health benefits, financial risk protection and equity appear to be in tension in the expansion of access to surgical care in rural Ethiopia. Health benefits from each of the examined policies accrued primarily to the poor. However, without travel vouchers, many policies also induced impoverishment in the poor while providing financial risk protection to the rich, calling into question the equitable distribution of benefits by these policies. Adding travel vouchers removed the impoverishing effects of a policy but decreased the health benefit that could be bought per dollar spent. These results were robust to sensitivity analyses. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Costing Human Rights and Community Support Interventions as a Part of Universal Access to HIV Treatment and Care in a Southern African Setting

PubMed Central

Jones, Louisa; Akugizibwe, Paula; Clayton, Michaela; Amon, Joseph J; Sabin, Miriam Lewis; Bennett, Rod; Stegling, Christine; Baggaley, Rachel; Kahn, James G; Holmes, Charles B; Garg, Navneet; Obermeyer, Carla Makhlouf; Mack, Christina DeFilippo; Williams, Phoebe; Smyth, Caoimhe; Vitoria, Marco; Crowley, Siobhan; Williams, Brian; McClure, Craig; Granich, Reuben; Hirnschall, Gottfried

2011-01-01

Expanding access to antiretroviral therapy (ART) has both individual health benefits and potential to decrease HIV incidence. Ensuring access to HIV services is a significant human rights issue and successful programmes require adequate human rights protections and community support. However, the cost of specific human rights and community support interventions for equitable, sustainable and non-discriminatory access to ART are not well described. Human rights and community support interventions were identified using the literature and through consultations with experts. Specific costs were then determined for these health sector interventions. Population and epidemic data were provided through the Statistics South Africa 2009 national mid-year estimates. Costs of scale up of HIV prevention and treatment were taken from recently published estimates. Interventions addressed access to services, minimising stigma and discrimination against people living with HIV, confidentiality, informed consent and counselling quality. Integrated HIV programme interventions included training for counsellors, ‘Know Your Rights’ information desks, outreach campaigns for most at risk populations, and adherence support. Complementary measures included post-service interviews, human rights abuse monitoring, transportation costs, legal assistance, and funding for human rights and community support organisations. Other essential non-health sector interventions were identified but not included in the costing framework. The annual costs for the human rights and community support interventions are United States (US) $63.8 million (US $1.22 per capita), representing 1.5% of total health sector HIV programme costs. Respect for human rights and community engagement can be understood both as an obligation of expanded ART programmes and as a critically important factor in their success. Basic rights-based and community support interventions constitute only a small percentage of overall programmes costs. ART programs should consider measuring the cost and impact of human rights and community support interventions as key aspects of successful programme expansion. PMID:21999777

Costing human rights and community support interventions as a part of universal access to HIV treatment and care in a Southern African setting.

PubMed

Jones, Louisa; Akugizibwe, Paula; Clayton, Michaela; Amon, Joseph J; Sabin, Miriam Lewis; Bennett, Rod; Stegling, Christine; Baggaley, Rachel; Kahn, James G; Holmes, Charles B; Garg, Navneet; Obermeyer, Carla Makhlouf; Mack, Christina DeFilippo; Williams, Phoebe; Smyth, Caoimhe; Vitoria, Marco; Crowley, Siobhan; Williams, Brian; McClure, Craig; Granich, Reuben; Hirnschall, Gottfried

2011-09-01

Expanding access to antiretroviral therapy (ART) has both individual health benefits and potential to decrease HIV incidence. Ensuring access to HIV services is a significant human rights issue and successful programmes require adequate human rights protections and community support. However, the cost of specific human rights and community support interventions for equitable, sustainable and non-discriminatory access to ART are not well described. Human rights and community support interventions were identified using the literature and through consultations with experts. Specific costs were then determined for these health sector interventions. Population and epidemic data were provided through the Statistics South Africa 2009 national mid-year estimates. Costs of scale up of HIV prevention and treatment were taken from recently published estimates. Interventions addressed access to services, minimising stigma and discrimination against people living with HIV, confidentiality, informed consent and counselling quality. Integrated HIV programme interventions included training for counsellors, 'Know Your Rights' information desks, outreach campaigns for most at risk populations, and adherence support. Complementary measures included post-service interviews, human rights abuse monitoring, transportation costs, legal assistance, and funding for human rights and community support organisations. Other essential non-health sector interventions were identified but not included in the costing framework. The annual costs for the human rights and community support interventions are United States (US) $63.8 million (US $1.22 per capita), representing 1.5% of total health sector HIV programme costs. Respect for human rights and community engagement can be understood both as an obligation of expanded ART programmes and as a critically important factor in their success. Basic rights-based and community support interventions constitute only a small percentage of overall programmes costs. ART programs should consider measuring the cost and impact of human rights and community support interventions as key aspects of successful programme expansion.

Availability and accessibility of evidence-based information resources provided by medical libraries in Australia.

PubMed

Ritchie, A; Sowter, B

2000-01-01

This article reports on the results of an exploratory survey of the availability and accessibility of evidence-based information resources provided by medical libraries in Australia. Although barriers impede access to evidence-based information for hospital clinicians, the survey revealed that Medline and Cinahl are available in over 90% of facilities. In most cases they are widely accessible via internal networks and the Internet. The Cochrane Library is available in 69% of cases. The Internet is widely accessible and most libraries provide access to some full-text, electronic journals. Strategies for overcoming restrictions and integrating information resources with clinical workflow are being pursued. State, regional and national public and private consortia are developing agreements utilising on-line technology. These could produce cost savings and more equitable access to a greater range of evidence-based resources.

Digital technology use among disadvantaged Australians: implications for equitable consumer participation in digitally-mediated communication and information exchange with health services.

PubMed

Newman, Lareen; Biedrzycki, Kate; Baum, Fran

2012-05-01

To present research findings on access to, and use of, digital information and communication technologies (ICTs) by Australians from lower income and disadvantaged backgrounds to determine implications for equitable consumer access to digitally-mediated health services and information. Focus groups were held in 2008-09 with 80 residents from lower income and disadvantaged backgrounds in South Australia, predominantly of working- and family-formation age (25 to 55 years). Qualitative analysis was conducted on a-priori and emergent themes to describe dominant categories. Access to, and use of, computers, the Internet and mobile phones varied considerably in extent, frequency and quality within and across groups due to differences in abilities, resources and life experience. Barriers and facilitators included English literacy (including for native speakers), technological literacy, education, income, housing situation, social connection, health status, employment status, and trust. Many people gained ICT skills by trial and error or help from friends, and only a few from formal programs, resulting in varied skills. The considerable variation in ICT access and use within lower income and disadvantaged groups must be acknowledged and accommodated by health initiatives and services when delivering digitally-mediated consumer-provider interaction, online health information, or online self-management of health conditions. If services require consumers to participate in a digitally-mediated communication exchange, then we suggest they might support skills and technology acquisition, or provide non-ICT alternatives, in order to avoid exacerbating health inequities.

Shared Housing Arrangements in Germany—An Equitable Alternative to Long Term Care Services beyond Homes and Institutions?

PubMed Central

Frisina Doetter, Lorraine; Schmid, Achim

2018-01-01

Given the saliency of socio-demographic pressures, the highly restrictive definition of “need for care” characterizing the German long-term care system at its foundations in 1994 has since been subject to various expansionary reforms. This has translated into greater interest in innovative care models that provide more choice and flexibility to beneficiaries. One such model is ‘shared housing arrangements’ (“ambulant betreute Wohngemeinschaften”), where a small group of people rent private rooms, while sharing a common space, domestic support, and nursing care. Using interview and secondary data, this study examines the potential for such arrangements to provide an equitable alternative to care that is accessible to a larger population of beneficiaries than presently seen in Germany. PMID:29443948

Dr Who? Equity and Diversity among University Postgraduate and Higher Degree Cohorts

ERIC Educational Resources Information Center

Harvey, Andrew; Andrewartha, Lisa

2013-01-01

Lack of equitable access at the higher levels of university is detrimental to individuals and more broadly to economic productivity and social cohesion. This paper considers the nature and extent of under-representation in postgraduate and higher degree study and proposes responses at both the institutional and policy levels. Particular focus is…

Education as an Ethical Concern in the Global Era

ERIC Educational Resources Information Center

Arnove, Robert; Bull, Barry L.

2015-01-01

This article examines the issue of the ethical status of education, particularly as related to individual dignity and freedom. We select cases that have been described in fine detail by social science--the education of girls and the education of all children within counter-hegemonic movements. These cases involve issues of access to equitable and…

Could Participant-Produced Photography Augment Therapeutic Interventions for People with Intellectual Disabilities? A Systematic Review of the Available Evidence

ERIC Educational Resources Information Center

Boulton, Natalie E.; Williams, Jonathan; Jones, Robert S. P.

2018-01-01

Background: People with intellectual disabilities are entitled to equitable access to psychological support. Traditional therapeutic approaches often rely on a person's ability to verbally articulate a description of their life, which can be particularly difficult for emotionally salient information. Methods: A systematic literature review was…

Lost and Found: Music Activities Delivered by Primary Classroom Generalists

ERIC Educational Resources Information Center

King, Fiona

2015-01-01

Primary classroom teachers can play a vital role in the music education of primary school students, providing a basis for lifelong learning in music and the arts. Research shows that not all Victorian primary school students have equitable access to music education and that the role of the classroom teacher becomes valuable in supplying or…

Increasing Equitable Care for Youth through Coordinated School Health

ERIC Educational Resources Information Center

Sanetti, Lisa M. Hagermoser

2017-01-01

Nearly a quarter of the students in the U.S. education system have a chronic health condition, disability, or special healthcare need. Students living in poverty and those at risk for or with disabilities have higher rates of health issues and encounter more barriers to accessing appropriate health care than their peers. The reciprocal influences…

Updating Algebra for All?: Evidence of a Middle-Grades Math Acceleration Policy

ERIC Educational Resources Information Center

Dougherty, Shaun M.; Goodman, Joshua; Hill, Darryl; Litke, Erica; Page, Lindsay

2014-01-01

The Wake County Public School System (WCPSS) in North Carolina recently addressed the issue of advancement in and equitable access to advanced mathematics. Under a recent policy, WCPSS uses a SAS-generated predicted probabilities of students' success in obtaining a passing score on the NC Algebra I End-of-Course (EOC) exam, to determine…

Exploring the Digital Divide: The Use of Digital Technologies in Ontario Public Schools

ERIC Educational Resources Information Center

Chen, Bodong

2015-01-01

Combining data from a school principal survey with student demographics and achievement data, the present study aimed to develop a much needed understanding of ICT usage in Ontario's K-12 public schools. Results indicated equitable first-order access to technology for schools, early integration of ICT from the earliest grades, frequent application…

Expanded Learning Time and Opportunities: Key Principles, Driving Perspectives, and Major Challenges

ERIC Educational Resources Information Center

Blyth, Dale A.; LaCroix-Dalluhn, Laura

2011-01-01

If expanded learning is going to make a real difference, then three key principles must inform how communities overcome challenges and assure equitable access to learning opportunities. Much of today's debate is framed in the language of formal education systems--students, classrooms, schools--even though part of the expansion seeks to engage a…

The Intersection of Race, Culture, Language, and Disability: Implications for Urban Education

ERIC Educational Resources Information Center

Blanchett, Wanda J.; Klingner, Janette K.; Harry, Beth

2009-01-01

To date, few researchers have sought to examine the effect of issues of race, culture, language, and disability, let alone to look specifically at the intersection of these issues, as it relates to special education identification, special education service delivery, and students of color's access to an equitable education. Thus, this article will…

Creating Joint Representations of Collaborative Problem Solving with Multi-Touch Technology

ERIC Educational Resources Information Center

Mercier, E.; Higgins, S.

2014-01-01

Multi-touch surfaces have the potential to change the nature of computer-supported collaborative learning, allowing more equitable access to shared digital content. In this paper, we explore how large multi-touch tables can be used by groups of students as an external representation of their group interaction processes. Video data from 24 groups…

Learning to Lead: A Social Justice Perspective on Understanding Elementary Teacher Leadership in Papua New Guinea

ERIC Educational Resources Information Center

Brownlee, Joanne; Scholes, Laura; Farrell, Ann; Davis, Julie; Cook, Donna

2012-01-01

Leadership in elementary education is currently recognized as a political imperative in Papua New Guinea (PNG), as the nation develops strategies towards equitable access to schooling. One recent initiative aimed at building educational leadership was an intensive Australian Leadership Award Fellowship (ALAF) program funded by AusAID, involving a…

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…

Multilingual Language Policy and School Linguistic Practice: Globalization and English-Language Teaching in India, Singapore and South Africa

ERIC Educational Resources Information Center

Hornberger, Nancy; Vaish, Viniti

2009-01-01

This paper explores tensions in translating multilingual language policy to classroom linguistic practice, and especially the paradoxical role of and demand for English as a tool of decolonization for multilingual populations seeking equitable access to a globalizing economy. We take an ecological and sociolinguistic approach, depicting tensions…

Evaluating Admission Practices as Potential Barriers to Creating Equitable Access to Undergraduate Engineering Education

ERIC Educational Resources Information Center

Myers, Beth Ann

2016-01-01

To create a more competitive and creative engineering workforce, breakthroughs in how we attract and educate more diverse engineers are mandated. Despite a programmatic focus on increasing the representation of women and minorities in engineering during the last few decades, no single solution has been identified and is probably not realistic. But…

University and Participative Democracy: Adoption, Perception and Impact--Case Study Universidad Politécnica Salesiana

ERIC Educational Resources Information Center

Buele, Irene; Pablo, Vidueira

2016-01-01

The Constitution of Ecuador was approved in 2008, and promotes the application of participatory processes for resource distribution at different levels of government. The ultimate aim of the Constitution of Ecuador is to promote sustainable development and equitable distribution of resources and wealth, and to access the "Buen Vivir."…

Perspectives on Inclusive Education with Reference to United Nations

ERIC Educational Resources Information Center

Sharma, Arvind

2015-01-01

This essay explores inclusive education and explains the role of United Nations for imparting it to different nations. Undoubtedly, the UN and the United Nations Children's Fund (UNICEF) strive for all children to have equitable access to education as a basic human right. The Convention on the Rights of the Child (CRC) combined with the Convention…

Learning Support Policy for Mathematics in Irish Primary Schools: Equal Access but Unequal Needs

ERIC Educational Resources Information Center

Travers, Joseph

2010-01-01

This paper critiques learning-support policy for mathematics in Irish primary schools. The key policy question addressed is how equitable the development of the learning-support service has been in addressing low achievement in mathematics in designated schools compared to non-designated schools. The core argument developed is that there is a link…

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…

Education Policy Reform in Sri Lanka: The Double-Edged Sword of Political Will

ERIC Educational Resources Information Center

Little, Angela W.

2011-01-01

In 1997, the Government of Sri Lanka launched a comprehensive set of education reforms designed to promote equitable access to basic education and improvements in learning outcomes. The package of reforms arose as a political response to widespread youth unrest in the late 1980s and attracted considerable "political will", a vague but…

Examining the Digital Divide in K-12 Public Schools: Four-Year Trends for Supporting ICT Literacy in Florida

ERIC Educational Resources Information Center

Hohlfeld, Tina N.; Ritzhaupt, Albert D.; Barron, Ann E.; Kemker, Kate

2008-01-01

While there is evidence that access to computers in schools has increased, there remain questions about whether low socio-economic status (SES) schools provide students with equitable supports for achieving information communication technology (ICT) literacy. This research first presents a theoretical model to examine the digital divide within…

Breaking the Cycle: A Phenomenological Approach to Broadening Access to Post-Secondary Education

ERIC Educational Resources Information Center

Cefai, Carmel; Downes, Paul; Cavioni, Valeria

2016-01-01

Over the past decades, there has been a substantial increase in post-secondary education participation in most Organisation for Economic Co-operation and Development (OECD) and European Union countries. This increase, however, does not necessarily reflect a parallel equitable growth in post-secondary education, and early school leaving is still an…

Policy Implications of a Proposed Framework to Improve the Accessibility and Effectiveness of Internships in Accounting

ERIC Educational Resources Information Center

Capka, John; Foltin, Craig

2017-01-01

Accounting internships provide substantial benefits to employers and students alike. However, opportunities for students are not equitable across all populations due to the existing policies that exist for placing interns. This inequity is particularly true for students from community colleges where there is a larger proportion of underrepresented…

Providing Worker Education and Building the Labor Movement: The Joseph S. Murphy Institute of City University of New York

ERIC Educational Resources Information Center

D'Amico, Deborah

2011-01-01

To provide equitable access to formal, nonformal and workplace learning, experts urge community, business, education and government partnerships. While membership in unions continues to decline and "opportunities for entry-level workers to become skilled workers is lessening," the partnership described in this article shows that it is…

Building Trust-Based Sustainable Networks

DTIC Science & Technology

2013-06-05

entities to build sustainable networks with limited resources or misbehaving entities by learning from the lessons in the social sciences. We discuss...their individuality); and ■ Misbehaving nodes in terms of environmental, economic, and social perspectives. The sustainable network concerns...equitable access to particular services which are otherwise abused by misbehaving or malicious users. Such approaches provide a fair and

Towards achieving Abuja targets: identifying and addressing barriers to access and use of insecticides treated nets among the poorest populations in Kenya.

PubMed

Chuma, Jane; Okungu, Vincent; Ntwiga, Janet; Molyneux, Catherine

2010-03-16

Ensuring that the poor and vulnerable population benefit from malaria control interventions remains a challenge for malaria endemic countries. Until recently, ownership and use of insecticides treated nets (ITNs) in most countries was low and inequitable, although coverage has increased in countries where free ITN distribution is integrated into mass vaccination campaigns. In Kenya, free ITNs were distributed to children aged below five years in 2006 through two mass campaigns. High and equitable coverage were reported after the campaigns in some districts, although national level coverage remained low, suggesting that understanding barriers to access remains important. This study was conducted to explore barriers to ownership and use of ITNs among the poorest populations before and after the mass campaigns, to identify strategies for improving coverage, and to make recommendations on how increased coverage levels can be sustained. The study was conducted in the poorest areas of four malaria endemic districts in Kenya. Multiple data collection methods were applied including: cross-sectional surveys (n = 708 households), 24 focus group discussions and semi-structured interviews with 70 ITN suppliers. Affordability was reported as a major barrier to access but non-financial barriers were also shown to be important determinants. On the demand side key barriers to access included: mismatch between the types of ITNs supplied through interventions and community preferences; perceptions and beliefs on illness causes; physical location of suppliers and; distrust in free delivery and in the distribution agencies. Key barriers on the supply side included: distance from manufacturers; limited acceptability of ITNs provided through interventions; crowding out of the commercial sector and the price. Infrastructure, information and communication played a central role in promoting or hindering access. Significant resources have been directed towards addressing affordability barriers through providing free ITNs to vulnerable groups, but the success of these interventions depends largely on the degree to which other barriers to access are addressed. Only if additional efforts are directed towards addressing non-financial barriers to access, will high coverage levels be achieved and sustained.

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.

Human capital flight challenges within an equitable health system.

PubMed

Udonwa, N E

2007-01-01

The issue of human capital flight has been discussed at different forums with a consensus opinion that it has its merits and demerits to equitable health system. Most often one nation becomes a substantial net exporter of talent, leaving the provider nation at risk of depleting its natural supply of talent. This paper looks into the historical perspective of human capital flight or "brain drain", and its burden. It attempts to elucidate the various causes and suggested solutions. The paper's objective is to educate colleagues on the conceptual and contextual imperatives of the issue. Using a convenient sample of key informants who were medical colleagues in Nigeria relevant information was sourced from these colleagues, documents from the postgraduate medical college of Nigeria and the internet on maters relating to human capital flight and brain drain. Every year, thousands of qualified doctors, and other professionals leave Nigeria tempted by significantly higher wages, brighter prospects for employment and education, stability, food security. It appears that the potential exposure to different working conditions, resources and professional environments can be of advantage to the country, should Nigeria be able to recall these professionals. It also appears that necessary economic reforms that make staying at home rewarding, that is--good leadership, and policy planning that seriously looks into rural development, among other issues, are keys ingredients to reversing the trend in order to ensure a more equitable health system.

The ConNECT Framework: a model for advancing behavioral medicine science and practice to foster health equity

PubMed Central

Alcaraz, Kassandra I.; Sly, Jamilia; Ashing, Kimlin; Fleisher, Linda; Gil-Rivas, Virginia; Ford, Sabrina; Yi, Jean C.; Lu, Qian; Meade, Cathy D.; Menon, Usha; Gwede, Clement K.

2017-01-01

Health disparities persist despite ongoing efforts. Given the United States’ rapidly changing demography and socio-cultural diversity, a paradigm shift in behavioral medicine is needed to advance research and interventions focused on health equity. This paper introduces the Con-NECT Framework as a model to link the sciences of behavioral medicine and health equity with the goal of achieving equitable health and outcomes in the twenty-first century. We first evaluate the state of health equity efforts in behavioral medicine science and identify key opportunities to advance the field. We then discuss and present actionable recommendations related to ConNECT’s five broad and synergistic principles: (1) Integrating Context; (2) Fostering a Norm of Inclusion; (3) Ensuring Equitable Diffusion of Innovations; (4) Harnessing Communication Technology; and (5) Prioritizing Specialized Training. The framework holds significant promise for furthering health equity and ushering in a new and refreshing era of behavioral medicine science and practice. PMID:27509892

The ConNECT Framework: a model for advancing behavioral medicine science and practice to foster health equity.

PubMed

Alcaraz, Kassandra I; Sly, Jamilia; Ashing, Kimlin; Fleisher, Linda; Gil-Rivas, Virginia; Ford, Sabrina; Yi, Jean C; Lu, Qian; Meade, Cathy D; Menon, Usha; Gwede, Clement K

2017-02-01

Health disparities persist despite ongoing efforts. Given the United States' rapidly changing demography and socio-cultural diversity, a paradigm shift in behavioral medicine is needed to advance research and interventions focused on health equity. This paper introduces the ConNECT Framework as a model to link the sciences of behavioral medicine and health equity with the goal of achieving equitable health and outcomes in the twenty-first century. We first evaluate the state of health equity efforts in behavioral medicine science and identify key opportunities to advance the field. We then discuss and present actionable recommendations related to ConNECT's five broad and synergistic principles: (1) Integrating Context; (2) Fostering a Norm of Inclusion; (3) Ensuring Equitable Diffusion of Innovations; (4) Harnessing Communication Technology; and (5) Prioritizing Specialized Training. The framework holds significant promise for furthering health equity and ushering in a new and refreshing era of behavioral medicine science and practice.

The effects of poverty on children's development and oral health.

PubMed

da Fonseca, Marcio A

2012-01-01

According to the US Census Bureau, the poverty rate for children under 18 years of age increased to 22% in 2010. Poverty leads to adverse health outcomes in children and adolescents such as harmful effects on learning, psychosocial development, physical health, productivity and family life. Because the citizens and residents of a country are its most valuable assets, it is unwise to allow housing instability, food insecurity and hunger to continue to exist at its current levels. Reducing poverty is likely to prevent illnesses, decrease hospitalizations, and lead to lower health care costs. There is also a need for intervention strategies to ensure equitable access to healthy foods across the world. Children who are food insecure are more likely to be in poor health and to have poor nutritional outcomes. Poverty may lead to poor dental health due to malnutrition or incorrect diet and it may also have an effect on the child's behavior in the dental office. An understanding of poverty will lessen the anger, frustration and prejudice that pediatric dentists may feel when working with low-income families. This manuscript presents a concise overview of the effects of poverty in children's lives.

Problems facing Korean hospitals and possible countermeasures.

PubMed

Kim, Kwang-Tae

2004-07-01

Korea has a unique health care system, of which the private sector comprises most of the country's health resources: 88% of the beds and 91% of specialists in Korea, but are funded by public financing, such as national health insurance and the national aid program. However, the public financing pays only 50% of actual costs and the patient's co-payment is still high. Healthcare organizations in Korea are categorized into four types; tertiary care hospitals, general hospitals, hospitals and clinics by scale of operator: number of beds. General hospitals must have 100 beds and over, and compulsorily specialties in internal medicine, surgery, obstetrics-gynecology, pediatrics, dental service, other ancillary service units and an emergency care unit. General hospitals with 300 beds and more must operate an intensive care unit. There are many challenges facing the Korean healthcare system, such as reformation of primary healthcare system, enhancing hospitals' competitiveness, and permission of for-profit hospital, introduction of private health insurance, enhancement of geriatric care. These challenges can be resolved with long-term vision, willingness and strategies of the Korean government to ensure equitable financing and access to healthcare, combined with the active participation and utilization of the private sector.

Policy and Practice-Relevant Youth Physical Activity Research Center Agenda.

PubMed

Botchwey, Nisha; Floyd, Myron F; Pollack Porter, Keshia; Cutter, Carmen L; Spoon, Chad; Schmid, Tom L; Conway, Terry L; Hipp, J Aaron; Kim, Anna J; Umstattd Meyer, M Renee; Walker, Amanda L; Kauh, Tina J; Sallis, Jim F

2018-06-08

The Physical Activity Research Center developed a research agenda that addresses youth physical activity (PA) and healthy weight, and aligns with the Robert Wood Johnson Foundation's Culture of Health. This paper summarizes prioritized research studies with a focus on youth at higher risk for inactive lifestyles and childhood obesity in urban and rural communities. Systematic literature reviews, a survey, and discussions with practitioners and researchers provided guidance on research questions to build evidence and inform effective strategies to promote healthy weight and PA in youth across race, cultural, and economic groups. The research team developed a matrix of potential research questions, identified priority questions, and designed targeted studies to address some of the priority questions and inform advocacy efforts. The studies selected examine strategies advocating for activity-friendly communities, Play Streets, park use, and PA of youth in the summer. A broader set of research priorities for youth PA is proposed. Establishing the Physical Activity Research Center research agenda identified important initial and future research studies to promote and ensure healthy weight and healthy levels of PA for at-risk youth. Results will be disseminated with the goal of promoting equitable access to PA for youth.

Enabling sustainable pastoralism: policies and investments that optimise livestock production and rangeland stewardship.

PubMed

Ouedraogo, R; Davies, J

2016-11-01

Pastoralism is a system of dynamically managing livestock and land for economic, social and environmental benefit. To a large extent, pastoralism is an adaptation to ecological and climatic variability and is not simply a livestock production system but provides significant environmental services to humanity. Evidence from a range of national contexts shows that sustainable pastoralist development requires an understanding of the dual environmental and economic roles of pastoralism and an adaptation of policies and investments to support both. The current paper examines three cornerstones that have proven to be crucial for sustainable pastoralist development and for maximising the links between livestock production and environmental stewardship: strengthening pastoral capabilities and institutions, securing land tenure and natural resource governance, and ensuring equitable markets for pastoral diversity. To effectively support the dual economic-environmental roles of pastoralism requires not only optimisation of the production of ecosystem services through extensive livestock production, but also a major overhaul of the way we approach pastoralist development, and major investment in the people who are central to the system. As long as pastoralists remain marginalised, with weak rights and little access to services, their future will remain uncertain.

Introduction of sequential inactivated polio vaccine-oral polio vaccine schedule for routine infant immunization in Brazil's National Immunization Program.

PubMed

Domingues, Carla Magda Allan S; de Fátima Pereira, Sirlene; Cunha Marreiros, Ana Carolina; Menezes, Nair; Flannery, Brendan

2014-11-01

In August 2012, the Brazilian Ministry of Health introduced inactivated polio vaccine (IPV) as part of sequential polio vaccination schedule for all infants beginning their primary vaccination series. The revised childhood immunization schedule included 2 doses of IPV at 2 and 4 months of age followed by 2 doses of oral polio vaccine (OPV) at 6 and 15 months of age. One annual national polio immunization day was maintained to provide OPV to all children aged 6 to 59 months. The decision to introduce IPV was based on preventing rare cases of vaccine-associated paralytic polio, financially sustaining IPV introduction, ensuring equitable access to IPV, and preparing for future OPV cessation following global eradication. Introducing IPV during a national multivaccination campaign led to rapid uptake, despite challenges with local vaccine supply due to high wastage rates. Continuous monitoring is required to achieve high coverage with the sequential polio vaccine schedule. Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.

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?

Decline in Cancer Screening in Vulnerable Populations? Results of the EDIFICE Surveys.

PubMed

Morère, Jean-François; Eisinger, François; Touboul, Chantal; Lhomel, Christine; Couraud, Sébastien; Viguier, Jérôme

2018-03-05

We studied cancer screening over time and social vulnerability via surveys of representative populations. Individuals aged 50-75 years with no personal history of cancer were questioned about lifetime participation in screening tests, compliance (adherence to recommended intervals [colorectal, breast and cervical cancer]) and opportunistic screening (prostate and lung cancer). The proportion of vulnerable/non-vulnerable individuals remained stable between 2011 and 2016. In 2011, social vulnerability had no impact on screening participation, nor on compliance. In 2014, however, vulnerability was correlated with less frequent uptake of colorectal screening (despite an organised programme) and prostate cancer screening (opportunistic), and also with reduced compliance with recommended intervals (breast and cervical cancer screening). In 2016, the trends observed in 2014 were substantiated and even extended to breast, colorectal and cervical cancer screening uptakes. Social vulnerability has an increasingly negative impact on cancer screening attendance. The phenomenon was identified in 2014 and had expanded by 2016. Although organised programmes have been shown to ensure equitable access to cancer screening, this remains a precarious achievement requiring regular monitoring. Further studies should focus on attitudes of vulnerable populations and on ways to improve cancer awareness campaigns.

The prospects for national health insurance reform.

PubMed

Belcher, J R; Palley, H A

1991-01-01

This article explores the unequal access to health care in the context of efforts by the American Medical Association (AMA) and its allies to maintain a market-maximizing health care system. The coalition between the AMA and its traditional allies is breaking down, in part, because of converging developments creating an atmosphere which may be more conducive to national health care reform and the development of a reformed health care delivery system that will be accessible, adequate, and equitable in meeting the health care and related social service needs of the American people.

A survey of the availability, prices and affordability of essential medicines in Jiangsu Province, China.

PubMed

Xi, Xiaoyu; Li, Weixia; Li, Jun; Zhu, Xuan; Fu, Cong; Wei, Xu; Chu, Shuzhen

2015-08-27

Field surveys conducted in China before the implementation of the essential medicine policy showed that Chinese individuals faced less access to essential medicines. This paper aims to evaluate the availability, prices and affordability of essential medicines in Jiangsu Province, China after the implementation of the policy in 2009. A cross-sectional survey was conducted in Jiangsu in 2013 using the World Health Organization/Health Action International (WHO/HAI) methodology. Data on the availability and prices of 50 essential medicines were collected from the public and private healthcare sectors. The mean availabilities of innovator brands and lowest priced generics (LPGs) were 11.5% and 100% in primary healthcare facilities, 36.8% and 32.6% in the secondary and tertiary sectors, and 18.7% and 42.9% in the private sector, respectively. The median price ratios (MPRs) were 1.26 to 2.05 for generics and 3.76 to 27.22 for innovator brands. Treating ten common diseases with LPGs was generally affordable, whereas treatment with IBs was less affordable. The high availability of LPGs at primary healthcare facilities reflects the success of the essential medicine policy, while the low availability in secondary and tertiary levels and in private pharmacies reflects a failure to implement the policy in these levels. The health policy should be fully developed and enforced at the secondary and tertiary levels and in the private sector to ensure equitable access to health services.

Teaching: in light of Noel Gough's and Ajay Sharma's articles

NASA Astrophysics Data System (ADS)

Pouliot, Chantal

2017-12-01

In their articles, Ajay Sharma (Cult Stud Sci Educ, doi: 10.1007/s11422-017-9835-z, 2017) and Noel Gough (Cult Stud Sci Educ, doi: 10.1007/s11422-017-9834-0, 2017) shed light on the impact neoliberalism has on the teaching of science and suggest ways to ensure that science education remains critical and socially equitable. In this paper, I illustrate how their proposals influenced my instructional choices during the fall of 2016 in a course entitled Epistemology and Education.

Equity and child-survival strategies.

PubMed

Mulholland, Ek; Smith, L; Carneiro, I; Becher, H; Lehmann, D

2008-05-01

Recent advances in child survival have often been at the expense of increasing inequity. Successive interventions are applied to the same population sectors, while the same children in other sectors consistently miss out, leading to a trend towards increasing inequity in child survival. This is particularly important in the case of pneumonia, the leading cause of child death, which is closely linked to poverty and malnutrition, and for which effective community-based case management is more difficult to achieve than for other causes of child death. The key strategies for the prevention of childhood pneumonia are case management, mainly through Integrated Management of Childhood Illness (IMCI), and immunization, particularly the newer vaccines against Haemophilus influenzae type b (Hib) and pneumococcus. There is a tendency to introduce both interventions into communities that already have access to basic health care and preventive services, thereby increasing the relative disadvantage experienced by those children without such access. Both strategies can be implemented in such a way as to decrease rather than increase inequity. It is important to monitor equity when introducing child-survival interventions. Economic poverty, as measured by analyses based on wealth quintiles, is an important determinant of inequity in health outcomes but in some settings other factors may be of greater importance. Geography and ethnicity can both lead to failed access to health care, and therefore inequity in child survival. Poorly functioning health facilities are also of major importance. Countries need to be aware of the main determinants of inequity in their communities so that measures can be taken to ensure that IMCI, new vaccine implementation and other child-survival strategies are introduced in an equitable manner.

The Role of Hospice Care in the Nursing Home Setting

PubMed Central

Miller, Susan C.; Mor, Vince N.T.

2013-01-01

The last days of life for a substantial proportion of dying older adults are spent in nursing homes. Considering this, the provision of Medicare hospice care in nursing homes would appear to be an equitable use of Medicare expenditures as well as a valid investment in improving the quality of life for dying nursing home residents. However, government concerns regarding possible abuse of the hospice benefit in nursing homes, as well as suggestion that the payment for the benefit in nursing homes may be excessive, has perhaps slowed the adoption of hospice services into the nursing home setting. Currently, access to hospice care in nursing homes is inequitable across facilities, and across geographic areas. In nursing homes where hospice is available and present, however, recent research documents superior outcomes for residents enrolled in hospice, and perhaps for nonhospice residents. Still, more research is needed, particularly research focusing on the government costs associated with the provision of hospice care in nursing homes. If subsequent research continues to support the “added value” of hospice care in nursing homes and at the same or less total costs, the issue of foremost concern becomes how equitable access to Medicare hospice care in nursing homes can be achieved. Access may be increased to some extent by changing government policies, and conflicting regulations and interpretive guidelines, so they support and encourage the nursing home/hospice collaboration. PMID:12006229

Do health care reforms in Turkey have a significant effect in equal access to maternal and child health services in Turkey: An evidence from 20 years.

PubMed

Santas, Fatih; Celik, Yusuf; Eryurt, Mehmet Ali

2018-01-01

This study aimed to investigate whether there was an improvement in the equitable access to maternal and child health care services by examining the effects of socioeconomic and individual factors in Turkey from 1993 to 2013 and determine the effectiveness of health care reforms implemented mainly under the Health Transformation Program since 2003 on equitable access t;o maternal and child health care services in terms of years. The study used nationally representative 5 Turkey Demographic and Health Surveys (1993, 1998, 2003, 2008, and 2013). Prenatal care utilization rate increased from 67.0% in 1993 to 96.2% in 2013 while the rate of women giving birth at health care facilities increased from 63.8% to 98.1% in 2013. Prenatal care utilization and giving birth at health care facilities were higher among women who were under health insurance coverage, first time mothers, those staying in the western region and urban areas, and those with the highest level of wealth. The findings suggest that the issue of equity in the utilization of maternal and child health care services exists in Turkey, and the latest health care reforms under HTP are not effective in diminishing the effect of wealth. Copyright © 2017 John Wiley & Sons, Ltd.

Effective vaccine safety systems in all countries: a challenge for more equitable access to immunization.

PubMed

Amarasinghe, Ananda; Black, Steve; Bonhoeffer, Jan; Carvalho, Sandra M Deotti; Dodoo, Alexander; Eskola, Juhani; Larson, Heidi; Shin, Sunheang; Olsson, Sten; Balakrishnan, Madhava Ram; Bellah, Ahmed; Lambach, Philipp; Maure, Christine; Wood, David; Zuber, Patrick; Akanmori, Bartholomew; Bravo, Pamela; Pombo, María; Langar, Houda; Pfeifer, Dina; Guichard, Stéphane; Diorditsa, Sergey; Hossain, Md Shafiqul; Sato, Yoshikuni

2013-04-18

Serious vaccine-associated adverse events are rare. To further minimize their occurrence and to provide adequate care to those affected, careful monitoring of immunization programs and case management is required. Unfounded vaccine safety concerns have the potential of seriously derailing effective immunization activities. To address these issues, vaccine pharmacovigilance systems have been developed in many industrialized countries. As new vaccine products become available to prevent new diseases in various parts of the world, the demand for effective pharmacovigilance systems in low- and middle-income countries (LMIC) is increasing. To help establish such systems in all countries, WHO developed the Global Vaccine Safety Blueprint in 2011. This strategic plan is based on an in-depth analysis of the vaccine safety landscape that involved many stakeholders. This analysis reviewed existing systems and international vaccine safety activities and assessed the financial resources required to operate them. The Blueprint sets three main strategic goals to optimize the safety of vaccines through effective use of pharmacovigilance principles and methods: to ensure minimal vaccine safety capacity in all countries; to provide enhanced capacity for specific circumstances; and to establish a global support network to assist national authorities with capacity building and crisis management. In early 2012, the Global Vaccine Safety Initiative (GVSI) was launched to bring together and explore synergies among on-going vaccine safety activities. The Global Vaccine Action Plan has identified the Blueprint as its vaccine safety strategy. There is an enormous opportunity to raise awareness for vaccine safety in LMIC and to garner support from a large number of stakeholders for the GVSI between now and 2020. Synergies and resource mobilization opportunities presented by the Decade of Vaccines can enhance monitoring and response to vaccine safety issues, thereby leading to more equitable delivery of vaccines worldwide. Copyright © 2012 Elsevier Ltd. All rights reserved.

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.

Putting Making into High School Computer Science Classrooms: Promoting Equity in Teaching and Learning with Electronic Textiles in "Exploring Computer Science"

ERIC Educational Resources Information Center

Fields, Deborah Ann; Kafai, Yasmin; Nakajima, Tomoko; Goode, Joanna; Margolis, Jane

2018-01-01

Recent discussions of making have focused on developing out-of-school makerspaces and activities to provide more equitable and enriching learning opportunities for youth. Yet school classrooms present a unique opportunity to help broaden access, diversify representation, and deepen participation in making. In turning to classrooms, we want to…

Fracturing Opportunity: Mexican Migrant Students and College-Going Literacy. Counterpoints: Studies in the Postmodern Theory of Education. Volume 362

ERIC Educational Resources Information Center

Gildersleeve, R. Evely

2010-01-01

"Fracturing Opportunity" demonstrates a simple yet profound idea--that educational opportunity is learned. And if it is learned, then it can be taught and taught more equitably. This book brings sociocultural theories of learning and development to bear on the persistent problems of inequality in college access, and presents an innovative…

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…

In Their Own Words: High-Achieving, Low-Income Community College Students Talk about Supports and Obstacles to Their Success

ERIC Educational Resources Information Center

Carrasquillo, Carmen Ana

2013-01-01

Open-access admissions policies and greater affordability position community colleges at the forefront in addressing equitable academic outcomes. Yet, most community college students fail to complete their certificate, degree and transfer goals. The failure rate is particularly high for low-income, Black and Latino(a) students. Much has been…

Linkages between Youth Diversity and Organizational and Program Characteristics of Out-of-School-Time Science Programs: A Mixed-Methods Study

ERIC Educational Resources Information Center

Thiry, Heather; Archie, Timothy; Arreola-Pena, Melissa; Laursen, Sandra

2017-01-01

Science opportunities in out-of-school time (OST) programs hold potential for expanding access to science, engineering, and technology (SET) pathways for populations that have not participated in these fields at equitable rates (Coalition for Science After School, 2014). This mixed-methods study examines the relationship between the diversity of…

Middle School Math Acceleration and Equitable Access to Eighth-Grade Algebra: Evidence from the Wake County Public School System

ERIC Educational Resources Information Center

Dougherty, Shaun M.; Goodman, Joshua S.; Hill, Darryl V.; Litke, Erica G.; Page, Lindsay C.

2015-01-01

Taking algebra by eighth grade is considered an important milestone on the pathway to college readiness. We highlight a collaboration to investigate one district's effort to increase middle school algebra course-taking. In 2010, the Wake County Public Schools began assigning middle school students to accelerated math and eighth-grade algebra based…

Law and Order in School and Society: How Discipline and Policing Policies Harm Students of Color, and What We Can Do about It

ERIC Educational Resources Information Center

Scott, Janelle; Moses, Michele S.; Finnigan, Kara S.; Trujillo, Tina; Jackson, Darrell D.

2017-01-01

Systemic violence and disparate school discipline policies hinder equitable, just, and safe schooling. They also restrict access to social opportunities and civil liberties. Research shows that schooling contexts and social policies set up the conditions for young people of color to experience violence in regularized, systematic, and destructive…

Information Is Bliss: Information Use by School Choice Participants in Denver

ERIC Educational Resources Information Center

Yettick, Holly

2016-01-01

If school choice programs are to provide any degree of equitable access to educational opportunities, then useful information about academic quality needs to be available to all participants, not just those who hob knob with the school board members or chat with the superintendent over the backyard fence. This study draws upon a unique data set to…

Ontological Possibilities: Rhizoanalytic Explorations of Community Food Work in Central Appalachia

ERIC Educational Resources Information Center

D'Adamo-Damery, Philip C.

2014-01-01

In the United States, the community food movement has been put forward as a potential solution for a global food system that fails to provide just and equitable access to nutritious food. This claim has been subject to the criticism of a variety of scholars and activists, some of whom contend that the alternative food movement is complicit in the…

Contrasting Disclosure Practices and Experiences of School Support for Australian Adolescents with Cancer, Cystic Fibrosis and Anorexia Nervosa: Parent Perspectives

ERIC Educational Resources Information Center

Bowtell, Evelyn Cecile; Aroni, Rosalie; Green, Julie; Sawyer, Susan M.

2018-01-01

Schools in Australia are required to promote equitable access to education and provide support services to students with chronic health conditions (CHCs). This qualitative study was conducted to explore stakeholders' experiences and perceptions regarding school-based support. In-depth interviews were conducted with 38 parents of upper secondary…

Development of American Sign Language Guidelines for K-12 Academic Assessments

ERIC Educational Resources Information Center

Higgins, Jennifer A.; Famularo, Lisa; Cawthon, Stephanie W.; Kurz, Christopher A.; Reis, Jeanne E.; Moers, Lori M.

2016-01-01

The U.S. federal Every Student Succeeds Act (ESSA) was enacted with goals of closing achievement gaps and providing all students with access to equitable and high-quality instruction. One requirement of ESSA is annual statewide testing of students in grades 3-8 and once in high school. Some students, including many deaf or hard-of-hearing (D/HH)…

Splicing the Divide: A Review of Research on the Evolving Digital Divide among K-12 Students

ERIC Educational Resources Information Center

Dolan, Jennifer E.

2016-01-01

The digital divide has narrowed with regard to one definition of access to technology--the binary view of the "haves" and "have-nots." However, use of technology at home and in school is not equitable for all students. According to recent literature, a broader and more nuanced definition of the technological divide is necessary…

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.

Tactical resource allocation and elective patient admission planning in care processes.

PubMed

Hulshof, Peter J H; Boucherie, Richard J; Hans, Erwin W; Hurink, Johann L

2013-06-01

Tactical planning of resources in hospitals concerns elective patient admission planning and the intermediate term allocation of resource capacities. Its main objectives are to achieve equitable access for patients, to meet production targets/to serve the strategically agreed number of patients, and to use resources efficiently. This paper proposes a method to develop a tactical resource allocation and elective patient admission plan. These tactical plans allocate available resources to various care processes and determine the selection of patients to be served that are at a particular stage of their care process. Our method is developed in a Mixed Integer Linear Programming (MILP) framework and copes with multiple resources, multiple time periods and multiple patient groups with various uncertain treatment paths through the hospital, thereby integrating decision making for a chain of hospital resources. Computational results indicate that our method leads to a more equitable distribution of resources and provides control of patient access times, the number of patients served and the fraction of allocated resource capacity. Our approach is generic, as the base MILP and the solution approach allow for including various extensions to both the objective criteria and the constraints. Consequently, the proposed method is applicable in various settings of tactical hospital management.

Global challenges of implementing human papillomavirus vaccines

PubMed Central

2011-01-01

Human Papillomavirus vaccines are widely hailed as a sweeping pharmaceutical innovation for the universal benefit of all women. The implementation of the vaccines, however, is far from universal or equitable. Socio-economically marginalized women in emerging and developing, and many advanced economies alike, suffer a disproportionately large burden of cervical cancer. Despite the marketing of Human Papillomavirus vaccines as the solution to cervical cancer, the market authorization (licensing) of the vaccines has not translated into universal equitable access. Vaccine implementation for vulnerable girls and women faces multiple barriers that include high vaccine costs, inadequate delivery infrastructure, and lack of community engagement to generate awareness about cervical cancer and early screening tools. For Human Papillomavirus vaccines to work as a public health solution, the quality-assured delivery of cheaper vaccines must be integrated with strengthened capacity for community-based health education and screening. PMID:21718495

South African medical schools: Current state of selection criteria and medical students' demographic profile.

PubMed

van der Merwe, L J; van Zyl, G J; St Clair Gibson, A; Viljoen, M; Iputo, J E; Mammen, M; Chitha, W; Perez, A M; Hartman, N; Fonn, S; Green-Thompson, L; Ayo-Ysuf, O A; Botha, G C; Manning, D; Botha, S J; Hift, R; Retief, P; van Heerden, B B; Volmink, J

2015-12-16

Selection of medical students at South African (SA) medical schools must promote equitable and fair access to students from all population groups, while ensuring optimal student throughput and success, and training future healthcare practitioners who will fulfil the needs of the local society. In keeping with international practices, a variety of academic and non-academic measures are used to select applicants for medical training programmes in SA medical schools. To provide an overview of the selection procedures used by all eight medical schools in SA, and the student demographics (race and gender) at these medical schools, and to determine to what extent collective practices are achieving the goals of student diversity and inclusivity. A retrospective, quantitative, descriptive study design was used. All eight medical schools in SA provided information regarding selection criteria, selection procedures, and student demographics (race and gender). Descriptive analysis of data was done by calculating frequencies and percentages of the variables measured. Medical schools in SA make use of academic and non-academic criteria in their selection processes. The latter include indices of socioeconomic disadvantage. Most undergraduate medical students in SA are black (38.7%), followed by white (33.0%), coloured (13.4%) and Indian/Asian (13.6%). The majority of students are female (62.2%). The number of black students is still proportionately lower than in the general population, while other groups are overrepresented. Selection policies for undergraduate medical programmes aimed at redress should be continued and further refined, along with the provision of support to ensure student success.

South Africa's protracted struggle for equal distribution and equitable access - still not there.

PubMed

van Rensburg, Hendrik C J

2014-05-08

The purpose of this contribution is to analyse and explain the South African HRH case, its historical evolution, and post-apartheid reform initiatives aimed at addressing deficiencies and shortfalls. HRH in South Africa not only mirrors the nature and diversity of challenges globally, but also the strategies pursued by countries to address these challenges. Although South Africa has strongly developed health professions, large numbers of professional and mid-level workers, and also well-established training institutions, it is experiencing serious workforce shortages and access constraints. This results from the unequal distribution of health workers between the well-resourced private sector over the poorly-resourced public sector, as well as from distributional disparities between urban and rural areas. During colonial and apartheid times, disparities were aggravated by policies of racial segregation and exclusion, remnants of which are today still visible in health-professional backlogs, unequal provincial HRH distribution, and differential access to health services for specific race and class groups. Since 1994, South Africa's transition to democracy deeply transformed the health system, health professions and HRH establishments. The introduction of free-health policies, the district health system and the prioritisation of PHC ensured more equal distribution of the workforce, as well as greater access to services for deprived groups. However, the HIV/AIDS epidemic brought about huge demands for care and massive patient loads in the public-sector. The emigration of health professionals to developed countries and to the private sector also undermines the strength and effectiveness of the public health sector. For the poor, access to care thus remains constrained and in perpetual shortfall. The post-1994 government has introduced several HRH-specific strategies to recruit, distribute, motivate and retain health professionals to strengthen the public sector and to expand access and coverage. Of great significance among these is the NHI Plan that aims to bridge the structural divide and to redistribute material and human resources more equally. Its success largely hinges on HRH and the balanced deployment of the national workforce.Low- and middle-income countries have much to learn from South African HRH experiences. In turn, South Africa has much to learn from other countries, as this case study shows.

Acceptable Care? Illness Constructions, Healthworlds, and Accessible Chronic Treatment in South Africa

PubMed Central

Harris, Bronwyn; Eyles, John; Moshabela, Mosa

2015-01-01

Achieving equitable access to health care is an important policy goal, with access influenced by affordability, availability, and acceptability of specific services. We explore patient narratives from a 5-year program of research on health care access to examine relationships between social constructions of illness and the acceptability of health services in the context of tuberculosis treatment and antiretroviral therapy in South Africa. Acceptability of services seems particularly important to the meanings patients attach to illness and care, whereas—conversely—these constructions appear to influence what constitutes acceptability and hence affect access to care. We highlight the underestimated role of individually, socially, and politically constructed healthworlds; traditional and biomedical beliefs; and social support networks. Suggested policy implications for improving acceptability and hence overall health care access include abandoning patronizing approaches to care and refocusing from treating “disease” to responding to “illness” by acknowledging and incorporating patients’ healthworlds in patient–provider interactions. PMID:25829509

Adverse or acceptable: negotiating access to a post-apartheid health care contract.

PubMed

Harris, Bronwyn; Eyles, John; Penn-Kekana, Loveday; Thomas, Liz; Goudge, Jane

2014-05-15

As in many fragile and post-conflict countries, South Africa's social contract has formally changed from authoritarianism to democracy, yet access to services, including health care, remains inequitable and contested. We examine access barriers to quality health services and draw on social contract theory to explore ways in which a post-apartheid health care contract is narrated, practiced and negotiated by patients and providers. We consider implications for conceptualizing and promoting more inclusive, equitable health services in a post-conflict setting. Using in-depth interviews with 45 patients and 67 providers, and field observations from twelve health facilities in one rural and two urban sub-districts, we explore access narratives of those seeking and delivering - negotiating - maternal health, tuberculosis and antiretroviral services in South Africa. Although South Africa's right to access to health care is constitutionally guaranteed, in practice, a post-apartheid health care contract is not automatically or unconditionally inclusive. Access barriers, including poverty, an under-resourced, hierarchical health system, the nature of illness and treatment, and negative attitudes and actions, create conditions for insecure or adverse incorporation into this contract, or even exclusion (sometimes temporary) from health care services. Such barriers are exacerbated by differences in the expectations that patients and providers have of each other and the contract, leading to differing, potentially conflicting, identities of inclusion and exclusion: defaulting versus suffering patients, uncaring versus overstretched providers. Conversely, caring, respectful communication, individual acts of kindness, and institutional flexibility and leadership may mitigate key access barriers and limit threats to the contract, fostering more positive forms of inclusion and facilitating easier access to health care. Building health in fragile and post-conflict societies requires the negotiation of a new social contract. Surfacing and engaging with differences in patient and provider expectations of this contract may contribute to more acceptable, accessible health care services. Additionally, the health system is well positioned to highlight and connect the political economy, institutions and social relationships that create and sustain identities of exclusion and inclusion - (re)politicise suffering - and co-ordinate and lead intersectoral action for overcoming affordability and availability barriers to inclusive and equitable health care services.

From decentralization to commonization of HIV healthcare resources: keys to reduction in health disparity and equitable distribution of health services in Nigeria.

PubMed

Oleribe, Obinna Ositadimma; Oladipo, Olabisi Abiodun; Ezieme, Iheaka Paul; Crossey, Mary Margaret Elizabeth; Taylor-Robinson, Simon David

2016-01-01

Access to quality care is essential for improved health outcomes. Decentralization improves access to healthcare services at lower levels of care, but it does not dismantle structural, funding and programming restrictions to access, resulting in inequity and inequality in population health. Unlike decentralization, Commonization Model of care reduces health inequalities and inequity, dismantles structural, funding and other program related obstacles to population health. Excellence and Friends Management Care Center (EFMC) using Commonization Model (CM), fully integrated HIV services into core health services in 121 supported facilities. This initiative improved access to care, treatment, support services, reduced stigmatization/discrimination, and improved uptake of HTC. We call on governments to adequately finance CM for health systems restructuring towards better health outcomes.

Culturally Diverse and Underserved Populations of Gifted Students in the United States and in Taiwan: Equitable Access to Gifted Education

ERIC Educational Resources Information Center

Ho, Ya-Ting

2014-01-01

There is a continuing increase in the African American and Hispanic student populations in public schools. The students who are invited to gifted programs are overwhelmingly White. This is the situation in schools in the United States and also in Taiwan. Misunderstanding or unawareness of culture difference among educators might contribute to…

Advanced Placement Environmental Science and the Curriculum and Community Enterprise for Restoration Science (CCERS) Project in the New York City High School

ERIC Educational Resources Information Center

Birney, Lauren; McNamara, Denise

2018-01-01

This paper explores the issue of social justice through the lens of equitable access to Advanced Placement courses in the City of New York High Schools, with focus on Advanced Placement Environmental Science. A critical component of the Advanced Placement Environmental Science course is the incorporation of environmental fieldwork. The National…

Access or Quality? Why Do Families Living in Slums Choose Low-Cost Private Schools in Lagos, Nigeria?

ERIC Educational Resources Information Center

Härmä, Joanna

2013-01-01

Lagos is home to 12,098 private schools catering to 57% of the state's enrolled children, from ultra-rich to relatively poor households, with many schools targeting those of lower socio-economic status. Government schools were intended to provide a just and equitable option for all; however, they have not kept pace with demand in terms of both…

Disentangling Chile's Authoritarian Neoliberalism and Its Effects: The Downfall of Public Higher Education and Its Implications for Equitable Access

ERIC Educational Resources Information Center

Pitton, Viviana

2007-01-01

In recent decades, neoliberal reforms have spread across Latin America. Despite different accounts showing the adverse social impact of these reforms, what seems lacking are historical analyses of why and how neoliberal policies occurred in this region. For instance, there are only rare accounts of how dictatorships in the 1970s prepared the…

Learning Denied: The Case for Equitable Access to Effective Teaching in California's Largest School District. Policy Brief

ERIC Educational Resources Information Center

Education Trust-West, 2012

2012-01-01

Effective teachers have an enormous impact on the lives of their students. Great teachers can help students who are behind academically catch up to grade-level expectations. By accelerating student performance, they can help close the opportunity and achievement gaps that cut short the college and career dreams of so many low-income students and…

Course Access: Equitable Opportunities for College and Career Ready Students

ERIC Educational Resources Information Center

Worthen, Maria; Patrick, Susan

2014-01-01

Imagine a high school student who does not have the opportunity to take all of the courses she needs to get into college. Today, for far too many young people, this is a sobering reality. Public schools around the country may lack the resources, staff, or demand to offer a full catalog of courses. According to recent data from the U.S. Department…

Ethics and patient education: health literacy and cultural dilemmas.

PubMed

Marks, Ray

2009-07-01

This article discusses health literacy and cultural factors that have implications for the ethical practice of health education. It specifically focuses on recent data that speaks to the challenges in carrying out patient education from the perspective of comprehension and equitable distribution of health-related information across diverse cultures and communities. It discusses strategies for reducing the negative impact of low health literacy among diverse groups and the importance of acknowledging this pervasive problem in the context of ensuring equity in the optimal delivery of health promotion messages.

Distributed hierarchical control architecture for integrating smart grid assets during normal and disrupted operations

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

Kalsi, Karan; Fuller, Jason C.; Somani, Abhishek

Disclosed herein are representative embodiments of methods, apparatus, and systems for facilitating operation and control of a resource distribution system (such as a power grid). Among the disclosed embodiments is a distributed hierarchical control architecture (DHCA) that enables smart grid assets to effectively contribute to grid operations in a controllable manner, while helping to ensure system stability and equitably rewarding their contribution. Embodiments of the disclosed architecture can help unify the dispatch of these resources to provide both market-based and balancing services.

78 FR 17882 - Recreational Closure Authority Specific to Federal Waters Off Individual States for the...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-25

...NMFS issues this emergency rule to authorize NMFS to set the closure date of the recreational red snapper fishing season in the exclusive economic zone (EEZ) off individual Gulf of Mexico (Gulf) states. At its February 2013 meeting, the Gulf of Mexico Fishery Management Council (Council) requested an emergency rule to give NMFS this authority. The intent of this rulemaking is to constrain recreational red snapper harvest within the quota while ensuring a fair and equitable distribution of fishing privileges among participants in all the Gulf states.

Working toward equitable opportunities for science students with disabilities: using professional development and technology.

PubMed

Bargerhuff, Mary Ellen; Cowan, Heidi; Kirch, Susan A

2010-01-01

As a result of federal legislation, adolescents with disabilities and other exceptionalities are increasingly included in science and math classes alongside their peers who are typically developing. The effectiveness of this placement option, however, is largely dependent on the skill level of the general educator and the support afforded to this teacher through various channels. Efforts arising from two National Science Foundation grants address both skill and support. Center's Lesson Adaptations for Student Success (CLASS) project used summer professional development opportunities to equip teachers with the knowledge and skills needed to provide students with physical, sensory and learning disabilities equitable access to laboratory and field experiences. Second, to support teachers back in their classrooms, the Ohio Resource Center's Lesson Adaptations for Student Success (OR-CLASS) uses web resources to share high quality, peer-reviewed lesson plans, complete with specific recommendations on adaptations for students with a variety of exceptional learning needs.

Remote nursing certified practice: viewing nursing and nurse practitioner practice through a social justice lens.

PubMed

Tarlier, Denise S; Browne, Annette J

2011-06-01

Remote Nursing Certified Practice (RNCP) was introduced in 2010 to regulate nursing practice in remote, largely First Nations communities in British Columbia, Canada. These are communities that often experience profound health and health-care inequities. Typically nurses are the main health-care providers. Using a critical social justice lens, the authors explore the clinical and ethical implications of RNCP in terms of access to equitable, high-quality primary health care.They examine the fit between the level and scope of health services provided by registered nurses working under RNCP and the health needs of remote First Nations communities. In doing so, they draw comparisons between nurse practitioners (NPs) and outpost nurses working in NP roles who historically were employed to provide health care in these communities.The authors conclude by calling for nursing regulations that support equitable, high-quality primary care for all British Columbians.

Power and the Association with Relationship Quality in South African Couples: Implications for HIV/AIDS Interventions

PubMed Central

Conroy, Amy A.; McGrath, Nuala; van Rooyen, Heidi; Hosegood, Victoria; Johnson, Mallory O.; Fritz, Katherine; Marr, Alexander; Ngubane, Thulani; Darbes, Lynae A.

2016-01-01

Introduction Power imbalances within sexual relationships have significant implications for HIV prevention in sub-Saharan Africa. Little is known about how power influences the quality of a relationship, which could be an important pathway leading to healthy behavior around HIV/AIDS. Methods This paper uses data from 448 heterosexual couples (896 individuals) in rural KwaZulu-Natal, South Africa who completed baseline surveys from 2012–2014 as part of a couples-based HIV intervention trial. Using an actor-partner interdependence perspective, we assessed: (1) how both partners’ perceptions of power influences their own (i.e., actor effect) and their partner’s reports of relationship quality (i.e., partner effect); and (2) whether these associations differed by gender. We examined three constructs related to power (female power, male equitable gender norms, and shared power) and four domains of relationship quality (intimacy, trust, mutually constructive communication, and conflict). Results For actor effects, shared power was strongly and consistently associated with higher relationship quality across all four domains. The effect of shared power on trust, mutually constructive communication, and conflict were stronger for men than women. The findings for female power and male equitable gender norms were more mixed. Female power was positively associated with women’s reports of trust and mutually constructive communication, but negatively associated with intimacy. Male equitable gender norms were positively associated with men’s reports of mutually constructive communication. For partner effects, male equitable gender norms were positively associated with women’s reports of intimacy and negatively associated with women’s reports of conflict. Conclusions Research and health interventions aiming to improving HIV-related behaviors should consider sources of shared power within couples and potential leverage points for empowerment at the couple level. Efforts solely focused on empowering women should also take the dyadic environment and men’s perspectives into account to ensure positive relationship outcomes. PMID:26859436

Power and the association with relationship quality in South African couples: Implications for HIV/AIDS interventions.

PubMed

Conroy, Amy A; McGrath, Nuala; van Rooyen, Heidi; Hosegood, Victoria; Johnson, Mallory O; Fritz, Katherine; Marr, Alexander; Ngubane, Thulani; Darbes, Lynae A

2016-03-01

Power imbalances within sexual relationships have significant implications for HIV prevention in sub-Saharan Africa. Little is known about how power influences the quality of a relationship, which could be an important pathway leading to healthy behavior around HIV/AIDS. This paper uses data from 448 heterosexual couples (896 individuals) in rural KwaZulu-Natal, South Africa who completed baseline surveys from 2012 to 2014 as part of a couples-based HIV intervention trial. Using an actor-partner interdependence perspective, we assessed: (1) how both partners' perceptions of power influences their own (i.e., actor effect) and their partner's reports of relationship quality (i.e., partner effect); and (2) whether these associations differed by gender. We examined three constructs related to power (female power, male equitable gender norms, and shared power) and four domains of relationship quality (intimacy, trust, mutually constructive communication, and conflict). For actor effects, shared power was strongly and consistently associated with higher relationship quality across all four domains. The effect of shared power on trust, mutually constructive communication, and conflict were stronger for men than women. The findings for female power and male equitable gender norms were more mixed. Female power was positively associated with women's reports of trust and mutually constructive communication, but negatively associated with intimacy. Male equitable gender norms were positively associated with men's reports of mutually constructive communication. For partner effects, male equitable gender norms were positively associated with women's reports of intimacy and negatively associated with women's reports of conflict. Research and health interventions aiming to improving HIV-related behaviors should consider sources of shared power within couples and potential leverage points for empowerment at the couple level. Efforts solely focused on empowering women should also take the dyadic environment and men's perspectives into account to ensure positive relationship outcomes. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Implementation of accessible tourism concept at museums in Jakarta

NASA Astrophysics Data System (ADS)

Wiastuti, R. D.; Adiati, M. P.; Lestari, N. S.

2018-03-01

Accessibility, sustainability and equitable participation by all makeup what is known as Tourism for All. Tourism product must be designed for all people despite the age, gender and ability as one of the requirements to comply the accessible tourism concept. Museum as one of the elements of tourism chain must adhere to accessible tourism concept thus able to be enjoyed for everyone regardless of one’s abilities. The aim of this study is to identify the implementation of accessible tourism concept at the museum in Jakarta and to provide practical accessibility- improvement measures for the museum in Jakarta towards accessible tourism concept. This research is qualitative- explorative research. Jakarta Tourism Board website was used as the main reference to obtain which museum that was selected. Primary data collect from direct field observations and interview. The results outline museum implementation of accessible tourism that classified into five criteria; information, transport, common requirements, universal design, and accessibility. The implication of this study provides recommendations to enhance museums’ accessibility performance expected to be in line with accessible tourism concept.

Improving Access to Medicines in Low and Middle Income Countries: Corporate Responsibilities in Context

PubMed Central

Leisinger, Klaus Michael; Garabedian, Laura Faden; Wagner, Anita Katharina

2012-01-01

More than two billion people in low- and middle-income countries (LMIC) lack adequate access to essential medicines. In this paper, we make strong public health, human rights and economic arguments for improving access to medicines in LMIC and discuss the different roles and responsibilities of key stakeholders, including national governments, the international community, and non-governmental organizations (NGOs). We then establish a framework of pharmaceutical firms’ corporate responsibilities - the “must,” the “ought to,” and the “can” dimensions - and make recommendations for actionable business strategies for improving access to medicines. We discuss controversial topics, such as pharmaceutical profits and patents, with the goal of building consensus around facts and working towards a solution. We conclude that partnerships and collaboration among multiple stakeholders are urgently needed to improve equitable access to medicines in LMIC. PMID:23535994

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.

Inclusion of vulnerable groups in health policies: Regional policies on health priorities in Africa

PubMed Central

Eide, Arne Henning; Amin, Mutamad; MacLachlan, Malcom; Mannan, Hasheem

2013-01-01

Background If access to equitable health care is to be achieved for all, policy documents must mention and address in some detail different needs of groups vulnerable to not accessing such health care. If these needs are not addressed in the policy documents, there is little chance that they will be addressed at the stage of implementation. Objectives This paper reports on an analysis of 11 African Union (AU) policy documents to ascertain the frequency and the extent of mention of 13 core concepts in relation to 12 vulnerable groups, with a specific focus on people with disabilities. Method The paper applied the EquiFrame analytical framework to the 11 AU policy documents. The 11 documents were analysed in terms of how many times a core concept was mentioned and the extent of information on how the core concept should be addressed at the implementation level. Each core concept mention was further analysed in terms of the vulnerable group in referred to. Results The analysis of regional AU policies highlighted the broad nature of the reference made to vulnerable groups, with a lack of detailed specifications of different needs of different groups. This is confirmed in the highest vulnerable group mention being for ‘universal’. The reading of the documents suggests that vulnerable groups are homogeneous in their needs, which is not the case. There is a lack of recognition of different needs of different vulnerable groups in accessing health care. Conclusion The need for more information and knowledge on the needs of all vulnerable groups is evident. The current lack of mention and of any detail on how to address needs of vulnerable groups will significantly impair the access to equitable health care for all. PMID:28729986

Reimbursed Price of Orphan Drugs: Current Strategies and Potential Improvements.

PubMed

Mincarone, Pierpaolo; Leo, Carlo Giacomo; Sabina, Saverio; Sarriá-Santamera, Antonio; Taruscio, Domenica; Serrano-Aguilar, Pedro Guillermo; Kanavos, Panos

2017-01-01

The pricing and reimbursement policies for pharmaceuticals are relevant to balance timely and equitable access for all patients, financial sustainability, and reward for valuable innovation. The proliferation of high-cost specialty medicines is particularly true in rare diseases (RDs) where the pricing mechanism is characterised by a lack of transparency. This work provides an overall picture of current strategies for the definition of the reimbursed prices of orphan drugs (ODs) and highlights some potential improvements. Current strategies and suggestions are presented along 4 dimensions: (1) comprehensive value assessment, (2) early dialogs among relevant stakeholders, (3) innovative reimbursement approaches, and (4) societal participation in producing ODs. Comprehensive value assessment could be achieved by clarifying the approach of distributive justice to adopt, ensuring a representative participation of stakeholders, and with a broad consideration of value-bearing factors. With respect to early dialogs, cross-border cooperation can be determinant to companies and agencies. The cost-benefit ratio of early dialogs needs to be demonstrated and the "regulatory capture" effect should be monitored. Innovative reimbursement approaches were developed to balance the need for evidence-based decisions with the timely access to innovative drugs. The societal participation in producing ODs needs to be recognised in a collaborating framework where adaptive agreements can be developed with mutual satisfaction. Such agreements could also impact on coverage and reimbursement decisions as additional elements for the determination of a comprehensive societal value of ODs. Further research is needed to investigate the highlighted open challenges so that RDs will not remain, in practical terms, orphan diseases. © 2017 S. Karger AG, Basel.

Cancer statistics for African Americans, 2013.

PubMed

DeSantis, Carol; Naishadham, Deepa; Jemal, Ahmedin

2013-05-01

In this article, the American Cancer Society estimates the number of new cancer cases and deaths for African Americans and compiles the most recent data on cancer incidence, mortality, survival, and screening prevalence based upon incidence data from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries and mortality data from the National Center for Health Statistics. It is estimated that 176,620 new cases of cancer and 64,880 deaths will occur among African Americans in 2013. From 2000 to 2009, the overall cancer death rate among males declined faster among African Americans than whites (2.4% vs 1.7% per year), but among females, the rate of decline was similar (1.5% vs 1.4% per year, respectively). The decrease in cancer death rates among African American males was the largest of any racial or ethnic group. The reduction in overall cancer death rates since 1990 in men and 1991 in women translates to the avoidance of nearly 200,000 deaths from cancer among African Americans. Five-year relative survival is lower for African Americans than whites for most cancers at each stage of diagnosis. The extent to which these disparities reflect unequal access to health care versus other factors remains an active area of research. Overall, progress in reducing cancer death rates has been made, although more can and should be done to accelerate this progress through ensuring equitable access to cancer prevention, early detection, and state-of-the-art treatments. Copyright © 2013 American Cancer Society, Inc.

Drug pricing and reimbursement decision making systems in Mongolia.

PubMed

Dorj, Gereltuya; Sunderland, Bruce; Sanjjav, Tsetsegmaa; Dorj, Gantuya; Gendenragchaa, Byambatsogt

2017-01-01

It is essential to allocate available resources equitably in order to ensure accessibility and affordability of essential medicines, especially in less fortunate nations with limited health funding. Currently, transparent and evidence based research is required to evaluate decision making regarding drug registration, drug pricing and reimbursement processes in Mongolia. To assess the drug reimbursement system and discuss challenges faced by policy-makers and stakeholders. The study has examined Mongolian administrative documents and directives for stakeholders and analysed published statistics. Experts and decision-makers were interviewed about the drug pricing and reimbursement processes in Mongolia. Decisions regarding Mongolian drug registration were based on commonly used criteria of quality, safety, efficacy plus some economic considerations. A total of 11.32 billion Mongolian National Tugrugs (MNT) [5.6 million United States Dollars (USD)] or 12.1% of total health expenditure was spent on patient reimbursement of essential drugs. The highest reimbursed drugs with respect to cost in 2014 were the cardiovascular drug group. Health insurance is compulsory for all citizens; in addition all insured patients have access to reimbursed drugs. However, the decision making process, in particular the level of reimbursement was limited by various barriers, including lack of evidence based data regarding efficacy and comparative cost-effectiveness analysis of drugs and decisions regarding reimbursement. Drug registration, pricing and reimbursement process in Mongolia show an increasing trend of drug registration and reimbursement rates, along with lack of transparency. Limited available data indicate that more evidence-based research studies are required in Mongolia to evaluate and improve the effectiveness of drug pricing and reimbursement policies.

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

Systematic review on human resources for health interventions to improve maternal health outcomes: evidence from low- and middle-income countries.

PubMed

Lassi, Zohra S; Musavi, Nabiha B; Maliqi, Blerta; Mansoor, Nadia; de Francisco, Andres; Toure, Kadidiatou; Bhutta, Zulfiqar A

2016-03-12

There is a broad consensus and evidence that shows qualified, accessible, and responsive human resources for health (HRH) can make a major impact on the health of the populations. At the same time, there is widespread recognition that HRH crises particularly in low- and middle-income countries (LMICs) impede the achievement of better health outcomes/targets. In order to achieve the Sustainable Development Goals (SDGs), equitable access to a skilled and motivated health worker within a performing health system is need to be ensured. This review contributes to the vast pool of literature towards the assessment of HRH for maternal health and is focused on interventions delivered by skilled birth attendants (SBAs). Studies were included if (a) any HRH interventions in management system, policy, finance, education, partnership, and leadership were implemented; (b) these were related to SBA; (c) reported outcomes related to maternal health; (d) the studies were conducted in LMICs; and (e) studies were in English. Studies were excluded if traditional birth attendants and/or community health workers were trained. The review identified 25 studies which revealed reasons for poor maternal health outcomes in LMICs despite the efforts and policies implemented throughout these years. This review suggested an urgent and immediate need for formative evidence-based research on effective HRH interventions for improved maternal health outcomes. Other initiatives such as education and empowerment of women, alleviating poverty, establishing gender equality, and provision of infrastructure, equipment, drugs, and supplies are all integral components that are required to achieve SDGs by reducing maternal mortality and improving maternal health.

A Rising Tide of Primary School Standards--The Role of Data Systems in Improving Equitable Access for All to Quality Education in Vietnam

ERIC Educational Resources Information Center

Attfield, Ian; Vu, Binh Thanh

2013-01-01

The approach taken over the past decade to introduce minimum primary school standards in Vietnam is reviewed, with annual school audits that measured both input (quality) and output indicators. It describes a successful, context specific approach in which flexible data systems were used to support the evolution and adoption of a new set of…

Towards an Education for Social Justice: Ethics Applied to Education. New International Studies in Applied Ethics. Volume 7

ERIC Educational Resources Information Center

Cotton, Tony, Ed.

2012-01-01

This book challenges educators to envisage an education system which sees as its goal a more socially just world. It explores the question of how education, both formal and informal, can positively impact on all pupils' life chances and life experiences. The contributors to the book take the view that access to an equitable education for all is a…

Nonpublic School Students in Title I, ESEA Programs: A Question of "Equal" Services. A Special Report from the Title I District Practices Study.

ERIC Educational Resources Information Center

Jung, Richard K.

Based on data from a study of Title I of the Elementary and Secondary Education Act, this report describes the level of nonpublic school student participation in the Title I program during 1981-82, assesses whether nonpublic students receive an equitable share of Title I resources, and examines variables affecting the access of nonpublic students…

78 FR 8601 - AXA Equitable Life Insurance Company, et al; Notice of Application

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-06

... SECURITIES AND EXCHANGE COMMISSION [Release No. IC-30373; File No. 812-14036] AXA Equitable Life... the Act. Applicants: AXA Equitable Life Insurance Company (``AXA Equitable''), Separate Account 45 of...: Steven M. Joenk, Senior Vice President, AXA Equitable Life Insurance Company, 1290 Avenue of Americas...

`Does it answer the question or is it French fries?': an exploration of language supports for scientific argumentation

NASA Astrophysics Data System (ADS)

González-Howard, María; McNeill, Katherine L.; Marco-Bujosa, Lisa M.; Proctor, C. Patrick

2017-03-01

Reform initiatives around the world are reconceptualising science education by stressing student engagement in science practices. Yet, science practices are language-intensive, requiring students to have strong receptive and productive language proficiencies. It is critical to address these rigorous language demands to ensure equitable learning opportunities for all students, including English language learners (ELLs). Little research has examined how to specifically support ELL students' engagement in science practices, such as argumentation. Using case-study methodology, we examined one middle school science teacher's instructional strategies as she taught an argumentation-focused curriculum in a self-contained ELL classroom. Findings revealed that three trends characterized the teacher's language supports for the structural and dialogic components of argumentation: (1) more language supports focused on argument structure, (2) dialogic interactions were most often facilitated by productive language supports, and (3) some language supports offered a rationale for argumentation. Findings suggest a need to identify and develop supports for the dialogic aspects of argumentation. Furthermore, engaging students in argumentation through productive language functions could be leveraged to support dialogic interactions. Lastly, our work points to the need for language supports that make the rationale for argumentation explicit since such transparency could further increase access for all students.

Progressivity of health care financing and incidence of service benefits in Ghana.

PubMed

Akazili, James; Garshong, Bertha; Aikins, Moses; Gyapong, John; McIntyre, Di

2012-03-01

The National Health Insurance (NHI) scheme was introduced in Ghana in 2004 as a pro-poor financing strategy aimed at removing financial barriers to health care and protecting all citizens from catastrophic health expenditures, which currently arise due to user fees and other direct payments. A comprehensive assessment of the financing and benefit incidence of health services in Ghana was undertaken. These analyses drew on secondary data from the Ghana Living Standards Survey (2005/2006) and from an additional household survey which collected data in 2008 in six districts covering the three main ecological zones of Ghana. Findings show that Ghana's health care financing system is progressive, driven largely by the progressivity of taxes. The national health insurance levy (which is part of VAT) is mildly progressive while NHI contributions by the informal sector are regressive. The distribution of total benefits from both public and private health services is pro-rich. However, public sector district-level hospital inpatient care is pro-poor and benefits of primary-level health care services are relatively evenly distributed. For Ghana to attain an equitable health system and fully achieve universal coverage, it must ensure that the poor, most of whom are not currently covered by the NHI, are financially protected, and it must address the many access barriers to health care.

'Something needs to change': Mental health experiences of young autistic adults in England.

PubMed

Crane, Laura; Adams, Fern; Harper, Georgia; Welch, Jack; Pellicano, Elizabeth

2018-02-01

There is a high incidence and prevalence of mental health problems among young people, with several barriers to help-seeking noted in this group. High rates of mental health problems have also been reported in children and adults on the autism spectrum. Taken together, young autistic people may be a particularly vulnerable group when it comes to mental health. Yet, there has been remarkably little work on the mental health needs and experiences of young autistic adults (16-25 years). Adopting a community-based participatory research (CBPR) approach - in which academic researchers and young autistic adults collaborated in an equitable research partnership - we explored young autistic people's experiences of mental health problems and their perspectives on the support they sought, if any, for these problems. A total of 130 young autistic adults took part in the research: 109 completed an online survey and 21 took part in detailed interviews. The results highlight how young autistic people find it difficult to evaluate their mental health, experience high levels of stigma and often face severe obstacles when trying to access mental health support. The findings also demonstrate how listening to - and learning from - young autistic people is crucial in ensuring that their mental health needs are met.

Student nurses' attitudes to vulnerable groups: a study examining the impact of a social inclusion module.

PubMed

Wray, Jane; Walker, Liz; Fell, Benedict; Benedict

2008-05-01

Front line health care professionals have a responsibility to ensure that excluded groups and vulnerable people have equitable access to health care services. This obligation is stated explicitly in the Nursing and Midwifery Council Code of Professional Conduct (2004). Consequently, educationalists involved in the delivery of nurse education have sought to promote the principles of socially inclusive and anti-oppressive practice throughout the curriculum. This quantitative study, conducted with a group of nursing and midwifery university students, aimed to examine student attitudes prior to and on completion of a module on social inclusion/exclusion. The data demonstrated that the majority of students surveyed held views that were generally positive and inclusive. Yet, a small group of respondents held stereotypical views potentially compromising their ability to provide health care. This study identified important gaps within the current curriculum and the need for educators in the field of Health and Social Care to concentrate efforts throughout the curriculum on challenging stereotypical views and attitudes rather than assuming that students can understand the complex concepts of social inclusion in a stand alone module. The students who took part in the study generally held positive views and values and the module was to some extent able to shape their perspective on vulnerable people.

Energy Efficiency Financing for Low- and Moderate-Income Households: Current State of the Market, Issues, and Opportunities

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

Leventis, Greg; Kramer, Chris; Schwartz, Lisa

Ensuring that low- and moderate-income (LMI) households have access to energy efficiency is equitable, provides energy savings as a resource to meet energy needs, and can support multiple policy goals, such as affordable energy, job creation, and improved public health. Although the need is great, many LMI households may not be able to afford efficiency improvements or may be inhibited from adopting efficiency for other reasons. Decision-makers across the country are currently exploring the challenges and potential solutions to ramping up adoption of efficiency in LMI households, including the use of financing. The report’s objective is to offer state andmore » local policymakers, state utility regulators, program administrators, financial institutions, consumer advocates and other LMI stakeholders with an understanding of: -The relationship between LMI communities and financing for energy efficiency, including important considerations for its use such as consumer protections -The larger programmatic context of grant-based assistance and other related resources supporting LMI household energy efficiency -Lessons learned from existing energy efficiency financing programs serving LMI households -Financing products used by these programs and their relative advantages and disadvantages in addressing barriers to financing or to energy efficiency uptake for LMI households« less

Ethics and Policy Issues for Stem Cell Research and Pulmonary Medicine

PubMed Central

Lowenthal, Justin

2015-01-01

Stem cell research and related initiatives in regenerative medicine, cell-based therapy, and tissue engineering have generated considerable scientific and public interest. Researchers are applying stem cell technologies to chest medicine in a variety of ways: using stem cells as models for drug discovery, testing stem cell-based therapies for conditions as diverse as COPD and cystic fibrosis, and producing functional lung and tracheal tissue for physiologic modeling and potential transplantation. Although significant scientific obstacles remain, it is likely that stem cell-based regenerative medicine will have a significant clinical impact in chest medicine. However, stem cell research has also generated substantial controversy, posing a variety of ethical and regulatory challenges for research and clinical practice. Some of the most prominent ethical questions related to the use of stem cell technologies in chest medicine include (1) implications for donors, (2) scientific prerequisites for clinical testing and use, (3) stem cell tourism, (4) innovation and clinical use of emerging stem cell-based interventions, (5) responsible translation of stem cell-based therapies to clinical use, and (6) appropriate and equitable access to emerging therapies. Having a sense of these issues should help to put emerging scientific advances into appropriate context and to ensure the responsible clinical translation of promising therapeutics. PMID:25732448

Exploring low-income families' financial barriers to food allergy management and treatment.

PubMed

Minaker, Leia M; Elliott, Susan J; Clarke, Ann

2014-01-01

Objectives. Low-income families may face financial barriers to management and treatment of chronic illnesses. No studies have explored how low-income individuals and families with anaphylactic food allergies cope with financial barriers to anaphylaxis management and/or treatment. This study explores qualitatively assessed direct, indirect, and intangible costs of anaphylaxis management and treatment faced by low-income families. Methods. In-depth, semistructured interviews with 23 participants were conducted to gain insight into income-related barriers to managing and treating anaphylactic food allergies. Results. Perceived direct costs included the cost of allergen-free foods and allergy medication and costs incurred as a result of misinformation about social support programs. Perceived indirect costs included those associated with lack of continuity of health care. Perceived intangible costs included the stress related to the difficulty of obtaining allergen-free foods at the food bank and feeling unsafe at discount grocery stores. These perceived costs represented barriers that were perceived as especially salient for the working poor, immigrants, youth living in poverty, and food bank users. Discussion. Low-income families report significant financial barriers to food allergy management and anaphylaxis preparedness. Clinicians, advocacy groups, and EAI manufacturers all have a role to play in ensuring equitable access to medication for low-income individuals with allergies.

California's county hospitals and the University of California graduate medical education system. Current issues and future directions.

PubMed

Jameson, W J; Pierce, K; Martin, D K

1998-05-01

California's county hospitals train 45% of the state's graduate medical residents, including 33% of residents in the University of California system. This paper describes the interrelationships of California's county hospitals and the University of California (UC) graduate medical education (GME) programs, highlighting key challenges facing both systems. The mission of California's county health care systems is to serve all who need health care services regardless of ability to pay. Locating UC GME programs in county hospitals helps serve the public missions of both institutions. Such partnerships enhance the GME experience of UC residents, provide key primary care training opportunities, and ensure continued health care access for indigent and uninsured populations. Only through affiliation with university training programs have county hospitals been able to run the cost-effective, quality programs that constitute an acceptable safety net for the poor. Financial stress, however, has led county hospitals and UC's GME programs to advocate for reform in both GME financing and indigent care funding. County hospitals must participate in constructing strategies for GME reform to assure that GME funding mechanisms provide for equitable compensation of county hospitals' essential role. Joint advocacy will also be essential in achieving significant indigent care policy reform.

Assessment of global water security: moving beyond water scarcity assessment

NASA Astrophysics Data System (ADS)

Wada, Y.; Gain, A. K.; Giupponi, C.

2015-12-01

Water plays an important role in underpinning equitable, stable and productive societies, and the ecosystems on which we depend. Many international river basins are likely to experience 'low water security' over the coming decades. Hence, ensuring water security along with energy and food securities has been recognised as priority goals in Sustainable Development Goals (SDGs) by the United Nations. This water security is not rooted only in the limitation of physical resources, i.e. the shortage in the availability of freshwater relative to water demand, but also on social and economic factors (e.g. flawed water planning and management approaches, institutional incapability to provide water services, unsustainable economic policies). Until recently, advanced tools and methods are available for assessment of global water scarcity. However, integrating both physical and socio-economic indicators assessment of water security at global level is not available yet. In this study, we present the first global understanding of water security using a spatial multi-criteria analysis framework that goes beyond available water scarcity assessment. For assessing water security at global scale, the term 'security' is conceptualized as a function of 'availability', 'accessibility to services', 'safety and quality', and 'management'. The Water security index is calculated by aggregating the indicators using both simple additive weighting (SAW) and ordered weighted average (OWA).

Ethics and policy issues for stem cell research and pulmonary medicine.

PubMed

Lowenthal, Justin; Sugarman, Jeremy

2015-03-01

Stem cell research and related initiatives in regenerative medicine, cell-based therapy, and tissue engineering have generated considerable scientific and public interest. Researchers are applying stem cell technologies to chest medicine in a variety of ways: using stem cells as models for drug discovery, testing stem cell-based therapies for conditions as diverse as COPD and cystic fibrosis, and producing functional lung and tracheal tissue for physiologic modeling and potential transplantation. Although significant scientific obstacles remain, it is likely that stem cell-based regenerative medicine will have a significant clinical impact in chest medicine. However, stem cell research has also generated substantial controversy, posing a variety of ethical and regulatory challenges for research and clinical practice. Some of the most prominent ethical questions related to the use of stem cell technologies in chest medicine include (1) implications for donors, (2) scientific prerequisites for clinical testing and use, (3) stem cell tourism, (4) innovation and clinical use of emerging stem cell-based interventions, (5) responsible translation of stem cell-based therapies to clinical use, and (6) appropriate and equitable access to emerging therapies. Having a sense of these issues should help to put emerging scientific advances into appropriate context and to ensure the responsible clinical translation of promising therapeutics.

Patent and exclusivity status of essential medicines for non-communicable disease.

PubMed

Mackey, Tim K; Liang, Bryan A

2012-01-01

The threat of non-communicable diseases ("NCDs") is increasingly becoming a global health crisis and are pervasive in high, middle, and low-income populations resulting in an estimated 36 million deaths per year. There is a need to assess intellectual property rights ("IPRs") that may impede generic production and availability and affordability to essential NCD medicines. Using the data sources listed below, the study design systematically eliminated NCD drugs that had no patent/exclusivity provisions on API, dosage, or administration route. The first step identified essential medicines that treat certain high disease burden NCDs. A second step examined the patent and exclusivity status of active ingredient, dosage and listed route of administration using exclusion criteria outlined in this study. We examined the patent and exclusivity status of medicines listed in the World Health Organization's ("WHO") Model List of Essential Drugs (Medicines) ("MLEM") and other WHO sources for drugs treating certain NCDs. i.e., cardiovascular and respiratory disease, cancers, and diabetes. We utilized the USA Food and Drug Administration Orange Book and the USA Patent and Trademark Office databases as references given the predominant number of medicines registered in the USA. Of the 359 MLEM medicines identified, 22% (79/359) address targeted NCDs. Of these 79, only eight required in-depth patent or exclusivity assessment. Upon further review, no NCD MLEM medicines had study patent or exclusivity protection for reviewed criteria. We find that ensuring availability and affordability of potential generic formulations of NCD MLEM medicines appears to be more complex than the presence of IPRs with API, dosage, or administration patent or exclusivity protection. Hence, more sophisticated analysis of NCD barriers to generic availability and affordability should be conducted in order to ensure equitable access to global populations for these essential medicines.

An "integrated health neighbourhood" framework to optimise the use of EHR data.

PubMed

Liaw, Siaw-Teng; De Lusignan, Simon

2016-10-04

 General practice should become the hub of integrated health neighbourhoods (IHNs), which involves sharing of information to ensure that medical homes are also part of learning organisations that use electronic health record (EHR) data for care, decision making, teaching and learning, quality improvement and research. The IHN is defined as the primary and ambulatory care services in a locality that relates largely to a single hospital-based secondary care service provider and is the logical denominator and unit of comparison for the optimal use of EHR data and health information exchange (HIE) to facilitate integration and coordination of care. Its size may vary based on the geography and requirements of the population, for example between city, suburban and rural areas. The conceptual framework includes context; integration of data, information and knowledge; integration of clinical workflow and practice; and inter-professional integration to ensure coordinated shared care to deliver safe and effective services that are equitable, accessible and culturally respectful. We illustrate how this HIE-supported IHN vision may be achieved with an Australian case study demonstrating the integration of linked pseudonymised records with knowledge- and evidence-based guidelines using semantic web tools and informatics-based methods, researching causal links bewteen data quality and quality of care and the key issues to address. The data presented in this paper form part of the evaluation of the informatics infrastructure - HIE and data repository - for its reliability and utility in supporting the IHN. An IHN can only be created if the necessary health informatics infrastructure is put in place. Integrated care may struggle to be effective without HIE.

Towards tuberculosis elimination: an action framework for low-incidence countries

PubMed Central

Lönnroth, Knut; Migliori, Giovanni Battista; Abubakar, Ibrahim; D'Ambrosio, Lia; de Vries, Gerard; Diel, Roland; Douglas, Paul; Falzon, Dennis; Gaudreau, Marc-Andre; Goletti, Delia; González Ochoa, Edilberto R.; LoBue, Philip; Matteelli, Alberto; Njoo, Howard; Solovic, Ivan; Story, Alistair; Tayeb, Tamara; van der Werf, Marieke J.; Weil, Diana; Zellweger, Jean-Pierre; Abdel Aziz, Mohamed; Al Lawati, Mohamed R.M.; Aliberti, Stefano; Arrazola de Oñate, Wouter; Barreira, Draurio; Bhatia, Vineet; Blasi, Francesco; Bloom, Amy; Bruchfeld, Judith; Castelli, Francesco; Centis, Rosella; Chemtob, Daniel; Cirillo, Daniela M.; Colorado, Alberto; Dadu, Andrei; Dahle, Ulf R.; De Paoli, Laura; Dias, Hannah M.; Duarte, Raquel; Fattorini, Lanfranco; Gaga, Mina; Getahun, Haileyesus; Glaziou, Philippe; Goguadze, Lasha; del Granado, Mirtha; Haas, Walter; Järvinen, Asko; Kwon, Geun-Yong; Mosca, Davide; Nahid, Payam; Nishikiori, Nobuyuki; Noguer, Isabel; O'Donnell, Joan; Pace-Asciak, Analita; Pompa, Maria G.; Popescu, Gilda G.; Robalo Cordeiro, Carlos; Rønning, Karin; Ruhwald, Morten; Sculier, Jean-Paul; Simunović, Aleksandar; Smith-Palmer, Alison; Sotgiu, Giovanni; Sulis, Giorgia; Torres-Duque, Carlos A.; Umeki, Kazunori; Uplekar, Mukund; van Weezenbeek, Catharina; Vasankari, Tuula; Vitillo, Robert J.; Voniatis, Constantia; Wanlin, Maryse; Raviglione, Mario C.

2015-01-01

This paper describes an action framework for countries with low tuberculosis (TB) incidence (<100 TB cases per million population) that are striving for TB elimination. The framework sets out priority interventions required for these countries to progress first towards “pre-elimination” (<10 cases per million) and eventually the elimination of TB as a public health problem (less than one case per million). TB epidemiology in most low-incidence countries is characterised by a low rate of transmission in the general population, occasional outbreaks, a majority of TB cases generated from progression of latent TB infection (LTBI) rather than local transmission, concentration to certain vulnerable and hard-to-reach risk groups, and challenges posed by cross-border migration. Common health system challenges are that political commitment, funding, clinical expertise and general awareness of TB diminishes as TB incidence falls. The framework presents a tailored response to these challenges, grouped into eight priority action areas: 1) ensure political commitment, funding and stewardship for planning and essential services; 2) address the most vulnerable and hard-to-reach groups; 3) address special needs of migrants and cross-border issues; 4) undertake screening for active TB and LTBI in TB contacts and selected high-risk groups, and provide appropriate treatment; 5) optimise the prevention and care of drug-resistant TB; 6) ensure continued surveillance, programme monitoring and evaluation and case-based data management; 7) invest in research and new tools; and 8) support global TB prevention, care and control. The overall approach needs to be multisectorial, focusing on equitable access to high-quality diagnosis and care, and on addressing the social determinants of TB. Because of increasing globalisation and population mobility, the response needs to have both national and global dimensions. PMID:25792630

The relationship between healthcare services and the political economy with reference to the Jamaican experience.

PubMed

Maharaj, S R

2010-12-01

The availability of and equitable access to, health services have challenged healthcare providers with a greater degree of urgency since the end of World War II. Prior to that time, concepts such as equity and social justice were just that, concepts but no real attempts were ever made to operationalize them. Goods and services were still produced and distributed based on market forces, that is, one's ability and willingness to pay for something. Health in that context was a service, some say a commodity, to be bought and sold, hence its availability was not necessarily commensurate with its accessibility.

Map of biomedical research in Cameroon; a documentary review of approved protocols from 1997 to 2012.

PubMed

Walter, Ebile Akoh; Jerome, Ateudjieu; Marceline, Djuidje Ngounoue; Yakum, Martin Ndinakie; Pierre, Watcho

2017-11-21

Over the last decade, there has been a rapid increase in biomedical research in Cameroon. However, the question of whether these research projects target major health priorities, vulnerable populations and geographic locations at risk remains to be answered. The aim of this paper is to describe the state of biomedical research in Cameroon which is a key determinant that would guide future health care policies and promote equitable access to healthcare. A documentary review of all approved protocols (proposals) of biomedical research projects, from 1997 through 2012, at the Cameroon National Ethics Committee. Protocols were reviewed systematically by independent reviewers and data were extracted on a grid. Data were analyzed by calculating proportions at 95% confidence interval, chi-square test (chi2) and p-values. Two thousand one hundred seventy two protocols were reviewed for data extraction. One thousand three hundred ninety-five (64.7%) were student projects, 369 (17.0%) projects had international sponsors, and 1528 (72.4%) were hospital-based studies. The most targeted domain was the fight against diseases 1323 (61.3%); mostly HIV 342 (25.8%) and Malaria 136 (10.3%). Over half of the studies were concentrated in the Centre region 1242 (57.2%), with the least projects conducted in the Northern region 15 (0.7%). There was strong evidence that international and local sponsors would influence the research site (p-value = 0.01) and population targets (p-value = 0.00). Although biomedical research targets some important diseases that pose a great burden to Cameroonians, the most vulnerable populations are excluded from research. Biomedical research scarcely addresses other components of the health system and emerging diseases of vital public health importance. We recommend that the government should play a central role, between researchers from academic institutions, sponsors, NGOs and research institutions, to ensure that biomedical research addresses the health priorities of Cameroonians. It should include vulnerable populations, and address other components of the health system for a balance. These recommendations are critical to ensuring that future research informed health policies reflect the health needs of the populations and promote equity in healthcare access.

Financing family planning services: is categorical legislation still needed?

PubMed

Mcfarlane, D R; Meier, K J

1991-01-01

Federal and state funds have provided for family planning services in American since the 1960s. Since 1976, services have been funded principally through federal statutes Title X of the Public Health Service Act and Titles V, XIX, and XX of the Social Security Act as well as various state appropriations. While these statutes aim to ensure that women of lower socioeconomic status enjoy access to reproductive health care services, levels of public expenditure in this area vary widely among states. In 1987, public family planning expenditures/woman at risk ranged from $60.16 in Wisconsin to $9.41 in Florida. Within this range of expenditures, the relative importance of each funding source per state varies widely. States with the most robust Title XIX programs, Medicaid, however, have highest per woman family planning expenditures. Upon reviewing the complement of public funding sources and how they are spent at the state level, the authors argue that categorical legislation is still needed to protect access to contraceptive services in America. In particular, of funds from supporting statues, Medicaid is distributed most equitable across the country. These funds paid for 36% of all public outlays for family planning in 1987. Without categorical legislation, however, Medicaid is insufficient to maintain the national family planning effort; the 1987 contribution of $10.49/woman at risk of unwanted pregnancy was insufficient to provide minimum services. Title X requires grantees to follow regulations which ensure state uniformity of quality and service distribution; submission of annual 5-year plans to Congress on how family planning goals will be achieved; and also authorizes monies for training and research. Despite political attacks, family planning funding must remain separate from maternal and child health programs. Such independence will keep these services politically visible; allow use of the more extensive family planning delivery system; catalyze states to spend other monies on family planning; and fuel innovations in service delivery, client education, and new contraceptive technologies. Title X should even be reauthorized under more precise mandates and include a national data collection system, consideration of the shortage of clinicians, and codification of 1981 guidelines reversed by the gag rule.

Acceptable care? Illness constructions, healthworlds, and accessible chronic treatment in South Africa.

PubMed

Fried, Jana; Harris, Bronwyn; Eyles, John; Moshabela, Mosa

2015-05-01

Achieving equitable access to health care is an important policy goal, with access influenced by affordability, availability, and acceptability of specific services. We explore patient narratives from a 5-year program of research on health care access to examine relationships between social constructions of illness and the acceptability of health services in the context of tuberculosis treatment and antiretroviral therapy in South Africa. Acceptability of services seems particularly important to the meanings patients attach to illness and care, whereas-conversely-these constructions appear to influence what constitutes acceptability and hence affect access to care. We highlight the underestimated role of individually, socially, and politically constructed healthworlds; traditional and biomedical beliefs; and social support networks. Suggested policy implications for improving acceptability and hence overall health care access include abandoning patronizing approaches to care and refocusing from treating "disease" to responding to "illness" by acknowledging and incorporating patients' healthworlds in patient-provider interactions. © The Author(s) 2015.

Local health department activities to ensure access to care.

PubMed

Luo, Huabin; Sotnikov, Sergey; Shah, Gulzar

2013-12-01

Local health departments (LHDs) can play an important role in linking people to personal health services and ensuring the provision of health care when it is otherwise unavailable. However, the extent to which LHDs are involved in ensuring access to health care in its jurisdictions is not well known. To provide nationally representative estimates of LHD involvement in specific activities to ensure access to healthcare services and to assess their association with macro-environment/community and LHD capacity and process characteristics. Data used were from the 2010 National Profile of Local Health Departments Study, Area Resource Files, and the Association of State and Territorial Health Officials' 2010 Profile of State Public Health Agencies Survey. Data were analyzed in 2012. Approximately 66.0% of LHDs conducted activities to ensure access to medical care, 45.9% to dental care, and 32.0% to behavioral health care. About 28% of LHDs had not conducted activities to ensure access to health care in their jurisdictions in 2010. LHDs with higher per capita expenditures and larger jurisdiction population sizes were more likely to provide access to care services (p <0.05). There is substantial variation in LHD engagement in activities to ensure access to care. Differences in LHD capacity and the needs of the communities in which they are located may account for this variation. Further research is needed to determine whether this variation is associated with adverse population health outcomes. © 2013 American Journal of Preventive Medicine Published by American Journal of Preventive Medicine All rights reserved.

Promoting equitable global health research: a policy analysis of the Canadian funding landscape.

PubMed

Plamondon, Katrina; Walters, Dylan; Campbell, Sandy; Hatfield, Jennifer

2017-08-29

Recognising radical shifts in the global health research (GHR) environment, participants in a 2013 deliberative dialogue called for careful consideration of equity-centred principles that should inform Canadian funding polices. This study examined the existing funding structures and policies of Canadian and international funders to inform the future design of a responsive GHR funding landscape. We used a three-pronged analytical framework to review the ideas, interests and institutions implicated in publically accessible documents relevant to GHR funding. These data included published literature and organisational documents (e.g. strategic plans, progress reports, granting policies) from Canadian and other comparator funders. We then used a deliberative approach to develop recommendations with the research team, advisors, industry informants and low- and middle-income country (LMIC) partners. In Canada, major GHR funders invest an estimated CA$90 M per annum; however, the post-2008 re-organization of funding structures and policies resulted in an uncoordinated and inefficient Canadian strategy. Australia, Denmark, the European Union, Norway, Sweden, the United Kingdom and the United States of America invest proportionately more in GHR than Canada. Each of these countries has a national strategic plan for global health, some of which have dedicated benchmarks for GHR funding and policy to allow funds to be held by partners outside of Canada. Key constraints to equitable GHR funding included (1) funding policies that restrict financial and cost burden aspects of partnering for GHR in LMICs; and (2) challenges associated with the development of effective governance mechanisms. There were, however, some Canadian innovations in funding research that demonstrated both unconventional and equitable approaches to supporting GHR in Canada and abroad. Among the most promising were found in the International Development Research Centre and the (no longer active) Global Health Research Initiative. Promoting equitable GHR funding policies and practices in Canada requires cooperation and actions by multiple stakeholders, including government, funding agencies, academic institutions and researchers. Greater cooperation and collaboration among these stakeholders in the context of recent political shifts present important opportunities for advancing funding policies that enable and encourage more equitable investments in GHR.

Empowering health personnel for decentralized health planning in India: The Public Health Resource Network.

PubMed

Kalita, Anuska; Zaidi, Sarover; Prasad, Vandana; Raman, V R

2009-07-20

The Public Health Resource Network is an innovative distance-learning course in training, motivating, empowering and building a network of health personnel from government and civil society groups. Its aim is to build human resource capacity for strengthening decentralized health planning, especially at the district level, to improve accountability of health systems, elicit community participation for health, ensure equitable and accessible health facilities and to bring about convergence in programmes and services. The question confronting health systems in India is how best to reform, revitalize and resource primary health systems to deliver different levels of service aligned to local realities, ensuring universal coverage, equitable access, efficiency and effectiveness, through an empowered cadre of health personnel. To achieve these outcomes it is essential that health planning be decentralized. Districts vary widely according to the specific needs of their population, and even more so in terms of existing interventions and available resources. Strategies, therefore, have to be district-specific, not only because health needs vary, but also because people's perceptions and capacities to intervene and implement programmes vary. In centrally designed plans there is little scope for such adaptation and contextualization, and hence decentralized planning becomes crucial. To undertake these initiatives, there is a strong need for trained, motivated, empowered and networked health personnel. It is precisely at this level that a lack of technical knowledge and skills and the absence of a supportive network or adequate educational opportunities impede personnel from making improvements. The absence of in-service training and of training curricula that reflect field realities also adds to this, discouraging health workers from pursuing effective strategies. The Public Health Resource Network is thus an attempt to reach out to motivated though often isolated health workers. It interacts with, and works to empower, health personnel within the government health system as well as civil society, to meaningfully participate in and strengthen decentralized planning processes and outcomes. Structured as an innovative distance-learning course spread over 12 to 18 months of coursework and contact programmes, the Public Health Resource Network comprises 14 core modules and five optional courses. The technical content and contact programmes have been specifically developed to build perspectives and technical knowledge of participants and provide them with a variety of options that can be immediately put into practice within their work environments and everyday roles. The thematic areas of the course modules range from technical knowledge related to maternal and child health and communicable and noncommunicable diseases; programmatic and systemic knowledge related to health planning, convergence, health management and public-private partnerships; to perspective-building knowledge related to mainstreaming gender issues and community participation. Currently the Public Health Resource Network has been launched in four states of India--Chhattisgarh, Jharkhand, Bihar and Orissa--in its first phase, and reaches out to more than 500 participants with diverse backgrounds. The initiative has received valuable support from central and state government departments of health, state training institutes, the National Rural Health Mission--the current comprehensive health policy in the country--and leading civil society organizations.

Empowering health personnel for decentralized health planning in India: The Public Health Resource Network

PubMed Central

Kalita, Anuska; Zaidi, Sarover; Prasad, Vandana; Raman, VR

2009-01-01

The Public Health Resource Network is an innovative distance-learning course in training, motivating, empowering and building a network of health personnel from government and civil society groups. Its aim is to build human resource capacity for strengthening decentralized health planning, especially at the district level, to improve accountability of health systems, elicit community participation for health, ensure equitable and accessible health facilities and to bring about convergence in programmes and services. The question confronting health systems in India is how best to reform, revitalize and resource primary health systems to deliver different levels of service aligned to local realities, ensuring universal coverage, equitable access, efficiency and effectiveness, through an empowered cadre of health personnel. To achieve these outcomes it is essential that health planning be decentralized. Districts vary widely according to the specific needs of their population, and even more so in terms of existing interventions and available resources. Strategies, therefore, have to be district-specific, not only because health needs vary, but also because people's perceptions and capacities to intervene and implement programmes vary. In centrally designed plans there is little scope for such adaptation and contextualization, and hence decentralized planning becomes crucial. To undertake these initiatives, there is a strong need for trained, motivated, empowered and networked health personnel. It is precisely at this level that a lack of technical knowledge and skills and the absence of a supportive network or adequate educational opportunities impede personnel from making improvements. The absence of in-service training and of training curricula that reflect field realities also adds to this, discouraging health workers from pursuing effective strategies. The Public Health Resource Network is thus an attempt to reach out to motivated though often isolated health workers. It interacts with, and works to empower, health personnel within the government health system as well as civil society, to meaningfully participate in and strengthen decentralized planning processes and outcomes. Structured as an innovative distance-learning course spread over 12 to 18 months of coursework and contact programmes, the Public Health Resource Network comprises 14 core modules and five optional courses. The technical content and contact programmes have been specifically developed to build perspectives and technical knowledge of participants and provide them with a variety of options that can be immediately put into practice within their work environments and everyday roles. The thematic areas of the course modules range from technical knowledge related to maternal and child health and communicable and noncommunicable diseases; programmatic and systemic knowledge related to health planning, convergence, health management and public-private partnerships; to perspective-building knowledge related to mainstreaming gender issues and community participation. Currently the Public Health Resource Network has been launched in four states of India – Chhattisgarh, Jharkhand, Bihar and Orissa – in its first phase, and reaches out to more than 500 participants with diverse backgrounds. The initiative has received valuable support from central and state government departments of health, state training institutes, the National Rural Health Mission – the current comprehensive health policy in the country – and leading civil society organizations. PMID:19615106

Adverse or acceptable: negotiating access to a post-apartheid health care contract

PubMed Central

2014-01-01

Background As in many fragile and post-conflict countries, South Africa’s social contract has formally changed from authoritarianism to democracy, yet access to services, including health care, remains inequitable and contested. We examine access barriers to quality health services and draw on social contract theory to explore ways in which a post-apartheid health care contract is narrated, practiced and negotiated by patients and providers. We consider implications for conceptualizing and promoting more inclusive, equitable health services in a post-conflict setting. Methods Using in-depth interviews with 45 patients and 67 providers, and field observations from twelve health facilities in one rural and two urban sub-districts, we explore access narratives of those seeking and delivering – negotiating - maternal health, tuberculosis and antiretroviral services in South Africa. Results Although South Africa’s right to access to health care is constitutionally guaranteed, in practice, a post-apartheid health care contract is not automatically or unconditionally inclusive. Access barriers, including poverty, an under-resourced, hierarchical health system, the nature of illness and treatment, and negative attitudes and actions, create conditions for insecure or adverse incorporation into this contract, or even exclusion (sometimes temporary) from health care services. Such barriers are exacerbated by differences in the expectations that patients and providers have of each other and the contract, leading to differing, potentially conflicting, identities of inclusion and exclusion: defaulting versus suffering patients, uncaring versus overstretched providers. Conversely, caring, respectful communication, individual acts of kindness, and institutional flexibility and leadership may mitigate key access barriers and limit threats to the contract, fostering more positive forms of inclusion and facilitating easier access to health care. Conclusions Building health in fragile and post-conflict societies requires the negotiation of a new social contract. Surfacing and engaging with differences in patient and provider expectations of this contract may contribute to more acceptable, accessible health care services. Additionally, the health system is well positioned to highlight and connect the political economy, institutions and social relationships that create and sustain identities of exclusion and inclusion – (re)politicise suffering - and co-ordinate and lead intersectoral action for overcoming affordability and availability barriers to inclusive and equitable health care services. PMID:24885882

On Using Satellite-Based Networks for Capacity Building and Education for All: A Case Study of Rajiv Gandhi Project for EduSat-Supported Elementary Education

ERIC Educational Resources Information Center

Chaudhary, Sohanvir; Garg, Suresh

2010-01-01

One of the serious problems associated with Indian school education has been high dropout rate. The reasons are many and varied but the major constraints are: non-availability of adequate number of competent and trained teachers in most of the schools and separate room for each class. To overcome such problems and increase equitable access to all,…

The Dilemma of Inclusion: Is Full Inclusion Ethical? An Examination of the Culture of Special Education within a Semi-Rural Pre-K to Sixth Grade Elementary School District

ERIC Educational Resources Information Center

Press, Kandie A.

2010-01-01

At its core the political push for full inclusion models of special education delivery derives from the belief that inclusion provides equal access, equitable distribution of resources and increased social opportunity to children. This study focused upon the evolution of special education programming within a pre-K to sixth grade elementary school…

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.

Genetic modification technology for nutrition and improving diets: an ethical perspective.

PubMed

Glass, Sara; Fanzo, Jessica

2017-04-01

Genetically modified (GM) techniques to improve the nutrition and health content of foods is a highly debated area riddled with ethical dilemmas. Assessing GM technology with a public health ethical framework, this paper identifies public health goals, the potential burdens of the technology, and areas to consider for minimizing burdens and ensuring beneficence, autonomy, and little infringements on justice. Both policymakers and food producers should acknowledge local food environments and the agricultural context of each community in order to effectively prepare communication strategies and equitably distribute any proposed GM food intervention. Copyright © 2016 Elsevier Ltd. All rights reserved.

Patient-centered primary health care: synergy potential for health systems strengthening.

PubMed

Stender, S C; Christensen, A

2013-10-01

The ultimate goal of government health systems is to provide highly effective equitable services that save lives and reduce morbidity and mortality. The pressure to conform to duplicative global and donor initiatives compounds existing challenges to health systems strengthening such as shortages of human resources for health, weak supply chains, inadequate laboratory services and parallel data management systems. This article illustrates how primary health care, as the point of entry into the health care system for the majority of individuals in sub-Saharan Africa, should be strengthened to ensure that individuals and their communities receive essential, holistic care.

Addressing Health Care Disparities Among Sexual Minorities.

PubMed

Baptiste-Roberts, Kesha; Oranuba, Ebele; Werts, Niya; Edwards, Lorece V

2017-03-01

There is evidence of health disparities between sexual minority and heterosexual populations. Although the focus of lesbian, gay, bisexual, and transgender health research has been human immunodeficiency virus/acquired immunodeficiency syndrome and sexually transmitted infection among men who have sex with men, there are health disparities among sexual minority women. Using the minority stress framework, these disparities may in part be caused by individual prejudice, social stigma, and discrimination. To ensure equitable health for all, there is urgent need for targeted culturally sensitive health promotion, cultural sensitivity training for health care providers, and intervention-focused research. Copyright © 2016 Elsevier Inc. All rights reserved.

Ethics and equity in research priority-setting: stakeholder engagement and the needs of disadvantaged groups.

PubMed

Bhaumik, Soumyadeep; Rana, Sangeeta; Karimkhani, Chante; Welch, Vivian; Armstrong, Rebecca; Pottie, Kevin; Dellavalle, Robert; Dhakal, Purushottam; Oliver, Sandy; Francis, Damian K; Nasser, Mona; Crowe, Sally; Aksut, Baran; Amico, Roberto D

2015-01-01

A transparent and evidence-based priority-setting process promotes the optimal use of resources to improve health outcomes. Decision-makers and funders have begun to increasingly engage representatives of patients and healthcare consumers to ensure that research becomes more relevant. However, disadvantaged groups and their needs may not be integrated into the priority-setting process since they do not have a "political voice" or are unable to organise into interest groups. Equitable priority-setting methods need to balance patient needs, values, experiences with population-level issues and issues related to the health system.

Smoke-free hospitals and the role of smoking cessation services.

PubMed

Neubeck, Lis

The NHS must be smoke free by the end of 2006 (Department of Health, 2004). The necessary elements to introducing a smoke-free policy, which is workable and equitable, are the management of the policy and offering support to smokers. Smoking and second-hand smoking are responsible for many illnesses, premature deaths and reduced productivity. Employers have a responsibility to ensure the health of their employees by protecting them from exposure to cigarette smoke in the workplace. Although smoking restrictions in the workplace are popular, it is important to ensure good communication with everyone who will be affected, since there are many fears associated with the introduction of the policy. Help must be offered to people who wish to quit through behavioural and pharmacological interventions and support must also be given to the smoker who must abstain from smoking on the premises during work or hospital stay.

Toward universal coverage in Afghanistan: A multi-stakeholder assessment of capacity investments in the community health worker system.

PubMed

Edward, Anbrasi; Branchini, Casey; Aitken, Iain; Roach, Melissa; Osei-Bonsu, Kojo; Arwal, Said Habib

2015-11-01

Global efforts to scale-up the community health workforce have accelerated as a result of the growing evidence of their effectiveness to enhance coverage and health outcomes. Reconstruction efforts in Afghanistan integrated capacity investments for community based service delivery, including the deployment of over 28,000 community health workers (CHWs) to ensure access to basic preventive and curative services. The study aimed to conduct capacity assessments of the CHW system and determine stakeholder perspectives of CHW performance. Structured interviews were conducted on a national sample from 33 provinces and included supervisors, facility providers, patients, and CHWs. Formative assessments were also conducted with national policymakers, community members and health councils in two provinces. Results indicate that more than 70% of the NGO's provide comprehensive training for CHWs, 95% CHWs reported regular supervision, and more than 60% of the health posts had adequate infrastructure and essential commodities. Innovative strategies of paired male and female CHWs, institution of a special cadre of community health supervisors, and community health councils were introduced as systems strengthening mechanisms. Reported barriers included unrealistic and expanding task expectations (14%), unsatisfactory compensation mechanisms (75%), inadequate transport (69%), and lack of commodities (40%). Formative assessments evidenced that CHWs were highly valued as they provided equitable, accessible and affordable 24-h care. Their loyalty, dedication and the ability for women to access care without male family escorts was appreciated by communities. With rising concerns of workforce deficits, insecurity and budget constraints, the health system must enhance the capacity of these frontline workers to improve the continuum of care. The study provides critical insight into the strengths and constraints of Afghanistan's CHW system, warranting further efforts to contextualize service delivery and mechanisms for their support and motivation. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Gender differences in resources and negotiation among highly motivated physician-scientists.

PubMed

Holliday, Emma; Griffith, Kent A; De Castro, Rochelle; Stewart, Abigail; Ubel, Peter; Jagsi, Reshma

2015-04-01

Resources, including space, equipment, funding, personnel, and protected time, are essential in academic medical careers. Negotiation often plays a key role in the distribution of these resources. This study explored gender differences in resources, negotiation behaviors, and negotiation outcomes in a sample of career development awardees. Postal survey of a cohort of 1,708 clinician-researchers with responses from 1,275 (75 % response rate). Researchers who received NIH K08 or K23 awards between 2006 and 2009. We analyzed gender differences in resources, negotiation behaviors, and negotiation outcomes, using regression models adjusted for race, K award type, K award year, degree, academic rank, specialty, and institutional funding. Over one-fifth of respondents reported inadequate access to research space and one-third had asked for increased space or equipment. Perceived adequacy of these physical resources did not differ significantly by gender, but a higher proportion of women reported inadequate access to grants administrators (34.8 %) and statistical support (49.9 %) than men (26.9 %; p = 0.002 and 43.4 %; p = 0.025, respectively). Women were more likely to have asked for reduction in clinical hours (24.1 % vs. 19.3 %; p = 0.02) and to have raised concerns about unfair treatment (50.2 % vs. 38.2 %; p < 0.001). Overall, 42.9 % of women and 35.9 % of men asked for a raise in the two years preceding the survey (p = 0.09), and among those who had asked for increased resources, the likelihood that the request was granted did not differ significantly by gender. Many career development award recipients report resource needs and negotiate for increased resources. Gender differences in perceived access to research support personnel exist even in this select cohort of K awardees. Institutions should provide appropriate training in negotiation and ensure adequate and equitable distribution of resources to promote academic success.

South Africa’s protracted struggle for equal distribution and equitable access – still not there

PubMed Central

2014-01-01

The purpose of this contribution is to analyse and explain the South African HRH case, its historical evolution, and post-apartheid reform initiatives aimed at addressing deficiencies and shortfalls. HRH in South Africa not only mirrors the nature and diversity of challenges globally, but also the strategies pursued by countries to address these challenges. Although South Africa has strongly developed health professions, large numbers of professional and mid-level workers, and also well-established training institutions, it is experiencing serious workforce shortages and access constraints. This results from the unequal distribution of health workers between the well-resourced private sector over the poorly-resourced public sector, as well as from distributional disparities between urban and rural areas. During colonial and apartheid times, disparities were aggravated by policies of racial segregation and exclusion, remnants of which are today still visible in health-professional backlogs, unequal provincial HRH distribution, and differential access to health services for specific race and class groups. Since 1994, South Africa’s transition to democracy deeply transformed the health system, health professions and HRH establishments. The introduction of free-health policies, the district health system and the prioritisation of PHC ensured more equal distribution of the workforce, as well as greater access to services for deprived groups. However, the HIV/AIDS epidemic brought about huge demands for care and massive patient loads in the public-sector. The emigration of health professionals to developed countries and to the private sector also undermines the strength and effectiveness of the public health sector. For the poor, access to care thus remains constrained and in perpetual shortfall. The post-1994 government has introduced several HRH-specific strategies to recruit, distribute, motivate and retain health professionals to strengthen the public sector and to expand access and coverage. Of great significance among these is the NHI Plan that aims to bridge the structural divide and to redistribute material and human resources more equally. Its success largely hinges on HRH and the balanced deployment of the national workforce. Low- and middle-income countries have much to learn from South African HRH experiences. In turn, South Africa has much to learn from other countries, as this case study shows. PMID:24885691

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

Geographic Accessibility Of Food Outlets Not Associated With Body Mass Index Change Among Veterans, 2009-14.

PubMed

Zenk, Shannon N; Tarlov, Elizabeth; Wing, Coady; Matthews, Stephen A; Jones, Kelly; Tong, Hao; Powell, Lisa M

2017-08-01

In recent years, various levels of government in the United States have adopted or discussed subsidies, tax breaks, zoning laws, and other public policies that promote geographic access to healthy food. However, there is little evidence from large-scale longitudinal or quasi-experimental research to suggest that the local mix of food outlets actually affects body mass index (BMI). We used a longitudinal design to examine whether the proximity of food outlets, by type, was associated with BMI changes between 2009 and 2014 among 1.7 million veterans in 382 metropolitan areas. We found no evidence that either absolute or relative geographic accessibility of supermarkets, fast-food restaurants, or mass merchandisers was associated with changes in an individual's BMI over time. While policies that alter only geographic access to food outlets may promote equitable access to healthy food and improve nutrition, our findings suggest they will do little to combat obesity in adults. Project HOPE—The People-to-People Health Foundation, Inc.

The sharing of water between society and ecosystems: from conflict to catchment-based co-management.

PubMed Central

Wallace, J S; Acreman, M C; Sullivan, C A

2003-01-01

Human uses of freshwater resources are increasing rapidly as the world population rises. As this happens, less water is left to support aquatic and associated ecosystems. To minimize future human water shortages and undesirable environmental impacts, more equitable sharing of water resources between society and nature is required. This will require physical quantities and social values to be placed on both human and aquatic ecosystem requirements. Current water valuation systems are dominated by economic values and this paper illustrates new quantification and valuation methods that take more account of human well-being and environmental impacts. The key to the effective implementation of these more equitable water allocation methods is the use of catchment-based integrated water resources management. This holistic framework makes it possible for human and ecosystem water requirements and the interactions between them to be better understood. This knowledge provides the foundation for incorporating relevant social factors so that water policies and laws can be developed to make best use of limited water resources. Catchment-based co-management can therefore help to ensure more effective sharing of water between people and nature. PMID:14728795

Dental manpower planning in the Indian Health Service.

PubMed

Collins, R J; Broderick, E B; Herman, D J

1993-01-01

As a public health agency, the Indian Health Service (IHS) must plan for the needs of the entire American Indian and Alaskan Native (AI/AN) population and distribute resources as equitably as possible. To facilitate this process, the IHS has developed a manpower planning model to provide for the distribution of dental providers based upon the dental needs of the AI/AN population and within the limits of annual appropriations of funds. This paper briefly describes the original IHS Dental Program manpower planning model and the development of modifications over time. The need-based approach to manpower planning developed by the IHS Dental Program has exhibited utility and flexibility over time. It allows a determination of clinic size (number of operatories) and dental staffing requirements, and may be generalizable to other public health programs if an accurate assessment of utilization rate and treatment need can be made for the defined population. Nonetheless, the availability of resources in public programs is subject to the compromises inherent in the political process; thus, the use of a manpower planning model alone may not be sufficient to ensure the equitable distribution of dental resources and dental providers.

Bridges to sustainable tropical health

PubMed Central

Singer, Burton H.; de Castro, Marcia Caldas

2007-01-01

Ensuring sustainable health in the tropics will require bridge building between communities that currently have a limited track record of interaction. It will also require new organizational innovation if much of the negative health consequences of large-scale economic development projects are to be equitably mitigated, if not prevented. We focus attention on three specific contexts: (i) forging linkages between the engineering and health communities to implement clean water and sanitation on a broad scale to prevent reworming, after the current deworming-only programs, of people by diverse intestinal parasites; (ii) building integrated human and animal disease surveillance infrastructure and technical capacity in tropical countries on the reporting and scientific evidence requirements of the sanitary and phytosanitary agreement under the World Trade Organization; and (iii) developing an independent and equitable organizational structure for health impact assessments as well as monitoring and mitigation of health consequences of economic development projects. Effective global disease surveillance and timely early warning of new outbreaks will require a far closer integration of veterinary and human medicine than heretofore. Many of the necessary surveillance components exist within separate animal- and human-oriented organizations. The challenge is to build the necessary bridges between them. PMID:17913894

Female Engagement Teams: Making the Case for Institutionalization Based on U.S. Security Objectives in Africa

DTIC Science & Technology

2013-05-23

politically when men and women are afforded equitable access to health, education, economic, and political resources.8 However, a review of countries...theory; there would need to be an equal improvement in how the local community understood what the school and education more broadly represented for the...in its World Development Report 2012: Gender Equality and Development: 18LTG Michael T. Flynn, Capt Matt Pottinger, and Paul D. Batchelor, Fixing

Designing equitable workplace dietary interventions: perceptions of intervention deliverers.

PubMed

Smith, Sarah A; Visram, Shelina; O'Malley, Claire; Summerbell, Carolyn; Araujo-Soares, Vera; Hillier-Brown, Frances; Lake, Amelia A

2017-10-16

Workplaces are a good setting for interventions that aim to support workers in achieving a healthier diet and body weight. However, little is known about the factors that impact on the feasibility and implementation of these interventions, and how these might vary by type of workplace and type of worker. The aim of this study was to explore the views of those involved in commissioning and delivering the Better Health at Work Award, an established and evidence-based workplace health improvement programme. One-to-one semi-structured interviews were conducted with 11 individuals in North East England who had some level of responsibility for delivering workplace dietary interventions. Interviews were transcribed verbatim and analysed using thematic framework analysis. A number of factors were felt to promote the feasibility and implementation of interventions. These included interventions that were cost-neutral (to employee and employer), unstructured, involved colleagues for support, took place at lunchtimes, and were well-advertised and communicated via a variety of media. Offering incentives, not necessarily monetary, was perceived to increase recruitment rates. Factors that militate against feasibility and implementation of interventions included worksites that were large in size and remote, working patterns including shifts and working outside of normal working hours that were not conducive to workers being able to access intervention sessions, workplaces without appropriate provision for healthy food on site, and a lack of support from management. Intervention deliverers perceived that workplace dietary interventions should be equally and easily accessible (in terms of cost and timing of sessions) for all staff, regardless of their job role. Additional effort should be taken to ensure those staff working outside normal working hours, and those working off-site, can easily engage with any intervention, to avoid the risk of intervention-generated inequalities (IGIs).

Does HIV services decentralization protect against the risk of catastrophic health expenditures?: some lessons from Cameroon.

PubMed

Boyer, Sylvie; Abu-Zaineh, Mohammad; Blanche, Jérôme; Loubière, Sandrine; Bonono, Renée-Cécile; Moatti, Jean-Paul; Ventelou, Bruno

2011-12-01

Scaling up antiretroviral treatment (ART) through decentralization of HIV care is increasingly recommended as a strategy toward ensuring equitable access to treatment. However, there have been hitherto few attempts to empirically examine the performance of this policy, and particularly its role in protecting against the risk of catastrophic health expenditures (CHE). This article therefore seeks to assess whether HIV care decentralization has a protective effect against the risk of CHE associated with HIV infection. DATA SOURCE AND STUDY DESIGN: We use primary data from the cross-sectional EVAL-ANRS 12-116 survey, conducted in 2006-2007 among a random sample of 3,151 HIV-infected outpatients followed up in 27 hospitals in Cameroon. DATA COLLECTION AND METHODS: Data collected contain sociodemographic, economic, and clinical information on patients as well as health care supply-related characteristics. We assess the determinants of CHE among the ART-treated patients using a hierarchical logistic model (n = 2,412), designed to adequately investigate the separate effects of patients and supply-related characteristics. Expenditures for HIV care exceed 17 percent of household income for 50 percent of the study population. After adjusting for individual characteristics and technological level, decentralization of HIV services emerges as the main health system factor explaining interclass variance, with a protective effect on the risk of CHE. The findings suggest that HIV care decentralization is likely to enhance equity in access to ART. Decentralization appears, however, to be a necessary but insufficient condition to fully remove the risk of CHE, unless other innovative reforms in health financing are introduced. © Health Research and Educational Trust.

Defining pharmaceutical systems strengthening: concepts to enable measurement

PubMed Central

Hafner, Tamara; Lee, David; Aboagye-Nyame, Francis

2017-01-01

Abstract Pharmaceutical products are indispensable for improving health outcomes. An extensive body of work on access to and use of medicines has resulted in an assortment of tools measuring various elements of pharmaceutical systems. Until now however, there has been little attempt to conceptualize a pharmaceutical system as an entity and define its strengthening in a way that allows for measuring systems strengthening. The narrow focus of available tools limits their value in ascertaining which interventions result in stronger, more resilient systems. We sought to address this shortcoming by revisiting the current definitions, frameworks and assessment tools related to pharmaceutical systems. We conducted a comprehensive literature review and consulted with select pharmaceutical experts. On the basis of our review, we propose that a pharmaceutical system consists of all structures, people, resources, processes, and their interactions within the broader health system that aim to ensure equitable and timely access to safe, effective, quality pharmaceutical products and related services that promote their appropriate and cost-effective use to improve health outcomes. We further propose that pharmaceutical systems strengthening is the process of identifying and implementing strategies and actions that achieve coordinated and sustainable improvements in the critical components of a pharmaceutical system to make it more responsive and resilient and to enhance its performance for achieving better health outcomes. Finally, we established that, in addition to system performance and resilience, seven components of the pharmaceutical system are critical for measuring pharmaceutical systems strengthening: pharmaceutical products and related services; policy, laws and governance; regulatory systems; innovation, research and development, manufacturing, and trade; financing; human resources; and information. This work adds clarity to the concept of pharmaceutical systems and their strengthening by proposing holistic definitions on the basis of systems thinking. It provides a practical starting point for measuring the progress of pharmaceutical systems strengthening. PMID:28025324

Measuring global water security towards sustainable development goals

NASA Astrophysics Data System (ADS)

Gain, Animesh K.; Giupponi, Carlo; Wada, Yoshihide

2016-12-01

Water plays an important role in underpinning equitable, stable and productive societies and ecosystems. Hence, United Nations recognized ensuring water security as one (Goal 6) of the seventeen sustainable development goals (SDGs). Many international river basins are likely to experience ‘low water security’ over the coming decades. Water security is rooted not only in the physical availability of freshwater resources relative to water demand, but also on social and economic factors (e.g. sound water planning and management approaches, institutional capacity to provide water services, sustainable economic policies). Until recently, advanced tools and methods are available for the assessment of water scarcity. However, quantitative and integrated—physical and socio-economic—approaches for spatial analysis of water security at global level are not available yet. In this study, we present a spatial multi-criteria analysis framework to provide a global assessment of water security. The selected indicators are based on Goal 6 of SDGs. The term ‘security’ is conceptualized as a function of ‘availability’, ‘accessibility to services’, ‘safety and quality’, and ‘management’. The proposed global water security index (GWSI) is calculated by aggregating indicator values on a pixel-by-pixel basis, using the ordered weighted average method, which allows for the exploration of the sensitivity of final maps to different attitudes of hypothetical policy makers. Our assessment suggests that countries of Africa, South Asia and Middle East experience very low water security. Other areas of high water scarcity, such as some parts of United States, Australia and Southern Europe, show better GWSI values, due to good performance of management, safety and quality, and accessibility. The GWSI maps show the areas of the world in which integrated strategies are needed to achieve water related targets of the SDGs particularly in the African and Asian continents.

Measuring Global Water Security Towards Sustainable Development Goals

NASA Technical Reports Server (NTRS)

Gain, Animesh K.; Giupponi, Carlo; Wada, Yoshihide

2016-01-01

Water plays an important role in underpinning equitable, stable and productive societies and ecosystems. Hence, United Nations recognized ensuring water security as one (Goal 6) of the seventeen sustainable development goals (SDGs). Many international river basins are likely to experience 'low water security' over the coming decades. Water security is rooted not only in the physical availability of freshwater resources relative to water demand, but also on social and economic factors (e.g. sound water planning and management approaches, institutional capacity to provide water services, sustainable economic policies). Until recently, advanced tools and methods are available for the assessment of water scarcity. However, quantitative and integrated-physical and socio-economic-approaches for spatial analysis of water security at global level are not available yet. In this study, we present a spatial multi-criteria analysis framework to provide a global assessment of water security. The selected indicators are based on Goal 6 of SDGs. The term 'security' is conceptualized as a function of 'availability', 'accessibility to services', 'safety and quality', and 'management'. The proposed global water security index (GWSI) is calculated by aggregating indicator values on a pixel-by-pixel basis, using the ordered weighted average method, which allows for the exploration of the sensitivity of final maps to different attitudes of hypothetical policy makers. Our assessment suggests that countries of Africa, South Asia and Middle East experience very low water security. Other areas of high water scarcity, such as some parts of United States, Australia and Southern Europe, show better GWSI values, due to good performance of management, safety and quality, and accessibility. The GWSI maps show the areas of the world in which integrated strategies are needed to achieve water related targets of the SDGs particularly in the African and Asian continents.

Managing rapid urbanization in the third world: some aspects of policy.

PubMed

Hope, K R

1989-01-01

A priority task for developing countries is the formulation of national urbanization policies that: 1) foster the full development of national resources; 2) promote cohesion among regions, especially where there are striking inequities in per capita output; 3) prevent or correct the overconcentration of economic activity in a few urban centers; and 4) create a more efficient, equitable management of growth within cities. Although urban households tend to be served better by the health and educational sectors than their rural counterparts, the urban poor are denied these benefits in the absence of special programs to ensure universal access. The urban poor are further denied access to the benefits of urban centers through a transportation policy that is oriented more toward roads and cars than public transit systems. Of major concern are the overcrowded squatter settlements that have developed in response to massive rural-urban migration. Since the landlessness, joblessness, and demoralization in rural areas and the consequent urban influx are at the root of the urban crisis in the Third World, integrated rural development is essential to retain substantial new additions to the urban labor force in rural areas. Land reform is the single strategy with the greatest potential to improve the quality of life of the landless poor and small holders. Other needs include programs of labor-intensive rural public works to provide supplementary income-earning opportunities and improve the rural infrastructure and more widespread participation of the rural poor in the development process. Increasingly sophisticated administrative and financing systems will be required to carry out a national urbanization policy, and current politicized bureaucracies must be replaced by a reliance on technically skilled professional administrators.

Building consensus on key priorities for rural health care in South Africa using the Delphi technique.

PubMed

Versteeg, Marije; du Toit, Lilo; Couper, Ian

2013-01-24

South Africa is currently undergoing major health system restructuring in an attempt to improve health outcomes and reduce inequities in access. Such inequities exist between private and public health care and within the public health system itself. Experience shows that rural health care can be disadvantaged in policy formulation despite good intentions. The objective of this study was to identify the major challenges and priority interventions for rural health care provision in South Africa thereby contributing to pro-rural health policy dialogue. The Delphi technique was used to develop consensus on a list of statements that was generated through interviews and literature review. A panel of rural health practitioners and other stakeholders was asked to indicate their level of agreement with these statements and to rank the top challenges in and interventions required for rural health care. Response rates ranged from 83% in the first round (n=44) to 64% in the final round (n=34). The top five priorities were aligned to three of the WHO health system building blocks: human resources for health (HRH), governance, and finance. Specifically, the panel identified a need to focus on recruitment and support of rural health professionals, the employment of managers with sufficient and appropriate skills, a rural-friendly national HRH plan, and equitable funding formulae. Specific policies and strategies are required to address the greatest rural health care challenges and to ensure improved access to quality health care in rural South Africa. In addition, a change in organisational climate and a concerted effort to make a career in rural health appealing to health care workers and adequate funding for rural health care provision are essential.

A conceptual model: Redesigning how we provide palliative care for patients with chronic obstructive pulmonary disease.

PubMed

Philip, Jennifer; Crawford, Gregory; Brand, Caroline; Gold, Michelle; Miller, Belinda; Hudson, Peter; Smallwood, Natasha; Lau, Rosalind; Sundararajan, Vijaya

2017-05-31

Despite significant needs, patients with chronic obstructive pulmonary disease (COPD) make limited use of palliative care, in part because the current models of palliative care do not address their key concerns. Our aim was to develop a tailored model of palliative care for patients with COPD and their family caregivers. Based on information gathered within a program of studies (qualitative research exploring experiences, a cohort study examining service use), an expert advisory committee evaluated and integrated data, developed responses, formulated principles to inform care, and made recommendations for practice. The informing studies were conducted in two Australian states: Victoria and South Australia. A series of principles underpinning the model were developed, including that it must be: (1) focused on patient and caregiver; (2) equitable, enabling access to components of palliative care for a group with significant needs; (3) accessible; and (4) less resource-intensive than expansion of usual palliative care service delivery. The recommended conceptual model was to have the following features: (a) entry to palliative care occurs routinely triggered by clinical transitions in care; (b) care is embedded in routine ambulatory respiratory care, ensuring that it is regarded as "usual" care by patients and clinicians alike; (c) the tasks include screening for physical and psychological symptoms, social and community support, provision of information, and discussions around goals and preferences for care; and (d) transition to usual palliative care services is facilitated as the patient nears death. Our proposed innovative and conceptual model for provision of palliative care requires future formal testing using rigorous mixed-methods approaches to determine if theoretical propositions translate into effectiveness, feasibility, and benefits (including economic benefits). There is reason to consider adaptation of the model for the palliative care of patients with other nonmalignant conditions.

Building consensus on key priorities for rural health care in South Africa using the Delphi technique

PubMed Central

Versteeg, Marije; du Toit, Lilo; Couper, Ian

2013-01-01

Background South Africa is currently undergoing major health system restructuring in an attempt to improve health outcomes and reduce inequities in access. Such inequities exist between private and public health care and within the public health system itself. Experience shows that rural health care can be disadvantaged in policy formulation despite good intentions. The objective of this study was to identify the major challenges and priority interventions for rural health care provision in South Africa thereby contributing to pro-rural health policy dialogue. Methods The Delphi technique was used to develop consensus on a list of statements that was generated through interviews and literature review. A panel of rural health practitioners and other stakeholders was asked to indicate their level of agreement with these statements and to rank the top challenges in and interventions required for rural health care. Results Response rates ranged from 83% in the first round (n=44) to 64% in the final round (n=34). The top five priorities were aligned to three of the WHO health system building blocks: human resources for health (HRH), governance, and finance. Specifically, the panel identified a need to focus on recruitment and support of rural health professionals, the employment of managers with sufficient and appropriate skills, a rural-friendly national HRH plan, and equitable funding formulae. Conclusion Specific policies and strategies are required to address the greatest rural health care challenges and to ensure improved access to quality health care in rural South Africa. In addition, a change in organisational climate and a concerted effort to make a career in rural health appealing to health care workers and adequate funding for rural health care provision are essential. PMID:23364081

Perceptions of employment-based discrimination among newly arrived foreign-educated nurses.

PubMed

Pittman, Patricia; Davis, Catherine; Shaffer, Franklin; Herrera, Carolina-Nicole; Bennett, Cudjoe

2014-01-01

To determine whether foreign-educated nurses (FENs) perceived they were treated equitably in the U.S. workplace during the last period of high international recruitment from 2003 to 2007. With experts predicting that isolated nursing shortages could return as soon as 2015, it is important to examine the lessons learned during the last period of high international recruitment in order to anticipate and address problems that may be endemic to such periods. In this baseline study, we asked FENs who were recruited to work in the United States between 2003 and 2007 about their hourly wages; clinical and cultural orientation to the United States; wages, benefits, and shift or unit assignments; and job satisfaction. In 2008, we administered a survey to FENs who were issued VisaScreen certificates by the Commission on Graduates of Foreign Nursing Schools International between 2003 and 2007. We measured four outcomes of interest (hourly wages, job satisfaction, adequacy of orientation, and perceived discrimination) and conducted descriptive and regression analyses to determine if country of education and recruitment model were correlated with the outcomes. We found that 51% of respondents reported receiving insufficient orientation and 40% reported at least one discriminatory practice with regard to wages, benefits, or shift or unit assignments. FENs educated in low-income countries and those recruited by staffing agencies were significantly more likely than other FENs to report that they receive inequitable treatment compared with their U.S. counterparts. These findings raise both practical and ethical concerns that should interest those striving to create positive health care workplace environments and to ensure staff retention. Health care leaders should take steps to ensure that FENs are, and perceive that they are, treated equitably.

7 CFR 1400.8 - Equitable treatment.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 10 2010-01-01 2010-01-01 false Equitable treatment. 1400.8 Section 1400.8... AND SUBSEQUENT CROP, PROGRAM, OR FISCAL YEARS General Provisions § 1400.8 Equitable treatment. (a... Administrator deems necessary to provide fair and equitable treatment to such person or legal entity. (b...

A service-oriented data access control model

NASA Astrophysics Data System (ADS)

Meng, Wei; Li, Fengmin; Pan, Juchen; Song, Song; Bian, Jiali

2017-01-01

The development of mobile computing, cloud computing and distributed computing meets the growing individual service needs. Facing with complex application system, it's an urgent problem to ensure real-time, dynamic, and fine-grained data access control. By analyzing common data access control models, on the basis of mandatory access control model, the paper proposes a service-oriented access control model. By regarding system services as subject and data of databases as object, the model defines access levels and access identification of subject and object, and ensures system services securely to access databases.

Challenges of medicines management in the public and private sector under Ghana's National Health Insurance Scheme - A qualitative study.

PubMed

Ashigbie, Paul G; Azameti, Devine; Wirtz, Veronika J

2016-01-01

Ghana established its National Health Insurance Scheme (NHIS) in 2003 with the goal of ensuring more equitable financing of health care to improve access to health services. This qualitative study examines the challenges and consequences of medicines management policies and practices under the NHIS as perceived by public and private service providers. This study was conducted in health facilities in the Eastern, Greater Accra and Volta regions of Ghana between July and August 2014. We interviewed 26 Key Informants (KIs) from a purposively selected sample of public and private sector providers (government and mission hospitals, private hospitals and private standalone pharmacies), pharmaceutical suppliers and NHIS district offices. Data was collected using semi-structured interview guides which covered facility accreditation, reimbursement practices, medicines selection, purchasing and pricing of medicines, and utilization of medicines. Codes for data analysis were developed based on the study questions and also in response to themes that emerged from the transcripts and notes. Most KIs agreed that the introduction of the NHIS has increased access to and utilization of medicines by removing cost barriers for patients; however, some pointed out the increased utilization could also be corollary to moral hazard. Common concerns across all facilities were the delays in receiving NHIS reimbursements, and low reimbursement rates for medicines which result in providers asking patients to pay supplementary fees. KIs reported important differences between private and public sectors including weak separation of prescribing and dispensing and limited use of drugs and therapeutic committees in the private sector, the disproportionate effects of unfavorable reimbursement prices for medicines, and inadequate participation of the private sector providers (especially pharmacies and licensed chemical sellers) in the NHIS. Health providers generally perceive the NHIS to have had a largely positive impact on access to medicines. However, concerns remain about equity in access to medicines and the differences in quality of pharmaceutical care delivered by private and public providers. Routine monitoring of medicines use during the implementation of health insurance schemes is important to identify and address the potential consequences of medicines policies and practices under the scheme.

"I just answer 'yes' to everything they say": access to health care for deaf people in Worcester, South Africa and the politics of exclusion.

PubMed

Kritzinger, Janis; Schneider, Marguerite; Swartz, Leslie; Braathen, Stine Hellum

2014-03-01

To explore whether there are other factors besides communication difficulties that hamper access to health care services for deaf patients. Qualitative methodology using semi-structured interviews with 16 deaf participants from the National Institute for the Deaf in Worcester and 3 Key informants from the Worcester area, South Africa. Communication difficulties were found to be a prominent barrier in accessing health care services. In addition to this interpersonal factors including lack of independent thought, overprotectedness, non-questioning attitude, and lack of familial communication interact with communication difficulties in a way that further hampers access to health care services. These interpersonal factors play a unique role in how open and accepting health services feel to deaf patients. Health care services need to take cognizance of the fact that providing sign language interpreters in the health care setting will not necessarily make access more equitable for deaf patients, as they have additional barriers besides communication to overcome before successfully accessing health care services. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

75 FR 39994 - AXA Equitable Life Insurance Company, et al.; Notice of Application

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-13

... SECURITIES AND EXCHANGE COMMISSION [Release No. IC-29338; File No. 812-13686] AXA Equitable Life... securities and for an order of exemption pursuant to Section 17(b) of the Act. APPLICANTS: AXA Equitable Life... Equitable Separate Accounts''), MONY Life Insurance Company of America (``MLOA'') and MONY America Variable...

Scaling up HIV viral load - lessons from the large-scale implementation of HIV early infant diagnosis and CD4 testing.

PubMed

Peter, Trevor; Zeh, Clement; Katz, Zachary; Elbireer, Ali; Alemayehu, Bereket; Vojnov, Lara; Costa, Alex; Doi, Naoko; Jani, Ilesh

2017-11-01

The scale-up of effective HIV viral load (VL) testing is an urgent public health priority. Implementation of testing is supported by the availability of accurate, nucleic acid based laboratory and point-of-care (POC) VL technologies and strong WHO guidance recommending routine testing to identify treatment failure. However, test implementation faces challenges related to the developing health systems in many low-resource countries. The purpose of this commentary is to review the challenges and solutions from the large-scale implementation of other diagnostic tests, namely nucleic-acid based early infant HIV diagnosis (EID) and CD4 testing, and identify key lessons to inform the scale-up of VL. Experience with EID and CD4 testing provides many key lessons to inform VL implementation and may enable more effective and rapid scale-up. The primary lessons from earlier implementation efforts are to strengthen linkage to clinical care after testing, and to improve the efficiency of testing. Opportunities to improve linkage include data systems to support the follow-up of patients through the cascade of care and test delivery, rapid sample referral networks, and POC tests. Opportunities to increase testing efficiency include improvements to procurement and supply chain practices, well connected tiered laboratory networks with rational deployment of test capacity across different levels of health services, routine resource mapping and mobilization to ensure adequate resources for testing programs, and improved operational and quality management of testing services. If applied to VL testing programs, these approaches could help improve the impact of VL on ART failure management and patient outcomes, reduce overall costs and help ensure the sustainable access to reduced pricing for test commodities, as well as improve supportive health systems such as efficient, and more rigorous quality assurance. These lessons draw from traditional laboratory practices as well as fields such as logistics, operations management and business. The lessons and innovations from large-scale EID and CD4 programs described here can be adapted to inform more effective scale-up approaches for VL. They demonstrate that an integrated approach to health system strengthening focusing on key levers for test access such as data systems, supply efficiencies and network management. They also highlight the challenges with implementation and the need for more innovative approaches and effective partnerships to achieve equitable and cost-effective test access. © 2017 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society.

Equitability, mutual information, and the maximal information coefficient.

PubMed

Kinney, Justin B; Atwal, Gurinder S

2014-03-04

How should one quantify the strength of association between two random variables without bias for relationships of a specific form? Despite its conceptual simplicity, this notion of statistical "equitability" has yet to receive a definitive mathematical formalization. Here we argue that equitability is properly formalized by a self-consistency condition closely related to Data Processing Inequality. Mutual information, a fundamental quantity in information theory, is shown to satisfy this equitability criterion. These findings are at odds with the recent work of Reshef et al. [Reshef DN, et al. (2011) Science 334(6062):1518-1524], which proposed an alternative definition of equitability and introduced a new statistic, the "maximal information coefficient" (MIC), said to satisfy equitability in contradistinction to mutual information. These conclusions, however, were supported only with limited simulation evidence, not with mathematical arguments. Upon revisiting these claims, we prove that the mathematical definition of equitability proposed by Reshef et al. cannot be satisfied by any (nontrivial) dependence measure. We also identify artifacts in the reported simulation evidence. When these artifacts are removed, estimates of mutual information are found to be more equitable than estimates of MIC. Mutual information is also observed to have consistently higher statistical power than MIC. We conclude that estimating mutual information provides a natural (and often practical) way to equitably quantify statistical associations in large datasets.

Equitable access to comprehensive surgical care: the potential of indigenous private philanthropy in low-income settings.

PubMed

Samad, Lubna; Iqbal, Mehreen; Tariq, Ahson; Shahzad, Wasif; Khan, Aamir J

2015-01-01

Equitable access to surgical care is necessary for improving global health. We report on the performance, financial sustainability, and policy impact of a free-of-cost multispecialty surgical delivery program in Karachi, Pakistan built upon local private philanthropy. We evaluated trends in surgical service delivery, expenditures, and philanthropic donations from Indus Hospital's first 5 years of operation (2007-2012), projected these over the hospital's current expansion phase, compared these to publicly accessible records of other philanthropic hospitals providing surgical care, and documented the government's evolving policies toward this model. Between 2007 and 2012, Indus Hospital treated 40,012 in-patients free of cost, 33,606 (84 %) of them for surgical procedures. Surgical procedures increased fivefold to 9,478 during 2011-2012 from 1,838 during 2007-2008. Bed occupancy increased to 91 % from 65 % over the same period. External surgical missions accounted for less than 0.5 % of patients served. Ninety-eight percent (98 %) of all philanthropic donations--totaling USD 26.6 million over 2007-2012--were locally generated. Zakat (obligatory annual religious alms in the Islamic faith) constituted 34 % of all donations, followed by unrestricted funds (24 %) and donations-in-kind (24 %), buildings (12 %), grants (5 %), and return on investments (1 %). Overall, donations received between 2007 and 2012 increased sevenfold, with Zakat increasing 12-fold. During 2013-2014, the Government of Pakistan provided land lease and annual operational grants totaling USD 9 million. Local philanthropy can sustain and grow the provision of free, high-quality surgical care in low-income settings, and encourage the development of hybrid government-philanthropic models of surgical care.

Can ICTs contribute to the efficiency and provide equitable access to the health care system in Sub-Saharan Africa? The Mali experience.

PubMed

Bagayoko, C O; Anne, A; Fieschi, M; Geissbuhler, A

2011-01-01

The aim of this study is to demonstrate from actual projects that ICT can contribute to the balance of health systems in developing countries and to equitable access to human resources and quality health care service. Our study is focused on two essential elements which are: i) Capacity building and support of health professionals, especially those in isolated areas using telemedicine tools; ii) Strengthening of hospital information systems by taking advantage of full potential offered by open-source software. Our research was performed on the activities carried out in Mali and in part through the RAFT (Réseau en Afrique Francophone pour la Télémédecine) Network. We focused mainly on the activities of e-learning, telemedicine, and hospital information systems. These include the use of platforms that work with low Internet connection bandwidth. With regard to information systems, our strategy is mainly focused on the improvement and implementation of open-source tools. Several telemedicine application projects were reviewed including continuing online medical education and the support of isolated health professionals through the usage of innovative tools. This review covers the RAFT project for continuing medical education in French-speaking Africa, the tele-radiology project in Mali, the "EQUI-ResHuS" project for equal access to health over ICT in Mali, The "Pact-e.Santé" project for community health workers in Mali. We also detailed a large-scale experience of an open-source hospital information system implemented in Mali: "Cinz@n". We report on successful experiences in the field of telemedicine and on the evaluation by the end-users of the Cinz@n project, a pilot hospital information system in Mali. These reflect the potential of healthcare-ICT for Sub-Saharan African countries.

How equitable is vocational rehabilitation in Sweden? A review of evidence on the implementation of a national policy framework.

PubMed

Burstrom, Bo; Nylen, Lotta; Clayton, Stephen; Whitehead, Margaret

2011-01-01

Under the national framework law in Sweden, all eligible people should have equal chances of receiving vocational rehabilitation. We aimed to review the evidence on (1) whether access to vocational rehabilitation is equitable in practice and (2) whether the outcomes vary for different groups in the population. Systematic review of studies in Sweden that reported diagnostic or socio-demographic characteristics of people offered or taking up rehabilitation programmes and outcomes of such programmes for different diagnostic and socio-demographic groups. Searches of 11 relevant electronic databases, 15 organisational websites, citation searching and contact with experts in the field, for the period 1990-2009. A total of 11 studies were included in the final review, six of which addressed review question (1) and seven addressed review question (2). All the six observational studies of access reported biased selection into vocational rehabilitation: greater likelihood for men, younger people, those with longer-term sick leave, those with lower income, employed rather than unemployed people and those with musculoskeletal and mental disorders or alcohol abuse. Having had a rehabilitation investigation also increased the likelihood of receiving vocational rehabilitation. Differential outcome of rehabilitation was reported in seven studies: outcomes were better for men, younger people, employed individuals, those with shorter sick leave and those with higher income. Selection into vocational rehabilitation was perceived as important for successful outcomes, but success also depended on the state of the local labour market. There is evidence of socio-demographic differences in access to and outcomes of vocational rehabilitation in Sweden, even though the national framework law is meant to apply to everyone. Few studies have deliberately measured differential access or outcomes, and there is a need for this kind of equity analysis of population-wide policies. Studies evaluating the effects of vocational rehabilitation must consider selection into the programmes for adequate interpretation of impact results.

Assessing equitable access to urban green space: the role of engineered water infrastructure.

PubMed

Wendel, Heather E Wright; Downs, Joni A; Mihelcic, James R

2011-08-15

Urban green space and water features provide numerous social, environmental, and economic benefits, yet disparities often exist in their distribution and accessibility. This study examines the link between issues of environmental justice and urban water management to evaluate potential improvements in green space and surface water access through the revitalization of existing engineered water infrastructures, namely stormwater ponds. First, relative access to green space and water features were compared for residents of Tampa, Florida, and an inner-city community of Tampa (East Tampa). Although disparities were not found in overall accessibility between Tampa and East Tampa, inequalities were apparent when quality, diversity, and size of green spaces were considered. East Tampa residents had significantly less access to larger, more desirable spaces and water features. Second, this research explored approaches for improving accessibility to green space and natural water using three integrated stormwater management development scenarios. These scenarios highlighted the ability of enhanced water infrastructures to increase access equality at a variety of spatial scales. Ultimately, the "greening" of gray urban water infrastructures is advocated as a way to address environmental justice issues while also reconnecting residents with issues of urban water management.

Excluding the poor from accessing biomedical literature: a rights violation that impedes global health.

PubMed

Yamey, Gavin

2008-01-01

Most biomedical journals charge readers a hefty access toll to read the full text version of a published research article. These tolls bring enormous profits to the traditional corporate publishing industry, but they make it impossible for most people worldwide--particularly in low and middle income countries--to access the biomedical literature. Traditional publishers also insist on owning the copyright on these articles, making it illegal for readers to freely distribute and photocopy papers, translate them, or create derivative educational works. This article argues that excluding the poor from accessing and freely using the biomedical research literature is harming global public health. Health care workers, for example, are prevented from accessing the information they need to practice effective medicine, while policymakers are prevented from accessing the essential knowledge they require to build better health care systems. The author proposes that the biomedical literature should be considered a global public good, basing his arguments upon longstanding and recent international declarations that enshrine access to scientific and medical knowledge as a human right. He presents an emerging alternative publishing model, called open access, and argues that this model is a more socially responsive and equitable approach to knowledge dissemination.

Geographical heterogeneity and inequality of access to improved drinking water supply and sanitation in Nepal.

PubMed

He, Wen-Jun; Lai, Ying-Si; Karmacharya, Biraj M; Dai, Bo-Feng; Hao, Yuan-Tao; Xu, Dong Roman

2018-04-02

Per United Nations' Sustainable Development Goals, Nepal is aspiring to achieve universal and equitable access to safe and affordable drinking water and provide access to adequate and equitable sanitation for all by 2030. For these goals to be accomplished, it is important to understand the country's geographical heterogeneity and inequality of access to its drinking-water supply and sanitation (WSS) so that resource allocation and disease control can be optimized. We aimed 1) to estimate spatial heterogeneity of access to improved WSS among the overall Nepalese population at a high resolution; 2) to explore inequality within and between relevant Nepalese administrative levels; and 3) to identify the specific administrative areas in greatest need of policy attention. We extracted cluster-sample data on the use of the water supply and sanitation that included 10,826 surveyed households from the 2011 Nepal Demographic and Health Survey, then used a Gaussian kernel density estimation with adaptive bandwidths to estimate the distribution of access to improved WSS conditions over a grid at 1 × 1 km. The Gini coefficient was calculated for the measurement of inequality in the distribution of improved WSS; the Theil L measure and Theil T index were applied to account for the decomposition of inequality. 57% of Nepalese had access to improved sanitation (range: 18.1% in Mahottari to 100% in Kathmandu) and 92% to drinking-water (range: 41.7% in Doti to 100% in Bara). The most unequal districts in Gini coefficient among improved sanitation were Saptari, Sindhuli, Banke, Bajura and Achham (range: 0.276 to 0.316); and Sankhuwasabha, Arghakhanchi, Gulmi, Bhojpur, Kathmandu (range: 0.110 to 0.137) among improved drinking-water. Both the Theil L and Theil T showed that within-province inequality was substantially greater than between-province inequality; while within-district inequality was less than between-district inequality. The inequality of several districts was higher than what is calculated by regression of the Gini coefficient and our estimates. This study showed considerable geographical heterogeneity and inequality not evidenced in previous national statistics. Our findings may be useful in prioritizing resources to reduce inequality and expand the coverage of improved water supply and sanitation in Nepal.

Racial/Ethnic and Socioeconomic Disparities in Hydration Status Among US Adults and the Role of Tap Water and Other Beverage Intake

PubMed Central

Gortmaker, Steven L.; Long, Michael W.; Cradock, Angie L.; Kenney, Erica L.

2017-01-01

Objectives. To evaluate whether differences in tap water and other beverage intake explain differences in inadequate hydration among US adults by race/ethnicity and income. Methods. We estimated the prevalence of inadequate hydration (urine osmolality ≥ 800 mOsm/kg) by race/ethnicity and income of 8258 participants aged 20 to 74 years in the 2009 to 2012 National Health and Nutrition Examination Survey. Using multivariable regression models, we estimated associations between demographic variables, tap water intake, and inadequate hydration. Results. The prevalence of inadequate hydration among US adults was 29.5%. Non-Hispanic Blacks (adjusted odds ratio [AOR] = 1.44; 95% confidence interval [CI] = 1.17, 1.76) and Hispanics (AOR = 1.42; 95% CI = 1.21, 1.67) had a higher risk of inadequate hydration than did non-Hispanic Whites. Lower-income adults had a higher risk of inadequate hydration than did higher-income adults (AOR = 1.23; 95% CI = 1.04, 1.45). Differences in tap water intake partially attenuated racial/ethnic differences in hydration status. Differences in total beverage and other fluid intake further attenuated sociodemographic disparities. Conclusions. Racial/ethnic and socioeconomic disparities in inadequate hydration among US adults are related to differences in tap water and other beverage intake. Policy action is needed to ensure equitable access to healthy beverages. PMID:28727528

Energy justice and U.S. energy policy: Case study applications exploring U.S. energy policy through an energy justice framework

NASA Astrophysics Data System (ADS)

Prehoda, Emily W.

This thesis presents three examples of U.S. energy policy and demonstrates how these policies violate the principles of energy justice. First, requiring only Federal agencies to obtain a percentage of energy production from renewables violates the distributive energy justice principle through a lack of a federal renewable energy policy which distributes the potential for unequal electrical grid failure to populations. Second, U.S. energy policy violates the procedural energy justice principle through inequitable participation and poor knowledge dissemination that, in some cases, contributes to stagnant renewable targets during the decision-making process and inequitable distribution of the benefits associated with renewable energy arguably resulting from differential representation of economic groups in policy decision making. Third, the United States' continued reliance on and subsidization of fossil fuel extraction and use, violates the prohibitive energy justice principle by causing physical harm to humans and the environment. Finally, a lack of federal renewable energy policy hinders comprehensive energy policy including diversifying the U.S. renewable energy portfolios. Considering energy policy through the framework of energy justice offers a means of evaluating existing policy and can improve future energy policy decision-making. Demanding energy justice ensures that all populations have equitable distribution, participation, and access to affordable, efficient, and clean energy technologies that contribute to obtaining basic needs.

Racial/Ethnic and Socioeconomic Disparities in Hydration Status Among US Adults and the Role of Tap Water and Other Beverage Intake.

PubMed

Brooks, Carolyn J; Gortmaker, Steven L; Long, Michael W; Cradock, Angie L; Kenney, Erica L

2017-09-01

To evaluate whether differences in tap water and other beverage intake explain differences in inadequate hydration among US adults by race/ethnicity and income. We estimated the prevalence of inadequate hydration (urine osmolality ≥ 800 mOsm/kg) by race/ethnicity and income of 8258 participants aged 20 to 74 years in the 2009 to 2012 National Health and Nutrition Examination Survey. Using multivariable regression models, we estimated associations between demographic variables, tap water intake, and inadequate hydration. The prevalence of inadequate hydration among US adults was 29.5%. Non-Hispanic Blacks (adjusted odds ratio [AOR] = 1.44; 95% confidence interval [CI] = 1.17, 1.76) and Hispanics (AOR = 1.42; 95% CI = 1.21, 1.67) had a higher risk of inadequate hydration than did non-Hispanic Whites. Lower-income adults had a higher risk of inadequate hydration than did higher-income adults (AOR = 1.23; 95% CI = 1.04, 1.45). Differences in tap water intake partially attenuated racial/ethnic differences in hydration status. Differences in total beverage and other fluid intake further attenuated sociodemographic disparities. Racial/ethnic and socioeconomic disparities in inadequate hydration among US adults are related to differences in tap water and other beverage intake. Policy action is needed to ensure equitable access to healthy beverages.

Sex disparities in tuberculosis suspect evaluation: a cross-sectional analysis in rural Uganda.

PubMed

Miller, C R; Davis, J L; Katamba, A; Sserwanga, A; Kakeeto, S; Kizito, F; Cattamanchi, A

2013-04-01

Six primary health care centers in rural Uganda. To compare the quality of tuberculosis (TB) evaluation for men and women presenting to primary health care facilities in high-burden settings. Cross-sectional study using indicators derived from the International Standards of Tuberculosis Care (ISTC) to compare the quality of TB evaluation services provided to men and women. Of 161 230 patient visits between January 2009 and December 2010, 112 329 (69.7%) were women. We considered 3308 (2.1%) patients with cough ≥2 weeks as TB suspects, of whom 1871 (56.6%) were women. Female TB suspects were less likely to be referred for sputum smear examination (45.9% vs. 61.6%, P < 0.001), to complete sputum smear examination if referred (73.7% vs. 78.3%, P = 0.024) and to receive comprehensive evaluation and care as defined by the ISTC (33.0% vs. 45.6%, P < 0.001). After adjusting for age, clinic site and visit date, women remained less likely to be referred for sputum smear examination (risk ratio [RR] 0.81, 95%CI 0.74-0.89, P < 0.001) and to receive ISTC-recommended care (RR 0.79, 95%CI 0.72-0.86, P < 0.001). Strategies to ensure that women receive appropriate TB evaluation could provide a valuable opportunity for increasing case detection while also promoting equitable and universal access to care.

“Everything that looks good ain’t good!”: Perspectives on Urban Redevelopment among Persons with a History of Injection Drug Use in Baltimore, Maryland

PubMed Central

Linton, Sabriya L.; Kennedy, Caitlin E.; Latkin, Carl A.; Celentano, David D.; Kirk, Gregory D.; Mehta, Shruti H.

2013-01-01

Background While urban redevelopment is intended to ameliorate urban decay, some studies demonstrate that it can negatively impact some residents. Few studies have considered its impact on persons with a history of drug use. Methods A convenience sample of 25 current or former injection drug users from Baltimore, Maryland, enrolled in the AIDS Linked to the Intravenous Experience study, and reporting residence in or bordering a redeveloping neighborhood participated in 1-2 semi-structured in-depth interviews from July, 2011-February, 2012. Interviews explored personal experiences with redevelopment and perceptions of community-wide impact. Data were analyzed using the constant comparison method. Results Respondents rarely described urban redevelopment as solely negative or positive. Revitalization and increased security in the redeveloping area were reported as positive consequences. Negative consequences included the lack of redevelopment-related employment opportunities, disruption of social ties, and housing instability among relocated residents. Respondents also said that urban redevelopment led to the displacement of drug markets to adjacent neighborhoods and outlying counties. Residential relocation and displacement of drug markets were reported as beneficial for persons in contemplative and later stages of recovery. Conclusion These findings support a holistic approach to urban redevelopment that increases access to employment opportunities and affordable housing and ensures equitable coverage of public services such as law enforcement. PMID:23647924

The incidence of high medical expenses by health status in seven developed countries.

PubMed

Baird, Katherine Elizabeth

2016-01-01

Health care policy seeks to ensure that citizens are protected from the financial risk associated with needing health care. Yet rising health care costs in many countries are leading to a greater reliance on out-of-pocket (OOP) measures. This paper uses 2010 household survey data from seven countries to measure and compare the burden OOP expenses place on individuals. It compares countries based on the extent to which citizens with health problems devote a large share of their income to OOP expenses. The paper finds that in all countries but France, and to a lesser extent Slovenia, citizens with health problems face considerably higher medical costs than do those without. As many as one-quarter of less healthy citizens in the US, Poland, Russia and Israel devote a large share of their income to OOP expenses. The paper also finds a strong cross-national correlation between the degree to which citizens face high OOP expenses, and the disparities in OOP expenses between those with and without health problems. The levels of high OOP spending uncovered, and their inequitable impact on those with health problems in the seven countries, underscore the potential for OOP measures to undermine core objectives of health care systems, including those of equitable financing, equal access, and improved health among the population. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Sustaining Scientist-Community Partnerships that are Just, Equitable, and Trustworthy

NASA Astrophysics Data System (ADS)

Sheats, N.

2016-12-01

Communities of color, indigenous people, and low income communities throughout the United States are on the front lines of environmental and health impacts from polluting sources, and yet don't fully benefit from public policies that are intended to reduce or prevent those impacts. Many of the challenges faced by environmental justice communities can and should be addressed, in part, through science-based public policies. Community-relevant scientific information and equal access to this information is needed to protect people from public health and environmental hazards. Too often, however, the scientific community has failed to work collaboratively with environmental justice communities. This session will explore the challenges and opportunities faced by environmental justice advocates and scientists in working with one another. This talk will share findings from a recently-held forum, specifically discussing a formal set of principles and best practices for community-scientist partnerships to guide future collaborations between scientists and communities. When community members and scientists collaborate, they bring together unique strengths and types of knowledge that can help address our most pressing challenges, inform decision making, and develop solutions that benefit all people. The speaker will address institutional and historic barriers that hinder such collaboration, potential pitfalls to avoid, and share how institutional systems of scientific research can incorporate equity analyses into their work to ensure solutions that are truly effective.

Fire, Aim… Ready? Alberta's Big Bang Approach to Healthcare Disintegration.

PubMed

Donaldson, Cam

2010-08-01

Alberta's abolition in 2008 of its health regions and the creation of Alberta Health Services (AHS) was a bold move, but the reasons for the change remain hazy. The stated goals were to "help make Alberta's … system more effective and efficient" and to "provide equitable access to health services and long-term sustainability." Data show, however, that Alberta's health regions were already performing well on these goals relative to other provinces, and where changes have since occurred, they cannot necessarily be attributed to AHS.

The Productivity Costs of Inefficient Hiring Practices: Evidence from Late Teacher Hiring

PubMed Central

Papay, John P.; Kraft, Matthew A.

2017-01-01

We use matched employee-employer records from the teacher labor market to explore the effects of late teacher hiring on student achievement. Hiring teachers after the school year starts reduces student achievement by 0.042SD in mathematics and 0.026SD in reading. This reflects, in part, a temporary disruption effect in the first year. In mathematics, but not in reading, late-hired teachers remain persistently less effective, evidence of negative selection in the teacher labor market. Late hiring concentrates in schools that disproportionately serve disadvantaged student populations, contributing to challenges in ensuring an equitable distribution of educational resources across students. PMID:28966429

The Productivity Costs of Inefficient Hiring Practices: Evidence from Late Teacher Hiring.

PubMed

Papay, John P; Kraft, Matthew A

2016-01-01

We use matched employee-employer records from the teacher labor market to explore the effects of late teacher hiring on student achievement. Hiring teachers after the school year starts reduces student achievement by 0.042SD in mathematics and 0.026SD in reading. This reflects, in part, a temporary disruption effect in the first year. In mathematics, but not in reading, late-hired teachers remain persistently less effective, evidence of negative selection in the teacher labor market. Late hiring concentrates in schools that disproportionately serve disadvantaged student populations, contributing to challenges in ensuring an equitable distribution of educational resources across students.

20 CFR 404.365 - When an equitably adopted child is dependent.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false When an equitably adopted child is dependent...; Period of Disability Child's Benefits § 404.365 When an equitably adopted child is dependent. If you are the insured's equitably adopted child, as defined in § 404.359, you are considered dependent upon him...