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      Affordability, availability and acceptability barriers to health care for the chronically ill: longitudinal case studies from South Africa.

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          Abstract

          There is an increasing burden of chronic illness in low and middle income countries, driven by TB/HIV, as well as non-communicable diseases. Few health systems are organized to meet the needs of chronically ill patients, and patients' perspectives on the difficulties of accessing care need to be better understood, particularly in poor resourced settings, to achieve this end. This paper describes the experience of poor households attempting to access chronic care in a rural area of South Africa.

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          Health seeking behaviour and health service utilization in Pakistan: challenging the policy makers.

          B T Shaikh, J. Hatcher (2005)
          There is a growing literature on health seeking behaviours and the determinants of health services utilization especially in the context of developing countries. However, very few focused studies have been seen in Pakistan in this regard. This paper presents an extensive literature review of the situation in developing countries and relates the similar factors responsible for shaping up of a health seeking behaviour and health service utilization in Pakistan. The factors determining the health behaviours may be seen in various contexts: physical, socio-economic, cultural and political. Therefore, the utilization of a health care system, public or private, formal or non-formal, may depend on socio-demographic factors, social structures, level of education, cultural beliefs and practices, gender discrimination, status of women, economic and political systems environmental conditions, and the disease pattern and health care system itself. Policy makers need to understand the drivers of health seeking behaviour of the population in an increasingly pluralistic health care system. Also a more concerted effort is required for designing behavioural health promotion campaigns through inter-sectoral collaboration focusing more on disadvantaged segments of the population.
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            Case and Situation Analysis

            J. Clyde Mitchell (2011)
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              Implementing antiretroviral therapy in rural communities: the Lusikisiki model of decentralized HIV/AIDS care.

              Martha Bedelu, Nathan Ford, Katherine Hilderbrand … (2007)
              Health worker shortages are a major bottleneck to scaling up antiretroviral therapy (ART), particularly in rural areas. In Lusikisiki, a rural area of South Africa with a population of 150,000 serviced by 1 hospital and 12 clinics, Médecins Sans Frontières has been supporting a program to deliver human immunodeficiency virus (HIV) services through decentralization to primary health care clinics, task shifting (including nurse-initiated as opposed to physician-initiated treatment), and community support. This approach has allowed for a rapid scale-up of treatment with satisfactory outcomes. Although the general approach in South Africa is to provide ART through hospitals-which seriously limits access for many people, if not the majority of people-1-year outcomes in Lusikisiki are comparable in the clinics and hospital. The greater proximity and acceptability of services at the clinic level has led to a faster enrollment of people into treatment and better retention of patients in treatment (2% vs. 19% lost to follow-up). In all, 2200 people were receiving ART in Lusikisiki in 2006, which represents 95% coverage. Maintaining quality and coverage will require increased resource input from the public sector and full acceptance of creative approaches to implementation, including task shifting and community involvement.
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                Author and article information

                Journal
                Journal ID (iso-abbrev): BMC Health Serv Res
                Title: BMC health services research
                Publisher: Springer Science and Business Media LLC
                ISSN (Electronic): 1472-6963
                ISSN (Print): 1472-6963
                Publication date (Electronic): May 09 2009
                Volume: 9
                Affiliations
                [1 ] Centre for Health Policy, School of Public Health, University of Witwatersrand, Johannesburg, South Africa. jane.goudge@gmail.com
                Article
                Publisher Item ID: 1472-6963-9-75
                DOI: 10.1186/1472-6963-9-75
                PMC ID: 2694171
                PubMed ID: 19426533
                SO-VID: b73388bc-eeb5-4531-a00f-a8b9e68b3f13
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