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This paper adopts three approaches to classifying countries by level of constraint, in order to inform the choice of strategies for expanding access to health interventions in different contexts. We find substantial heterogeneity across the 84 low-income and (all) sub-Saharan African countries analysed. Poor sub-Saharan African countries are the most highly constrained; Asian countries, in general, less constrained; and the two Asian giants, China and India, consistently fall above the median. Former Soviet Union countries rank low in terms of governance, but high for health systems variables. Only 10 per cent of the total population of the countries included lives in countries with the greatest constraints. The potential applications of the analysis are discussed, as are the limitations of the cross-sectional, macro level approach. Copyright © 2003 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

A key issue in the expansion of access to priority health services is how best to implement scaling up efforts. In this paper, we explore the relative merits of vertical and horizontal delivery modes; review the literature on the impact of vertical programmes on health systems and on experiences of integrating these programmes; and analyse health interventions in terms of their different modes of delivery within the health system infrastructure. We conclude that expanding access to priority health services requires the concerted use of both modes of delivery, according to the capacity of health systems as it changes over time. Copyright © 2003 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This paper describes how the categorisation of patients by staff in a French emergency department (ED) leads to the micro-rationing of care. Although ED staff are reluctant to acknowledge it, they refuse to treat many would-be patients at the reception stage, and advise them to go to other care settings (such as general practitioners’ premises or social dispensaries). The study analyses the judgmental categories staff use to decide patients’ eligibility for care, paying particular attention to their clinical, organisational, moral and social dimensions. Staff ration care at the point of service delivery but they soften the harshness of the rationing by making a positive discrimination in favour of those seen to be in real need. Data from observations and interviews are used to analyse the tensions between the different models of ‘local justice’ employed by doctors. [ABSTRACT FROM AUTHOR]

Comorbid substance abuse and schizophrenia is a major cause for concern from clinical, economic and health care systems perspectives. Existing treatment strategies are frequently inadequate, partly due to a lack of research into the unique problems facing this dually diagnosed population. These individuals commonly place a disproportionate burden on the mental health delivery system. In addition, their families are left with the onerous task of caring for them. This paper reviews the literature on family interventions for both substance abuse and schizophrenia and postulates that a composite model of family therapy might be appropriate. [ABSTRACT FROM AUTHOR]

Although the literature on health inequalities in childhood is extensive, relatively little has been written about social differences in infectious disease. This is despite the strong association between poverty and infection noted historically, the continuing importance of infection as a cause of childhood mortality and morbidity, the resurgence of infectious disease as a public health problem and the increasing proportions of children living in poverty. This paper reviews the evidence, mainly from the United Kingdom, which shows that wide inequalities continue to occur in most types of infectious disease in childhood and the consequences stretch into adulthood. Possible reasons for the continuing association of poverty and infection in an age of high standards of hygiene, sanitation, and health care are discussed. Environmental and material factors are likely to have a stronger influence than social differences in behaviour, attitudes and lifestyle, and they can affect susceptibility to infection at the level of individuals, family, and community, and in access to health care. More emphasis needs to be placed on structural and community wide interventions than those directed at changing individual behaviour if a reduction in inequalities in childhood infection is to be achieved. [ABSTRACT FROM AUTHOR]

This paper examines interrelationships between health status, access and utilization. Indicators for each of these are measured for China and India. It is shown that China, both during Mao and Deng periods, scores over India in the provision of health services to the rural population. Differences in economic inequalities, organization of health services and motivation account for this. Contrary to the prevailing view there is no conclusive evidence that the post-Mao reforms have lowered the access of rural people to health services. The decline of barefoot doctors has been accompanied by an increase in private medical practitioners, and a decline in rural health insurance has coincided with new and alternative experiments in this domain. [ABSTRACT FROM AUTHOR]

Introduction and Aims: Opioid overdose prevention programs providing take-home naloxone have been expanding internationally. This paper summarises findings and lessons learnt from the Overdose Prevention and Emergency Naloxone Project which is the first take-home naloxone program in Australia implemented in a health care setting.Methods: The Project intervention provided education and take-home naloxone to opioid-using clients at Kirketon Road Centre and The Langton Centre in Sydney. The evaluation study examined uptake and acceptability of the intervention; participants' knowledge and attitudes regarding overdose and participants' experience in opioid overdose situations six months after the intervention. Participants completed baseline, post-training and follow-up questionnaires regarding overdose prevention and management which were analysed using repeated measures analysis of variance.Results: Eighty-three people participated in the intervention, with 35 (42%) completing follow-up interviews-51% reporting using naloxone with 30 overdoses successfully reversed. There were significant improvements in knowledge and attitudes immediately following training with much retained at follow-up, particularly regarding feeling informed enough (97%) and confident to inject naloxone (100%).Discussion: Take-home naloxone programs can be successfully implemented in Australian health settings. Barriers to uptake, such as lengthy processes and misperceptions around interest in overdose prevention, should be addressed in future program implementation. [ABSTRACT FROM AUTHOR]

A core consideration in the care of Indigenous patients at the end of life is their place of death. Dying in community can be of paramount importance to Indigenous people. This paper reports the experiences of the Top End Palliative Care Service with respect to the barriers and solutions in the return of Indigenous patients to community for end-of-life care. These barriers include not only those associated with the significant distances and remoteness in the Northern Territory but, also, spiritual and cultural factors, which often influence healthcare delivery. [ABSTRACT FROM AUTHOR]

Health insurance is a logical response to the highly variable need for health care. But expected need for health care is not random, being related to characteristics such as age, gender and previous health care utilisation. Thus an entirely private system would tend to price high-risk individuals, the old and the sick, out of health insurance, denying them access to health care. There are two ways to address this dilemma: universal cover, a predominantly publicly-funded health insurance system supporting access to health care on the basis of need; or a safety-net system that provides selective public funding for defined 'disadvantaged' groups. Both theory and international evidence suggest that universal health insurance represents the more efficient and equitable response to this problem. The rationale for promoting private health insurance within a universal health insurance system, the situation in Australia, is unclear and cannot be justified on either equity or efficiency grounds. [ABSTRACT FROM AUTHOR]