Barriers to formal healthcare utilisation among poor older people under the livelihood empowerment against poverty programme in the Atwima Nwabiagya District of Ghana

Abstract: Background: Even though there is a growing literature on barriers to formal healthcare use among older people, little is known from the perspective of vulnerable older people in Ghana. Involving poor older people under the Livelihood Empowerment Against Poverty (LEAP) programme, this study explores barriers to formal healthcare use in the Atwima Nwabiagya District of Ghana. Methods: Interviews and focus group discussions were conducted with 30 poor older people, 15 caregivers and 15 formal healthcare providers in the Atwima Nwabiagya District of Ghana. Data were analysed using the thematic analytical framework, and presented based on an a posteriori inductive reduction approach. Results: Four main barriers to formal healthcare use were identified: physical accessibility barriers (poor transport system and poor architecture of facilities), economic barriers (low income coupled with high charges, and non-comprehensive nature of the National Health Insurance Scheme [NHIS]), social barriers (communication/language difficulties and poor family support) and unfriendly nature of healthcare environment barriers (poor attitude of healthcare providers). Conclusions: Considering these barriers, removing them would require concerted efforts and substantial financial investment by stakeholders. We argue that improvement in rural transport services, implementation of free healthcare for poor older people, strengthening of family support systems, recruitment of language translators at the health facilities and establishment of attitudinal change programmes would lessen barriers to formal healthcare use among poor older people. This study has implications for health equity and health policy framework in Ghana

Development and validation of a search filter to identify equity-focused studies: reducing the number needed to screen

Search strategies and validation set papers. Contains validated search strategies, the number of records retrieved, and the MEDLINE validation set of papers. (PDF 722 kb

O processo de regionalização do SUS: revisão sistemática

This review focuses only on specific studies into the SUS regionalization process, which were based on empirical results and published since 2006, when the SUS was already under the aegis of the Pact for Health framework. It was found that the regionalization process is now underway in all spheres of government, subject to a set of challenges common to the different realities of the country. These include, primarily, that committee-structured entities are valued as spaces for innovation, yet also strive to overcome the bureaucratic and clientelist political culture. Regional governance is further hampered by the fragmentation of the system and, in particular, by the historical deficiency in planning, from the local level to the strategic policies for technology incorporation. The analyses enabled the identification of a culture of broad privilege for political negotiation, to the detriment of planning, as one of the main factors responsible for a vicious circle that sustains technical deficiency in management.Univ Fed Sao Paulo, Escola Paulista Med, Dept Med Prevent, R Botucatu 740-4, BR-04023062 Sao Paulo, SP, BrazilUniv Sao Paulo, Fac Med, Dept Med Prevent, Sao Paulo, SP, BrazilEscola Nacl Saude Publica, Rio De Janeiro, RJ, BrazilUniv Fed Sao Paulo, Escola Paulista Med, Dept Med Prevent, R Botucatu 740-4, BR-04023062 Sao Paulo, SP, BrazilWeb of Scienc

Regionalização no SUS: uma revisão crítica

Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.O artigo tem por objeto a produção científica sobre o tema da Regionalização da Saúde em periódicos brasileiros indexados no SciELO. Objetivo: Revisar tal produção, trabalhando os resultados como subsídios para gestores na tomada de decisão e também para o processo de análise da produção acadêmica sobre a temática. Método: Busca na base de dados online de artigos no SciELO, utilizando-se 02/06/2016 como corte temporal, ‘regionalização’ e ‘saúde’ como termos pesquisados e todos os índices como ‘abrangência da pesquisa’. Identificou-se 102 referências, cujos resumos foram analisados, chegando-se a 70 artigos que, efetivamente, discutem a regionalização da saúde no Brasil. Encontrou-se 4 artigos em periódicos fora da área da saúde. Análise: Critérios institucionais (periódico, área temática, data da publicação, abrangência, quantidade de autores) e categorias analíticas criadas pelo autor – Tipo 1, envolvendo “Estudos Exploratórios” (26), “Estudos Avaliativos” (6), “Estudos Comparados” (3) e “Relatos de Experiência” (5); Tipo 2, abrangendo “Textos Teóricos-Analíticos” (20) e “Revisões Histórico-Conceituais” (4); Tipo 3, com “Editoriais” (3) e “Resenhas de Livros” (3). Resultados: A regionalização tem repercussão nos periódicos a partir de 2010. Predominam artigos na categoria de Tipo 1.This article is a review of the literature on the regionalization of healthcare, published in Brazilian journals indexed in the SciELO system. Objective: to review the output and the use of the data to support managers in making decisions on the healthcare system, and analyze academic output on the theme. Method: An online search of the SciELO database for articles using ‘regionalization’ and ‘health/healthcare’ as the keywords, and all indices as the ‘scope of the study’. We found a total of 102 references, and after analyzing the abstracts selected 70 articles that effectively discuss regionalization of health/healthcare in Brazil. We also found four articles in non-health related journals. Analysis: the institutional criteria (journal, theme area, date of publication, scope and number of authors), and the analytical criteria created by author - Type 1 - “Exploratory Studies” (26), “Evaluation Studies” (6), “Comparison Studies” (3); and “Reports of Experience” (5), Type 2 - “Theoretical-Analytical” papers (20) and “Historical-Conceptual Reviews” (4), and Type 3 - “Editorials (3) and “Book Reviews” (3). Findings: regionalization has become more important in journals published since 2010. Most of the articles fall in the Type 1 category