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Economic transition and maternal health care for internal migrants in Shanghai, China.
Nordic Council of Ministers, Nordic School of Public Health NHV. UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), The World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland.
2002 (English)In: Health Policy and Planning, ISSN 0268-1080, E-ISSN 1460-2237, Vol. 17 Suppl, 47-55 p.Article in journal (Refereed) Published
Abstract [en]

Economic migration and growth in informal employment in many of the major cities of developing countries, combined with health sector reforms that are increasingly relying on insurance and out-of-pocket payment, are raising concerns about equity and sustainability of economic and social development. In China, the number of internal migrants has dramatically grown since economic transition started in 1980, and maternal health care for these is a pressing issue to be addressed. To provide information for policy-makers and health administrators, a medical records review, a questionnaire survey and qualitative interviews were carried out in Minhang District, Shanghai. This paper describes important inequities in main maternal health outcomes and utilization indicators relating to economic and social transformation of the Chinese society. Analysis of the data collected clarifies that insufficient antenatal care is one of the main determinants for poor maternal health outcomes and that migrants are using antenatal care services significantly less than permanent residents. The data suggest that there is no single explanatory factor, but that migrants are faced with a package of obstacles to accessing health care services, and that health systems may need to rethink and redesign their delivery approaches to specifically target those groups that are faced with such multi-faceted packages of obstacles to service-access. Although the study addresses a specific Chinese phenomenon related to internal migration and registration of residency, parallels can be drawn to other settings where a combination of economic and social transitions of the society and a reform of health care financing are potentially creating the same conditions of significant inequalities.

Place, publisher, year, edition, pages
2002. Vol. 17 Suppl, 47-55 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:norden:org:diva-3787PubMedID: 12477741OAI: oai:DiVA.org:norden-3787DiVA: diva2:787368
Available from: 2015-02-10 Created: 2015-02-10 Last updated: 2015-02-10Bibliographically approved
In thesis
1. 1990 - 2000: A Decade of Health Sector Reformin Developing Countries: Why, and What Did We Learn?
Open this publication in new window or tab >>1990 - 2000: A Decade of Health Sector Reformin Developing Countries: Why, and What Did We Learn?
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Objective: The overall aim of the work is to contribute to a better understanding of the dynamics between health sector reform policies and practices as well as the factors that determine and shape the thinking about global public health; and to try out a framework for understanding the inter-linkages and interactions between the determinants for and the elements of health sector reforms and their implementation.

Methods: The object of study was a contemporary phenomenon, consisting of a diverse array of interventions in many different directions and fields within a complex political, social and economic environment. It is difficult to attribute the effects of the reforms to any single intervention or to establish exact boundaries between the phenomenon and the context. Therefore, a multi-stage case study research strategy, based on the work of R.K.Yin, was chosen. The study involved two major sub-units of analysis, i.e., the macro and the micro level. Each of these involved several sub-units of analysis. The analysis of the micro level further comprised a cross-case analysis of 10 individual case studies conducted in six developing countries.

Results: Clear linkages were found between the greater societal processes and the shape and results of reforms during the decade. The reforms had not been completed in any of the countries studied, but appeared to be stuck with undesired effects, lacking energy to move forward. Contributing to this was the diminishing role of the state, which bordered abdication from public health in most of the countries, leaving the drive to the market and individual demands and interests. The net effect could well be a reversal of some of the public health achievements of the past - however, it was also found that reverting to dedicated disease control programmes would not be the answer, as these were found unsustainable and undermining the health systems.

Conclusion: There is a divide between libertarian and utilitarian values on the one side and communitarian and egalitarian values on the other. Thus, it is not just about public health practitioners not being good enough to implement, it is more so about what we want to achieve and what it acceptable respectively not acceptable and reaching compromises. This place the societal processes at centre-stage for public health. However, it is also about implementation, it is about how public health policy-makers and reformers can effectively dialogue and facilitate achieving consensus and translate the societal 'wants' and 'want nots' into managerial bites. Implementation becomes a process of constant adjustment and readjustment oscillating between political and technocratic levels

Publisher
110 p.
Series
NHV Reports and Doctor of Public Health-Theses, ISSN 0283-1961 ; NHV Report 2005:2
Keyword
Health sector reform, values, implementation, developing countries, international public health
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3794 (URN)91-7997-111-3 (ISBN)
Public defence
2015-06-01, Nordic School of Public Health NHV, Göteborg, Sweden, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2015-02-10 Created: 2015-02-10 Last updated: 2015-02-10Bibliographically approved

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