Right to health in developing countries

West Africa stands out as the region with some of the worst health and mortality indices. There are nonetheless sharp differentials in health and well-being by urban/rural residence, and individual characteristics such as education and age. Whereas some inequalities are structural in origin, there are, however, inequalities which have a more local origin, depending on household and family level factors that affect, for example, access to health services as well as life styles and behaviour.

After a discussion of some concepts underlying the description of individual and population health states, we use two case studies based on several years of West African field work – women’s health in Accra and the welfare of young people in Bamako – to illustrate how adoption of the capability framework can refine the analysis of unequal access to health. We apply the capability approach developed by Sen and colleagues to distinguish, inter alia, the role of the resources of the context (offer side) from inequalities of individual capacity to use them to improve their well being, due to social, family and individual characteristics. This framework seems especially promising to examine the complex determinants of urban health.

Female circumcision is a phenomenon specific to Africa continent.There is a discussion about the practices of circumcision where it is seen as the perpetuation of social and cultural values on one hand whereas, on the other hand, there are views that the individual choice and rights as an element to be factored in within the larger debate of health risk of women. The primary reason for selecting the two countries for analysis is that both are low economy country, yet the prevalence of circumcision has a telling difference even with its similar historical origination.In comparing the two countries with large scale survey (DHS), the prevalence of circumcision is much more in Nigeria than Kenya and the former lacks behind when it comes to positive perception.In carrying out the analysis, age of women, religion, ethnicity, and education are some of the important predictors affecting the perception on circumcision. The likelihood for the circumcised women wanting the practice to continues remains high for the both countries with circumcised women in Kenya 11 times more likely than the uncircumcised and in Nigeria, it is 21 times more likely than the uncircumcised women.

Most analyses of differentials and trends in health and mortality find the anticipated relationship between measured outcomes and a range of socio-economic status variables including education, income status of employment and wealth. From a multi-year longitudinal study of health and mortality in Accra called the Women’s Health Study of Accra (WHSA), we produce a much finer grained analyses of health and mortality differentials within an urban area (Weeks, Hill et al. 2006; Douptcheva and Hill 2011). First, in some of the communities designated as ‘slums’ by UN Habitat, child mortality and adult morbidity are surprisingly good. The socio-demographic profile of the population, shaped heavily by migration, modifies the risk profile (Fink, Weeks et al. 2012). Secondly, the anticipated differentials in both self-reported and objectively measured dimensions of adult health are very narrow and often in the opposite direction anticipated (Darko, Adanu et al. 2012). Thirdly, there is evidence of pronounced neighbourhood effects where even for those poorer than the mean for the whole neighbourhood, place of residence can mitigate some of the otherwise adverse health outcomes associated with poverty (Weeks, Getis et al. 2010).These empirical facts present a challenge to conventional theory on the determinants of health outcomes.

India has been trying to improve the maternal health care services but it is still low in Empowered Action Group (EAG) states. These states are socioeconomically and demographically backward. These facts motivate to examine variations in utilization of maternal health care services among EAG states and to know socio-economic determinants of MHC services at district levels and household levels. Study utilizes the data from District Level Household and Facility Survey (2007-08) and Census of India 2001 for analysis. Composite index, Bivariate, correlation and logit regression technique is used for the analysis of data. Result shows that Jharkhand and Orissa have the highest and lowest score in maternal health care index (MHCI) as, 0.11 and 0.72 respectively. The correlation Score (0.27) between MHCI and Socio-economic Development Index at state level is positive . More importantly the factors that influence the utilization of MHC. at district level is the electricity followed by female literacy rate and non-agricultural workforce participation among the development indicators in each EAG states. P value shows that those women who have received ANC have double chance to receive safe delivery and taking PNC within two weeks.

Introduction: Around 68,000 deaths occur worldwide due to unsafe abortions while 97% of these deaths occur in developing countries. It is estimated that 25% of all clients are refused services in Bangladesh for various reasons.
Methods: The research was carried out between March 2009-October 2011 in 4 districts of Bangladesh. Methods included in-depth interviews with women (53) having MRs or attempted MRs and focus group discussions (24) with younger and older males and females of reproductive age.
Results: MR was viewed as sin from religious and social perspectives. This perception often resulted in huge delays in seeking MRs (i.e. beyond six months of gestation) and often led to clandestine careseeking from different formal and informal biomedical and traditional providers. Careseeking data showed around 61% of all careseeking was from non-formal sector, which included pharmacists, paramedics, homeopaths, herbalists, TBAs, other informal providers, and home remedies. Out of this non-formal careseeking, around 44% was with pharmacists and other informal providers, while 24% was with traditional providers.
Conclusion: Menstrual regulation is a professed need for women and their families. Judging from this context, it is important that policy makers try to create a better atmosphere for women to avail safe MR services.

Female sex workers are one of the most vulnerable groups who face challenges in their day to day life with the clients, police, pimps and their counterparts. The nature of profession leaves them alone in this world to face the critical health, HIV/AIDS, Psychological & social discrimination at various stages of life.

SAKSHAM GS project of CARE India was initiated in 2009 in Andhra Pradesh under AVAHAN Initiatives to mobilize female sex workers by using community to community learning intervention strategy with an aim to reduce their vulnerabilities through collectivization.

With the efforts 22633 FSWs have become the members of 22 community based organizations. Approximately 1154 Hot Spot leaders are democratically selected to deal with the crisis situations. In a state level get together for FSW a message is given to the society that they are also human being entitle to get human rights. The efforts empower them to form a state level network and provided toll free number for easy accessibility of community members. The empowered community members are not only leading their life with choice but also saving the lives of many girls/women from trafficking.

How far the coverage of health insurance available to Indians, both in rural and urban areas? Who can afford to pay for health insurance coverage? This study examines health insurance scenario of India by analyzing the trends and patterns and household characteristics of health insurance policy holders. The study utilized available data from the latest rounds of two nationally representative surveys DLHS (2007-08) and NFHS (2005-06). Only 5 percent of the households in India were covered under any kind of health insurance. Within the insurance schemes, the state owned health schemes are the most subscribed (39.2), followed by the Employee State Insurance Scheme (17 percent). Among the households belonging to the lowest economic categories, less than 3 percent were covered by any health scheme or health insurance. However, the recent trends show that the community health insurance targeting poor households are becoming much popular and it may be the most appropriate way of supporting the families vulnerable to catastrophic health spending.

Refugees have greater problem in accessing health services compared with general population and with other migrants. This study is an attempt to highlight the access to utilization of health care services and problems faced while accessing facilities by Chakma refugees in India. Study is based on the primary survey from the 400 head of the households. Result indicates that most desired facility for them is hospital, followed by electricity and school facilities. However fact is that Chakma refugees are living in such a deplorable situation of absences of heath facilities and health personals nearby that on an average they travel around 10 to 12 kilometers on foot or use bicycle to reach nearest government facility. In spite of 87 percent of them face shortage of money to spend on health care they opt private medical store even at the time of fatal ailment like malaria. Only 1 percent refugees are satisfied with the government facility and around 14 percent says that they are somewhat satisfied. On being asked about reasons, at least 95 percent of them feel that government facility is too far and around 27 percent says that problems they face are the negligence from the health personals.

The unaffordable health care cost is believed to be one of the important causes of impoverishment in India. Using the data of WHO sponsored Study on Global AGEing and Adult Health (SAGE-India) of 2007, an attempt is made here to examine the health care expenditure, catastrophic health spending and the extent of health insurance coverage in rural and urban India. The survey covers about 10,000 households from six states of India. The analysis indicates that on an average , a household spent 13 percent of its income on health care. Among the households incurring catastrophic health expenditure, 24 percent became impoverished. Study also found that nine percent of non-poor households have become poor (impoverished) due to health spending. About 20 percent of households borrowed from their relatives and 8 percent sold their assets like land, furniture, livestock and jewellery to meet health care costs. According to this survey, the households having health insurance/policy are 5 percent in urban areas, it is only 1 percent in rural areas. The findings of the study convincingly illustrate the vulnerability of poor in India in the context of spiralling health care costs, privatization of medical sector, and lack of health insurance coverage.

This paper explores Infant mortality gaps between indigenous and non indigenous children in Latin America from a human rights framework. The data provided by population censuses shows that indigenous peoples suffer the greatest inequalities with a persistence of excess mortality. As most of these deaths are preventable with appropriate access to health, the over mortality became an indicator of the human rights violation. Given the persistent inequity and heterogeneity, the challenge is to develop a cross cultural approach considering cultural and geographical diversity in the frame of equity and human rights. The 2010 Census offers a great opportunity for measuring to what extent infant mortality -close to 60 per 1,000 live births in the 2000 censuses- has declined; Also it is an important moment for estimating if the equity gap between indigenous and non indigenous children has increased, decreased or maintained. It is crucial to know the patterns and tendencies to evaluate the impact of cross cultural programs and interventions developed since the 90's in most Latin American countries.