Health Access Livelihood Framework Reveals Potential Barriers in the Control of Schistosomiasis in the Dongting Lake Area of Hunan Province, China

Abstract

BackgroundAccess to health care is a major requirement in improving health and fostering socioeconomic development. In the People's Republic of China (P.R. China), considerable changes have occurred in the social, economic, and health systems with a shift from a centrally planned to a socialist market economy. This brought about great benefits and new challenges, particularly for vertical disease control programs, including schistosomiasis. We explored systemic barriers in access to equitable and effective control of schistosomiasis.MethodologyBetween August 2002 and February 2003, 66 interviews with staff from anti-schistosomiasis control stations and six focus group discussions with health personnel were conducted in the Dongting Lake area, Hunan Province. Additionally, 79 patients with advanced schistosomiasis japonica were interviewed. The health access livelihood framework was utilized to examine availability, accessibility, affordability, adequacy, and acceptability of schistosomiasis-related health care.Principal FindingsWe found sufficient availability of infrastructure and human resources at most control stations. Many patients with advanced schistosomiasis resided in non-endemic or moderately endemic areas, however, with poor accessibility to disease-specific knowledge and specialized health services. Moreover, none of the patients interviewed had any form of health insurance, resulting in high out-of-pocket expenditure or unaffordable care. Reports on the adequacy and acceptability of care were mixed.Conclusions/SignificanceThere is a need to strengthen health awareness and schistosomiasis surveillance in post-transmission control settings, as well as to reduce diagnostic and treatment costs. Further studies are needed to gain a multi-layered, in-depth understanding of remaining barriers, so that the ultimate goal of schistosomiasis elimination in P.R. China can be reached.

The impact of health service variables on healthcare access in a low resourced urban setting in the Western Cape, South Africa

“… 2 , 4 , 5 , 6 , 7 , 8 The more comprehensive of these frameworks, such as the Health Access Livelihood Framework (ACCESS) described below, acknowledges a dynamic interaction between demand (user) and supply (service). 2 , 5 , 6 , 8 , 9 , 10 For instance, an accessible service will attempt to structure hours of operation (supply) in accordance with the schedule of users (demand).…”

“…In this article, ACCESS 2 , 9 , 10 is used to explore health care access for vulnerable groups in a specific setting. According to this framework, healthcare access constitutes five dimensions: availability, accessibility, affordability, adequacy and acceptability, as defined in Table 1 .…”

“…These are influenced by a dynamic interaction with user livelihood assets (the human, social, physical, financial and natural assets, or capital, a person has access to) 11 on the one hand, and policies, institutions, organisation and processes on the other. 2 , 6 , 8 , 9 , 10 …”

Global aspirations, local realities: the role of social science research in controlling neglected tropical diseases

“…A further ethnographic study in Tanzania commented on how district-level health staff considered handling multiple NTD interventions simultaneously as more of a burden than a cost-saving strategy [ 21 ]. Cairncross et al [ 50 ] discussed 13 years of stagnation in dracunculiasis eradication in Ghana (due partially to the implementation of a sector-wide approach, government decentralisation and staff transfers) while Balen et al [ 78 ] drew attention to more subtle social equity issues in China for schistosomiasis, where barriers to treatment were driven by the lack of medical insurance among the poor, despite a well planned and integrated programme.…”

Identifying Spatial Clusters of Schistosomiasis in Anhui Province of China: A Study from the Perspective of Application

“…The Chinese government has been paying a high amount of attention to the control of schistosomiasis, and a multitude of control programs have been implemented over the past 60 years [ 8 , 13 , 14 ]. The latest two control programs at the national level were the World Bank Loan Project (WBLP) that started from 1992 to 2001 [ 15 ], which mainly emphasized praziquantel-based morbidity control on humans and domestic animals [ 16 ], and the integrated control program implemented since 2005, which emphasized infection source control [ 17 ]. The disease burden, therefore, has been decreased significantly, and the disease transmission has been blocked in many areas that were previously endemic [ 8 , 16 , 18 ].…”