Department of Markets, Public Policy and Law, Boston University School of Management, 595 Commonwealth Avenue, Boston, MA 02215, USA; Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, 1101 McGavran-Greenberg Hall, CB #7411, Chapel Hill, NC 27599, USA.
Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, 1101 McGavran-Greenberg Hall, CB #7411, Chapel Hill, NC 27599, USA.
Soc Sci Med. 2015 May;132:30-7. doi: 10.1016/j.socscimed.2015.03.013. Epub 2015 Mar 10.
The simultaneous burdens of communicable and chronic non-communicable diseases cause significant morbidity and mortality in middle-income countries. The poor are at particular risk, with lower access to health care and higher rates of avoidable mortality. Integrating health-related services with microfinance has been shown to improve health knowledge, behaviors, and access to appropriate health care. However, limited evidence is available on effects of fully integrating clinical health service delivery alongside microfinance services through large scale and sustained long-term programs. Using a conceptual model of health services access, we examine supply- and demand-side factors in a microfinance client population receiving integrated services. We conduct a case study using data from 2010 to 2012 of the design of a universal screening program and primary care services provided in conjunction with microfinance loans by Pro Mujer, a women's development organization in Latin America. The program operates in Argentina, Bolivia, Mexico, Nicaragua, and Peru. We analyze descriptive reports and administrative data for measures related to improving access to primary health services and management of chronic diseases. We find provision of preventive care is substantial, with an average of 13% of Pro Mujer clients being screened for cervical cancer each year, 21% receiving breast exams, 16% having a blood glucose measurement, 39% receiving a blood pressure measurement, and 46% having their body mass index calculated. This population, with more than half of those screened being overweight or obese and 9% of those screened having elevated glucose measures, has major risk factors for diabetes, high blood pressure, and cardiovascular disease without intervention. The components of the Pro Mujer health program address four dimensions of healthcare access: geographic accessibility, availability, affordability, and acceptability. Significant progress has been made to meet basic health needs, but challenges remain to ensure that health care provided is of reliable quality to predictably improve health outcomes over time.
在中等收入国家，传染性和非传染性慢性病同时带来的负担导致了大量的发病率和死亡率。贫困人口尤其面临风险，他们获得医疗保健的机会较少，避免死亡的几率更高。将与健康相关的服务与小额信贷相结合，已被证明可以提高健康知识、行为，并增加获得适当医疗保健的机会。然而，通过大规模和持续的长期项目，将临床医疗服务的提供与小额信贷服务完全整合在一起的效果，证据有限。我们使用健康服务获取的概念模型，研究接受综合服务的小额信贷客户人群中的供需双方因素。我们对 2010 年至 2012 年期间进行的一项研究进行了案例分析，该研究是关于一个普遍筛查计划和初级保健服务的设计，这些服务是由拉丁美洲的妇女发展组织 Pro Mujer 与小额信贷贷款一起提供的。该计划在阿根廷、玻利维亚、墨西哥、尼加拉瓜和秘鲁开展业务。我们分析了相关描述性报告和行政数据，以了解与改善初级卫生服务获取和慢性病管理相关的措施。我们发现，预防保健的提供相当可观，每年平均有 13%的 Pro Mujer 客户接受宫颈癌筛查，21%接受乳房检查，16%进行血糖测量，39%接受血压测量，46%进行体重指数计算。该人群中，超过一半的筛查对象超重或肥胖，9%的筛查对象血糖水平升高，这是糖尿病、高血压和心血管疾病的主要危险因素，如果不进行干预，这些疾病的发病率将会很高。Pro Mujer 健康计划的组成部分解决了医疗保健获取的四个维度：地理可达性、可及性、可负担性和可接受性。在满足基本健康需求方面已经取得了重大进展，但仍面临挑战，需要确保所提供的医疗保健具有可靠的质量，以随着时间的推移可预测地改善健康结果。
