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Article
Publication date: 24 June 2022

Jean Grugel, Sarah C. Masefield and Alan Msosa

Health in low-income countries has become associated with the provision of minimum guaranteed public health services though Essential Health Packages (EHPs). How far do EHPs…

1994

Abstract

Purpose

Health in low-income countries has become associated with the provision of minimum guaranteed public health services though Essential Health Packages (EHPs). How far do EHPs deliver the human right to health for all? This study addresses this question through qualitative research into access to health care for vulnerable communities, using Malawi as a case study. This study shows that there are significant accountability gaps and perceptions of weak service provision in Malawi’s EHP in relation to some particularly marginalised (and stigmatised) groups that limit the right to health and the promise of “health for all”.

Design/methodology/approach

This study extends the body of qualitative work on EHPs in general and on Malawi in particular by exploring the perceptions of key stakeholders in relation to inclusivity and the delivery of health policies to particularly vulnerable groups. To do so, this study adopted an approach based on interpretive epistemologies (Scott, 2014). This study conducted largely unstructured interviews with a range of health stakeholders, speaking to stakeholders individually, rather than through focus groups due to the potentially sensitive nature of the topic.

Findings

The findings of this study are as follows: limited inclusion of civil society actors and local communities; local communities and local policymakers feel frustration with the gap between the promises of consultation in the EHP and the reality, and the difficulties of not having effective channels of communication; and exclusionary health practices for particularly vulnerable groups.

Research limitations/implications

There are limitations based on the qualitative methodology, and in terms of the particularly vulnerable groups – the authors studied two such groups (people with disabilities and those who identify as LBTQ) but a wider survey of vulnerable groups is needed to extend and confirm the findings.

Practical implications

Greater attention to the health rights of vulnerable groups would improve access and services, even in the context of resource restrictions. This study suggests that a deeper engagement with human rights-based approaches would pay dividends in terms of increasing access to health in Malawi, even within the constraints of the EHP process. Furthermore, without this, there is the risk that discrimination and exclusion will become more embedded in health policies, rather than progressively minimised.

Social implications

Without addressing these issues, there is the risk that discrimination and exclusion will become more embedded in health policies, rather than progressively minimised.

Originality/value

This paper makes an important contribution to the growing literatures on EHP in sub-Saharan Africa and Malawi in particular and to the importance of listening to stakeholder perceptions. It provides original data on stakeholder perspectives of the challenges associated with universalising health care in resource-constrained countries. To the best of the authors’ knowledge, it is one of the first papers to focus on the rights of disabled and LBTQ people in relation to EHPs.

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International Journal of Human Rights in Healthcare, vol. 17 no. 1
Type: Research Article
ISSN: 2056-4902

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Article
Publication date: 1 April 1955

ARTHUR ELTON

The film approach to history in this paper I want to consider the film as source material for history in the sense that palimpsest and parchment, hieroglyph and rune, clay tablet…

541

Abstract

The film approach to history in this paper I want to consider the film as source material for history in the sense that palimpsest and parchment, hieroglyph and rune, clay tablet and manorial roll are source materials—fragments, sometimes fragments of fragments, often defaced by time, and applied to purposes of historical reconstruction rarely contemplated by the original authors. For the most part I shall not be particularly concerned with the various philosophies of history—whether it is the job of the historian to lay material dispassionately before the student so that he can make up his own mind about what happened in the past, or to digest source material in order to arrive at the truth—that is, what the historian may hope is the whole incontrovertible real truth, or to digest source material, as Macaulay and Carlyle digested it, in order to justify something in contemporary life or thought. All that need be said here for the moment is that films can be used, as other historical source material can be used, for various and different historical purposes.

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Aslib Proceedings, vol. 7 no. 4
Type: Research Article
ISSN: 0001-253X

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Publication date: 1 August 1941

SEPTEMBER, as always, sees us contemplating our activities for the winter months. Exigencies of publishing compel us to write these notes a short time before that month begins…

48

Abstract

SEPTEMBER, as always, sees us contemplating our activities for the winter months. Exigencies of publishing compel us to write these notes a short time before that month begins, and our contemplation of things this year is coloured by the now rather remote possibility that September may bring the invasion that has been the shadow ahead for a year or more. To plan in a twilight time, as it were, is more than ordinarily difficult, and yet it is a commonsense and correct course to go on, not as if nothing could happen, but to the full extent of our means as they exist. Otherwise general paralysis would occur every time our statesmen warned us of possible attacks. There is no fear of such premature paralysis, however, as our people only want to be up and doing “with a heart for any date.”

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New Library World, vol. 44 no. 2
Type: Research Article
ISSN: 0307-4803

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Publication date: 1 April 1964

LIBRARIANS in Britain stand at the threshold of great possibilities. Having passed through the ages of the ecclesiastical library, the rich collector's private library, the…

66

Abstract

LIBRARIANS in Britain stand at the threshold of great possibilities. Having passed through the ages of the ecclesiastical library, the rich collector's private library, the academic institutional library, and the rate‐supported public library—all general libraries —they have reached the age of the special library. The next will be that of the co‐ordinated, co‐operative library service.

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New Library World, vol. 65 no. 10
Type: Research Article
ISSN: 0307-4803

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Publication date: 1 April 1912

WHILE there is no doubt that the system of issuing books at “net” prices is of great benefit to booksellers, there is also no doubt that, unless care is taken, it is a serious…

45

Abstract

WHILE there is no doubt that the system of issuing books at “net” prices is of great benefit to booksellers, there is also no doubt that, unless care is taken, it is a serious drain upon a limited book‐purchasing income. A few years ago the position had become so serious that conferences were held with a view to securing the exemption of Public Libraries from the “net” price. The attempt, as was perhaps to be expected, failed. Since that time, the system has been growing until, at the present time, practically every non‐fictional book worth buying is issued at a “net price.”

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New Library World, vol. 14 no. 10
Type: Research Article
ISSN: 0307-4803

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Publication date: 1 October 1915

While the much‐maligned saying, “Business as usual,” has its imperative and very necessary application to the upholding of our commerce and financial position during the war, one…

20

Abstract

While the much‐maligned saying, “Business as usual,” has its imperative and very necessary application to the upholding of our commerce and financial position during the war, one is inclined to ask those patriots who day in and day out decry the loyalty of thousands who are carrying a double and sometimes even a treble burden to keep business going, what is to be done if the country is exhausted by the drying up of her resources, and the ruin of her industries, we cannot but feel that the time has come for all of us to put to ourselves the enquiry as to where our own duty lies? Many who have not the physical fitness or strength for the actual fighting line might yet, we believe, find room in the direct service of the State. We have a splendid list of men who, greatly loving home and honour, have sacrificed position and given themselves for service abroad. Are there not others who are great enough to follow in their train? The large places may be already filled, but the strain on the country intensifies month by month, and we can only come to full self‐realisation as the very thought of self is slain, and the splendid spirit in the line, “Who dies if England lives?” enters into our own hearts.

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New Library World, vol. 18 no. 4
Type: Research Article
ISSN: 0307-4803

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Article
Publication date: 1 September 1946

This report is drawn up by the Director‐General of Health and Medical Services for State of Queensland and presented by him to the Minister for Health and Home Affairs of the…

27

Abstract

This report is drawn up by the Director‐General of Health and Medical Services for State of Queensland and presented by him to the Minister for Health and Home Affairs of the State. The report is a record of conscientious and efficient public service by a depleted staff working under great difficulties; over a wide stretch of territory; hampered by shortage of labour and materials for repair or construction. In addition to this was the concentration of large bodies of troops in areas by no means primarily designed for their accommodation. It may be remarked that the huge area now called Queensland was separated from New South Wales in 1859. Its area is 670,000 square miles. Length from north to south 1,300–1,400 miles and from east to west at the widest about 1,000 miles. The greater part lies in the tropics. The east coast and for some distance inland is a trade wind and monsoon belt. With this region the report is mainly concerned. The rainfall diminishes towards west and south. The temperature of the State is by no means excessive. In general the climate is a good one. It is in favour of the public health authorities. On January 1st, 1945, the estimated population was in round figures just over a million, including Brisbane with 384,370. There is closer settlement in the east and along the east coast. Ports, mining and manufactures have developed urban areas so that in addition to Brisbane we have sub‐offices such as Cairns, Toowomba, Townsville, and Rockhampton. Owing to war conditions already referred to, it was not possible without much difficulty for the head quarters staff to carry out sanitary surveys in country areas. It is noted that the limited staff available “carried out all duties assigned to them in the same competent and efficient manner” as before. Rockhampton states that there was only one officer available for a district with a population of 40,000; Cairns that 50 towns were visited with a total of 113 separate visits and a distance of 6,334 miles being traversed. These figures give some idea of the demands made on the sanitary officers. The inspections in one area included anti‐malaria drainage, 39 inspections; malaria investi‐gation, 9; mosquito infestation, 10; swamps, 2; rat infestation, 73; food premises, 77; milk premises, 28; food factories, 129. It will be noticed that much attention is given to the danger of mosquito infestation, with the attendant risk of malaria. In 1943 the Government offered a 50 per cent. subsidy to local authorities for carrying out approved mosquito eradication measures, and though the response was not as great as was expected, the expenditure by those local authorities who, at the time of making this report, had availed themselves of the scheme runs into many thousands of pounds. This was mainly for drainage works, but in addition to this there was spraying and the appointment of additional inspectors. Taking one or two instances, Brisbane expended £173,375; Rockhampton £8,918; Charleville £4,000. It is stated “in Toowomba and to a lesser degree in the other large towns [in the area] the townspeople have become mosquito conscious” and will readily report the presence of even a few mosquitoes. On the other hand in country districts the attitude seems to be that mosquitoes have always been present and will always be present, so “Why worry?” A good instance of bucolic fatalism. After the rains it is obvious that unless water be run off from or sprayed in town puddles and from patches of swampy ground nearby these places become breeding grounds for the nuisance. In the 1944–5 period 696 cases of malaria were notified. Many of these were possibly recurrent attacks among Service and ex‐Service men. Still, the “utmost vigilance” is necessary. The rat nuisance and danger is common to every port in the world. Apart from the fouling and destruction of food and house infestation there is the graver menace of plague. This risk in Queensland most happily seems to be slight, as out of 113,000 examinations of rat bodies and spleen smears no instance of Pasteurella pestis was detected, but again “Vigilance” is the watchword. Poisoning (several kinds of poisons are used), gassing, trapping and hunting are all good within their limits, but rat proofing, removal of harbourages, the use of sanitary rubbish bins, and so forth, are admittedly better, as they strike at the root of the evil. Some seven cities are named where the rat population has not diminished during the last seven years owing to the latter precautions having been more or less neglected. These “starve the rat” and “build out the rat.” Milk claims a large share of attention. The offences are of the kind that we know so well in this country, namely added water and fat deficiency. With regard to added water, some of the figures given range from 19 per cent. to 34 per cent., with, we are glad to note, a correspondingly heavy fine. The Queensland Health Acts prescribe a fine of not less than £1 for each one per centum of added water up to a maximum of £50. It is illegal to carry water on a milk delivery cart when milk is being sold therefrom. Some dishonest vendors had adopted the practice of taking a dip out of a can of water so carried at the instant of delivery to the buyer. It was clearly almost impossible under these circumstances to prosecute successfully a dishonest vendor. Rockhampton states that out of 199 samples of milk officially analysed in the district in the period under review, eleven convictions were obtained for added water, and four for carrying water on the milk delivery van. It is added “Whilst the number of samples of milk which proved to be adulterated with added water was almost twice that of the previous year, it was more than ever apparent that the practice most frequently adopted by offenders is that of carrying water in smaller cans to adulterate the milk when measuring for individual customers.” This evil practice would seem to be widespread, and as its success would seem to depend on delivery from large open containers—an old and almost obsolete method—the remedy is to insist, as far as that be possible having regard to local conditions, that all milk should be pasteurised and sold in bottles. Clearly a person who systematically perpetrates day by day a series of petty frauds on his neighbours is likely to be as careless of their health as he is of their pocket. Pasteurising and bottling are being more widely practised. The periodical examination by the health authorities of milk so treated shows that statutory standards of purity are maintained. Most of the milk sold in Toowomba is pasteurised milk; the same seems to be the case in Townsville, and, as we should expect, in a city such as Brisbane. The game is, or, as we hope, was, an uphill one for milk vendors. Townsville says that local dairymen “still endeavour to carry on under very severe handicaps, such as staff shortages, transport and equipment shortages, and lack of sufficient fodder.” We hope that these drawbacks may by now be referred to in the past tense, for Cairns hopefully stated that “a return to normality is gener ally observable.” During the period under review 2,099 “legal samples” were taken by inspectors in accordance with the provisions of the Health Acts. Of these, 79 85 per cent. passed the standard; 3.95 were adulterated with water; 3.176 were deficient in fat only; 12.44 were below the standard in total solids and/or solids not fat. Of the 2,099 samples taken 1,666 were taken in the “Greater Brisbane Area”; 81.2 per cent. were, it seems, below the standard quality. As the population of the city of Brisbane is about 384,000 it is perhaps not too much to say that 40 per cent. of the total population of the State of Queensland is consuming milk a large proportion of which—about 19 per cent.—is below the standard set by the laws of the State. At Rockhampton 92 out of 135 samples, and at Townsville 28 out of 36, passed the standard. The figures are much the same for seven other towns named and 11 others not named. The results for the whole State is the subject for unfavourable criticism by the Health Department. Proprietary Medicines.—The report states that the prescribing of expensive medicines of this type is a common practice, and that the pharmacist may put the medicine in a different container and usually replaces the proprietary label with his own. “The prescribing of proprietary medicines may maintain the patient's faith in his medical practitioner : it also augments the profit of the pharmacist.” Price fixing has reduced the latter. Homeopathic medicines claim some attention. “As is common with homeopathic medicines those submitted during the year consisted of milk sugar only.” Saccharum lactis seems to be harmless kind of stuff with no particularly marked positive properties. Dose ad lib, says the pharmacopoelig;ia. It is “used for weakly children,” and “diabetics are said to occasionally show slight improvement” by ingesting it. Its normal price is about half‐a‐crown a pound. When, however, it has been “improved ” by the addition of minute traces of the phosphates of calcium, magnesium, and potassium and of calcium fluoride, then made up into tabloid form and sold, the recorded price in one instance had risen to £15 9s. 0d. a pound. The Health Department does not accept an enhanced price to be necessarily a measure of an increase in therapeutic virtues. It observes that“ two hundred tablets of one preparation (a month's course) contained no more mineral substance than one‐third of a teaspoonful of milk,” and after some further remarks to the same purpose, suggests “that in the light of modern therapeutics there would appear to be necessity for health administrations to define their attitude towards homeopathy.” It further quotes responsible medical opinion to the effect that “modern therapeutics has inherited from homeopathy the knowledge of the remarkable power the body possesses of healing itself, if given a chance.” Vitamins. —The grossly exaggerated claims of some food manufacturers and patent medicine manufacturers are referred to. It seems that in 1941 it was suggested to the Queensland Department of Health “that vitamin claims for foods and patent medicines should be re stricted within the known knowledge on the subject or within scientific bounds,” and that the Canadian definition of “vitamin” should be adopted; and that in 1943 the Commonwealth National Health and Medical Research Council recommended that the quantity of each vitamin present in a food should be indicated on the label in units per ounce or pound, and in drugs or medicinal preparations in units per dose. It is perhaps no great exaggeration to say that magic and medicine are still mutually identified in the minds of a sufficient number of people to make the hawking about of what is, in many cases, rubbish, a monetary success. The belief held by such people that what is repeatedly stated must for that and for no other reason be unquestionably true, together with an appeal to their fears and impulses form the psychological basis for success based on the claims made. Thus, it may be said that London, Brisbane, and the aborigines of the Cape York Peninsula are in this respect on much the same level.

Details

British Food Journal, vol. 48 no. 9
Type: Research Article
ISSN: 0007-070X

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Article
Publication date: 1 June 2012

Marielle R. Risse

504

Abstract

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Learning and Teaching in Higher Education: Gulf Perspectives, vol. 9 no. 1
Type: Research Article
ISSN: 2077-5504

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Publication date: 1 May 1972

Muriel Hutton

ONE MUST BEGIN with Dickens. A chapter by Christopher Hibbert in Charles Dickens, 1812–1870: centenary volume, edited by E. W. F. Tomlin, and The London of Charles Dickens

88

Abstract

ONE MUST BEGIN with Dickens. A chapter by Christopher Hibbert in Charles Dickens, 1812–1870: centenary volume, edited by E. W. F. Tomlin, and The London of Charles Dickens, published by London Transport with aid from the Dickens Fellowship, make a similar study here superfluous; both are illustrated, the latter giving instructions for reaching surviving Dickensian buildings. Neither warns the reader of Dickens's conscious and unconscious imaginative distortion, considered in Humphrey House's The Dickens World. Dickens himself imagined Captain Cuttle hiding in Switzerland and Paul Dombey's wild waves saying ‘Paris’; ‘the association between the writing and the place of writing is so curiously strong in my mind.’ Author and character may be in two places at once. ‘I could not listen at my fireside, for five minutes to the outer noises, but it was borne into my ears that I was dead.’ (Our Mutual Friend)

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Library Review, vol. 23 no. 5
Type: Research Article
ISSN: 0024-2535

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Publication date: 1 October 1947

THE problem that Dr. E.A. Savage introduced in our last issue may well be one of the crucial debates of this winter. When it is remembered that there was a time, as our writer in…

27

Abstract

THE problem that Dr. E.A. Savage introduced in our last issue may well be one of the crucial debates of this winter. When it is remembered that there was a time, as our writer in Letters on Our Affairs asserts, when it was thought inadvisable for a public librarian to be Hon. Secretary of the Library Association, we can see that times have changed. There is no doubt that the Brighton Conference showed the impossibility of adequate discussion of purely professional matters when authority members are present. The manner of achieving what many desire, and yet to retain the goodwill' of intelligent authority members, is what has to be determined.

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New Library World, vol. 50 no. 4
Type: Research Article
ISSN: 0307-4803

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