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1.
Lancet ; 391 Suppl 2: S25, 2018 Feb 21.
Artículo en Inglés | MEDLINE | ID: mdl-29553423

RESUMEN

BACKGROUND: People living in the Gaza Strip have experienced a protracted political conflict and extreme socioeconomic adversity since 1948. Economic conditions have deteriorated markedly since the onset of the Palestinian Intifada in 1987 and have been exacerbated by the economic siege after 2006. The health system in the Gaza Strip has faced additional challenges. The aim of this study was to assess how Palestinian households in the Gaza Strip experienced health care services during this period of political turmoil, socioeconomic adversity, and challenges to health services. METHODS: Mixed methods research (MMR) was used. The quantitative part of the MMR involved the analysis of data from ten rounds of the Palestinian Expenditure and Consumption Survey from 1996 to 2011. This survey enabled the components of out-of-pocket health expenditures and their catastrophic and impoverishing effects across the years to be measured and traced in different groups of households. The occurrence of catastrophic out-of-pocket spending was calculated at thresholds of spending 10% or more of the households' resources and 40% of their capacity to pay (non-food expenditure) for health care. The qualitative component of MMR consisted of life histories reported via semi-structured in-depth interviews with heads of households aged 46 years or older to capture changes over time in their experience with health services. The interviews were analysed using thematic narrative analysis and timeline analysis. The results of the Palestinian Expenditure and Consumption Survey and the interviews were triangulated. FINDINGS: The occurrence of catastrophic out-of-pocket spending was stable, with no changes between 1996 and 2011. However, vulnerable groups tended to become less exposed to catastrophic out-of-pocket spending, especially after the major deterioration of the economic situation in the Gaza Strip after 2006. The ability to pay for health care, the nature of health conditions of the households, and the accessibility and entitlement to certain health services determined their choice of health providers and influenced their health-seeking behaviours. Additionally, households had used a wide range of coping mechanisms, including self-medications, decreasing the use of private health services, and relying on social capital. Interview respondents noticed the expansion of both public and private health services, but expressed their dissatisfaction with public services. The low financial cost of using public services is coupled with other costs such as increased waiting times, perceptions of indignity, and perceived low quality of services. INTERPRETATIONS: The findings are interpreted within the political history of the Gaza Strip and its health-care system during the last three decades. The reduced occurrence of health-care-related financial catastrophe and impoverishment in the more vulnerable groups in the Gaza Strip could point to an emerging paradox of resilience and high level of household and health-system adaptation, which should be investigated carefully. FUNDING: None.

2.
Health Policy Plan ; 32(suppl_3): iii88-iii90, 2017 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-29029154

RESUMEN

The Fourth Global Symposium on Health Systems Research was themed around 'Resilient and responsive health systems for a changing world.' This commentary is the outcome of a panel discussion at the symposium in which the resilience discourse and its use in health systems development was critically interrogated. The 2014-15 Ebola outbreak in West-Africa added momentum for the wider adoption of resilient health systems as a crucial element to prepare for and effectively respond to crisis. The growing salience of resilience in development and health systems debates can be attributed in part to development actors and philanthropies such as the Rockefeller Foundation. Three concerns regarding the application of resilience to health systems development are discussed: (1) the resilience narrative overrules certain democratic procedures and priority setting in public health agendas by 'claiming' an exceptional policy space; (2) resilience compels accepting and maintaining the status quo and excludes alternative imaginations of just and equitable health systems including the socio-political struggles required to attain those; and (3) an empirical case study from Gaza makes the case that resilience and vulnerability are symbiotic with each other rather than providing a solution for developing a strong health system. In conclusion, if the normative aim of health policies is to build sustainable, universally accessible, health systems then resilience is not the answer. The current threats that health systems face demand us to imagine beyond and explore possibilities for global solidarity and justice in health.


Asunto(s)
Atención a la Salud/organización & administración , Política de Salud , Atención a la Salud/normas , Prioridades en Salud/organización & administración , Humanos , Política , Administración en Salud Pública
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