A Comparative Case Study: Does the Organization of Primary Health Care in Brazil and Turkey Contribute to Reducing Disparities in Access to Care?

Brazil and Turkey are among the few high-middle-income countries that explicitly chose to strengthen their primary health care (PHC) systems as the centerpiece of much broader health system reforms aiming to narrow inequities in access to care. This comparative case study reviews the organization of Brazil and Turkey's PHC systems to derive lessons that can apply to other countries that may consider reforming the organization of PHC systems as a way to address health inequities. The analysis uses the Flagship Framework to investigate how the organization of PHC delivery in Brazil and Turkey can lead to measurable improvements in access to care.

Health system stewardship of National Health Ministries in the WHO European region: concepts, functions and assessment framework.

Objectives: To propose an operational framework for assessing the completeness and consistency of the stewardship function of national health ministries.

Methods: The authors carried out a purposive and multidisciplinary review of the literature and derived an operational framework through iterative discussions and participatory methods. The results of the literature review were compared to the authors' observations of stewardship in action and key functions were matched with case examples from Europe and North America.

Geographical, spatial, and temporal distributions of multiple indoor air pollutants in four Chinese provinces.

Exposure to indoor air pollution from household energy use depends on fuel, stove, housing characteristics, and stove use behavior. We monitored three important indoor air pollutants-respirable particles (RPM), carbon monoxide (CO), and sulfur dioxide (SO2)-for a total of 457 household-days in four poor provinces in China (Gansu, 129 household-days; Guizhou, 127 household-days; Inner Mongolia, 65 household-days; and Shaanxi, 136 household-days), in two time intervals during the heating season to investigate spatial and temporal patterns of pollution. The two provinces where biomass is the primary fuel (Inner Mongolia and Gansu) had the highest RPM concentrations (719 microg/m3 in the single cooking/living/bedroom in Inner Mongolia in December and 351-661 microg/m3 in different rooms and months in Gansu); lower RPM concentration were observed in the primarily coal-burning provinces of Guizhou and Shaanxi (202-352 microg/m3 and 187-361 microg/m3 in different rooms and months in Guizhou and Shaanxi, respectively).

Exposure to indoor air pollution from household energy use in rural China: the interactions of technology, behavior, and knowledge in health risk management.

Indoor air pollution (IAP) from household use of biomass and coal is a leading environmental health risk in many developing nations. Much of the initial research on household energy technology overlooked the complex interactions of technological, behavioral, economic, and infrastructural factors that determine the success of environmental health interventions. Consequently, despite enormous interest in reducing the large and inequitable risks associated with household energy use in international development and global health, there is limited empirical research to form the basis for design and delivery of effective interventions.

Patterns of household concentrations of multiple indoor air pollutants in China.

Most previous studies on indoor air pollution from household use of solid fuels have used either indirect proxies for human exposure or measurements of individual pollutants at a single point, as indicators of (exposure to) the mixture of pollutants in solid fuel smoke. A heterogeneous relationship among pollutant-location pairs should be expected because specific fuel-stove technology and combustion and dispersion conditions such as temperature, moisture, and air flow are likely to affect the emissions and dispersion of the various pollutants differently. We report on a study for monitoring multiple pollutants--including respirable particles (RPM), carbon monoxide, sulfur dioxide, fluoride, and arsenic--at four points inside homes that used coal and/or biomass fuels in Guizhou and Shaanxi provinces of China.

Should interventions to reduce respirable pollutants be linked to tuberculosis control programmes?

The potential benefits of linking tuberculosis control programmes with interventions to reduce smoking and indoor air pollution make research to improve our understanding of their relation a high priority