Health access livelihood framework reveals potential barriers in the control of schistosomiasis in the Dongting Lake area of Hunan Province, China.
BACKGROUND
Access 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.


METHODS
Between 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.


RESULTS
We 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
There 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.
Molecular Parasitology Laboratory, Division of Infectious Diseases, Queensland Institute of Medical Research, Brisbane, Australia. j.balen@imperial.ac.uk
Julie
J
Balen
Zhao-Chun
ZC
Liu
Donald P
DP
McManus
Giovanna
G
Raso
Jürg
J
Utzinger
Shui-Yuan
SY
Xiao
Dong-Bao
DB
Yu
Zheng-Yuan
ZY
Zhao
Yue-Sheng
YS
Li
D000328:Adult; D000368:Aged; D000818:Animals; D002681:China; D003140:Communicable Disease Control / Q000379:methods*; D005260:Female; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D012552:Schistosomiasis / Q000175:diagnosis* / Q000188:drug therapy*; D055815:Young Adult