Salud
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Item Demographic diversity and change in the Central American Isthmus(RAND, 1997) Pebley, Anne R.; Rosero Bixby, LuisThe chapters in this volume were originally presented at the International Conference on the Population of the Central American Isthmus, organized by the Central American Population Program (PCP) at the University of Costa Rica in collaboration with colleagues at RAND. Both the papers at the conference and the subset that are included in this volume represent research in a broad range of disciplines including demography, public health, anthropology, history, sociology, human ecology, and economics. The conference played an important role in bringing together an international group of researchers working on related issues in the region. The objective of this volume is to provide, in one central location, a collection of recent research on demographic, social, and environmental issues in the Central American Isthmus for English-speaking readers, both those who are not familiar with the region and those who know it well. For Spanish-speakers, the same collection of papers has been independently published as De los Mayas a la planificación familiar: DemografÍa del Istmo (L. Rosero Bixby, A. Pebley, and A. Bermúdez Méndez, editors) by the Editorial de la Universidad de Costa Rica. This book is the first English-language collection of recent research on demographic, social, and environmental issues in Central America. The region's experience with ethnic and cultural identity provides food for thought for scholars concerned with the meaning of ethnicity and the consequences of cultural change. Countries in the region also have grapppled with the complex issues of promoting economic growth and reducing poverty while avoiding environmental destruction. The chapters in this volume provide important and often novel insights into these and many other demographic, social, and policy issues in the Central American Isthmus. For the first time in the English language, Central America's rich demographic history comes into focus in this volume. Editors Anne R. Pebley and Luis Rosero-Bixby provide the first and only English translations of works originally presented at the International Conference on the Population of the Central American Isthmus. The chapters in this volume offer insights on a broad range of subjects, including estimates of the indigenous population, differences in education and earnings, trends in fertility and maternal and child health, migration, the environment, and many other demographic, social, and policy issues in the region.Item Physical accessibility to health facilities in Costa Rica(International population conference Montreal. UNFPA, 1993) Rosero Bixby, LuisThis paper estimates physical accessibility to health services in Costa Rican communities and identifies target geographic areas for opening new health facilities. The analyses use geographic information system (GIS) methods and relies on the concept of population potential. The paper aims at illustrating the use of simple GIS techniques for solving an important problem with demographic connotations. Measuring physical access of individuals and populations to health or other public services is crucial in planning the opening of new facilities, evaluating program's impact, and understanding changes in fertility and mortality. Besides, displaying accessibility information on maps is essential to describe a situation, to have a feeling of topological relationships, and to facilitate the use of information by decision makers. Research and evaluation of health and family planning programs have approached the issue of measuring accessibility in a casual way, coming out with common-sense solutions that are far from satisfactory. Some of these common-sense measures of accessibility is the distance to the nearest outlet, the presence of outlets in a community or area, density of services in an area, and the services available in a determined radius. All of these measures have drawbacks that have hampered the inquiries about the relationship between physical access and health and contraceptive behaviour. This paper addresses the following research issues involved in measuring access (National Research Council, 1991): * Contamination across communities: Often people use services located in communities or administrative divisions other than those in which they live.. The lack of services in their communities, or convenience considerations, are causes for this behaviour. Access measures of the type "density of services in an area" do not reflect this contamination effect and can be seriously biased. * Overlapping services: Different organizations may offer similar or related services in a community (e.g., ministry of health, social security, ONGs). This situation -- which is frequent in health services in Latin America -- presents aggregation problems and it is not properly handled by "the nearest outlet" approach. * Competition for services: Access to a clinic will be substantially different if this is the only facility in a big dty than it is in a small town. Competition for services in heavily populated areas reduces the access to them. This circumstance is not considered by only-distance measures of accessibility.Item Oferta y Acceso a los servicios de salud en Costa Rica(Instituto de Investigaciones en Salud (INISA), 1999) Güell, Douglas; Rosero Bixby, Luis¿Cuán equitativo es el acceso a los servicios de salud en Costa Rica? ¿Hasta qué punto el actual proceso de reforma del sector salud ha alterado el entorno de oferta de servicios y su accesibilidad? El presente estudio ensambla un sistema de información geográfica (GIS) y usa técnicas de análisis espacial para relacionar la población (la demanda) con los servicios de salud (la oferta), con el fin de valorar la accesibilidad de los servicios y su equidad. Se utilizan medidas tradicionales de acceso, como densidad de servicios o distancia al establecimiento más cercano. Dadas las limitaciones de estos indicadores, se desarrolla además un índice de accesibilidad que agrega todos los establecimientos ponderándolos por su tamaño, su cercanía y ciertas características del individuo y el establecimiento. Las características que componen el índice y sus ponderaciones se determinaron con un análisis de las probabilidades de que un hogar elija determinado establecimiento, en una muestra nacional de más de dos mil hogares y utilizando un modelo de regresión logística condicional. El estudio incluye un inventario de los servicios públicos de salud en Costa Rica y sus características. El inventario muestra que un número considerable de centros y puestos de salud han dejado de prestar servicios a la población. El estudio analiza también la demanda de servicios y su localización espacial, en el contexto del proceso de reforma. Encuentra que la reforma ha tenido lugar primero en lugares apartados, en poblaciones más dispersas y de menor condición socioeconómica. Las tendencias en la salud de estas poblaciones, medidas con la tasa de mortalidad infantil, no son diferentes que en las poblaciones que no están participado en la reforma. En lo referente al acceso a los servicios de salud y su equidad, en cambio, la reforma sí parece haber tenido un impacto, pues ha mejorado el acceso en las poblaciones que se encontraban en situación menos favorable, reduciendo las inequidades. Este resultado se debe al hecho ya anotado de que la reforma se inició en poblaciones menos privilegiadas y que se adoptaron medidas tales como la apertura de consultorios comunales o la conformación de los equipos básicos de atención integral de la salud (EBAIS) para atender a dichas poblaciones. El índice de accesibilidad desarrollado en este estudio se calculó para todas las localidades del país, lo que permitió identificar aquéllas con acceso deficitario y en las que intervenciones para mejorar el acceso tendrían mayor impacto. Entre esa poblaciones destacan las regiones hacia el Sur y Oeste del Valle Central, incluyendo los Santos y Acosta.