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Political Economy of Health Workforce Policy : The Chhattisgarh Experience with a Three-year Course for Rural Health Care PractitionersThis case study analyzes the reasons for
 adoption and the implementation process of a key policy in
 Chhattisgarh state, India, to create a rural cadre of
 trained physicians in order to address the acute shortage of
 doctors in the state's primary health facilities. It
 documents the experience specific to Chhattisgarh state, but
 with its attention to the policy processes and
 implementation challenges associated, it also highlights the
 necessity of a political economy perspective currently
 missing in much of the published literature on human
 resources for health. A principal lesson of this case
 concerns why it matters how interests of various
 stakeholders who had interests in the three-year course are
 included early in the policy process, namely the anticipated
 opposition of the medical doctor community represented by
 the Indian Medical Association (IMA) and the interests of
 the students themselves and their desire to be given
 appropriate status as medical doctors. This case study
 addresses the legal hurdles faced and the importance of
 institutional support structures to maintain quality
 standards and provide for grievance procedures. Through this
 case study, it also becomes apparent why the role of
 institutional ownership of policy matters rather than
 success or failure of policy that is linked entirely to the
 authority of a few key appointed officials.
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Frecuencia de la cesárea en Andalucía: relación con factores sociales, clínicos y de los servicios sanitarios (2007-2009).BACKGROUND Increasing trend and geographical variations in the use of caesarean section suggest the influence of non-clinical factors. The objective was to describe the use of caesarean section in the Andalusian region in Spain by exploring the role of social, clinical, and health services variables. METHODS A cross-sectional study was carried out using vital statistics. It involves all births occurred in Andalusia during the period of 2007-2009. The dependent variable was the use of caesarean section and the set of covariates were classified into three groups: those with a clinical meaning, those related to the health services organization, and those with a social significance. Multivariate logistic regressions were used. RESULTS In the data set of 293,558 births, the prevalence of caesarean delivery was 24.8%. The multivariate analysis highlights the labour complications as the clinical variable with the highest odds ratio (OR=19.36). Regarding the health services variables, the odds of experiencing a caesarean delivery were 55% higher on weekdays than on weekends. Cádiz was the province with the highest OR for caesarean section (comparison between Cádiz and Almería: OR=1,21) where the ratio between births in public and private hospitals was 3.7. The frequency of caesarean section was 34% higher in women with third level education than those with no education. CONCLUSIONS Labour complication is the most influential variable for caesarean section. Caesarean birth rate is above the accepted standards for all social classes and increases with educational level. Inter-provincial differences reflect different patterns with regard to the use of private medicine.
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The Impoverishing Effect of Adverse Health Events : Evidence from the Western BalkansThis paper investigates the extent to
 which the health systems of the Western Balkans (Albania,
 Bosnia and Herzegovina, Montenegro, Serbia, and Kosovo) have
 succeeded in providing financial protection against adverse
 health events. The authors examine disparities in health
 status, healthcare utilization, and out-of-pocket payments
 for healthcare (including informal payments), and explore
 the impact of healthcare expenditures on household economic
 status and poverty. Methodologies include (i) generating a
 descriptive assessment of health and healthcare disparities
 across socioeconomic groups, (ii) measuring the incidence
 and intensity of catastrophic healthcare payments, (iii)
 examining the effect of out-of-pocket payments on poverty
 headcount and poverty gap measures, and (iv) running sets of
 country-specific probit regressions to model the
 relationship between health status, healthcare utilization,
 and poverty. On balance, the findings show that the impact
 of health expenditures on household economic wellbeing and
 poverty is most severe in Albania and Kosovo, while
 Montenegro is striking for the financial protection that the
 health system seems to provide. Data are drawn from Living
 Standards and Measurement Surveys.