Suchergebnisse

Analysis of national health insurance accounts in the Democratic Republic of Congo (DRC) clearly shows the importance of international sanitary aid, particularly for the funding of general referral hospitals, the management of inpatients with AIDS, administration of health zones and funding of preventive care providers. It The targeted changes described in this article could possibly optimize the efficiency of international aid for the DRC population, mainly for disorders considered to be a health care priority (i.e. malaria, AIDS, tuberculosis) as well as in the fight against malnutrition. Recommendations target the implementation of procedures for control of food chain security, changes in lifestyle and dietary habits of the population but also comprise extensive restructuring of the health care administration. A dramatic change of the structure in charge of drug distribution as well as eradication of the transfer of part of public health structure income to public health administrative personnel could result in the allocation of significant funds to the fight against the most important diseases. Better collaboration between the various departments in charge of health care professional training, together with enhanced responsibility of health care personnel is essential. Independent and respected non-governmental organizations should be involved in an audit process, targeting all aspects of the current DRC health system. Eventually, in an equal opportunity perspective, taking into consideration the very high degree of poverty of DRC inhabitants, implementation of health insurance programmes, use of generic drugs and generalization of micro-credit initiatives should also be implemented. ; L'analyse des comptes nationaux de santé de la République Démocratique du Congo (RDC) montre le rôle essentiel joué par l'aide internationale, en particulier dans le financement des hôpitaux généraux de référence, des hôpitaux de prise en charge du sida, de l'administration des zones de santé et du financement des prestataires de soins préventifs. Il semble possible, par des changements ciblés, évoqués dans cet article, d'optimaliser le bénéfice retiré par la population congolaise de l'aide internationale, en particulier, dans le domaine des maladies prioritaires (paludisme, sida, tuberculose) ainsi que dans la lutte contre la malnutrition. Les recommandations portent sur la mise en place de procédures de contrôle de la sécurité de la chaîne alimentaire, sur le changement des comportements de la population vis-à-vis de la prévention des maladies prioritaires mais également sur une refonte globale de l'organisation des soins de santé. Une modification drastique de la structure de distribution des médicaments et l'arrêt de la rétrocession, à la hiérarchie, d'une part des recettes des structures de santé devraient permettre de libérer des moyens importants pour lutter contre les maladies prioritaires. Une meilleure collaboration entre le Ministère de l'Enseignement supérieur et le Ministère de la Santé, aboutissant à une refonte de la formation des personnels de santé, avec une responsabilisation progressive des agents en place, semble un prérequis. Il convient d'impliquer des organisations non-gouvernementales crédibles dans un processus d'évaluation des structures sanitaires de la RDC. Enfin, dans un souci d'équité tenant compte de la pauvreté des ménages, des actions telles que la mise en place d'une assurance-santé, le recours aux médicaments génériques et la généralisation des micro-crédits peuvent également être considérés. ; Peer reviewed

Purpose: Aggregated results of systematic reviews separately show how light used as a treatment and some occupational therapy interventions could have a positive impact on psychobehavioural disorders in older people. Since the beginning of June 2014 the Walloon Government has been financing a project which consists of a non-pharmacological approach that combines light and occupational therapy for a psychogeriatric population with specific symptoms: spatial and temporal disorientations, apathy, depression, agitation, anxiety, confusion and circadian disorder. The objective of this abstract is to expose the assumptions that the combination of two different light devices and one specific occupational therapy program could have an impact on the different symptoms of a psychogeriatric population. Methods: To build our hypothesis, two literature reviews have been achieved. The first one concerning the use of light as therapy gathered 30 studies while the other one about occupational therapy activities collected 35 articles. Results: Despite of a heterogeneity between studies dealing with light and occupational therapy, the combination of these two non-pharmacological interventions might fight the depressive syndrome, reduce the temporal disorientation thanks to a regularity in the period of activity, restore the circadian rhythm and so reduce some troubles that can be linked to them: sleep disorder, risk of fall, apathy, agitation, behavioural and cognitive troubles (attention, concentration). Moreover, one of the two light devices used which can modulate the light intensity according to the rooms might reduce the spatial disorientation if it's employed as a landmark. Conclusions: Based on literature reviews and our experience into this field it's seems that a non-pharmacological approach involving light and occupational therapy intervention could have a positive effect on symptoms of psychogeriatric population. In admitting that those effects are becoming true after experimentation and analyses, we can also expect an improvement of the quality of life. ; Peer reviewed

Introduction: Continuity of care is essential when trying to avoid untimely institutionalization of the frail elderly. Either continuously or occasionally, multiple care providers are involved in the integrated care for a community-dwelling frail older person. In this coming and going of care providers over time, the informal caregiver usually remains the constant factor. In 2009 the Belgian Federal Government launched a call for innovative projects that aim at maintaining the community-dwelling frail elderly at home for as long as possible. That call resulted in 66 projects that offer a variety of innovative interventions. Aims: The aim of this study is to describe to what extent these projects involve the informal caregivers in the organization of care for the frail elderly. Methods: Data are collected through the projects initial application files, yearly questionnaires, interviews and focus groups. We performed a descriptive analysis of the data and compared subgroups of projects based on the type of interventions. Results: First results show that in most projects involvement of the informal caregiver in the care process is not well established. A minority of projects describe how they plan to implement caregiver involvement in their application files. Caregiver involvement mainly occurs sporadically, when important decisions about an individual client have to be made. Conclusion: The projects lack a structured approach to implement informal caregiver involvement in the care process of frail elderly.

Introduction: Continuity of care is essential when trying to avoid untimely institutionalization of the frail elderly. Either continuously or occasionally, multiple care providers are involved in the integrated care for a community-dwelling frail older person. In this coming and going of care providers over time, the informal caregiver usually remains the constant factor. In 2009 the Belgian Federal Government launched a call for innovative projects that aim at maintaining the community-dwelling frail elderly at home for as long as possible. That call resulted in 66 projects that offer a variety of innovative interventions. Aims: The aim of this study is to describe to what extent these projects involve the informal caregivers in the organization of care for the frail elderly. Methods: Data are collected through the projects initial application files, yearly questionnaires, interviews and focus groups. We performed a descriptive analysis of the data and compared subgroups of projects based on the type of interventions. Results: First results show that in most projects involvement of the informal caregiver in the care process is not well established. A minority of projects describe how they plan to implement caregiver involvement in their application files. Caregiver involvement mainly occurs sporadically, when important decisions about an individual client have to be made. Conclusion: The projects lack a structured approach to implement informal caregiver involvement in the care process of frail elderly.

Purchasing power increase, improvement of living conditions and health funding of vulnerable people in African urban areas: the case of the health zone of Bandalungwa, Kinshasa (Congo) Through a survey, the study analyses the living improvement possibilities for microentrepreneurs, by the improvement of their purchasing power through microcredits provided by the Programme National d'Appui à la Protection Sociale (PNPS), in the health zone of Bandalungwa (Kinshasa). The credits were affected to wheat flour, starches, fresh food, fruits and vegetables, small restoration, smoked fish, clothing, electronic devices. Main results suggest that 68% of the microentrepreneurs financed by the program have declared improved living conditions. This improvement was associated to access to health care, children schooling, household's access to food, loan reimbursement, and rent payment. The bivariate analysis has shown that those who had invested the whole credit in the funded activity experienced living improvement. To help vulnerable people in increasing their purchasing power, the loans should be linked to projects that are helpful to the households, and avoid that households use the credit in unsuitable ways, which could maintain them in a high level of debt. ; Résumé Cette étude analyse les possibilités d'amélioration des conditions de vie des micro-entrepreneurs en augmentant leur pouvoir d'achat par le micro-crédit octroyé par le Programme National d'Appui à la Protection Sociale (PNPS), dans la zone de santé de Bandalungwa à Kinshasa, Congo, par une enquête exhaustive en 2008. Les prêts obtenus ont été investis dans : la farine de blé ou de froment (37,5%), les féculents (20,3%), les vivres frais (15,6%), les fruits et/ou légumes (14,1%), la petite restauration (6,3%), les poissons fumés et/ou salés (3,1%), la friperie (1,6%) et les matériaux électriques (1,6%). Les principaux résultats de cette étude ont montré que 68,8% des vendeuses financées ont déclaré une augmentation de leur pouvoir d'achat. Les micro-entrepreneurs qui ont déclaré avoir amélioré leurs conditions de vie ont associé cela à l'amélioration de leur accès aux soins de santé (86,4%), à la scolarisation de leurs enfants (54,6%), à l'approvisionnement de leur ménage en nourriture (40,9%), au remboursement de dettes contractées auprès de tiers (22,7%) et au paiement de loyer (18,2%) (p=0,003). L'analyse bivariée a montré que ceux qui ont investi l'intégralité du prêt dans le capital de l'activité financée ont vu leur pouvoir d'achat augmenter (65,6%) (OR=3,7). En l'absence d'une protection sociale adéquate, l'octroi de prêts permet aux individus et aux ménages de se prémunir contre les risques : les crédits servent au fonds de roulement de l'activité, à financer le capital humain et social ainsi qu'à la gestion de la trésorerie pour l'amélioration des conditions de vie. ; Peer reviewed