Jens Seeberg

Treatment seeking and health financing in selected poor urban neighbourhoods in India, Indonesia and Thailand

This article presents a comparative analysis of socio-economic disparities in relation to treatment-seeking strategies and healthcare expenditures in poor neighbourhoods within larger health systems in four cities in India, Indonesia and Thailand. About 200 households in New Delhi, Bhubaneswar, Jogjakarta and Phitsanulok were repeatedly interviewed over 12 months to relate health problems with health seeking and health financing at household level. Quantitative data were complemented with ethnographic studies involving the same neighbourhoods and a number of private practitioners at each site. Within each site, the higher and lower income groups among the poor were compared. The lower income group was more likely than the higher income group to seek care from less qualified health providers and incur catastrophic health spending. The study recommends linking quality control mechanisms with universal health coverage (UHC) policies; to monitor the impact of UHC among the poorest; intervention research to reach the poorest with UHC; and inclusion of private providers without formal medical qualification in basic healthcare.

Medical syncretism in Yogyakarta: what do the practitioners get?

Background Medical syncretism involves activities conducted by healers who are mixing or blending different treatment strategy and explanatory models, is prevalent in the modern world. In medical pluralism, the pattern demonstrates that biomedicine exerts dominance over alternative medical system. The rigid clinical practice guidelines derived from the current best evidence of systematic reviews and meta-analyses involving many randomised-controlled trials (RCTs), have strictly guided physicians in managing patients’ diseases. In poor neighbourhood of Yogyakarta, it is not only the health seekers who combine biomedicine and traditional medicines, but some biomedical practitioners combined their techniques with alternative or traditional system. This paper aimed to describe why biomedical practitioners practicing medical syncretism; to explore what are their underlying practices; and what are their roles in medical pluralism.

Redistributing vulnerabilities: house reconstruction following the 2006 Central Java earthquake

Vulnerability in the face of disaster varies across individuals, households, neighbourhoods and social class. It is this social distribution of vulnerability in a given society that may turn hazardous events into disasters for some people and not for others. This distributional approach draws attention to continuities that explain catastrophes as an outcome of the workings of society prior to the event. Expanding on and partially deviating from this approach, in this paper, we draw attention to the social processes whereby vulnerability is modified and renegotiated in the period after the event of natural disaster where resources for disaster alleviation and reconstruction reach local communities. Specifically, we explore the social dynamics of house damage classification in the wake of the 2006 Central Java earthquake, and we explore relations between citizens and the state during post-disaster house reconstruction. We argue that disastrous outcomes of catastrophic events do not follow pre-existing fault lines of vulnerability in a simple or predictable manner, and that the social process of redistribution of vulnerability continues in the post-disaster scenario.