Wilma Bailey

Spatial patterns of use of health services in the Kingston Metropolitan Area, Jamaica

This study focuses on the influence of distance, transport and accessibility on the use of health services in Kingston, Jamaica. It reviews various factors affecting the use of health care with particular reference to Third World cities and presents results from a case study of utilization in the Kingston Metropolitan Area. Three pairs of sites of contrasting social status were selected and 50 respondents questioned in each about spatial patterns of primary health care (PHC) attendance. Types of facility attended, mode of transport, travel times, distance and frequency of utilization were discussed. Some distinctive differences appeared between low and high status site respondents with regard to distances to facilities and travel times, which were almost always higher for the low status respondents. Most respondents were not using their nearest facilities, for varying reasons which included, for poorer respondents, need to attend frequently distant public facilities and, for wealthier respondents, loyalty to old family doctors and use of company-related doctors. The mobility of the higher status respondents afforded them considerable choice of locations used for health care and their attendance was much more convenient than that of lower status respondents. Utilization rates were somewhat higher in the high status sites although not to the extent found by some earlier studies in similar settings.

Linking researchers and policy-makers: some challenges and approaches

In developing a proposal for the study of the effect of user fees on access to preventive care, a team, comprising researchers and policy-makers, initiated interaction with key policy implementers in the Jamaicas Ministry of Health to ensure that their perspectives were considered at the preliminary stage. There were many pressing events occupying the minds and energies of the implementers, but the team was able to capitalize on existing good relationships to capture attention. In the interviews that followed, agreement was reached on the necessity for the study, its focus and methodology. The process of consultation achieved notable successes and can be regarded as a model for successful research and policy interaction.

Patterns of contraceptive use in Kingston and St Andrew, Jamaica, 1970–1977

The records of a sample of Family Planning acceptors were examined to identify those factors which influenced the choice of a contraceptive and the drop-out rate in the period 1970--1977 inclusive. It was found that although a full range of contraceptives was theoretically available, as the 1970s advanced the effective choice appeared to lie between the two hormonal contraceptives, medroxyprogesterene acetate (Depo Provera) and the oral contraceptive pill with family size being the deciding factor. The drop-out rate as also influenced by family size with nulliparous women showing the highest rate. Explanations for the drop-out rates and the percentage of single visits made to the clinics were sought through the utilization of partial correlations. In both cases the average distance between the acceptors home and the clinic appeared to play a decisive role.

Child morbidity in the Kingston metropolitan area, Jamaica 1983

The case reports of all children admitted to public and private hospitals in the Kingston metropolitan area were examined for an analysis, by special areas, of spatial variations in child morbidity. A Poisson probability test was applied in order to determine areas of significant excesses in admission rates and three special areas selected for a child health survey. At the 0.025 significance level 20 of the 72 special areas had significantly higher and three significantly lower levels of admission. The survey confirmed the pattern revealed by hospital admissions and suggested that the children of young, unemployed and single women may be particularly vulnerable.

Women in search of stability

This paper is based on a study of 97 recruits--50 sterilized and 47 non-sterilized--to a family planning programme in Kingston, Jamaica and tries to account for the reluctance of Jamaican women to accept contraceptive sterilization. The study demonstrates the association between mating patterns in the island and the acceptance of sterilization. This irreversible method was more likely to be chosen by women in more stable sexual unions.

Race, integration and family planning in Trinidad and Tobago.

The study considered the effect of the integration of the health services on family planning in Trinidad and Tobago. A drop-out study was based on a sample of six clinics, three representing integrated and three clinics that were non-integrated or vertical. Efforts were also made to solicit the views of a sample of drop outs, current acceptors and health-care providers.The study found that there were characteristics of the population from which acceptors were drawn that were more important in explaining utilization than the question of integration or non-integration of the clinics. Many of the problems were organizational and could, with adequate financing, be met by an even higher level of integration.