Health Services Utilization Across the Arizona-Sonora Border: A Binational Maternal and Child Health Project

144 Pages·1991·5.5 MB·English

by  Homedes, N.;LaBrec, P.

OFFICEOFMINORITYHEALTH Monograph No. 28
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Health Services Utilization Across
The Arizona-Sonora Border
A Binational Maternal
and Child Health Project
PreliminaryUtilizationStudyPhaseIIReport
NuriaHomedes,M.D.,Dr.PH
PaulLaBrec,B.A.
April 1991
RevisedOctober1991
—
(.
OFFICEOFMINORITYHEALTH
I ResourceCenter
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TheSouthwestBorderRuralHealthResearchCenterissupportedbyGrantNo.HA-R-000020-03fromthe
OfficeofRuralHealthPolicy,HealthResourcesandServicesAdministration.PublicHealthService,
U.S.D.H.H.S.,intheamountof$256,846.
SOUTHWEST BORDER RURAL HEALTH RESEARCH CENTER
The Southwest Border Rural Health Research Center is the research and
evaluationarmoftheRuralHealthOfficeattheUniversityofArizona.
The Southwest Border Rural Health Research Center is one of seven centers
funded by the Office of Rural Health Policy, Health Resources and Services
Administration,PublicHealthService. TheCenterreceivesadditionalfundingfrom
theNational Instituteon DrugAbuse, otherfederalagencies, andseveralprivate
foundations. The Center has, as itsfundamental mission, increased accessto
health services and concomitant improved health status of people living in the
Southwest border region. Emphasis is placed on those issues which are
amenable to public health/rural health policy assessments, including, but not
limitedto, primary health care delivery, health manpower distribution, financing
mechanismsandbarrierstohealthcareutilization.
THE AUTHOR(S)
Nuria Homedes, M.D., Dr. P.H., is a Faculty Research Instructor. She is
involvedinHealthServicesUtilizationStudiesalongtheU.S.-MexicoBorder.
Paul A. LaBrec, B.A., is a Research Specialist with the SWBRHRC. His
research interests include epidemiology, U.S.-Mexico border health, and health
careutilization.
TABLE OF CONTENTS
Page
I. INTRODUCTION 2
II. BACKGROUNDOFTHEPRIMARYHEALTHCARE
REVIEWPROJECT 2
#
HI. THEPRIMARYHEALTHCAREREVIEW (PHCR)METHOD.... 4
IV. THEPRIMARYHEALTHCAREREVIEWOFCHILDBEARING
AGEWOMENINTHEARIZONA-SONORABORDER.... 10
V. HEALTHSERVICESUTILIZATIONACROSSTHEBORDER... 18
BriefDescriptionoftheSurveysConductedin
Nogales,Arizona,andNogales,Sonora 18
CrossingtheBorderforDeliveryServices 20
CrossingtheBorderinSearchofPrenatal
CareServices 21
AdequacyofPrenatalCare 29
BarriersandSolutionstoObtainingPrenatalCare
andDeliveryServices 37
•
CrossingtheBorderforHealthServicesOther
ThanPrenatalCareandDelivery 40
VI. CONCLUSIONS 48
VII. RECOMMENDATIONS 49
VIII. SUGGESTEDRESEARCHQUESTIONS 50
REFERENCES 52
APPENDIX
I
APPENDIX
II
ABSTRACT
Thispaperreportstheresultsofabinationalprojectfocusingonthehealth
issuesofwomenofchildbearingage(18-44years). Theprojectwasconductedinthe
Nogales,ArizonaandNogales,Sonora,communitiesduringtheFallof1990;itwas
fundedbytheCarnegie-PewFoundationsandadministeredbythePanAmerican
HealthOrganization. TheprojectusedthePrimaryHealthCareReviewmethod.
Researcherswereabletodocumentbordercrossingbehaviorinsearchofprenatal
careanddeliveryservicesbywomenwhogavebirthduringthetwoyearspriortothe
survey. Sources of payment, reasons for using Mexican services, and
sociodemographicdatawereamongthevariablesmeasured. Inaddition,information
wasgatheredonworkingwomenandtheirinfants,theirneedsforhealthservices
andtheirworkingconditions.
Whilealmost8%ofMexicanresidents cametotheU.S. todelivertheir
babies,only2%ofU.S.residentwomenwenttoMexicofortheirdelivery. Twelve
percentofArizonaresidents,however,wenttoSonorafortheirprenatalcare. In
addition,14%ofthewomenwhoneededhealthcareservicesforthemselvesand14%
ofthosewhoneededhealthservicesfortheirchildrenduringtheyearprevioustothe
survey,usedMexicanresidentprovidersexclusively.Almost70%ofNogales,Arizona
respondentsboughtmedicinesinMexicowithoutaprescription.
While the presentation of findings, recommendations for action and
suggestions forfurther research are focused on issues related to health seeking
behavioracrosstheborder, thereportincludes an exhaustive descriptions ofthe
PrimaryHealthCareReviewmethodandtheChildbearingwomenresearchproject.
L INTRODUCTION
Thisreport contains informationregarding Health Services Utilization by
womenofchildbearingageattheNogales,Arizona-Nogales, Sonoraborder. The
report is based on data gathered during the Primary Health Care Review on
ChildbearingAgeWomen(18to44years)conductedduringtheFallof1990bythe
SouthwestBorderRuralHealthResearchCenterandElColegiodeSonora. Since
thisisthefirstmonographdrawingfromdatacollectedduringthePrimaryHealth
CareReview,adescriptionofthemethodandadescriptionoftheProjectprecedethe
presentationofthefindings.
EL BACKGROUNDOFTHEPRIMARYHEALTHCAREREVIEWPROJECT
InOctober1989,theSouthwestRuralHealthResearchCenterwasawarded
atwo-yeargrantthroughthe PanAmerican Health Organizationto carryouta
maternalandchildhealthprojectattheArizona-Sonoraborder. Fundingforthe
projectwasprovidedbytheCarnegie-PewFoundations.
TheArizona-SonoraborderprojectwasasubsetofthemuchbroaderCarnegie-
Pew/PAHO Project entitled "Review ofPrimary Health and Maternal and Child
HealthTechnologies forWomen, Children, andAdolescents ontheMexico-United
StatesBorder."
The aimoftheprojectwas to consolidate abinational, multi-institutional
networkintheU.S.andMexicoborderregionsandenhanceinstitutionalcapacityto
assistcommunitiesinplanningand conductingreviews ofthehealth statusand
healthservicesaccessandutilizationofselectedvulnerablepopulationgroups. The
project included researchers from the University ofTexas, the University of
Tamaulipas,theUniversityofArizona,theColegiodeSonora,andtheUniversityof
California. Theimpetusforinvolvementinthedevelopmentofabinationalproject
revolvesaroundmutuallysharedinterestsinworkingtogethertodelineatekeyhealth
issuesalongtheU.S.-Mexicoborder.
ResearchersagreedtoapplymethodstestedbytheWorldHealthOrganization
(WHO)tothereviewofprimaryhealthcare. Thepriorityhealthissuestoaddress
included those ofworking women, women in their childbearing years, infants,
children,adolescents,andmigratorypopulations,aswellasaccesstoandutilization
ofhealthservices. ThePrimaryHealthCareReview(PHCR)approachwaschosen
because it can be rapidly andreadily adapted to different settings; itis action-
orientedandreviewstheexistinghealthcaresystemwiththeintentofimproving
identifiedshortcomings. ThePHCRiscommunity-based,enlistingthecommunityin
allphasesofthereviewfromresearchdesigntoimplementationofpolicyobjectives.
Itgivesprovidersatalllevelsachancetogivetheirperceptions;placesmuchofthe
planningandevaluatingofservicesatthegrass-rootslevel;andencouragespublic
supportforfindings,decisions,andrecommendations.
BeforedescribingthePHCRconductedamongwomenofchildbearingageat
theArizona-Sonoraborder, anoverviewofthePHCRmethodwillbepresented.
in. THEPRIMARYHEALTHCAREREVIEWMETHOD1
ThePrimaryHealthCareReviewisbasicallyameansofdoingafocusedand
comprehensiveanalysisofthehealthsystemusingasetofquestionsabouthealth
statusandservicesdevelopedwithcommunityinput,withthegoalofimprovingboth
the health status ofthe population and health service delivery. It combines
epidemiological, sociological,anthropological,policyanalysis, andhealthplanning
approaches. Policyanalysisisimportantbecauseitprovidesamorecompletepicture
ofthediscrepancybetweenservicedeliveryexpectationsandreality. ThePHCRis
carriedoutinashortperiodoftime,isveryspecificincontent,and shouldhave
implicationsforaction.
TheWorldHealthOrganizationcallsthismethoda"Review"becauseitcan
serveasaneedsassessment,asadescriptionofdiscrepancybetweenhealthservice
policyandreality,asanevaluation,andasabaselinetocomparewithfuturereviews.
KeyPhasesinCarryingOutaReview
1. Planning:
a. formingtheReviewCommittee,
b. determiningtheobjectivesorquestionstobeaddressedintheReview,
c. decidingwhatextantdataareavailable,
d. assigningresponsibilityforthestepsoftheReviewtovariousmembersof
theReviewCommittee,and
e. preparingforthefieldworkforcollectingtherestofthedesireddata.
2. Gatheringandanalyzingtheextantdata.
1 Formoreinformationaboutthemethodology,see"ThePrimaryHealthCareReview
Method: HowWellDoesItWorkinaBorderCommunity?" Forthcomingmonograph.
3. Conductingthefieldwork.
4. Analyzingandreportingthefindings.
5. Makingrecommendationsforaction.
PlanningiskeytothesuccessofthePHCRmethod. Outofaproposedtwelve
monthproject,forexample,atleasteightmonthswouldbespentinplanningand
arrivingatthepointofdoingfieldwork. TheorganizationofthePHCRrevolves
around aworking group ofpeople called "TheReview Committee." The Review
Committeeiscrucialbecauseitguidestheplanningprocess.
TheReviewCommittee
Membershipmustbegearedtothosewhoknowthetopicoftheservicesunder
review.
AnimportantroleoftheReviewCommitteeistolimitthescopeoftheReview.
Ifthereviewistoobig,hastoomanyquestionstoanswer,isnotsharplyfocused,or
is too complex, then execution and analysis will be more difficult, reducingthe
probabilityofsuccessfulcompletionandreplicationofthePHCR.
ReviewCommitteeStructure:
TherearetwoessentialcomponentsinthestructureoftheReviewCommittee:
1. Abilitytomakepublicpolicyandimplementinterventions—committeemembers
who,asindividualsorrepresentativesofinstitutions,areabletomakeandcarry
out policy decisions. Members ofthe community at large may be included
representingcommunityvaluesas"policy."
2. Technicalcapacity~committeememberswhohaverequisiteskillsintheconduct
ofthe PHCR, includingepidemiology, community development, planningand
evaluation,datamanagementandsurveyresearch.
Thecombinationofthesecomponentsfacilitatesthetranslationofstatisticsand
informationintoaction.
ReviewCommitteeRoleandFunction:
TheroleoftheReviewCommitteeistoassumeresponsibilityforthePHCR
andfollowthroughwiththeimplementationoftherecommendationswhenthereview
is completed. The function ofthe Review Committee is to make decisions and
participateintheworkoftheReview. Decision-makingisintwoprincipalareas:1)
Policygoverningthereviewactivity,and2)TechnicalmanagementoftheReview.
Policydecisionsinclude:
a. Determinationofthepurpose,expectationsandscopeoftheReview. This
functionincludes: theacceptanceormodificationoftheguidelinesand
fundamentalresearchquestionsfortheprojectestablishedbythefunding
foundationsandPAHO;definitionofthequestionsofimportancetoarea
communitiestobeaddressedbytheReview;limitationoftheworkofthe
Reviewinaccordancewithprioritiesandresourceavailable.
b. Identificationofprioritiesamongtheproblemswhicharethesubjectofthe
Review.
c. ManagementdecisionsintheconductoftheReviewandparticipationinthe
activitiesoftheReview.
d. Thedevelopmentofrecommendationsandimplementationstrategiesand
activities. Committeemembersshouldexpecttoactonthefindingsofthe
Review.
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