Effect of removing user fees on attendance for curative and preventive primary health care services in rural South Africa

User fees are used to recover costs and discourage unnecessary attendance at primary care clinics in many developing countries. In South Africa, user fees for children aged under 6 yea rs and pregnant women were removed in 1994, and in 1997 all user fees at all primary health care clinics were abolished. The intention of these policy changes was to improve access to health services for previously disadvantaged communities. We investigated the impact of these changes on clinic attendance patterns in Hlabisa health district. Average quarterly new registrations and total attendances for preventive services (antenatal care, immunization, growth monitoring) and curative services (treatment of ailments) at a mobile primary health care unit were studied from 1992 to 1998. Regression analysis was undertaken to assess whether trends were statistically significant. There was a sustained increase in new registrations (P = 0.0001) and total attendances (P = 0.0001)for curative services, and a fall in new registrations (P = 0.01) and total attendances for immunization and growth monitoring (P = 0.0002) over the study period. The upturn in demand for curative services started at the time of the first policy change. The decreases in antenatal registrations (P = 0.07) and attendances (P = 0.09) were not statistically significant The number of new registrations for immunization and growth monitoring increased following the first policy change but declined thereafter. We found no evidence that the second policy change influenced underlying trends. The removal of user fees improved access to curative services but this may have happened at the expense of some preventive services. Governments should remain vigilant about the effects of new health policies in order to ensure that objectives are being met.

A framework for table driven testing of Java classes

With the advent of object-oriented languages and the portability of Java, the development and use of class libraries has become widespread. Effective class reuse depends on class reliability which in turn depends on thorough testing. This paper describes a class testing approach based on modeling each test case with a tuple and then generating large numbers of tuples to thoroughly cover an input space with many interesting combinations of values. The testing approach is supported by the Roast framework for the testing of Java classes. Roast provides automated tuple generation based on boundary values, unit operations that support driver standardization, and test case templates used for code generation. Roast produces thorough, compact test drivers with low development and maintenance cost. The framework and tool support are illustrated on a number of non-trivial classes, including a graphical user interface policy manager. Quantitative results are presented to substantiate the practicality and effectiveness of the approach. Copyright (C) 2002 John Wiley Sons, Ltd.

Dynamic multi-resolution spatial object derivation for mobile and WWW applications

Online geographic information systems provide the means to extract a subset of desired spatial information from a larger remote repository. Data retrieved representing real-world geographic phenomena are then manipulated to suit the specific needs of an end-user. Often this extraction requires the derivation of representations of objects specific to a particular resolution or scale from a single original stored version. Currently standard spatial data handling techniques cannot support the multi-resolution representation of such features in a database. In this paper a methodology to store and retrieve versions of spatial objects at, different resolutions with respect to scale using standard database primitives and SQL is presented. The technique involves heavy fragmentation of spatial features that allows dynamic simplification into scale-specific object representations customised to the display resolution of the end-user's device. Experimental results comparing the new approach to traditional R-Tree indexing and external object simplification reveal the former performs notably better for mobile and WWW applications where client-side resources are limited and retrieved data loads are kept relatively small.

Mobile message services and communications policy

Something of a design after-thought, mobile phone SMS (Short-Message Services) have been enthusiastically adopted by consumers worldwide, who have created a new text culture. SMS is now being deployed to provide a range of services and transactions, as well as playing a critical role in offering an interactive path for television broadcasting. In this paper we offer a case study of a lucrative, new industry developing internationally at the intersection of telecommunications, broadcasting, and information services—namely, premium rate SMS/MMS. To explore the issues at stake we focus on an Australian case study of policy responses to the development of premium rate mobile messaging services in the 2002-2005 period. In the first part, we give a brief history of premium rate telecommunications. Secondly, we characterise premium rate mobile message services and examine their emergence. Thirdly, we discuss the responses of Australian policy-makers and industry to these services. Fourthly, we place the Australian experience in international context, and indicate common issues. Finally, we draw some conclusions from the peregrinations of mobile message services for regulators grappling with communications policy frameworks.