Knowledge of the needs, demands, utilization, and health care seeking behaviors
By Prof. Elsie Le Franc
Professional Research Fellow
University of the West Indies
Science, Health and Development: Achievements and Challenges in One Hundred Years of PAHO.
XXXVII Meeting of the Advisory Committee on Health Research
Washington, D.C., 12-14 June 2002
"Recognition of the importance of health demand and health needs assessments is not new. The renewed attention being given to these topics has no doubt been spurred by growing concerns with ensuring a more efficient relationship between health care services and the needs of the population, that policy-makers are able to properly define what ought to be the priorities in limited resource situations, and that the issue of health equity is adequately addressed.
There have been important advances in knowledge and understanding - especially in respect of the influence of socio-economic factors on both health status and health demand. This progress has nevertheless raised several new questions, and identified critical areas in need of much greater investigation. Thus for example, the specific or precise pathways between socioeconomic factors and health demand remain unclear, as does the state of knowledge about the most effective ways of increasing the search for preventive care - especially among the poor. Significant knowledge gaps therefore continue to hamper the development of adequate and effective health promotion strategies. There are at least three reasons for the persistence of these gaps. One is the continuing dominance of institution or service-based approaches to measurement and assessment which, inter alia, equates health demand with service use and consumption. This has meant that unmet health needs tend to be insufficiently known, understood or tackled. Another is the poor data base and limited skill capacity on which most governments in the developing world must depend. The third is the somewhat tepid character of some of the official expressions of interest - a fact no doubt related to the probable futility of forward planning in very limited resource environments.
There are then at least two important challenges. These are a) the need to identify relatively simple and fairly rapid methodologies for the assessment and measurement of health needs - especially unmet needs, and b) the improvement of the understanding of the factors influencing the health utilization decision-making process. Addressing both challenges is critical for the provision of the evidence bases necessary for health planning and the design of appropriate health promotion efforts"(Au)