Abstract
BackgroundThe study set out to give an in-depth intersection of geo, eco-socio exposition of the factors relating to geography, healthcare supply and utilization in an island setting. This analysis is informed by what has emerged to be known as social epidemiology. We provide in-depth explanation of context to health care access, utilization and outcomes. We argue that health care delivery has multiple intersections that are experientially complex, multi-layered and multi-dimensional to the disadvantage of vulnerable population segments of society in the study area.MethodsWe used a cross-sectional qualitative exploratory design. Qualitative methods facilitated an in-depth exploration and understanding of this island dispersed and peripheral setting. Data sources included a review of relevant literature and an ethnographic exploration of the lived experiences of community members while seeking and accessing health care. Data collection methods included in-depth interviews (IDI) from selected respondents, observation, focus group discussions (FGDs) and key informant interviews (KII).ResultsWe report based on the health care systems model which posits that, health care activities are diverse but interconnected in a complex way. The identified themes are; the role of geography, access (geographical and financial) to health services, demand and utilization, Supplies, staffing and logistical barriers and a permissive and transient society. When and how to travel for care was beyond a matter of having a health need/ being sick and need arising. A motivated workforce is as critical as health facilities themselves in determining healthcare outcomes.ConclusionGeography doesn’t work and affect health outcomes in isolation. Measures that target only individuals will not be adequate to tackle health inequalities because aspects of the collective social group and physical environment may also need to be changed in order to reduce health variations.
Highlights
The study set out to give an in-depth intersection of geo, eco-socio exposition of the factors relating to geography, healthcare supply and utilization in an island setting
Location as a barrier to service access Poor communication, transport and a transient population Seasons and healthcare ii) Access to health services, demand and utilization to the Ministry of Health norms, to adequately cover its population of 54,100, the district should have a total of 16 health centers in addition to a hospital
Our findings indicate that health infrastructure in Kalangala is limited with the nearest hospitals in Entebbe (30-120 km) and Masaka (40-114 km)
Summary
The study set out to give an in-depth intersection of geo, eco-socio exposition of the factors relating to geography, healthcare supply and utilization in an island setting. This analysis is informed by what has emerged to be known as social epidemiology. We provide in-depth explanation of context to health care access, utilization and outcomes. In Uganda, the north-eastern and island populations have less access to healthcare [13, 14], but the focus has been on technical factors in health care especially health infrastructure and supplies [15] and not geo-socio factors. This study is a further exposition of what has emerged to be known as social epidemiology [18,19,20]
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