Access To Primary Health Care Research Articles

Challenging terrains: socio-spatial analysis of Primary Health Care Access Disparities in West Virginia.

Challenging terrains: socio-spatial analysis of Primary Health Care Access Disparities in West Virginia.

Effect of landuse on floristic composition and diversity of medicinal plants in the Guinea Savanna zone of Ghana

The use of medicinal plants is the most accessible primary health care approach in rural communities with limited infrastructure for western medicine. Medicinal plants are therefore an integral component of traditional medicine in Ghana, but wild bushes where medicinal plants regenerate naturally are being converted to alternative landuse. Although most landuse changes are destructive to biodiversity, some indigenous land use systems are known to be environmentally friendly. The present study examined the diversity and abundance of medicinal plants in three landuse types (Protected Area, Fallow land and Farmland) of northern Ghana. Twenty-five quadrates of 30 × 30 m were randomly laid in each landuse and replicated in three communities. Leguminosae, Combretaceae and Rubiaceae occurred as the most dominant medicinal plant families in all landuse but woody plants were significantly abundant in protected areas (p = 0.001). Species richness, Shannon diversity index, alpha and gamma diversities were all higher in the protected areas. Species composition also varied between landuse in beta diversity (p = 0.005, r2 = 0.33). Medicinal plant population have reduced significantly in farmlands, farmers should therefore adopt agroforestry practices to help conserve medicinal plant biodiversity.

Using the PMAQ-AB Mobile App and Management System to Evaluate the Quality of Primary Health Care in Brazil: Qualitative Case Study.

BackgroundThe application of cell phones, similar portable devices (ie, tablets), apps, the internet, and GPS in evaluation have established new ways of collecting, storing, retrieving, transmitting, and processing data or information. However, evidence is incipient as to which technological resources remain at the center of assessment practice and the factors that promote their use by the assessment community.ObjectiveThis study aimed to analyze the relationship between the use of the National Program for Improving Primary Healthcare Access and Quality’s (PMAQ-AB; Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica) mobile app and management system and the external evaluation quality of Brazil’s PMAQ-AB.MethodsWe conducted a qualitative case study during the external evaluation of Brazil’s PMAQ-AB. Data collection consisted of interviews, focus groups, and document analysis. A total of 7 members from the Department of Primary Care of the Ministry of Health and 47 researchers from various higher education and research institutions across the country participated in the study. Data were categorized using the ATLAS.ti software program, according to the quality standards of the Joint Committee on Standards for Educational Evaluation, following the content analysis approach by Bardin.ResultsThe results related to feasibility, thematic scope, field activity management, standardized data collection, data consistency, and transparency. They demonstrated improvements and opportunities for advancements in evaluation mediated by the use of information technology (IT), favored the emergence of new practices and remodeling of existing ones, and took into account the multiple components required by the complex assessment of access and quality in primary health care. Difficulties in technology operation, inoperative systems, and lack of investment in equipment and human resources posed challenges to increasing the effectiveness of IT in evaluation.ConclusionsThe use of technology-based tools—the app and the management system—during the external evaluation offered evaluators a greater opportunity for stakeholder engagement. This also allowed the insertion of different organizational, operational, and methodological components that are capable of triggering influences and confluences. In addition, this allowed connections in collaborative and synergistic networks to increase the quality and allow the development of a more consistent and efficient evaluation process with greater possibility of incorporating the results into public health policies.

Fostering Gender-IQ: Barriers and Enablers to Gender-affirming Behavior Amongst an Australian General Practitioner Cohort

ABSTRACT While the visible population of trans and gender diverse Australians has grown significantly in recent years, primary health-care access remains hindered by a lack of practitioner competency and stigmatization. This article draws on qualitative research of purposively selected gender-affirming general practitioners (GPs) in Australia to explore barriers, and enablers when treating trans and gender diverse patients. Perspectives and behaviors during the gender-affirming clinical encounter were theoretically informed through minority stress theory, and master narrative frameworks. Reflexive thematic analysis facilitated a rich description of exemplary gender-affirming primary care. A considerable gap exists between structural, clinical, and cultural behaviors among competent gender-affirming GPs in Australia, and the majority of practitioners evidenced in the literature. This critical analysis contributes to better understanding how gender-affirming Australian GPs diffuse minority stress, negotiate cis-normative biases, and foster a person-centered longitudinal therapeutic relationship with their trans and gender diverse patients. An encounter the article argues may also provide an essential buffer for GPs in Australia against the risk of professional burnout. Gender-affirming practice should be taught as a core competency and be required as professional development for GPs in Australia, to ensure a beneficial clinical encounter for the growing trans and gender diverse population.

Availability of the Yellow Fever Vaccine in Primary Health Care Services in Brazil

ObjectivesTo analyze the availability of the Yellow Fever (YF) vaccine at Primary Health Care (PHC) services located in areas with vaccine recommendation in Brazil between two different periods.MethodsSecondary data from the Program for Improving Access and Quality in PHC, with 13,666 services in 2013-14, and 19,125 in 2017-18, were used. A structured questionnaire was used for the data collection. Pearson’s chi-square and thematic cartographic maps were used to analyze the frequency of the YF vaccine, and Poisson regression with robust variances was used to analyze the associated factors.ResultsThe overall frequency of PHC facilities with YF vaccine always available increased from 87.0% (CI 95%; 86.4-87.5) in 2013-14 to 89.7% (CI 95%; 89.2-90.1) in 2017-18. Facilities located in the South, Southeast, Midwest and Northern regions and in non-state capitals, as well as centers that had adequate facilities for vaccination actions, as well as an adey -50quate cold chain network, showed a greater prevalence of YF vaccine always available.ConclusionThe frequency of a steady supply of YF vaccine available at PHC facilities, located in Areas with Routine Vaccination Recommendations, increased between 2013-14 and 2017-18. Geographical and structural characteristics related to vaccine actions at PHC facilities influenced access. The effective supply chain networks for the YF vaccine, together with adequate services at PHC facilities are essential to ensuring that the YF vaccine is always available.

Assessment of primary healthcare accessibility and inequality in north-eastern Kazakhstan.

Out of the many aspects of health care, the concept of physical accessibility is a priority that not only encompasses availability of health care resources, but also requires that they are easily accessible for all. To assess this factor as expressed in terms of the number of available physicians in the north-eastern part of Kazakhstan, we used the enhanced two-step float catchment area in a geographic information system approach. The Gini index and the Lorentz curve were used to evaluate the economic inequality within this region. Based on the data obtained, we developed models to increase the availability of health care considering allocation of additional primary health care resources. A low to zero index was found to be typical for most rural settlements, which currently make up less than 15% of the total population. We also identified a correlation between the index of accessibility and that of inequality, which indicates that areas with high accessibility show a more equitable distribution of resources. The developed location/ allocation models of additional primary health care resources can be useful in implementing government initiatives to improve the availability of primary health care in rural areas.

Optimising scale and deployment of community health workers in Sierra Leone: a geospatial analysis

BackgroundLittle is known about strategies for optimising the scale and deployment of community health workers (CHWs) to maximise geographic accessibility of primary healthcare services.MethodsWe used data from a national georeferenced...

Rethinking referral pathways: qualitative evaluation of general practice networks to increase access to intrauterine contraception.

Long-acting reversible contraceptives are recommended first-line contraception; however, intrauterine device (IUD) uptake remains low in Australia. To describe the outcomes of an independent evaluation of the General Practitioner IUD Insertion Network (GPIIN), a project designed to address access barriers through formalized referral pathways between general practitioners (GPs) inserting IUDs and noninserters. An independent qualitative pragmatic inductive evaluation, involving 14 in-depth interviews with GPIIN members, was conducted 18 months post-GPIIN implementation in 2 Australian jurisdictions to identify and explore critical success factors and limitations of the model. Local GP-to-GP IUD referral networks were considered a useful model to assist affordable and timely IUD access, improve noninserters' IUD knowledge and inserters' reflection on best practice. However, pathway simplification is needed to determine optimal integration of the concept into pragmatic GP-to-GP referral arrangements. GPIIN provides an opportunity to improve IUD access in Primary Health Care. Further consideration of organizations best positioned and resourced to facilitate sustainable delivery and coordination is necessary.

The results and perspectives of primary health care reforming in Moscow

The primary health care is characterized by its directivity to population health, while general practitioner is key figure in its organization and is responsible for assigned population health. The Russian Federation continues to suffer from overspecialization of medical care in outpatient health care. At that, the number of unreasonable visits to medical specialists is too high. The general practitioner, with appropriate training, can appoint patients by 11 specialties and in conditions of municipal polyclinic can undertake up to 81% of visits to medical specialists. The purpose of the study is to evaluate primary health care functioning in Moscow and to formulate proposals for reforming health care, considering development of general medical practices in a metropolis. The study was focused on analysis of morbidity of population of Moscow, on support of out-patient health care with physicians before and after implementation of three-level system of ambulatory polyclinic care, on evaluation of preventive activities of general practitioners and on development of proposals for improving organizational forms of activities with emphasis on health preservation. In the study were applied such methods as statistical, direct observation, sociological. The analysis was applied to forms of federal statistical observation i.e. form № 30 in Moscow and the Russian Federation for 2010-2019. The population sociological surveys concerning satisfaction with medical care were carried out. The research base was Moscow. The analysis demonstrated that results of Moscow health care system reformation is economically effective because of shortage of medical personnel primarily of administrative staff and its rational employment. The reformation results were positively assessed by patients, whose satisfaction with medical care made up to 95.6%. The general practitioner is to be responsible for health status of attached population and is called upon not only to carry out treatment and preventive activities, but also to coordinate organization of medical care of attached population at all stages of its provision. The implementation of general medical practice in conditions of municipality is to calculate complete transition of medical organizations providing out-patient medical care to general medical practice, that will result to certain extent, in reduction of staff positions of medical specialists. It is necessary to expand duties of medical nurse in general practice. The optimal model of joint work of general practitioner with feldsher and medical nurse of general practice. The complex general practice team can include medical registrar. The proposed perspective models permit to implement integrating role of general practitioner and to increase accessibility and efficiency of primary health care.

The relationship between structural racism and COVID-19 related health disparities across 10 metropolitan cities in the United States

IntroductionBlack, Hispanic, and Indigenous groups have carried the burden of COVID-19 disease in comparison to non-marginalized groups within the United States. It is important to examine the factors that have led to the observed disparities in COVID-19 risk, morbidity, and mortality. We described primary health care access within large US metropolitan cities in relation to COVID-19 rate, race/ethnicity, and income level and hypothesized that observed racial/ethnic disparities in COVID-19 rates are associated with health care provider number. MethodsWe accessed public city health department records for reported COVID-19 cases within 10 major metropolitan cities in the United States and also obtained publicly available racial/ethnic demographic median income and primary health care provider counts within individual zip codes. We made comparisons of COVID-19 case numbers within zip codes based on racial/ethnic and income makeup in relation to primary health care counts. ResultsMedian COVID-19 rates differed by race/ethnicity and income. There was an inverse relationship between median income and COVID-19 rate within zip codes (rho: -0.515; p<0.001). However, this relationship was strongest within racially/ethnically non-marginalized zip codes relative to those composed mainly of racially/ethnically marginalized populations (rho: -0.427 vs. rho: -0.175 respectively). Health care provider number within zip codes was inversely associated with the COVID-19 rate. (rho: -0.157; p<0.001) However, when evaluated by stratified groups by race the association was only significant within racially/ethnically marginalized zip codes(rho: -0.229; p<0.001). DiscussionCOVID-19 case rates were associated with racial/ethnic makeup and income status within zip codes across the United States and likewise, primary care provider access also differed by these factors. However, our study reveals that structural and systemic barriers and inequities have led to disproportionate access to health care along with other factors that require identification. Conclusion: These results pose a concern in terms of pandemic progression into the next year and how these structural inequities have impacted and will impact vaccine distribution.

Ethnobotanical Survey of Local Flora Used for Medicinal Purposes among Indigenous People in Five Areas in Lagos State, Nigeria.

Traditional medicine is typically the most accessible primary healthcare for a large proportion of the people in Nigeria. However, its potential remains under-explored, especially with regards to their documentation. This research investigated and documented the use of medicinal plants in the management of various health conditions/diseases among local populations in Lagos State. This study was conducted in five (5) locations of Lagos State i.e., Alimosho, Badagry, Eti-Osa, and Epe (including Ijebu and Imota). Ethnobotanical information from 100 participants was obtained using semi-structured questionnaires. Frequency of citation (FC), relative frequency of citation (RFC), fidelity level (FL), and informant consensus factor (ICF) were used to assess the importance of plants utilised for various health conditions/diseases. We identified 183 plants from 61 plant families with the highest number (24) of plants belonging to Fabaceae. Based on the high FC, the top-five popular plants used for managing health conditions/diseases in the study areas were Mangifera indica (95%), Waltheria indica (93%), Zingiber officinale (87%), Alchornea cordifolia (83%) and Ipomoea involucrata (81%). Furthermore, Rauvolfia vomitoria, Urena lobata and Waltheria indica were recognised as the most adaptable plants, as they were used to treat five different health conditions/diseases. The most commonly used life-forms were herbs (34%) and woody species (shrubs; 30%, and trees; 22%). The most regularly used plant parts were leaves. The calculated RFC values for all medicinal plant species ranged from 0.01 to 0.95, while FL values ranged from 7.14 to 100%. We found 14 health conditions/diseases, with ICF values ranging from 0.88 to 0.95. Insomnia, insanity, convulsion, nervousness, and muscle relaxants had the lowest (ICF = 0.88) agreement, while malaria/fevers, stomach, and respiratory-related diseases had the most (ICF = 0.95) agreement. The documented therapeutic uses of the plants provide basic data for further research aimed at pharmacological and conservation studies of the most important flora existing in the study areas.

Consequences of barriers to primary health care for children in Aotearoa New Zealand

Inequities in the provision of accessible primary health care contribute to poor health outcomes and health inequity. This study evaluated inequities in the prevalence and consequences of barriers that children face in seeing a general practitioner (GP) in Aotearoa New Zealand. We analysed data on 5,947 children from the Growing Up in New Zealand longitudinal study cohort on barriers to seeing a GP in the previous year, reported by mothers when their children were aged 24 months and 54 months (in 2011/12 and 2013/14 respectively); and maternal-reported hospitalisations in the year prior to age 54 months. We used logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CIs) for consequences of these barriers.Overall, 4.7% (n = 279) of children experienced barriers to seeing a GP in the year to 24 months and 5.5% (n = 325) in the year to 54 months. At each age, and for each specific barrier studied, barriers were more prevalent among Māori (the indigenous people of Aotearoa New Zealand), and among Pacific, compared to New Zealand European, children. Children facing barriers in the year to age 24 months were twice as likely to be hospitalised in the year to 54 months (OR 2.18, 95%CI: 1.38 to 3.44). When this relationship was analysed by ethnicity, the association was strongest for Māori (OR: 2.92, 95%CI: 1.60 to 5.30), less strong for Pacific (OR 2.01, 95%CI: 0.92 to 4.37) and not present for New Zealand European (OR 1.27, 95%CI 0.39 to 4.12) families.Barriers that children face to seeing a GP have social and cost implications for families and the health system. Changes to the health system, and future health policy, must align with the New Zealand government’s obligations under Te Tiriti o [The Treaty of] Waitangi, to ensure that health equity becomes a reality for Māori.

Approaches Used to Describe, Measure, and Analyze Place of Practice in Dentistry, Medical, Nursing, and Allied Health Rural Graduate Workforce Research in Australia: A Systematic Scoping Review.

Redressing the maldistribution of the health workforce in regional, rural, and remote geographical areas is a global issue and crucial to improving the accessibility of primary health care and specialist services. Geographical classification systems are important as they provide an objective and quantifiable measure of access and can have direct policy relevance, yet they are not always consistently applied in rural health research. It is unclear how research focusing on the graduate health workforce in Australia has described, measured, and analyzed place of practice. To examine approaches used, this review systematically scopes Australian rural studies focusing on dentistry, medicine, nursing, and allied health graduates that have included place of practice as an outcome measure. The Joanna Brigg’s Institute Scoping Review Methodology was used to guide the review. Database searches retrieved 1130 unique citations, which were screened, resulting in 62 studies for inclusion. Included studies were observational, with most focusing on the practice locations of medical graduates and predicators of rural practice. Variations in the use of geographical classification approaches to define rurality were identified and included the use of systems that no longer have policy relevance, as well as adaptations of existing systems that make future comparisons between studies challenging. It is recommended that research examining the geographical distribution of the rural health workforce use uniform definitions of rurality that are aligned with current government policy.

КОМПЛЕКСНЫЙ АНАЛИЗ РЕЗУЛЬТАТИВНОСТИ И ЭФФЕКТИВНОСТИ ДЕЯТЕЛЬНОСТИ МЕДИЦИНСКИХ ОРГАНИЗАЦИЙ СТАВРОПОЛЬСКОГО КРАЯ, ОКАЗЫВАЮЩИХ ПЕРВИЧНУЮ МЕДИКО-САНИТАРНУЮ ПОМОЩЬ В УСЛОВИЯХ РЕАЛИЗАЦИИ ПРИНЦИПОВ БЕРЕЖЛИВОГО ПРОИЗВОДСТВА В ЗДРАВООХРАНЕНИИ

Significance. A large number of efforts of health professional, as well as many modern targeted programs and projects are aimed at developing primary health care, including the Federal project "Lean polyclinic". The principles of lean manufacturing gained momentum in the priority project "Creation of a new model of medical organization providing primary health care (2017-2022)". Increasing patient satisfaction, access to services, elimination of the existing time, financial and other losses, as well as organization of safe and comfortable workplaces for employees improve performance effectiveness and efficiency of medical organizations. The purpose of the study. Scientific substantiation of the adoption of evidence-based management decisions for developing primary healthcare sector based on results of the independent comprehensive assessment of primary care quality and accessibility in the Stavropol Territory. Material and Methods. The present study assessed the quality and accessibility of primary health care in the Stavropol Territory over the period 2014-2020 according to the improved methodology of integral indicators and well-being index with adaptation to the structural transformations in health care. All medical organizations providing outpatient medical care (multidisciplinary hospitals and central city hospitals with attached population; individual polyclinics; district hospitals and central district hospital; local hospitals and outpatient clinics) were included in the study. The methodology has been adapted and improved to reflect changes in information sources in accordance with the adjustment of federal and sectoral statistical observation forms in 2019-2020. Conclusion. A comprehensive assessment of quality and accessibility of primary health care in the Stavropol Territory in 2014-2020 showed a multidirectional well-being index as an integral assessment criterion. In the period 2014-2019, all medical organizations that provide primary health care had a pronounced positive well-being index. In the conditions of the COVID-19 pandemic, the primary health care sector has been actively involved in providing diagnostics and treatment to patients with COVID-19, reflected by the decrease in the average well-being index in dynamics in comparing 2020 to 2014. However, the study results show that the decrease in the well-being index was not pronounced due to sustaining lean manufacturing principles in the primary care sector during the COVID-19 pandemic. Scope of application. Chief physicians of medical organizations, managers, executors of the project "Lean Polyclinic" can use the study results in order to improve efficiency and effectiveness of medical organizations of the Stavropol Territory, providing primary health care.

Global Health Strategies in the Face of the COVID-19 Pandemic and Other Unprecedented Threats.

Global health is evolving as a discipline aiming at exploring needs and offering equitable health services for all people. Over the past four decades, several global initiatives have been introduced to improve the accessibility of primary health care (PHC) and solve most health issues at this level. Historically, the 1978 Alma-Ata and 2018 Astana Declarations were perhaps the most important documents for a comprehensive approach to PHC services across the world. With the introduction of the United Nations Sustainable Development Goals in 2015, developments in all spheres of human life and multi-sectoral cooperation became the essential action targets that could contribute to improved health, well-being, and safety of all people. Other global initiatives such as the Riyadh Declaration on Digital Health and São Paulo Declaration on Planetary Health called to urgent action to employ advanced digital technologies, improve health data processing, and invest more in research management. All these initiatives are put to the test in the face of the coronavirus disease 2019 (COVID-19) pandemic and other unprecedented threats to humanity.

Advanced Access in Primary Health Care: experiences from Brazil and Canada

Access is the timely use of services in order to meet the needs of the user. As an alternative to the traditional model, the Advanced Access (AA) model appears in Canada , with schedules restricted to specific cases. Objectives: The purpose of this article is to analyze the existing scientific production about the Advanced Access model in Primary Health Care. Methods: Integrative literature review using the descriptors (1) “Health Care Accessibility” OR “Primary Health Care” AND and (2) "Advanced Access" in the PubMed, Scopus and BIREME databases. Selection criteria were studies published in the last five years, available in Portuguese, English or Spanish and dealing with the theme. Results: Eight studies were selected, six were grouped into two categories of analysis: “The Canadian experience with AA : a model in consolidation”; and “The Brazilian experience with AA: local experiments” and the other two contributed to enrich the discussion. The AA stands out to balance capacity and demand with physical infrastructure and adequate staff, both in the international arena, as the experiences of municipalities, improving the quality of APS. Conclusion: Studies that detail the AA in its practice, as well as the challenges and needs, can inspire other health units to study it and consider its implementation if it is appropriate for its context, aiming to improve the health and care of its population.

Access to primary healthcare Services in Conflict-Affected Fragile States: a subnational descriptive analysis of educational and wealth disparities in Cameroon, Democratic Republic of Congo, Mali, and Nigeria

BackgroundMeasuring and improving equitable access to care is a necessity to achieve universal health coverage. Pre-pandemic estimates showed that most conflict-affected and fragile situations were off-track to meet the Sustainable Development Goals on health and equity by 2030. Yet, there is a paucity of studies examining health inequalities in these settings. This study addresses the literature gap by applying a conflict intensity lens to the analysis of disparities in access to essential Primary Health Care (PHC) services in four conflict-affected fragile states: Cameroon, Democratic Republic of Congo, Mali and Nigeria.MethodsFor each studied country, disparities in geographic and financial access to care were compared across education and wealth strata in areas with differing levels of conflict intensity. The Demographic Health Survey (DHS) and the Uppsala Conflict Data Program were the main sources of information on access to PHC and conflict events, respectively. To define conflict intensity, household clusters were linked to conflict events within a 50-km distance. A cut-off of more than two conflict-related deaths per 100,000 population was used to differentiate medium or high intensity conflict from no or low intensity conflict. We utilized three measures to assess inequalities: an absolute difference, a concentration index, and a multivariate logistic regression coefficient. Each disparity measure was compared based on the intensity of conflict the year the DHS data was collected.ResultsWe found that PHC access varied across subnational regions in the four countries studied; with more prevalent financial than geographic barriers to care. The magnitude of both educational and wealth disparities in access to care was higher with geographic proximity to medium or high intensity conflict. A higher magnitude of wealth rather than educational disparities was also likely to be observed in the four studied contexts. Meanwhile, only Nigeria showed statistically significant interaction between conflict intensity and educational disparities in access to care.ConclusionBoth educational and wealth disparities in access to PHC services can be exacerbated by geographic proximity to organized violence. This paper provides additional evidence that, despite limitations, household surveys can contribute to healthcare assessment in conflict-affected and fragile settings.

Racial/Ethnic Disparities in Health Care Setting Choice for Adults Seeking Severe Acute Respiratory Syndrome Coronavirus 2 Testing.

Equitable access to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing is important for reducing disparities. We sought to examine differences in the health care setting choice for SARS-CoV-2 testing by race/ethnicity and insurance. Options included traditional health care settings and mobile testing units (MTUs) targeting communities experiencing disproportionately high coronavirus disease 2019 (COVID-19) rates. We conducted a retrospective, observational study among patients in a large health system in the Southeastern US. Descriptive statistics and multinomial logistic regression analyses were employed to evaluate associations between patient characteristics and health care setting choice for SARS-CoV-2 testing, defined as: (1) outpatient (OP) care; (2) emergency department (ED); (3) urgent care (UC); and (4) MTUs. Patient characteristics included race/ethnicity, insurance, and the existence of an established relationship with the health care system. Our analytic sample included 105,386 adult patients tested for SARS-CoV-2. Overall, 55% of patients sought care at OP, 24% at ED, 12% at UC, and 9% at MTU. The sample was 58% White, 24% Black, 11% Hispanic, and 8% other race/ethnicity. Black patients had a higher likelihood of getting tested through the ED compared with White patients. Hispanic patients had the highest likelihood of testing at MTUs. Patients without a primary care provider had a higher relative risk of being tested through the ED and MTUs versus OP. Disparities by race/ethnicity were present in health care setting choice for SARS-CoV-2 testing. Health care systems may consider implementing mobile care delivery models to reach vulnerable populations. Our findings support the need for systemic change to increase primary care and health care access beyond short-term pandemic solutions.

Critical social framework on the determinants of primary healthcare access and utilisation

This paper aims to contextualise ‘healthcare access and utilisation’ within its wider social circumstances, including structural factors that shape primary healthcare for marginalised groups. Mainstream theories often neglect complexities among...

The experience, results, and possible perspectives of organizing the optimally accessible primary medical care for the rural population of Zaporizhzhia region

Nowadays, the assessment of the activity of the domestic healthcare system is an important and actual issue, especially against the background the active reformation of this industry. One of the important elements of the assessment is studying the availability of primary healthcare to the rural population. The aim of this work is to study the territorial accessibility of primary healthcare, the adequacy and effectiveness of the principles of forming a network of primary care facilities in the rural areas of Zaporizhzhia region that enables to address issues and optimize the location of primary care facilities in the rural areas. Materials and methods. The materials of the research were the data of the official statistical reports for the past 20 years, which characterize the state of health and the degree of medical care accessibility to the rural population. During the research, the technique of complex social and hygienic research was applied, with the use of historical, sociological, sanitary and statistical methods, organizational experiment and others. Results. The article presents the main results of studying the current state of primary healthcare organization for the rural population of Zaporіzhzhia region against the background of active reforming processes. According to the research results, the main elements forming the system of accessibility are territorial, medical, social and economic. The main factors of impact on territorial accessibility are identified. These are: the nature of the settlement of rural residents (density, compactness, service-area radius, the proportion of the rural population, the distance between villages, the distance from a household to a healthcare facility); quality of roads; transport connections between settlements and healthcare facilities; availability of communication means. Conclusions. As a result of the research, the following conclusions were drawn. Such factors as population density, compactness of its location, service-area radius, distance between villages, distance from a household to a healthcare facility, condition and quality of roads, transport connections between settlements and healthcare facilities are important during forming or improving the network of healthcare facilities in rural areas. These factors must be considered for the rational placement of primary care facilities in rural areas.