Accessing Quality Healthcare Services Research Articles

A perspective on policies and practices regarding access to and quality of healthcare for people with intellectual disabilities in Zambia

AbstractZambia is a low‐income country on the African continent which is facing a high rate of health inequalities. Although the government has made efforts to reform the organization of healthcare to reduce inequalities, the practical implementation of disability policies remains challenging. Specifically, people with intellectual disabilities (ID) face barriers to accessing healthcare services in Zambia, due to geographic or socioeconomic factors, stigma, and limited specialized health professionals. This perspective paper provides an overview of the current policy and organization on the healthcare provision for people with ID. It presents the key challenges people with ID face in Zambia to access quality healthcare services. Additionally, we provide examples of good practices with a community approach. We discuss policy implementation of disability rights, including access to healthcare, the impact of raising knowledge and awareness about people with ID, and how gathering contextual information through research can help to reduce inequalities. Community and culturally sensitive approaches to improve access to healthcare for people with ID in Zambia are crucial. We call for close collaboration between the fields of research and practice to combine expertise and strengthen the impact and possibilities of scaling good practices within Zambia.

Digital health and Universal Health Coverage: Opportunities and policy considerations for low- and middle-income Pacific Island countries and territories

Introduction: Providing affordable, accessible, quality health services is critical to attaining Universal Health Coverage (UHC). Despite this, progress in many Pacific Island countries and territories could be faster. Digital health is an advancement in information communication technology that is anticipated to change health care delivery.
 Methods: A systematic review of the literature and 5-years of Pacific Heads of Health, Pacific Health Ministers, and WHO’s (Western Pacific) Regional Committee meeting reports was conducted. In addition, an umbrella review of the literature pertaining to digital health's use to address health systems challenges in low-and middle-income countries was undertaken and key-informant interviews with policymakers, digital health managers, technical advisors, development specialists, and donors were held. Data was thematically analysed using an inductive approach. Finally, a series of consultations were held with Pacific Health Information Network members to test findings and refine recommendations.
 Results/Discussion: Four broad UHC-related challenges and associated priority digital health responses were identified. The challenges identified were a need to: (i) build systems for the collection and timely exchange of health data to support clinical management and health system planning; (ii) address barriers to accessing quality health care services (particularly in rural areas); (iii) improve mechanisms for communication between health staff and functions of the health system, and (iv) address workforce training and essential skills development. Priority digital health responses identified include electronic health and patient information systems, telehealth, digital stock and supply chain management systems, technology-supported collection and linkage of population data, digitally enabled health worker-to health-worker communication and digital clinical decision-making.
 Conclusion: While digital health can enhance health system function through accelerated access to and exchange of information, it does not replace fundamental health systems components such as a sufficient skilled health workforce, supply chains, health reporting, financing, or governance. Where adopted appropriately, digital health offers opportunities to improve the efficiency and effectiveness of established health enterprises and improve access to equitable and quality health care.

Beyond Access: Can a School Health Initiative Facilitate Healthcare Services Utilisation for School-Going Children?

Accessing quality healthcare services is critical to addressing the different health challenges confronting school-going children, especially those in low-resource communities. However, the evidence of access to services is utilisation and not the mere availability of such services. This study explored caregivers' descriptions of the factors influencing the access and utilisation of quality healthcare services for school-going children and their perceptions of the services provided through the integrated school health programme in South Africa. Qualitative interviews were conducted with 17 caregivers of school-going children in three low-resource communities of KwaZulu-Natal province. The data was analysed using thematic analysis, and the themes were clustered using components of the Aday and Andersen framework for access. Despite the efforts to expand the coverage and range of services provided through the Integrated School Health Programme (ISHP), we identified various factors that undermine the overall aim of the ISHP. Financial constraints, distance to health facilities, poor communication and information dissemination systems, low literacy levels, healthcare workers' negative attitudes, and long waiting periods at the referral sites constitute barriers to service utilisation. Specific attention should be paid to improving the communication system between the school-health team and the caregivers, providing support for transportation, improving the attitude of the clinic staff, and providing follow-up services for children referred for further screening and treatment.

Experiences of stigma and discrimination of women living with HIV/AIDS in health-care settings of Kashmir.

Stigma and discrimination create barriers for women living with HIV/AIDS (WLHA) in accessing quality health-care services, affecting their well-being and also increasing the number of cases. The current article studies issues of stigma and discrimination that WLHA experience in health-care settings and highlights the importance of building awareness and sensitivity regarding HIV among all health-care workers. This hospital-based study was conducted in an anti-retroviral therapy center in Kashmir. Twenty-one WLHA participated in the study. The WLHA internalizes stigma and experiences shock, guilt, anger, and numbness while receiving a diagnosis. The stigma is socially constructed, having very little medical or logical basis. Verbal abuse, gossiping, expression of shock and disbelief of health-care workers, discriminatory attitudes such as wearing multiple surgical gloves, denial of care and treatment, and disclosing their HIV-positive status without their consent to their families and others have been learned. These experiences in health-care institutions are disempowering for WLHA. Gender stereotyping and inequalities within health-care settings and the discriminatory approach of some health practitioners toward women is the main barrier to accessing the services for HIV prevention, treatment and support services.

Identifying potential community barriers for accessing health care services context to health for all in rural-tribal geographical setting in India: A systematic review

This review article focuses on community barriers among tribes living in different parts of rural regions in India and placed to find out the possible resolution/passion. The access to health care services has a very low coverage in rural region of the country especially in tribal communities. A systematic search was covered since last two decades from 2000 to 2020 of articles were extracted from Google Scholar, PubMed, Science Direct, JSTOR, WHO portal, Research Gate, Census 2011, etc. The health indicators of tribes were originated alarming status quo as widely held malnourished and sufferer from different disease and illness. Findings towards accessing quality health care services revealed that difficult geographical situation, communication in own language, financial constraint, low level of education, illiteracy, approaching traditional medicine and ancient culture as community barriers were remained constant. Low level of education, strong cultural believes and traditional culture norms are the strongest community barriers reflected their self-decision-making for not accessing the modern health care facility. An approach as creating effective awareness in harmonic way could be useful for bridging the gaps by involving existing medical resources and staffs, which can play a critical role in reducing the barriers. Thus, review findings suggest the need for implementing awareness programs can divert towards quality health care and thereby can “connect the unconnected” to stay healthy.

P106 Where is the care in healthcare? Mother perspectives’ of caring for a child with narcolepsy

Abstract Introduction When caring for a child with a chronic illness, primary caregivers become care coordinators, system navigators, and illness experts. There is limited research on the challenges faced by family/carers of a child with narcolepsy. Methods Twenty participants who self-identified as a family/carer of a child with narcolepsy were interviewed, all of whom were mothers. Prior thematic analysis of submissions made by family/carers to the parliamentary inquiry informed interview questions. Interviews were analysed using the framework approach by a team of six multidisciplinary researchers. Results Three themes were identified. ‘Adjustment, communication and coping’ encapsulates challenges associated with diagnosis, the mental health toll it has on the whole family, and the limited support available to mothers. ‘Healthcare journey of narcolepsy families’ described challenges faced in the healthcare system, with mothers speaking of dismissal of their concerns and experiences of a lack of equity when accessing quality healthcare services for their child. ‘Independence, support, and resources’ unveiled the challenges carers faced accessing disability and academic supports at school and the workplace, underscoring mothers’ concerns for the future independence of their child. Discussion Mothers felt they had limited control over the trajectory of their child’s healthcare journey and emphasized the adverse psychological effect narcolepsy had on the entire family. There was an expectation that clinicians should be providing more information and support than currently is provided, across areas that traditionally are not within the healthcare domain. This raises important questions around who is responsible for providing this information and where is sourced from.

Historical Antecedents and Challenges of Racialized Immigrant Women in Access to Healthcare Services in Canada: an Exploratory Review of the Literature.

Examining the historical antecedents of racialized immigrant women are important precursors to understanding the challenges they face in access to quality and timely healthcare in Canada. Changes to immigration policies, structural and systemic racial discrimination perpetuate the feminization of migration in Canada, create structural barriers in labour market integration, increase social exclusion and ultimately create unequal access to healthcare services. Despite their high levels of education, racialized immigrant women in Canada are over-represented in low-paid, low-skill precarious jobs. They also face powerful structural barriers to decent professional employment due to the lack of acceptance of foreign educational and licencing credentials. Ultimately, these challenges negatively impact how they interact with healthcare services. Utilizing an intersectional and socio-ecology framework, this review aims to highlight the historical antecedents of racialized immigrant women in access to healthcare services in Canada and examine the challenges racialized immigrant women face in access to healthcare services in Canada. Findings from this review can be used to open dialogues on possible changes to immigration and social policies in Canada, including changes to labour market practices, and initiatives to address structural and systemic barriers, to enable racialized immigrant women overcome the challenges they face in accessing quality healthcare services in a timely manner.

9.M. Workshop: Migration and health

Abstract Migration has witnessed important development worldwide and in the Mediterranean region because of globalization, political and economic transformations and climate changes. Global agreements on trade in service in addition to deteriorating working conditions have facilitated movement of health professionals from countries of the south to countries of the north with dramatic implications on health systems. The middle east and North Africa region are presently hosting the highest numbers of refugees and migrants fleeing wars and civil strives in South East Asia, Sub Saharan Africa and Middle East. They live in difficult conditions and do not access quality health care services. The geostrategic position of Maghreb and North African countries and their historic ties with Europe imposes to build collaboration and solidarity to deal with the issue of migration and health. Refugees and migrants in Northern and Southern banks of the Mediterranean lack appropriate health and social services, often provided by generous civil society organizations with limited commitment from national governments. Also, their vulnerable status makes them easy targets for international and national human trafficking gangs. Professional associations and scientific societies and schools of public health have an important advocacy role through research and generation of evidence. Health professionals from countries of the southern Mediterranean countries are migrating at increasing pace for several reasons including worsening working conditions to countries of the north and mainly to Europe. Such uncoordinated migration is negatively impacting on health service delivery in countries and it is representing a serious challenge to health systems. Unfortunately, countries of the North, apart from Germany in relation to nurses migrating from Vietnam, are not applying the WHO code of ethics in international recruitment of health professionals. The objectives of the workshop are to: Document gaps in health and social services provided to refugees and migrants as well as issues related to human trafficking among refugees and migrants.Share experiences among countries of the region in provision of health and social services to migrantsAdvocate human right approach in access to decent health and social services to refugees and migrants in Europe and southern Mediterranean countries.Plea for the implementation of the WHO code of ethics in international recruitment of health professionals. Presentations during the workshop: Human trafficking among refugees and migrants in Tunisia: By Dr. Belgacem Sabri.Health promotion for migrants in Morocco: Progress, challenges et prospects, By Pr. Abderrahmane Maaroufi.Brain drain of Tunisian competencies: The case of health professionals: By Pr. Lassaad Laabidi, and Dr Belgacem SabriMapping of access of refugees and migrants in Tunisia in access to social and health care services by Pr. Chokri Arfa. Key messages Advocate human right approach in access to decent health and social services to refugees and migrants in Europe and southern Mediterranean countries. Plea for the implementation of the WHO code of ethics in international recruitment of health professionals.

A Framework for Real-Time Healthcare System Performance in Developing Countries

This study proposes a conceptual structure for the success of the real-time healthcare program in developing countries. Whilst developing and some developed countries face a significant challenge in adopting the application of real-time healthcare, this work aims to analyze the perspectives of healthcare practitioners in Malaysia. Since 1997, Malaysia has been putting efforts to introduce a real-time healthcare system, but due to geographical constraints and shortage of physicians, people in the rural area often have a hard time accessing quality healthcare services. This research proposes a remote patient's management framework to predict user's behaviour by three outputs of the real-time healthcare system performance: Net gain, system expectation and acceptance. Remote patient management system offering access to patient's data regardless of the location of patients and physicians is the only way forward for healthcare providers in developed and developing countries facing a shortage of healthcare services due to geographical constraints natural disasters of pandemics. We emphasize that there should be no compromise when it comes to the privacy of the patient's data in the proposed system. However, recent technologies such as the Internet of Things and Blockchain is deployed to ensure utmost privacy and security of patient's data.

Provision of Health Services to the Internally Displaced Persons in Maiduguri, Borno State, Nigeria: Collaborative Approach

There is need to respond to the plight of the Internally Displaced Persons (IDPs) amidst the growing number of calls for concerted efforts and better management. This can be facilitated through collaboration among the agencies responsible for the management of IDPs. The government of Nigeria and indeed Borno state government lacked the capacity to wholly manage the IDPs, hence, the need for the NGOs to assist the government in that regard. The study assesses the effect of collaboration among agencies in the management of the IDPs in Borno state. The obligatory humanistic theory was used in the study. The study adopted survey method and both primary and secondary data were used. The questionnaire, Interview, and Focus Group Discussion were used to obtained primary data. The study population is 2018 consisting of government officials, NGOs, and IDPs. The sample size of the study was 349 respondents; 333 government officials and 16 NGOs. Multi-staged sampling technique was used in selecting the sample. Both descriptive and inferential statistics were used for analysis of the data obtained. ANOVA and chi-square were used to test the hypotheses. The study found out that inter-agency collaboration effort has significantly reduced the outbreak of disease in IDPs camps in Maiduguri. The IDPs have access to child and maternal cares services and all barriers to accessing quality healthcare services have been eliminated in camps in Maiduguri. The study concludes that inter-agency collaboration has been effective in the provision of healthcare services to IDPs in Borno state. The study, therefore, recommends among others that agencies should work out modality to ensure improved referral healthcare system.

Governance and stewardship of quality in health services in Peru

The care of people and their health is a primary function of the family and of society as shown by studies on primitive humans, as well as in pre-Hispanic Peru. The conquest and subsequent centuries of colonization fractured the traditional way of caring for people, replacing social solidarity with charity actions mainly from religious orders that provided hospices later called hospitals. During the colony and until the beginning of the 20th century, the care of the sick continued to be the responsibility of charitable institutions, such as the Charities created after independence. Social rights such as education and health only emerged in the first decades of the last century and were enshrined in the 1933 Constitution. However, both in that Constitution as in those from 1979 and 1993, the right to education was recognized more fully, while the right to heath was limited. The Universal Health Coverage Act of 2009 propounds guaranteeing the right to access quality healthcare services for everybody, as part of the right to health in the broadest sense. The current limitations force us to redefine the right of every citizen to comprehensive care of their health and the State's guidance to guarantee it.

Patient-Provider Communication Training for Dysarthria: Lessons Learned from Student Trainees

AbstractPatient-provider communication skills training programs rarely include content addressing how health care providers can improve communication with patients exhibiting dysarthria and other communication disorders. Consequently, these patients often struggle to access quality health care services. This article describes a training program focused on giving health care students the opportunity to interact with standardized patients portraying dysarthria and aphasia. A summary of the program's outcome is then provided from the perspective of the students involved as well as lessons students taught us about how to continue improving this type of program and to make it a more universal part of health care education.

Implementation of a 4-tier cloud-based architecture for collaborative health care delivery

Cloud services permit healthcare providers to ensure information handling and allow different service resources such as Software as a Service (SaaS), Platform as a Service (PaaS) and Infrastructure as a Service (IaaS) on the Internet, given that security and information proprietorship concerns are attended to. Health Care Providers (HCPs) in Nigeria however, have been confronted with various issues because of their method of operations. Amongst the issues are ill-advised methods of data storage and unreliable nature of patient medical records. Apart from these challenges, trouble in accessing quality healthcare services, high cost of medical services, and wrong analysis and treatment methodology are not left out. Cloud Computing has relatively possessed the capacity to give proficient and reliable method for securing medical information and the need for data mining tools in this form of distributed system will go a long way in achieving the objective set out for this project. The aim of this research therefore is to implement a cloud-based architecture that is suitable to integrate Healthcare Delivery into the cloud to provide a productive mode of operation. The proposed architecture consists of four phases (4-Tier); a User Authentication and Access Control Engine (UAACE) which prevents unauthorized access to patient medical records and also utilizes standard encryption/decoding techniques to ensure privacy of such records. The architecture likewise contains a Data Analysis and Pattern Prediction Unit (DAPPU) which gives valuable data that guides decision making through standard Data mining procedures as well as Cloud Service Provider (CSP) and Health Care Providers (HCPs). The architecture which has been implemented on CloudSim has proved to be efficient and reliable base on the results obtained when compared with previous work. Keywords: Architecture, collaborative, cloud computing, cloud service provider (CSP), health care

Enhanced Cloud based Model for Healthcare Delivery Organizations in Developing Countries

Healthcare Delivery Organizations (HDOs) in developing countries have been faced with a number of problems due to their mode of operations. Amongst the problems are improper modes of data storage, insecurity of patient medical records, difficulty in accessing quality healthcare services, high cost of medical services, and inaccurate diagnosis and therapy procedures. In recent times, research has identified Cloud Computing (CC) as a new and substantial business model capable of providing efficient services that would benefit the healthcare industry. Despite its numerous advantages, CC has not been able to provide efficient means of securing medical data and it also lacks adequate data mining tools. This research therefore, proposes an enhanced model that integrates HDOs in developing countries into the cloud. The proposed model consists of a Data Security and User Authentication Engine (DSUAE) which prevents unauthorized access to patient medical records and as well employs standard encryption/decryption techniques to guarantee confidentiality of such records. The model also contains a Data Mining/Analysis and Pattern Prediction Engine (DMAPPE) which provides useful information that aids decision making through standard Data Mining techniques.

A community (dis)service: Reflections of a community service clinical psychologist

In improving access to quality health care, the National Department of Health has made community service mandatory in South Africa for newly graduated health professionals. Largely informed by the shortage of health care professionals within the public health sector, the community service initiative can also be located within the larger global impetus of integrating mental health into primary health care. This article attempts to answer the question as to whether the author’s particular community service placement, located in the Overberg District Municipality, improved the access to quality mental health care services. The challenges inherent in this placement site are numerous. These include, but are not limited to, patients’ inability to access the service due to financial constraints and the lack of public transport, the burdensome work environment of generalised nursing personnel and their lack of training in mental health care, the absence of mental health specialists and a multidisciplinary health team, the provision of mental health care being embedded within the biomedical model, and a lack of institutional support. As the article will argue, these weaknesses are largely reflective of the poorly integrated health system operative within the Overberg District Municipality. The author aims to provide recommendations as to how these can be addressed so as to ensure that the strategic thrust, as envisioned by the National Department of Health with the introduction of the community service initiative, comes to fruition in that individuals can access quality health care services within their respective communities at the primary level of care.

The Second Market Failure Phenomenon in Safety-Net Health Systems: The Case of a Municipal Academic Medical Center from 1980 to 2000

The specific aim of this analysis is to demonstrate how the trade-off between efficiency and equity policy approaches affects the ability of at-risk children to access quality health care services at the King/Drew Medical Center of Los Angeles County from 1980 to 2000. The concept of a second market phenomenon is used as a framework to illustrate how efficiency-seeking behaviors of federal, state, and local government actors affected government intervention efforts initiated to remedy health care access hardships created by market failure in low-income communities. A second market failure occurs when government failure results from the reintroduction of market protocols in an environment where the market had originally failed to facilitate the distribution of basic goods and services. The review suggest that financial austerity at the Los Angeles County Department of Health Services in the context of federal, state, and local government policies that emphasized allocative efficiencies, compromised equity values by undermining access to quality pediatric services at the King/Drew Medical Center which was a municipal academic medical center.

Perceived Health Needs of Elderly Mexicans Living on the U.S.-México Border

This descriptive study explores the health beliefs of an underserved elderly group to gain insight regarding their self-perceived health needs. Focus groups were conducted with 112 elderly Mexicans living on the U.S.-Mexico border. Participants were asked questions regarding positive aspects of aging, self-perception of health status, and health care service needs. Many felt having knowledge gained from life experience and raising a family was positive; participants indicated their overall health status was poor; and they believed it was difficult to access quality health care services. Many participants self-reported that health status depended on socioeconomic status, family support, chronic diseases, and previous lifestyle. These findings can help develop culturally appropriate interventions designed to improve the overall health of the elderly living on the U.S.-Mexico border.