Access To Public Health Services Research Articles

Economic instability, income, and unemployment effects on mortality: using SUR panel data in Iran.

This study aims to investigate the effects of socioeconomic factors on mortality in Iran. To this end, this research examines how economic instability, income, and unemployment affect mortality using a seemingly unrelated regression (SUR) with panel data for 30 provinces in Iran from 2004 to 2019. The results indicate that unemployment and mortality have a countercyclical relationship among the working age-groups 20-59 but a procyclical pattern among old-age (60+), except for rural mortality. This result is harmonious between employment and age-group mortality. This finding implies that unemployment increases mortality in working age-groups due to psychological stress and poverty risk. In addition, the income level decreases mortality in all ages over 40 years due to the provision of higher access to health and medical services and social welfare. However, it increases mortality in rural areas and age-group 20-39 because of their hazardous, unsafe, and stressful work conditions. Therefore, policymakers should plan for an inclusive economic growth to reduce poverty and out-of-pocket payments and increase the quality and accessibility of public health services, especially for beneficiaries of lower social groups. Moreover, they should adopt strategies to alleviate the burden of premature, preventable, and treatable deaths.

Administrative Decentralisation and Health Service Delivery in Ibanda District Local Government, Uganda

While research on public service delivery in the Ibanda administrative area is abundant, there is a notable dearth of studies addressing the shortcomings in public health services. This investigation is specifically concerned with examining the influence of governance on the quality and accessibility of public health services in Ibanda District, as well as the impact of administrative decentralization on these services. A cross-sectional research design was employed for this study, involving data collection from 574 participants through self-administered surveys and interviews. Quantitative data were subjected to descriptive and inferential statistical analysis, while qualitative data underwent content analysis. The study's findings and conclusions reveal a positive correlation between governance and the quality of public health services, as well as a favorable association between governance management and these services. Additionally, administrative management was found to have a positive impact on public health services. Consequently, the study offers recommendations for the central government, urging consistent vigilance in supporting district performance and allocating adequate resources for drug distribution and medical equipment to bolster healthcare within the district. Furthermore, the study advocates for a continued emphasis on effective administration, encouraging public involvement in decision-making processes, open communication through public hearings, and grassroots participation in financial planning, all aimed at enhancing public health services. In conclusion, this study underscores the need for greater attention to public health services within the Ibanda administrative area, as it contributes to the existing body of research on public service delivery

PP12 Challenges In Assessing The Efficacy Of Non-Pharmacological Measures In The Context Of The COVID-19 Pandemic

IntroductionThe outbreak of the COVID-19 global pandemic in 2020 has been a major challenge for the world’s population and governments. The lack of vaccines, the saturation of health systems, and its rapid spread forced governments to take non-pharmacological interventions (NPI) that had a high impact on the population. Assessing the efficacy of these measures is a challenge for health technology assessment bodies.MethodsThe main NPIs for which assessment was required were: mobility restrictions, social distancing, cancellation of events or reduction of seating capacity, closure or reduction of seating capacity in non-essential businesses, closure or limitation of seating capacity in educational establishments, and promotion of teleworking in potential jobs. The implementation of these measures at a global level provides a large population for the study of the impact of these measures. However, the challenges for their evaluation are numerous: •The joint implementation of these measures makes it difficult to evaluate them in an isolated manner.•The heterogeneity between countries and regions of the pandemic situation at the time when these measures are initiated and terminated.•The different accuracy in the application of the measures.•Heterogeneity in the quality and accessibility of public health services for citizens.ResultsOutcome variables to assess the effectiveness of these measures should include parameters related to:•Incidence variables: the number of new or accumulated cases in a given time range, the variation in the number of cases in a given time range and the proportion of positive tests.•Transmission variables: the basic reproductive number (R0) and the effective reproductive number (Rt).•Severity and mortality variables: the number or variation of hospitalizations, the number or variation of intensive care unit (ICU) hospitalizations and the number or variation of deaths.ConclusionsThe large number of available data, the heterogeneity of the measures, the differences between populations, the numerous outcome variables and the possible inclusion of mathematical modelling studies, are a methodological challenge for the HTA bodies.

Accessibility of Availability of Public Health Services Dayak Tribe in Samarinda “Qualitative Study”

In Indonesia, health service are still a problem both in terms of financing, quality, and public access. The purpose of this study to analyze the availability of public health services in the Dayak tribes. Informants in this study are indigenous Dayaks Society, the Society who were and had experienced/illness, Dayak Customary Chief, Head of health center and health workers. Analysis of the data in this study using thematic analysis. The primary data obtained from direct observation and in-depth interviews and focus group Discuccion (FGD), while the secondary data obtained from the study documents. Based on this research, accessibility of public health services in the Dayak based on an interview to the informant still have limited Human Resources (HR), infrastructure, medical equipment and pharmaceuticals (drugs). Advice to the city administration should have to provide health care facilities that can be accessed 24 hours as “Homecare Health Center” mainly Dayak and other communities who live on the outskirts of the city of Samarinda. There needs to increase the number of health workers, especially doctors and surveillance personnel.

Availability and accessibility of public health services for adolescents and young people in South Africa

Against the background of increasing international calls for the development and implementation of age-appropriate programmes that address both quality and access issues to improve adolescent and youth health, this paper explores the extent to which public health facilities are available and accessible to adolescents and youth in South Africa. The impetus for the study was the current evidence that there was generally poor utilisation of services offered at public health facilities by young people in the country. The overall findings are that despite the country's comprehensive legal and policy framework and commitment to improve the health of young people, there continues to be some structural and systemic factors that hamper effective provision and programming of adolescent and youth friendly services. The paper concludes with recommendations for policy and practice.

A study on effective utilization of health care services provided by primary health centre and sub-centres in rural Tamilnadu, India

Background: The utilization rates in public health services systems ranges from 10-30%. The skewed rural/urban availability of public health services is well known. This study has been done to study the extent of utilization of primary health care services in a primary health centre and its Subcentres and the factors associated for the utilization of services. Methods: This descriptive study was conducted at Orathur PHC, Cuddalore district, Tamil Nadu and its sub-centres, covering a population of 45183 by using structured interview schedule with sample size of 3220 (80 houses in each sub-centre) by simple random sampling technique. Results: 60.2% of selected households are located beyond 5 kms. Out of 560 households, 552 are headed by males and the remaining females. 71.96% of study subjects had formal education. 85.5% of respondents were aware of the PHC. 71.2% of respondents had satisfactory opinion about health services. Only 45.40% and 58.80% of the patient`s households with acute & chronic illness had utilized the services at PHC respectively. 81.65% of the ANC mothers had utilized the PHC, 77.98% for TT immunization, 75.24% for delivery, 75.76% for postnatal care, and 79% for immunizing their children. Conclusion: The utilization of primary level services (PHC and Subcentres) is better for preventive and promotive care but is poor for treatment of acute illness, intranatal care and family welfare services, special investigation services.

The Relationship between Health Care Needs and Accessibility to Health Care Services in Botosani County- Romania

The population's access to health care services is conditioned by the offer of medical services, which, being unevenly distributed in the country and in Botosani County, determine limited access of the population, especially in rural areas. This paper focuses on the assesing and interpretation of the population's accessibility indicators to health services and health care needs index in Botosani, in the period 2000-2013, in order to highlight the relationship between the health care needs and the accessibility to health care services. The methodology of the research consists of collecting statistical data from existing statistical online databases, as provided by the Public Health Department of Botosani, which was analyzed, processed and converted into relevant indices in order to highlight the spatial and temporal dynamics of the population's accessibility to Botosani county health resources (the health services index), to highlight the dependence of the population on health services (the health care needs index) and the population's accessibility to health resources (spatial and temporal accessibility indicators). The spatial analyse was used for mapping calculated indicators using ArcGIS software, to emphasize spatial inequalities in Botosani County. The spatial distribution of health resources, shows that the rural Botosani area is poorly covered by health services, compared to the urban area, causing a limited access of rural population to health services. The health needs index also shows that the population's dependence on health services is higher in rural areas and lower in urban areas. This outlines an inverse relationship between the two indices: the higher the health care needs are the poorer the health care services. The spatial accessibility of public health services was analyzed taking into account the average distance that the patient has to cover up to the nearest medical unit and the temporal accessibility according to the time that the patient needs in order to cover the distance to the nearest medical unit (travel time). The low accessibility of the population to health care services overlaps with urgent health care needs areas and high deprivation areas, which is reflecting on the population's health outcomes. The outlined inequalities in people's access to health services have serious consequences on the health status of population of Botosani County.

Issues of Unequal Access to Public Health in India.

Even after more than 50 years of independence, health in India remains a luxury and only the rich can afford it. People visit equally poor private practitioners, ignoring the available public health units, and pay beyond their capacity. Quality health services, either public or private, with some government regulation, can help to improve the present scenario. The adivasi and the dalits are still away from the health equity and face more challenges than the others. Well-equipped health facilities in the vicinity and knowledge of disease conditions can improve the access of public health services. Rather than focusing on the doorstep services, well-equipped PHCs even can do better.

Hospital Contributions to the Delivery of Public Health Activities in US Metropolitan Areas: National and Longitudinal Trends.

We investigated changes in hospital participation in local public health systems and the delivery of public health activities over time and assessed the relationship between hospital participation and the scope of activities available in local public health systems. We used longitudinal observations from the National Longitudinal Survey of Public Health Systems to examine how hospital contributions to the delivery of core public health activities varied in 1998, 2006, and 2012. We then used multivariate regression to assess the relationship between the level of hospital contributions and the overall availability of public health activities in the system. Hospital participation in public health activities increased from 37% in 1998 to 41% in 2006 and down to 39% in 2012. Regression results indicated a positive association between hospital participation in public health activities and the total availability of public health services in the systems. Hospital collaboration does play an important role in the overall availability of public health services in local public health systems. Efforts to increase hospital participation in public health may have a positive impact on the scope of services provided and population health in US communities.

Maternal Health Status and Behaviours of Immigrant Women

Background/Objectives: The purposes of this study were to explore the type and frequency of material health status and behaviors in immigrant women and to examine factors affecting maternal health outcomes. Methods/Statistical analysis: This cross-sectional study was conducted with a sample of 106 female marriage immigrants. A well-developed questionnaire was used to measure health-related needs and behaviors and socio-demographic data. The data collection was conducted by face-to-face interview and translators were used when needed. Results: The main findings showed that 33% of participants used birth control methods, 54% performed exclusive breastfeeding for six months, 78% received prenatal care, 67% received postpartum care, 19% had at least one health problem associated with pregnancy, and 21% experienced natural or induced abortion. These indicate that the immigrant participants tend to have somewhat different health problems and behaviors as compared with the general Korean female population. Furthermore, determining factors associated with maternal health outcomes were age, original nationality, employment status, communication experiences with husband and parents-in-law, knowledge about public health center services, and needs for childrearing services in public health centers. Conclusion/Application: Developing culture-specific strategies to improve maternal health outcomes and to communicate effectively with their families is necessary to increase the accessibility of public health services in female marriage immigrants. Keywords: Health Services Needs and Demand, Health Status, Immigrants, Maternal Welfare.

A Study on the Health Status of Elderly Irular Tribal Women in Kancheepuram District

Indian tribals are a heterogeneous group; most of them remain at the lowest stratum of the society due to various factors like geographical and cultural isolation, low levels of literacy, primitive occupations, and extreme levels of poverty. The present paper attempts to study the health problems of the elderly Irular women in three villages of Kancheepuram district. A total of 30 elderly tribal were interviewed using a pre-tested Interview schedule. Around 66% of the women belonged to the age group of 60-69 years old. A majority of them had health problems such as hypertension followed by arthritis, diabetes, constipation etc. The results of the study showed that there is a need for geriatric clinics that can take care of their physical and psychological needs. It further stressed accessibility of health services as a main reason for the elderly not availing the health care services. The study also suggested provision of mobile clinic to cater to the needs of the community every month on a selected date on a regular basis. Keywords: Health status, Tribal women I. INTRODUCTION Ageing is mainly associated with social isolation, poverty, apparent reduction in family support, inadequate housing, impairment of cognitive functioning, mental illness, widowhood, loss, bereavement, limited options for living arrangement and dependency towards end of life. Generally, at household level, cultural norms and practices and socio-economic factors determine the extent of health problems among women. Change in socio-economic status and various health problems adversely affect an individual's way of life during old age. In India the size of the elderly population, i.e. persons above the age of 60 years is fast growing although it constituted only 7.4% of total population at the turn of the new millennium. For a developing country like India, this may pose mounting pressures on various socio economic fronts including pension outlays, health care expenditures, fiscal discipline, savings levels etc. Again this segment of population faces multiple medical and psychological problems. India is home to almost half the tribal population of the world. Tribals are characterized by a distinctive culture, primitive traits, and socio-economic backwardness. The tribal's of India, constituting 8.2% of the total population (84 million), belong to around 698 communities or clans. Around 75 of these groups are called primitive tribal groups due to pre-agricultural level of knowledge, extreme backwardness, and a dwindling population. However, the exact number of tribal groups may be lesser than 500 due to group-overlapping in more than one state. Although scheduled tribes are accorded special status under the fifth/sixth schedules of the Indian Constitution, their status on the whole, especially their health still remains unsatisfactory. Tribal communities in general and primitive tribal groups in particular are highly disease prone. Also they do not have required access to basic health facilities. They are most exploited, neglected, and highly vulnerable to diseases with high degree of malnutrition, morbidity and mortality (Balgir, 2004(1)). Their misery is compounded by poverty, illiteracy, ignorance of causes of diseases, hostile environment, poor sanitation, lack of safe drinking water and blind beliefs, etc. Some of the preventable diseases such as tuberculosis, malaria, gastroenteritis, filariasis, measles, tetanus, whooping cough, skin diseases (scabies), etc. are also high among the tribals. Some of the diseases of genetic origin reported to be occurring in the Indian tribal population are sickle cell anemia, alpha- and beta- thalassemia, glucose-6-phosphate dehydrogenase (G6PD) deficiency, etc. (Balgir, 2004(2)). Night blindness, sexually transmitted diseases are well known public health problems of tribals in India. This paper explores the Health problems of the elderly in the Irular Tribal women. It also explores the accessibility and availability of public health services to these disadvantaged women in the tribal population at Kancheepuram district of Tamilnadu and suggests solutions.

Training Primary Care Physicians for Local Health Authority Duties in Texas

Only one fourth of Texas counties have a local health authority (LHA) or health district. Primary care physicians in the remaining counties could be trained in public health basics by providing an online LHA training course and courses at annual meetings of the Texas Medical Association and the Texas Academy of Family Physicians. The Texas Department of State Health Services should develop a web portal for LHAs. The Texas Association of Local Health Officials should also provide automatic limited membership for LHAs. These initiatives would provide public health training to primary care physicians and would greatly improve availability of public health services for the citizens of Texas.

Constraints to universal coverage: inequities in health service use and expenditures for different health conditions and providers

BackgroundThere is need for new information about the socio-economic and geographic differences in health seeking and expenditures on many health conditions, so to help to design interventions that will reduce inequity in utilisation of healthcare services and ensure universal coverage.ObjectivesThe paper contributes additional knowledge about health seeking and economic burden of different health conditions. It also shows the level of healthcare payments in public and private sector and their distribution across socioeconomic and geographic population groups.MethodsA questionnaire was used to collect data from randomly selected householders from 4,873 households (2,483 urban and 2,390 rural) in southeast Nigeria. Data was collected on: health problems that people had and sought care for; type of care sought, outpatient department (OPD) visits and inpatient department (IPD) stays; providers visited; expenditures; and preferences for improving access to care. Data was disaggregated by socio-economic status (SES) and geographic location (urban versus rural) of the households.ResultsMalaria and hypertension were the major communicable and non-communicable diseases respectively that required OPD and IPD. Patent medicine dealers (PMDs) were the most commonly used providers (41.1%), followed by private hospitals (19.7%) and pharmacies (16.4%). The rural dwellers and poorer SES groups mostly used low-level and informal providers. The average monthly treatment expenditure in urban area was 2444 Naira (US$20.4) and 2267 Naira (US$18.9) in the rural area. Higher SES groups and urbanites incurred higher health expenditures. People that needed healthcare services did not seek care mostly because the health condition was not serious enough or they could not afford the cost of services.ConclusionThere were inequities in use of the different providers, and also in expenditures on treatment. Reforms should aim to decrease barriers to access to public and formal health services and also identify constraints which impede the equitable distribution and access of public health services for the general population especially for poor people and rural dwellers.

Accessibility of Delivery Facilities in Rural Uttar Pradesh Looking Beyond Individual and Household Factors

This study examines the association of individual and community-level characteristics with the choice of delivery location (home, public or private facility) for the most recent live birth of currently married women in Rural Uttar Pradesh, India. District Level Household Survey-Reproductive and Child Health Survey (DLHS-RCH, 2007-08) data on 30,856 currently married women belonging to 2827 villages in Uttar Pradesh, is used to assess effect of the village infrastructure and availability of public health services on choice of delivery location. Anderson Behavioural Model of health service use has been utilized through Multinomial Logistic regression analysis. Result indicates that other than usual individual risk factors, presence of government health facility, distance to nearest primary health centre and functioning of maternity benefit schemes in the villages has significant impact on choice of delivery location, where as presence of village health worker may not found to be associated with institutional delivery.

Rurality and Birth Outcomes: Findings From Southern Appalachia and the Potential Role of Pregnancy Smoking

Rates of preterm birth (PTB) and low birth weight (LBW) vary by region, with disparities particularly evident in the Appalachian region of the South. Community conditions related to rurality likely contribute to adverse birth outcomes in this region. This study examined associations between rurality and related community conditions, and newborn outcomes in southern Appalachia, and explored whether pregnancy smoking explained such associations. Data for all births in a southern Appalachian county over a 2-year period were extracted from hospital records. Data were available for 4,144 births, with 45 different counties of residence. Babies born to women from completely rural counties, on average, weighed 700 g less, were 1.5 inches shorter, and were born over 3 weeks earlier than less rural infants. In addition, these babies were 4.5 times more likely to be LBW, 4 times more likely to be PTB, and 5 times more likely to be admitted to the neonatal intensive care unit (NICU). Effects were also found for per capita income, poverty rate, and unemployment rate, all of which were associated with rurality. Some, but not all of the association was explained by elevated rates of pregnancy smoking. Babies born to women residing in rural and economically depressed counties in southern Appalachia are at substantially increased risk for poor birth outcomes. Improving these outcomes in the rural South will likely require addressing access to health services and information, health care provider retention, transportation services, employment opportunities, and availability of public health services including smoking cessation assistance.

Regionalization

To assess the impact of regionalization of Kansas counties associated with emergency preparedness since 2002 via local health departments (LHDs). Three focus groups were conducted in May 2005 with 31 Kansas health department employees. Most participants were public health administrators, women, and 40 years or older. Regionalization was perceived as "absolutely necessary" by participants and resulted in improved collaboration and communication among LHDs. The process supported the development of relationships, trust, and mutual respect among LHDs and other governmental agencies. Participants agreed that LHD functioning has improved the delivery and availability of public health services, increased the efficiency and timeliness of operations, and enhanced public health's visibility in emergency preparedness efforts. Moreover, regionalization added resources to LHDs including personnel, knowledge, technology, technical expertise, and fiscal resources. Dissatisfaction with regionalization was associated with insufficient funding, frustration with changing preparedness guidelines, and differences between state and local expectations. Participants identified four issues necessary to sustain regions: funding, documented benefits, commitment from LHDs and their communities, and engagement from local elected officials. The regionalization process has been beneficial for LHDs and produced tangible and intangible benefits. Barriers to regionalization expansion should be addressed for additional collaborative ventures.

Data mining and visualization for decision support and modeling of public health-care resources

This paper proposes an innovative use of data mining and visualization techniques for decision support in planning and regional-level management of Slovenian public health-care. Data mining and statistical techniques were used to analyze databases collected by a regional Public Heath Institute. We also studied organizational aspects of public health resources in the selected Celje region with the objective to identify the areas that are atypical in terms of availability and accessibility of public health services for the population. The most important step was the detection of outliers and the analysis of availability and accessibility deviations. The results are applicable to health-care planning and support in decision making by local and regional health-care authorities. In addition to the practical results, which are directly useful for decision making in planning of the regional health-care system, the main methodological contribution of the paper are the developed visualization methods that can be used to facilitate knowledge management and decision making processes.