Basic Services Research Articles

Progress in access to water in homes in Bolivia: special attention to inequality issues

ABSTRACT One of the main challenges of the water sector worldwide, and mainly in developing countries, is related to the availability of water that households receive. However, it is not only important to analyze availability, but also affordability considering equity aspects. In this sense, through the estimation of indicators proposed by the Joint Monitoring Program for Water Supply, Sanitation and Hygiene (JMP), and statistical tests of means (ANOVA), it is evident that, in the case of Bolivia, for the year 2021, the basic service of access to water at the national level is approximately equal to 90.3% of households, for the urban sector 98.1% and for the rural sector 73.0%, showing a significant statistical difference between the two geographic areas. Also, if considered at the level of income deciles, for example, at the national level, the difference between the first and tenth decile is almost 22.5%. In this sense, although water policy in Bolivia has made great progress in recent years, it is important to consider actions to reduce this inequality for the greater well-being of society, and mainly of the most vulnerable households.

Rethinking waste and resource management for underserved communities

ABSTRACT Municipal solid waste management (MSWM) is a basic service, yet over 2.7 billion people still lack access to collection, and 40% of collected MSW is open dumped or burned. This global waste emergency has severe local and global impacts — extending services to all would reduce macroplastic dispersal to the environment by ~80% and mitigate climate heating. We use our nine development bands (9DBs) framework to rethink how to extend services to underserved communities at pace and at scale. Funding needs to target community-up operator models and no regret investments. Win5 benefits include community services, reduced disease outbreaks, more sustainable livelihoods, reduced MSW quantities and management costs, and reduced local and global environment impacts. Cities can transition earlier to more circular, integrated, waste and resource management (WaRM). Separating (wet) organic wastes from (dry) recyclable materials at source unlocks markets for both. A blend of financing is needed, from national and city sources, resource revenues, disposal pricing, extended producer responsibility (EPR) and international development (including climate and plastics) finance. New multi-lateral impact funds need to target extension of services to underserved communities.

The importance of city services to internally displaced persons, returnees, and host residents in Juba, South Sudan

ABSTRACT Increasing numbers of people are displaced worldwide (108 million), and well over half of displaced persons move to urban areas in lower-income countries. While some research has focused on how displaced persons fare in camps, little research focuses on displaced persons, returnees, and host residents living together in urban areas. This research uses a mixed-methods approach for data collection, including 60 randomly selected households in three residential areas (n = 180) in Juba, South Sudan. Household surveys compared how displaced persons valued basic city services (water, latrine/wastewater, electricity, and security), transportation, and shared facilities (hospitals, schools, parks, and markets) relative to host residents and returnees. Using linear regression modeling, our research found that the perceived value of city services amongst hosts, IDPs, and returning refugees varied significantly when controlling for residential areas and household characteristics. However, many common patterns existed among the three groups. Host residents and IDPs rated cheaper transportation as their greatest need. All three groups highly rated the need for security, and IDPs and returnees highly rated the need for parks. When designing and implementing development projects, we recommend that humanitarian agencies collaborate with city officials to engage with existing IDP and returnee networks.

Assessing housing and basic services access for internally displaced persons in conflict-affected Gaza Strip: a mixed-methods study

Assessing housing and basic services access for internally displaced persons in conflict-affected Gaza Strip: a mixed-methods study

Co-created Citizen Science Creates Space for Dialogue Around Environmental Challenges Faced by Urban Residents in the Global South

In the Global South, rapid, unplanned urbanisation is associated with environmental degradation, pollution, and poor basic services, in particular for resource poor and vulnerable communities. With insufficient resources available for standardised monitoring of these issues, citizen science (CS) approaches have the potential to address evidence gaps and inform mitigation strategies and environmental policies. The majority of CS projects reported in the scientific literature are contributory, involving members of the public only in the data collection aspects of projects. There is growing recognition of the benefits of co-created CS, where participants are engaged in multiple or all stages of the scientific process. However, descriptions and evaluations of such projects are rarely reported in the literature, which is needed in order to refine and grow the use of co-created CS. Here, a review of the co-created CS literature is presented, followed by a six-step, researcher-initiated co-created CS methodology which was implemented with vulnerable communities within two cities in the Global South – Nakuru, Kenya and Udon Thani, Thailand. Successes and challenges experienced in these projects are discussed and recommendations for future co-created CS are presented. As for contributory CS, data generated in projects concretely identified environmental challenges faced by each community. However, using the six-step co-created CS methodology, participating citizens were uniquely able to leverage their data on behalf of their communities to establish dialogue with local authorities, generating meaningful shared understanding and priorities.

Prevalence and Characteristics of Eye Problems Reported in an East African Refugee Camp: A Cross-Sectional Survey

Despite efforts to improve global access to basic ophthalmologic services, there remains a paucity of data regarding the prevalence of untreated ocular disease among forced migrants and refugees, particularly in east Africa. We aimed to estimate the prevalence of untreated and surgically amenable eye conditions among refugees in Nyarugusu Refugee Camp, Tanzania, and to identify factors associated with untreated eye problems. We conducted cluster-randomized sampling using the cross-sectional Surgeons OverSeas Assessment of Surgical Needs (SOSAS) survey tool to assess prevalence of surgical eye disease and access to health services among refugees in Nyarugusu from August-September 2021. Descriptive analysis and multivariable logistic regression were performed to explore associations between covariates and the presence of unresolved eye problem(s). Among 3574 refugees, 12% (n=430; mean age 36±20 yrs.) reported eye issues. Of these, 296 (69%) further characterized their problems, with 44% reporting acquired disability and 42% non-injury-related wounds. Of the 368 (86.4%) who described their issues as disabling, 78.8% endorsed a negative impact on ability to work and 27.7% required help with daily living. Most were currently (84.6%; 357/427) and chronically affected (>12 months; 88.3%; 378/428). Farming and housewife occupations were positively associated with unresolved eye problem(s). Among 312 (72.7%) who sought care, only 13 (4.2%) underwent surgery. Nearly half (136) of 279 surveyed individuals self-reported potential surgical needs, citing barriers to surgical care such as lack of available services, financial and time constraints, and limited knowledge about accessing treatment. In conclusion, nearly 1 in 8 refugees endorsed chronic and disabling eye problems, negatively impacting their work and daily life. Most who may benefit from surgery have not received care due to significant barriers and gaps in ophthalmologic services. Further investigation to better characterize specific ocular etiologies in under-resourced protracted refugee settings can inform resource allocation strategies to address unmet eye care needs.

Life and health status of older migrants with hypertension in China: results from the 2018 China health and retirement longitudinal study

BackgroundIn China, internal migrants are a vulnerable population due to the challenges of the health and social system. With the increase of population aging, older migrants have an increasing risk of developing chronic conditions. To date, limited research is available to document the life and health status of older migrants with hypertension, especially those who live alone. This study aims to report and compare the life and health status of older migrants with hypertension among those who live alone or do not.MethodsData were collected from the 2018 China Health and Retirement Longitudinal Survey (CHARLS). We included 40 older migrants with hypertension who lived alone and 214 who did not. The T-test, Chi-square test, Fisher exact test and Goodman and Kruskal’s Gamma were employed to test the differences between these groups. Additionally, multivariable linear and logistic regression analyses were used to confirm such differences.ResultsOf the 254 participants, 51.6% were male and the average age was 70.8. Furthermore, 81.1% had received secondary school education or below. Among older migrants with hypertension, 38.9% had received basic public health services such as regular blood pressure measurements from community health workers. Compared to hypertensive older migrants who did not live alone, those who lived alone had a higher CES-D score, a greater proportion of participants with depression, and a lower willingness to reduce alcohol consumption (11.91 vs. 8.53, p = 0.008; 18.8% vs. 6.3%, p = 0.018; 14.3% vs. 33.7%, p = 0.022). The multivariable analysis indicated that hypertensive older migrants who lived alone had higher risk scores for depression (adjusted β = 3.145, 95%CI = 0.092–6.198, p = 0.044).ConclusionsOur study indicates the lack of effective implementation of basic public health services for older migrants with hypertension. In particular, hypertensive older migrants who live alone has less favourable psychological status and lifestyle.

Basic public service equalization and household risk investment behavior

Basic public service equalization and household risk investment behavior

Status of women Safai Karmacharis

A scavenger is wholly or partly engaged in manually removing night soil from dry latrines or manually handling the dead bodies of animals and humans. In India today, scavengers are now so-called sweepers due to the introduction of an organized framework of jobs that still carry out basic sanitary services in cities and towns. As per the caste hierarchy this Schedule caste placed at the bottom and treated as untouchable by other castes even other non-scavenging Schedule castes, they are deprived of all socio-economic privileges due to stigma discrimination, and lack of willingness of social welfare implementing agencies for this Dalit communities, mostly they living under chronic poverty, illiteracy, and with absence of enlightenment, though several program and policies framed by the government for them. This paper exclusively regards the status of women who are engaged in the scavenging occupation, the present paper tries to explore and analyse their socio-economic condition as well as how they are still far away from empowerment as nowadays women’s empowerment is a preliminary propaganda of the government

Water service delivery challenges in Modimolle-Mookgophong Local Municipality, Limpopo, South Africa

Background: Water is not equally accessible, and climate change is altering patterns of weather and rainwater around the world, causing shortages that will both intensify water scarcity and threaten the quality of the current water supply.Aim: The study analyses the effectiveness of Modimolle-Mookgophong Local Municipality (MMLM) in provisioning water services. This study took place in the Limpopo province of South Africa.Methods: A mixed-method approach was adopted under a pragmatic paradigm. The researcher used both probability and non-probability sampling techniques, including random and purposive sampling, to select participants for interviews and questionnaires. This was done to understand the challenges of water service delivery among the MMLM community members.Results: Research findings revealed that the MMLM operates at about 70% capacity as a Water Service Authority. The water system, mostly asbestos pipes, is heavily deteriorated, affecting around 80% of the network. Frequent winter pipe bursts particularly common in winter and illegal connections in informal settlements further strain water provision.Conclusion: The study established that MMLM faces several service delivery challenges related to the delivery of water. Although the local government has the primary constitutional obligation to deliver basic services such as water provisioning, the national and provincial governments should play a significant role in supporting municipalities to fulfil these obligations.Contribution: This study will benefit municipalities and officials in improving future water service delivery. It will also guide other local municipalities facing similar challenges, helping establish a more efficient and effective water service system.

The Nexus Between Per-capita Income and Life Expectancy in Ghana

This study explores the relationship between health expenditure per capita, per capita income, and life expectancy in Ghana. Using annual time-series data from 2000 to 2022 provided by the World Development Indicators, the analysis examines variables such as life expectancy, per capita income, public health spending per capita, birth rate, employment-to-population ratio, CO<sub>2</sub> emissions per capita, and the proportion of the population with access to safe drinking water and sanitation services. The study also reviews annual trends in life expectancy, per capita income, public health spending, and access to basic services. To analyze short- and long-term relationships among these variables, the research employs the Autoregressive Distributed Lag cointegration approach, preceded by a unit root test to determine stationarity. EViews software is used for the analysis, which includes graphical representations to illustrate trends. The results indicate a negative relationship between health expenditure per capita and life expectancy, while per capita income is positively associated with life expectancy. Cointegration is observed across all variables. Additionally, birth rate and access to sanitation services are positively related to life expectancy, whereas CO<sub>2</sub> emissions per capita are negatively associated with it. The study recommends policies focusing on prioritizing health funding, efficient resource allocation, and strategies to increase individual incomes.

Discrete choice experiment on the preferences for continuing medical education training programs among primary health care physicians in China

BackgroundImproving primary health care (PHC) physician’s capacity has been identified as an important area in the healthcare reform. The continuing medical education (CME) training programs are conducive to enhancing competence of PHC physicians. But few studies have explored PHC physicians’ needs and preferences for CME training programs. This study aimed to explore the preferences for CME training programs from the perspective of PHC physicians, and to understand the willingness, tendency, and needs in CME.MethodsA Discrete Choice Experiment (DCE) was developed based on literature review and semi-structured interviews with 4 general practitioners to identify key attributes of CME programs. The DCE survey was administered to 360 PHC physicians in Jiangsu Province, China, in August 2023, to elicit preferences for: training frequency, training time, training duration, training location, training content of basic medical services, and training content of basic public health services. A total of 281 valid responses were included after the quality control test, which involved checking completion time and consistency in repeated choice tasks. DCE data were analyzed using Mixed Logit, and Latent Class Models to explore preference heterogeneity and class membership.ResultsPHC physicians showed strong preference for CME training programs that were conducted during working hours on weekdays, once a year, at a local meeting place and training on health management of patients with multiple chronic diseases. Latent class analysis identified 2 preference classes, with half (51.2%) of the respondents focused only on training frequency and time while the rest considered training logistic arrangement as well as training content. These preferences could be explained by some observed characteristics of PHC physicians such as age and professional level.ConclusionsOverall, PHC physicians valued the convenience of participation in CME training programs and training on health management of patients with multiple chronic disease. Our findings can be used to inform the design of CME training programs for PHC physicians in China.

Impact of Species and Developmental Stage on the Bacterial Communities of Aphaenogaster Ants.

Ants are distributed across the globe and there are currently over 14,000 described species. Due to the high diversity between species, ants are considered vital keystone species to many ecosystems. They provide basic ecosystem services such as: seed dispersal, soil bioturbation, decomposition, and pest control. Within these ecosystems ants form complex symbiotic relationships with plants, fungi, and bacteria. Studying the interaction between ants and their bacteria is important because of the crucial role that microbes play in the overall health of ants. Aphaenogaster Mayr, 1853, which is a globally distributed ant genus, remains understudied in terms of their bacterial community. This study aims to determine the taxonomic composition and abundance of the Aphaenogaster bacterial community and to determine if development stage and species impact the bacterial community composition. For this study, ants from several colonies were collected from the Gordon Natural Area in West Chester, Pennsylvania, USA. DNA was then extracted from the ants in all stages of development and the 16S rRNA gene was amplified and sequencing following the NGS amplicon approach. The findings from this study reveal that species and development stage have a significant impact upon the bacterial community composition and abundance of Aphaenogaster ants, and Wolbachia is highly associated with these ants.

Determinantes sociales de la salud y la desnutrición crónica en la primera infancia en comunidades urbanas vulnerables colombianas

Introduction: chronic childhood malnutrition (CCMN) is a global issue affecting millions of children, especially in middle-income and low-income countries. This phenomenon, resulting from a variety of factors, carries serious sequelae on a child´s growth, and physical and cognitive development. Addressing this problem by analyzing the social determinants of health (SDH), provides a broad view of the need of impacting each of these factors. Lack of accessing essential nutrients linked to factors such as poverty, discrimination and social inequalities have a direct impact on child nutrition. The problem is aggravated by living conditions, especially in rural areas, where access to basic services such as drinking water and sanitation is limited. Objective: to analyze the SDH present in vulnerable urban communities in Bogotá, related to CCMN. Discussion and conclusion: understanding these determinants is fundamental to tackle this problem and design comprehensive public policies considering the complete territorial and social reality in combating child malnutrition. However, assuming this great challenge requires comprehensive actions addressing inequalities, from poverty to ethnic identity, ensuring equal opportunities, access to health and nutrition services, and community empowerment promotion.

A Comparative Study of Out-Patient Department (OPD) Dental Clinic Statistics before and during the COVID-19 Pandemic in Sri Lanka

Background: The coronavirus disease (COVID-19) pandemic has substantially impacted global healthcare service utilization, including oral healthcare.Objective: This study aimed to evaluate the variations in outpatient department (OPD) dental clinic utilization across Sri Lanka before and during the COVID-19 pandemic, using pre-pandemic data from to 2018-2019 and during the pandemic data from to 2020-2021.Methods: Data were retrospectively extracted from national OPD dental clinic records maintained by the Research and Surveillance Unit of the Institute of Oral Health, Ministry of Health, Sri Lanka. Key variables included basic services provided, patient attendance, and specific demographics, such as pregnant mothers, children under three, and adolescents. Descriptive and inferential analyses were performed using Microsoft Excel and SPSS (v28). The Mann-Whitney U test was used to statistically compare service utilization before and during the pandemic.Results: The number of patients treated per dental surgeon per month increased from 306 in 2018 to 340 in 2019, then declined significantly to 219 in 2020, and further to 166 in 2021 (p < 0.05). Consistent reductions were noted across all treatment categories, except for oral facial pain management, which showed a relatively minor decrease. The detection rates of Oral Potentially Malignant Disorders (OPMDs) per dental surgeon fell sharply from 59 in 2018 to 34 in 2021.Conclusion: COVID-19 has resulted in a marked decline in public OPD dental service utilization, emphasizing the need for strategic interventions to bridge service gaps, enhance preventive care access, and promote early detection of OPMDs. Enhanced support for vulnerable populations, such as children and pregnant mothers, is recommended along with capacity-building initiatives for dental professionals.

Optimizing Energy Alternatives in Colombia’s Isolated Regions: A Multi-Criteria Evaluation

Access to affordable, reliable, and sustainable energy is crucial for achieving the Sustainable Development Goals, improving quality of life, combating poverty, and fostering socioeconomic growth. However, a significant portion of the global population still struggles with energy poverty, lacking access to basic services such as electricity and clean cooking. Current strategies to combat this issue often rely on fossil fuels, which are costly and have negative environmental and health impacts. Hybrid energy systems offer a promising solution, but designing and evaluating them is complex. This study proposes an integrated approach for tackling that problem using Hybrid Optimization of Multiple Energy Resources (HOMER) software, along with the Criteria Importance Through Inter-Criteria Correlation (CRITIC) and multi-criteria decision making method (VIKOR). The methodology was applied to a case study in a remote region of Colombia. Results demonstrate that this approach enhances decision-making and identifies viable alternatives for energy-poor regions, providing a valuable tool for energy planning in developing contexts.

Analisis Pengetahuan Ibu dan Usia Balita terhadap Kunjungan Posyandu Era New Normal Kota Pekalongan

One of the efforts to produce quality human resources (HR) is to reduce morbidity and mortality of children under five. The development of the quality of human resources by optimizing the potential for growth and development of children can be carried out evenly, if a community-based health service system such as posyandu can be carried out effectively and efficiently and can reach all targets that need services such as child growth and development, pregnant women, breastfeeding mothers and postpartum mothers. Posyandu is a form of Community Based Health Efforts (UKBM) which is managed and organized from, by for and with the community in the implementation of health development, in order to empower the community and provide convenience to the community in obtaining basic health services to accelerate the reduction of maternal and infant mortality. The purpose of this study was to determine the relationship between mother's level of knowledge and age of toddlers with visits by mothers with toddlers to the new normal era posyandu in Pekalongan city. This research was conducted using a descriptive correlative research method with a cross sectional approach, sampling with a saturated sampling technique with a total of 37 mothers who have toddlers 1-5 years. The instrument used was a questionnaire sheet and the analysis used was Chi Square statistical test. Based on the results of univariate analysis, most of the children who visited the posyandu were aged 3 years, namely 10 children (31.2%), with parental education as many as 22 respondents (68.8%) having higher education (PT), dominated by working parents as many as 24 children (75%). A total of 25 respondents (78.1%) visited the posyandu regularly and most of the respondents had a good level of knowledge, as many as 29 respondents (20%). The results of the bivariate analysis showed that there was no relationship between children's age and posyandu visits (p value 0.217) and there was a relationship between parents' knowledge level and posyandu visits (p value 0.002). It is hoped that parents who have children aged 1-5 years will continue to routinely bring their children to the posyandu in the new normal era even though they still apply health protocols.

A Multifaceted Approach to Uplifting Tribal Communities: A Viewpoint of Tribes through Empowerment and Development

Tribal communities face marginalization and limited access to necessities and economic opportunities. This research proposes a multi-pronged development approach to empower these communities. It emphasizes education (including culturally sensitive early childhood programs and skill development), women’s empowerment (through promoting gender equality and economic independence), and sustainable land and livelihood practices. Additionally, it explores fostering economic development by supporting traditional livelihoods and micro and small enterprises, alongside ensuring access to healthcare and addressing social issues. By analysing existing literature and conducting interviews with community members, this research aims to assess the effectiveness of this multi-faceted approach in achieving sustainable development and uplifting tribal communities. This research explores fascinating results of tribal communities’ perspective and actual problems that include, these 84.2% remote dwelling families encounter difficulties accessing basic healthcare services due to the absence of primary health centres (PHCs). Decision-making power typically lies with family heads, predominantly male figures. While agriculture remains the primary occupation, 66.7% tribal individuals work as agricultural labourers despite owning land. Superstitions persist, impacting health-seeking behaviour. Education and awareness play a crucial role, and addressing irrational practices is essential. Additionally, alcohol consumption patterns affect tribal health. Bridging gaps in healthcare, promoting education, and dispelling superstitions are vital steps toward improving the well-being of tribal communities.

Climate refugees and political borders: An emerging crisis in environmental and International policies

One of the most important global policy and environmental institution issues in recent days is the climate refugee phenomenon. The climate refugees confronting unsecured legal status and, appalling, human rights violations as well as dangerous access to basic services. The scale of this crisis grows ever more pronounced from day to day, and given its highly endemic character it is doubtful that existing international instruments, particularly the 1951 Refugee Convention, are in a position to offer effectively to the distinct dangers and vulnerabilities of climate-displaced people. As a special emphasis, the article focuses on case studies in the Pacific Islands, Sub-Saharan Africa, South Asia, where climate displacement is severely afflicting, disproportionate to the rest of the world. Moreover, the article discusses the boundaries between migration of climate refugees across international borders under the Constraint of strained resources, national security access and social integration. To avoid this coming crisis the article advocates for global policies that are inclusive that would include environmental sustainability, human rights protection and equitable resource allocation. For instance, there is a need for cooperative international action which revises existing legal instruments and institutes some new paradigms for climate migration to relative justice and security for climate refugees.

Competence of Barangay Nutrition Scholars in the Implementation of National Health Nutrition Program in Nabua, Camarines Sur

Barangay Nutrition Scholar plays a vital role in the communities, who provides basic nutrition services for the members of the barangay. They are the grassroots in the delivery of national health nutrition programs. The study utilized a qualitative descriptive correlational design with a questionnaire as a tool for data collection tool for data collection to identify the competence of barangay nutrition scholars in the implementation of the national health nutrition program in Nabua, Camarines Sur. A total of 68 BNS of Nabua participated the survey. Weighted mean, t-test, and chi-square test were used to analyze the data collected. Findings revealed that the respondents are competent along implementation, monitoring and evaluation, documentation and record keeping, coordination, advocacy and promotion and planning and the political, social and personal factors affects the level of competence of Barangay Nutrition Scholars in the Implementation of National Health Nutrition Program in Nabua, Camarines Sur. Additionally, the study revealed that there is a significant relationship between the profile of the respondents and the level of competence of BNS across various aspects of the National Health Nutrition Program. Although BNS display sufficient knowledge and commitment, training, resources, and support gaps result in sub-optimal program, leading to sub-standard delivery. Overarching themes clearly demonstrated the necessity of increased capacity-building efforts, logistical support, and shifts in policy to enable BNS and strengthen program success. Frequent periodic trainings, availability of proper tools and effective inter department coordination are some of the recommendations given, to ensure proper implementation of National Health and Nutrition Program.