Dimensions Of Access Research Articles

The feasibility of the PicPecc application as an mHealth tool: Reflections from South African children

Background: Access to technology (and data) through mobile health (mHealth) can alleviate some of the challenges children experience in accessing healthcare services. However, the South African context is unique with children living in under-resourced and rural communities, with limited transport, long commute times to reach clinics, and poor access to technology. Therefore, even though mHealth tools can be beneficial, researchers need to determine the feasibility of such an application for the South African context.Aim: The study focussed on determining the feasibility of the PicPecc application (app) (an mHealth tool) in South Africa for children requiring mental health support.Setting: The study included 20 children between the age of 7 years and 18 years in different mainstream schools and a special school.Methods: A qualitative research design was used to conduct structured interviews with children, either via an online meeting (e.g., Google Meet) or in a natural setting (in the child’s school or home context).Results: The data were analysed and themes were identified according to five dimensions of access to healthcare and technology, namely acceptability, availability, accessibility, affordability, and accommodation.Conclusion: This study found that the PicPecc app is promising for implementation in the South African clinical setting. Participants reported various advantages when utilising the app to self-report health symptoms and thus considered it feasible for implementation in the South African context.Contribution: The study highlights important considerations for the implementation of mHealth technologies in the South African context.

Association between multiple dimensions of access to care and cervical cancer screening among Kenyan women: a cross-sectional analysis of the Demographic Health Survey

BackgroundCervical cancer remains the second most common cause of death in women and poses a growing public health challenge. It is urgent to increase cervical cancer screening rates in Kenya as per the 2018 Kenya National Cancer Screening Guidelines. Addressing access to care may serve as a target to achieve this goal; however, how individual dimensions of access to care are associated with the utilization of cervical cancer screening services in low- and middle-income countries, including Kenya, remains unclear. This study aimed to examine how different aspects of access to care (affordability, availability, geographical access, and social influence) were associated with cervical cancer screening among Kenyan women of reproductive age.MethodsThis cross-sectional study used data from the 2014 Kenya Demographic and Health Survey and the 2010 Kenya Service Provision Assessment. The final sample included 5,563 women aged 25–49 years. Logistic regression models were used to examine the association between different aspects of access to care and the uptake of cervical cancer screening.ResultsFactors such as being in the poorest wealth quintile, lacking health insurance, having difficulty obtaining funds for treatment (affordability), limited availability of screening services at nearby facilities (availability), living in rural areas (geographical access), and having healthcare decisions made solely by husbands/partners or others (social influence) were associated with a decreased likelihood of the uptake of cervical cancer screening.ConclusionsIncreasing health insurance coverage, enhancing the availability of screening services at health facilities, expanding mobile screening health facilities in rural areas, and empowering women to make their own healthcare decisions are crucial steps for increasing cervical cancer screening uptake in Kenya.

Sustainability Assessment Tools for Dairy Supply Chains: A Typology

The dairy sector faces increasing pressure to adopt sustainable practices. Various tools have been developed to evaluate sustainability of the dairy supply chain. This paper provides an overview of these tools, highlighting their strengths and limitations regarding sustainability dimensions, indicators, and system boundaries. A systematic literature search identified 27 tools that were then categorized into a typology based on dimensions of sustainability, geographical applicability, and accessibility. In-depth analysis was conducted on six tools: Sustainability Assessment of Food and Agriculture (SAFA), Sustainability Monitoring and Assessment RouTine (SMART), Response-Inducing Sustainability Evaluation (RISE) 3.0 version, Swiss Agricultural Life Cycle Assessment (SALCAsustain), MOnitoring Tool for Integrated Farm Sustainability (MOTIFS), and Technology Impact and Policy Impact CALculations (TIPICAL). Assessment focused on the relevance of covered sustainability dimensions to the dairy sector, level of supply chain coverage, type of indicators, accessibility, and practicability. The review identified tools which integrate multiple sustainability aspects in a comprehensive way (SAFA and SMART) and tools offering accurate quantification of the impact on sustainability dimensions of the production system (SALCAsustain, RISE, MOTIFS, TIPICAL). Only two tools extend assessment past the farm gate (SAFA, SMART). Future users should select tools based on the specific objectives of measuring sustainability in dairy systems. This review contributes to the literature by addressing various aspects of sustainability assessment tools, by addressing the need for an integrated and comprehensive view, and by considering the entire dairy supply chain.

Women’s access to health care for non-communicable diseases in South Africa: A scoping review.

Background Non-communicable diseases (NCDs) such as obesity, hypertension (HPT), and type II diabetes (T2D) are of increasing concern in South Africa (SA), with women being more at risk. Authors conducted a scoping review to identify and map the evidence available about the barriers of access to obesity, HPT, and T2D care among women in SA. Methods Arksey and O'Malley's framework for scoping review was used. The search of the literature was completed in the Scopus, Web of Science, and PubMed databases between April and May 2022. Only studies conducted among women in SA were eligible for inclusion. Identified barriers were mapped onto Levesque’s framework of access to health care to determine which points along the chain of accessing NCD health care among women are mostly impacted. Results Seven articles were included in the review: qualitative (n=2), quantitative (n=2), mixed methods (n=2), and grey literature (n=1). The included studies reported barriers of access to HPT and T2D care only, and no study reported barriers to obesity care. Supply-side barriers included lack of knowledge about available services, physician heavy workloads, medicine stock-outs, limited availability of testing equipment, travelling long distances, long waiting times, and delayed referral. Demand-side barriers included women having low self-awareness of NCD status, concerns about confidentiality, perceived discrimination, and poverty. Conclusions The study highlighted barriers related to the availability and accessibility dimension of access to health care, indicating that care for HPT and T2D is often inaccessible, with women often unable to reach health facilities or service providers. There is a pressing need for further research on access to healthcare for obesity, T2D, and HPT for women in South Africa, particularly among women who bear a disproportionately high burden of these conditions.

Instruments used to assess gender-affirming healthcare access: A scoping review.

The overall aim of this scoping review was to identify, explore and map the existing literature pertaining to healthcare access for transgender and non-binary individuals. The scoping review followed Arksey and O'Malley's methodological framework, and the reporting adhered to the guidelines provided by the PRISMA Extension for Scoping Reviews. To gather relevant articles, a comprehensive search strategy was employed across four electronic databases, with the assistance of a university librarian. In addition, manual and internet searches were conducted for grey literature. From the initial search, a pool of 2,452 potentially relevant articles was retrieved, which was supplemented by an additional 23 articles from the supplemental search. After an independent review by two researchers, 93 articles were assessed, resulting in the inclusion of 41 articles in the review. The literature highlights the identification of barriers and enablers, spanning across 32 individual data sets that affect healthcare accessibility for transgender and non-binary individuals. Leveque's five dimensions of healthcare access, namely approachability, acceptability, availability and accommodation, affordability, and appropriateness, were utilized to categorise these 42 factors. Some of the key themes that emerged in these dimensions include challenges in accessing information about services, concerns about acceptance from family and peers, past experiences of discrimination in healthcare settings, considerations related to cost and insurance, and the difficulty in finding appropriately trained competent providers. The review focused on the most commonly researched aspects of healthcare access and identified gaps in research and opportunities for future studies. The findings provide recommendations for policy and practice, which could guide the development of interventions aimed at addressing the barriers faced by transgender individuals seeking gender-affirming care.

Exploring the Factors Influencing Coronary Heart Disease Prevalence in the US Population: A Retrospective Observational Study.

Coronary heart disease (CHD) remains a significant global health concernand is characterized by inadequate blood supply to the myocardium due to the accumulation of plaque in the coronary arteries. Despite therapeutic advancements, prevalence disparities persist across various segments of the U.S. population, posing a significant challenge to healthcare systems. This study aims to find the prevalence disparities of CHD using Behavioral Risk Factor Surveillance System (BRFSS) data. A retrospective observational study was done using the 2022 BRFSS dataset on January 17, 2024. The study examined the presence of CHD as the dependent variable and investigated various independent variables. Descriptive and logistic regression analyses were conducted using the BRFSS Web Enabled Analysis Tool (Centers for Disease Control and Prevention, Atlanta, GA). Data management and storage utilized Microsoft Excel, and graphical analysis employed GraphPad Prism, version 9.4.1 (GraphPad Software, Inc., San Diego, CA). In demographics, respondents aged 65+ had higher CHD odds, while females exhibited lower risk than males. Hispanics had the lowest odds of CHD among all races. Socioeconomically, inability to work and retirees had higher CHD odds, as did income below $20,000 but ≥$15,000. Poor physical health increased CHD odds, as did having multiple healthcare providers. Medicare users had the highest CHD odds among insurance options. Significant disparities in CHD prevalence were seen across demographic, socioeconomic, health status, and healthcare access dimensions in the United States, emphasizing the urgent need for targeted interventions to address these disparities and improve overall public health outcomes.

Towards Sustainable Beach Tourism: Analysis of Beach Attractiveness, Overall Experience, and Revisit Intention in Coastal Ghana

Beaches are distinctive destinations, and their attractiveness is decisive in attracting tourists, enriching their experience, and sustaining coastal tourism. This study examined the relationship between beach attractiveness dimensions (scenery and cleanliness, facilities and services, geophysical aspects, and access and comfort), the overall experience, and revisit intentions of visitors. The mediating role of overall experience in the relationship between beach attractiveness and revisit intention was also tested. Data were collected from 311 respondents and analyzed using structural equation modeling in AMOS. These findings indicate the direct effects of beach scenery and cleanliness, as well as geophysical aspects, on revisit intentions. In addition, beach scenery, cleanliness, geophysical aspects, and facilities and services directly affect the overall experience of beach users. Finally, overall experience also mediated positive indirect relationships between facilities and services, access and comfort dimensions and revisit intentions. The results underscore the importance of enhancing beach attractiveness and user experience to attract tourists sustainably. The results are discussed from a demand perspective and implications are provided for beach management, regulators, and local governments on the supply side towards sustainable beach tourism in Ghana.

Universal health coverage and equal access in Sweden: a century-long perspective on macro-level policy

BackgroundWhen today’s efforts to achieve universal health coverage are mainly directed towards low-income settings, it is perhaps easy to forget that countries considered to have universal, comprehensive and high-performing health systems have also undergone this journey. In this article, the aim is to provide a century-long perspective to illustrate Sweden’s long and ongoing journey towards universal health coverage and equal access to healthcare.MethodsThe focus is on macro-level policy. A document analysis is divided into three broad eras (1919–1955; 1955–1989; 1989–) and synthesises seven points in time when policies relevant to overarching goals and regulation of universal health coverage and equal access were proposed and/or implemented. The development is analysed and concluded in relation to two egalitarian goals in the context of health: equality of access and equal treatment for equal need.ResultsOver the past century, macro-level policy evolved from the concept of creating access for the neediest and those reliant on wages for their survival to a mandatory insurance with equal right to healthcare for all. However, universal health coverage was not achieved until 1955, and individuals had to rely on their personal financial resources to cover the cost at the time of care utilization until the 1970s. It was not until 1983 that legislation explicitly stated that access to healthcare should be equal for the entire population (horizontal equity), while a vertical equity-principle was not added until 1997. Subsequently, ideas of free choice and privatization have gained significance. For instance, they aim to increase service access, addressing the Swedish health system’s Achilles’ heel in this regard. However, the principle of equal access for all is now being challenged by the emergence of private health insurance, which offers quicker access to services.Conclusions: brief summary and potential implicationsIt can be concluded that there is no perpetual Swedish healthcare model and various dimensions of access have been the focus of policy discussion. The discussion on access barriers has shifted from financial to personal and organizational ones. Today, Sweden still ranks high in terms of affordability and equity in international comparisons: although not as well as a decade ago. Whether this marks the beginning of a new trend intertwined with a decline in Sweden’s welfare ‘exceptionalism’, or is a temporary decline remains to be assessed in the future.

Access to maternal health services for Indigenous women in low- and middle-income countries: an updated integrative review of the literature from 2018 to 2023.

Ninety-seven per cent of Indigenous Peoples live in low-and middle-income countries (LMICs). A previous systematic integrative review of articles published between 2000 and 2017 identified numerous barriers for Indigenous women in LMICs in accessing maternal healthcare services. It is timely given the aim of achieving Universal Health Coverage in six years' time, by 2030, to undertake another review. This article updates the previous review exploring the recent available literature on Indigenous women's access to maternal health services in LMICs identifying barriers to services. An integrative review of literature published between 2018 and 2023 was undertaken. This review followed a systematic process using Whittemore and Knafl's five-step framework for integrative reviews and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 944 articles were identified from six databases: Academic Search Premier, MEDLINE, Psychology and Behavioral Sciences Collection, APA PsycInfo, CINAHL Plus with Full Text and APA PsycArticles (through EBSCOhost). The search was undertaken on 16 January 2023. After screening of the title/abstract and the full text using inclusion and exclusion criteria 26 articles were identified. Critical appraisal resulted in 24 articles being included in the review. Data were extracted using a matrix informed by Penchansky and Thomas's taxonomy, extended by Saurman, which focused on six dimensions of access to health care: affordability, accessibility, availability, accommodation, acceptability and awareness. Ten studies took place in Asia, 10 studies were from the Americas and four studies took place in the African region. Seventeen articles were qualitative, two were quantitative and five were mixed methods. The methods for the integrative review were prespecified in a protocol, registered at Open Science Framework. Barriers identified included affordability; community awareness of services including poor communication between providers and women; the availability of services, with staff often missing from the facilities; poor quality services, which did not consider the cultural and spiritual needs of Indigenous Peoples; an overreliance on the biomedical model; a lack of facilities to enable appropriate maternal care; services that did not accommodate the everyday needs of women, including work and family responsibilities; lack of understanding of Indigenous cultures from health professionals; and evidence of obstetric violence and mistreatment of Indigenous women. Barriers to Indigenous women's access to maternal health services are underpinned by the social exclusion and marginalisation of Indigenous Peoples. Empowerment of Indigenous women and communities in LMICs is required as well as initiatives to challenge the stigmatisation and marginalisation that they face. The importance of community involvement in design and interventions that support the political and human rights of Indigenous Peoples are required. Limitations of this review include the possibility of missing articles as it was sometimes unclear from the articles whether a particular group was from an Indigenous community. More research on access to services in the postnatal period is still needed, as well as quality quantitative research. There is also a lack of research on Indigenous groups in North Africa, and in sub-Saharan Africa - especially hunter-gatherer groups - as well as the impact of COVID-19 on access to services.

Racial differences in the incidence of mental health illness among ovarian cancer patients: An analysis of SEER-Medicare data

BackgroundOvarian cancer (OC) patients have an increased risk for a mental health illness (MHI) after their cancer diagnosis, but limited research exists on whether this risk differs by race/ethnicity. Hence, we used SEER-Medicare data to evaluate racial/ethnic differences in MHI incidence among OC patients aged 65+. MethodsNon-Hispanic (NH) Black, NH White, and Hispanic women diagnosed with OC in 2008–2015 without a mental health history 12 months prior to their cancer diagnosis were identified from SEER-Medicare. Cox proportional hazards regression evaluated new MHI incidence in the first five years post diagnosis and the differences by race/ethnicity. Hazard ratios (HR) and 95% confidence intervals (CI) adjusted for demographic/clinical covariates and healthcare access (HCA) dimensions. ResultsWe identified 5441 OC patients, including 364 NH Black (6.7%), 4982 NH White (91.6%), and 95 Hispanic (1.7%) patients. About 41% of NH White, 33.3% of NH Black, and 37.2% of Hispanic OC patients were diagnosed with MHI during the follow-up period between 2008 and 2016. In the fully adjusted model, NH Black OC patients were less likely to be diagnosed with any MHI (aHR: 0.67, 95% CI: 0.54, 0.82), depression (aHR: 0.66, 95% CI: 0.51, 0.86), and anxiety disorder (aHR: 0.64, 95% CI: 0.49, 0.84), while Hispanic OC patients were less likely to be diagnosed with anxiety disorder (aHR: 0.56, 95% CI: 0.33, 0.95) compared to NH White OC patients. DiscussionNH Black OC patients are less likely to receive a clinical MHI diagnosis compared to NH White OC patients. Further studies on racial differences in MHI incidence after OC diagnosis in primary cohorts are needed to better estimate population-level prevalence less vulnerable to exposure misclassification and to account for patient-level factors impacting MHI.

ParkLIV – engaging non-users in green space management

ABSTRACT Everyone has the right to feel welcome, safe and be able to access public green spaces without fear, anxiety or stress. However, the term “accessibility” is primarily used in relation to physical accessibility, while social and cultural dimensions of accessibility to urban public green spaces remains underexplored. Methods and tools for universal design and management that also meets the needs of marginalised groups, are needed. This requires involvement of both users and potential users through participatory methods, building on individual needs and perspectives. In Sweden, traditionally marginalised groups and non-users are rarely engaged in the development of public urban green spaces. Local governments may have the will, but lack resources and appropriate methods in order to do so. Research has recently described a further engagement of users as an unleashed potential in relation to planning and management of urban green spaces. Based on the study of three test beds and the use of public green space governance and management theory, we developed a process model for user participation in green space maintenance with focus on involving marginalised groups and non-users. The model balances what is theoretical optimal with what is practically feasible within the daily work of a municipal organisation. We present an empirically tested process model that can form the basis for future maintenance of urban green spaces, with the use of limited resources.

The complex networks of an entrepreneurship and innovation ecosystem: proposal for a representation model

This article presents a proposal for a representation model of entrepreneurial innovation ecosystems, based on the Theory of Complex Networks, in order to understand the complexity of the relationships between its actors. The methodology used was a qualitative approach, of a bibliographic and documentary nature, which defined categorized axes based on the dimensions of politics, economy, culture, support institutions, human capital and access to the market, present in an entrepreneur. The model that will contribute to supporting the connections and dissemination of knowledge in an entrepreneurial innovation ecosystem, providing insights for its actors to analyze public policies based on their impact in terms of multidimensional development was applied in the city of Salvador/BA, as proof concept. Its application allowed the collection of mapping results from the main actors in the ecosystem of the capital of Bahia, in addition to identifying the dissemination of knowledge as an important dimension for the development of new actions and partnerships between them to foster innovation.

Healthcare access for pregnant women in a rural developing country context: Formal and informal institutional challenges

This study examines healthcare access for pregnant women in a rural developing country context. Drawing upon institutional theory and Levesque et al’s model of access, the study finds pregnant women face challenges both of a formal and informal nature in accessing healthcare. The findings suggest the need for integrated and collaborative workings across formal and informal institutional networks. Theoretically, the study makes two contributions. First, it adds value to institutional theory by incorporating a dimension of access. Second, it builds upon Levesque et al.’s healthcare access framework by highlighting the role and significance of a third dimension—that is informal institutions, in addition to the current two—formal institutions and individual factors.

The role of perceived quality of care on outpatient visits to health centers in two rural districts of northeast Ethiopia: a community-based, cross-sectional study

BackgroundPatients who have had a negative experience with the health care delivery bypass primary healthcare facilities and instead seek care in hospitals. There is a dearth of evidence on the role of users’ perceptions of the quality of care on outpatient visits to primary care facilities. This study aimed to examine the relationship between perceived quality of care and the number of outpatient visits to nearby health centers.MethodsA community-based cross-sectional study was conducted in two rural districts of northeast Ethiopia among 1081 randomly selected rural households that had visited the outpatient units of a nearby health center at least once in the previous 12 months. Data were collected using an interviewer-administered questionnaire via an electronic data collection platform. A multivariable analysis was performed using zero-truncated negative binomial regression model to determine the association between variables. The degree of association was assessed using the incidence rate ratio, and statistical significance was determined at a 95% confidence interval.ResultsA typical household makes roughly four outpatient visits to a nearby health center, with an annual per capita visit of 0.99. The mean perceived quality of care was 6.28 on a scale of 0–10 (SD = 1.05). The multivariable analysis revealed that perceived quality of care is strongly associated with the number of outpatient visits (IRR = 1.257; 95% CI: 1.094 to 1.374). In particular, a significant association was found for the dimensions of provider communication (IRR = 1.052; 95% CI: 1.012, 1.095), information provision (IRR = 1.088; 95% CI: 1.058, 1.120), and access to care (IRR = 1.058, 95% CI: 1.026, 1.091).ConclusionsService users’ perceptions of the quality of care promote outpatient visits to primary healthcare facilities. Effective provider communication, information provision, and access to care quality dimensions are especially important in this regard. Concerted efforts are required to improve the quality of care that relies on service users’ perceptions, with a special emphasis on improving health care providers’ communication skills and removing facility-level access barriers.

Socioeconomic inequalities in hospital access for prostate cancer before and after COVID-19

Prostate cancer is one of the most common cancers with 36,016 registered cases in 2020 in the United Kingdom. Access to cancer care remains a policy priority across OECD countries, but there are concerns that socioeconomic inequalities have been amplified following the COVID-19 pandemic due to accumulated backlogs. Using administrative data from the Hospital Episodes Statistics, this study examines socioeconomic inequalities in different dimensions of access to prostate cancer surgery in England in 2015–22, and whether such inequalities increased after COVID-19. Access is a multifaceted concept encompassing several dimensions along the patient pathway. We investigate socioeconomic inequalities in the volume of surgeries, waiting time of patients on the list (patient responsiveness), hospital length of stay (intensity of care), 30-day emergency readmissions and 3-year mortality (health outcomes). We find that, after controlling for a range of factors (e.g. age composition, ethnicity, rurality, primary care availability), the number of prostate surgeries for the most income-deprived quintile is 41.0 % lower than the least income-deprived quintile in the pre-COVID period. The gradient appears similar in the post-COVID period in proportionate terms when volume dropped. We generally find no evidence of inequalities in other dimensions of access, such as waiting times (from patient addition to treatment list) and length of stay (from hospital admission to discharge). We also find no evidence of inequalities in the probability of being readmitted as an emergency within 30 days from discharge. Instead, patients in the most income-deprived quintile have a higher mortality rate by at least one percentage point relative to the least-deprived quintile. This difference in mortality does not appear to be related to differences in the quality of care across hospitals. The analysis highlights the need to take a multidimensional approach when assessing socioeconomic inequalities in access to hospital care along the patient pathway.

Access to care in Afghanistan after august 2021: a cross-sectional study exploring Afghans’ perspectives in 10 provinces

BackgroundThe Taliban takeover in August 2021 ended a decades-long conflict in Afghanistan. Yet, along with improved security, there have been collateral changes, such as the exacerbation of the economic crisis and brain drain. Although these changes have altered the lives of Afghans in many ways, it is unclear whether they have affected access to care. This study aimed to analyse Afghans’ access to care and how this access has changed after August 2021.MethodsThe study relied on the collaboration with the non-governmental organisation EMERGENCY, running a network of three hospitals and 41 First Aid Posts in 10 Afghan provinces. A 67-item questionnaire about access to care changes after August 2021 was developed and disseminated at EMERGENCY facilities. Ordinal logistic regression was used to evaluate whether access to care changes were associated with participants’ characteristics.ResultsIn total, 1807 valid responses were returned. Most respondents (54.34%) reported improved security when visiting healthcare facilities, while the ability to reach facilities has remained stable for the majority of them (50.28%). Care is less affordable for the majority of respondents (45.82%). Female respondents, those who are unmarried and not engaged, and patients in the Panjshir province were less likely to perceive improvements in access to care.ConclusionsFindings outline which dimensions of access to care need resource allocation. The inability to pay for care is the most relevant barrier to access care after August 2021 and must therefore be prioritised. Women and people from the Panjshir province may require ad hoc interventions to improve their access to care.

Next Generation Computing and Communication Hub for First Responders in Smart Cities.

This paper contributes to the development of a Next Generation First Responder (NGFR) communication platform with the key goal of embedding it into a smart city technology infrastructure. The framework of this approach is a concept known as SmartHub, developed by the US Department of Homeland Security. The proposed embedding methodology complies with the standard categories and indicators of smart city performance. This paper offers two practice-centered extensions of the NGFR hub, which are also the main results: first, a cognitive workload monitoring of first responders as a basis for their performance assessment, monitoring, and improvement; and second, a highly sensitive problem of human society, the emergency assistance tools for individuals with disabilities. Both extensions explore various technological-societal dimensions of smart cities, including interoperability, standardization, and accessibility to assistive technologies for people with disabilities. Regarding cognitive workload monitoring, the core result is a novel AI formalism, an ensemble of machine learning processes aggregated using machine reasoning. This ensemble enables predictive situation assessment and self-aware computing, which is the basis of the digital twin concept. We experimentally demonstrate a specific component of a digital twin of an NGFR, a near-real-time monitoring of the NGFR cognitive workload. Regarding our second result, a problem of emergency assistance for individuals with disabilities that originated as accessibility to assistive technologies to promote disability inclusion, we provide the NGFR specification focusing on interactions based on AI formalism and using a unified hub platform. This paper also discusses a technology roadmap using the notion of the Emergency Management Cycle (EMC), a commonly accepted doctrine for managing disasters through the steps of mitigation, preparedness, response, and recovery. It positions the NGFR hub as a benchmark of the smart city emergency service.

Digital Inclusion in Rural Areas: A Case Study in Two Indonesian Villages

The acceleration of digital transformation is an unavoidable challenge for all countries worldwide, including in rural areas. However, there is a digital divide between rural and urban areas. Digital inclusion is a condition that needs to be achieved to close the gap. This study aims to measure digital inclusion based on four key dimensions: access, skills, use, and supportive environment, which are represented by several indicators and variables at the village level. We compare two cases in Indonesia, namely Tamansari Village initiated by the government and Melung Village initiated by the local community. Our results show that digital inclusion in both cases already has the dimensions of access and actual use which tend to be suitable for the majority of the households. However, the skills and supportive environment dimensions still need to be improved in the two study areas. It is indicated because the approach are still focused on providing access, not improving skills through optimizing the benefits of digital technology.

Impact of Privatization on Healthcare System: A Systematic Review.

A notable shift in healthcare policy is healthcare privatization, which refers to the transfer of ownership, management, or provision of healthcare services from the public sector to private entities. To provide a narrative examination of the impact of privatization on various dimensions of healthcare, including quality, equity, accessibility, and cost-effectiveness. Policymakers can utilize the findings of this study to make well-informed decisions regarding privatization strategies. A systematic review was implemented using the following databases: PubMed, Scopus, and Google Scholar. Studies conducted from January 2000 to January 2023 in developing or developed countries that assessed the impact of healthcare privatization on population health within public sector institutions were included. Eleven studies were included. The findings revealed diverse perspectives on the impact of healthcare privatization, with four studies (36.4%) supporting privatization (two of these were conducted in Saudi Arabia), six studies (54.5%) opposing it (three of these were conducted in European countries), and one study (9.1%) taking a neutral stance. Two studies investigated the impact on healthcare quality, and both revealed that privatization negatively impacts uninsured patients and low-income populations. In addition, five studies investigated the healthcare access and equity dimensions following privatization: one was in favor, one was neutral, and three were opposing it. Four studies investigated the cost-effectiveness dimension, with three in favor and one study opposing it. This review highlights different perspectives on healthcare privatization. While studies, as those from Saudi Arabia, suggest benefits in terms of efficiency and innovation, others, particularly from European countries, emphasize negative consequences such as inequity and reduced quality. This emphasizes the need for more investigations to understand privatization's impact on healthcare.

Outpatient Palliative Care Program: Impact on Home Death Rate in Brazil.

While the positive impact of early palliative care on the quality of life of cancer patients is well established, there is a noticeable research gap in developing countries. This study sought to determine the impact of an outpatient palliative care (OPC) program on the location of death among patients in Brazil. This was a retrospective study including patients with cancer who died between January 2022 and December 2022 in 32 private cancer centers in Brazil. Data were collected from medical records, encompassing demographics, cancer characteristics, and participation in the OPC program. The study involved 1980 patients, of which 32.3% were in the OPC program. OPC patients were predominantly younger (average age at death of 66.8 vs. 68.0 years old, p = 0.039) and composed of women (59.4% vs. 51.3%, p = 0.019) compared to the no-OPC patients. OPC patients had more home/hospice deaths (19.6% vs. 10.4%, p < 0.001), and participation in the outpatient palliative care program strongly predicted home death (OR: 2.02, 95% CI: 1.54-2.64). Our findings suggest a significant impact of the OPC program on increasing home and hospice deaths among patients with cancer in our sample. These findings emphasize the potential of specialized OPC programs to enhance end-of-life care, particularly in low-resource countries facing challenges related to social and cultural dimensions of care and healthcare access.