Gaps In Access Research Articles

Palliative Care in Rural Communities.

Rural communities in the United States are frequently marginalized and misrepresented. These communities face unique challenges, such as limited access to health care, nutritious food, and clean water, that contribute to persistent health disparities. This article presents the CARE (Complex, Access, Resourceful, Extraordinary) framework, which illustrates the dichotomy of rurality-its negative and positive aspects-in order to inform the development of palliative care delivery in rural settings. Various palliative care models are described that address access gaps, bolster provider capacity, and increase the provision of specialty palliative care. However, workforce shortages and reimbursement structures restrict the expansion of these services. Nurses, the largest segment of the health care workforce and the most trusted professionals, must partner with interdisciplinary colleagues and rural communities to advocate for equitable and inclusive care.

Accessibility enhancement of mass transit system through GIS based modeling of feeder routes

Access and ingress to and from the metro stations plays a crucial role in elevating the efficacy of transportation systems. This study presents a novel approach to optimize and integrate feeder route network with mass transit system using GIS. An initial accessibility analysis of existing feeder routes revealed only 0.12% of the total population being served. To address the accessibility challenge a comprehensive GIS based feeder route design model based on population data and road network attributes was developed. The model efficiently identified candidate feeder stops which were further subjected to a route analysis model for optimal route design. A total of 29 feeder routes with an average length of 10.2 ​km were identified by the route analysis model. The results demonstrated that the feeder routes obtained through this method exhibited exceptional coverage across the study area effectively bridging the accessibility gaps. The effectiveness of the proposed model was validated through the service area analysis and density analysis, verifying a noticeable increase in route density and substantial population served corresponding to 0.25%. which is doubled as compared to the population served existing feeder routes. The study provides an opportunity for transit authorities to design efficient feeder networks complying with better integration and accessibility.

Evaluating the feasibility of a tele-diagnostic auditory brainstem response service in a rural context.

There is a noticeable gap in access to audiology services in South Africa, and the gap is intensified in rural areas. Often, primary healthcare (PHC) facilities have an unequal ratio of audiologists to patients in need. Telehealth can expand the range of hearing healthcare services. This study aimed to determine whether, for infants, tele-diagnostic Auditory Brainstem Response (ABR) assessment results conducted within a mobile clinic van are comparable to face-to-face diagnostic ABR results in rural Winterveldt, Pretoria North, South Africa. The study utilised a quantitative, prospective cross-sectional comparative within-subject design. Each participant received both face-to-face and mobile tele-diagnostic ABR tests, which were then compared to evaluate the feasibility of mobile tele-diagnostic ABR testing. The Student's t-test was used to determine whether there was a difference between face-to-face and tele-diagnostic tests, and Bland -Altman plots were used to assess the level of agreement between the ABR testing results. There was a strong correlation (p 0.001) between face-to-face and mobile tele-diagnostic ABR test results for both neurological and audiological ABR tests. The study found that there was no statistical significance between face-to-face and tele-diagnostic ABR measures; additionally, the results were within clinically acceptable and normative measures. Tele-diagnostic ABR offered within a mobile clinic van is feasible as it produces similar and clinically acceptable results when compared to the traditional assessment method.Contribution:This feasibility study is a positive indicator that tele-diagnostic ABR testing through a mobile clinic van may be considered to accelerate the delivery of hearing healthcare services to the infant population in rural communities.

Unlocking financial access in a developing country amidst COVID-19: the impacts of financial literacy and fintech

We examine the impacts of financial technology and financial literacy on the development of financial inclusion among the younger generation using data from a survey with 1288 students in Vietnam in the city and rural areas. We employ logistic regression and two-stage instrumental variable regression for our analysis, with location and financial shock caused by COVID-19 serving as the instruments. Vietnam is a fintech hub in Asia with the world-leading adaption of cryptocurrency and a significantly high rate of e-wallet use. The results indicate although there is a gap in access to financial services between urban and rural areas, the access rate is considerably high. Fintech and financial literacy play a significant role in facilitating this high level of financial inclusion development. Women have better access to financial services, showing the effectiveness of women’s empowerment programs. Little evidence shows the negative impact of the pandemic on financial inclusion.

Transforming Education in Coastal Indonesia: A Survey of Digital Literacy and Competence Among Educators

This research explores the digital literacy and competence of educators in coastal areas of Indonesia, focusing on technology access, usage patterns, and challenges in integrating digital tools into teaching practices. Utilizing a quantitative survey method, data was collected from 235 educators teaching in coastal area schools. The study found a generally positive trend in technology access, with reliable availability of computers, laptops, and internet connection supporting educators' professional tasks. However, gaps in access to up-to-date software highlight the need for improved resources and support to ensure equitable technology use. Educators demonstrated a strong trend towards integrating digital tools in lesson planning and communication with students. Despite this, the uneven adoption of these tools suggests a need for broader and more equitable technology integration. Significant challenges include difficulties in keeping up with technological advancements and managing technical issues, emphasizing the need for comprehensive professional development and targeted training on advanced digital tools and troubleshooting. While the study provides valuable insights, it is limited by its small sample size and geographic focus, potentially not fully representing the diverse experiences of educators across Indonesia. Future research should expand the sample size and geographic range to offer a more comprehensive understanding of technology integration challenges and to support more effective recommendations for enhancing technology use in education.

Attitude, Knowledge and Perception Among General Public About Tele-Manas Services in Delhi NCR

This study delves into the impact of the National Tele Mental Health Programme of India, known as Tele MANAS, on public access to and perceptions of mental health services in Delhi NCR. Despite India's rich history in mental health awareness, contemporary hurdles such as accessibility and stigma persist. Tele MANAS end eavours to tackle these challenges by offering integrated tele-mental health services across the nation. Through a cross-sectional study involving 207 participants, this research delves into public attitudes, knowledge and awareness regarding Tele MANAS. Findings reveal a notable demand for mental health services but a limited awareness of the program. Notably, social media and television emerged as primary channels for awareness dissemination. While attitudes toward Tele MANAS were generally positive, there remains a need for targeted outreach to engage neutral segments of the population. Analysis uncovered variations in demand, awareness, and perception, highlighting the necessity for tailored strategies. This research holds significant implications for improving Tele MANAS's efficacy and advancing mental health care in India. By understanding the current landscape and addressing gaps in awareness and access, Tele MANAS can better serve the populace, particularly in regions like Delhi NCR. Moreover, the study underscores the importance of ongoing efforts to destigmatize mental health issues and ensure equitable access to quality care for all individuals, regardless of background or demographics.

Patterns and predictors of malaria among head porters: a mobile population in Ghana

BackgroundHead porters popularly known as ‘Kayayeis in Ghana, face challenges in accessing essential health care services due to the mobile nature of their trade, low formal education, poor settlements, low-income among others. Kayayeis are predominantly females and form part of the mobile population who are at increased risk of malaria infection. Despite their increased risk of malaria, mobile populations are difficult to target for malaria interventions, hence serving as potential drivers of transmission even if malaria in the general population is controlled. The study, therefore, assessed the patterns and predictors of malaria among the Kayayei population in Ghana to inform policy decisions.MethodsA mixed methods study was conducted among Head-porters and their leaders in the three main hubs of Head-porters in Ghana; namely Accra, Kumasi, and Tamale. Blood samples were collected from participants and tested for malaria parasites using Rapid Diagnostic Test (RDT). Additionally, data including socio-demographics, malaria knowledge, attitude and practice were collected using a semi-structured questionnaire. Associations between malaria status and participants characteristics were determined by logistic regression (p < 0.05). Thematic analysis was used to analyse transcripts from the key informant interviews.ResultsOut of 754 head porters studied, 10.48% (79) tested positive for malaria. The majority 43.10% (325/754) of the head porters were twenty years and below, and most 67.11% (506/754) had no formal education. Nearly half (50.4%) were not on any health insurance. Receiving malaria education in the past 6 months [AOR = 0.48, (0.26–0.88), p-value 0.02], and having poor knowledge of malaria [AOR = 2.23, (1.26–4.27), p < 0.02], were the factors significantly associated with malaria infection.ConclusionThe prevalence of malaria among ‘Kayayei’s was estimated at 10.46%. A majority of them sleeps outside and in structures without mosquito screens. Receiving malaria education in the past 6 months reduced the odds of malaria infection whilst poor knowledge of malaria increased the odds of malaria infection among the porters. The authors recommend that the National Malaria Elimination Programme and partners should provide long-lasting insecticidal nets (LLIN) and other outdoor interventions for use by this special group. Designated state institutions should arrange free National Health Insurance Scheme (NHIS) registration for ‘Kayayeis’ to narrow the health access gap.

Advancements in Interventional Pulmonology: Harnessing Ultrasound Techniques for Precision Diagnosis and Treatment.

Medical ultrasound has emerged as an indispensable tool within interventional pulmonology, revolutionizing diagnostic and procedural practices through its non-invasive nature and real-time visualization capabilities. By harnessing the principles of sound waves and employing a variety of transducer types, ultrasound facilitates enhanced accuracy and safety in procedures such as transthoracic needle aspiration and pleural effusion drainage, consequently leading to improved patient outcomes. Understanding the fundamentals of ultrasound physics is paramount for clinicians, as it forms the basis for interpreting imaging results and optimizing interventions. Thoracic ultrasound plays a pivotal role in diagnosing conditions like pleural effusions and pneumothorax, while also optimizing procedures such as thoracentesis and biopsy by providing precise guidance. Advanced ultrasound techniques, including endobronchial ultrasound, has transformed the evaluation and biopsy of lymph nodes, bolstered by innovative features like elastography, which contribute to increased procedural efficacy and patient safety. Peripheral ultrasound techniques, notably radial endobronchial ultrasound (rEBUS), have become essential for assessing pulmonary nodules and evaluating airway structures, offering clinicians valuable insights into disease localization and severity. Neck ultrasound serves as a crucial tool in guiding supraclavicular lymph node biopsy and percutaneous dilatational tracheostomy procedures, ensuring safe placement and minimizing associated complications. Ultrasound technology is suited for further advancement through the integration of artificial intelligence, miniaturization, and the development of portable devices. These advancements hold the promise of not only improving diagnostic accuracy but also enhancing the accessibility of ultrasound imaging in diverse healthcare settings, ultimately expanding its utility and impact on patient care. Additionally, the integration of enhanced techniques such as contrast-enhanced ultrasound and 3D imaging is anticipated to revolutionize personalized medicine by providing clinicians with a more comprehensive understanding of anatomical structures and pathological processes. The transformative potential of medical ultrasound in interventional pulmonology extends beyond mere technological advancements; it represents a paradigm shift in healthcare delivery, empowering clinicians with unprecedented capabilities to diagnose and treat pulmonary conditions with precision and efficacy. By leveraging the latest innovations in ultrasound technology, clinicians can navigate complex anatomical structures with confidence, leading to more informed decision-making and ultimately improving patient outcomes. Moreover, the portability and versatility of modern ultrasound devices enable their deployment in various clinical settings, from traditional hospital environments to remote or resource-limited areas, thereby bridging gaps in healthcare access and equity.

ASSESSMENT OF TÜRKİYE'S PROVINCES WITH HEALTH INFRASTRUCTURE INDICATORS USING DESCRIPTIVE ANALYSIS AND HEALTH INDEX

Health systems assessment is critical to ensure the sustainability of health services. The interest of researchers in analysing health systems, which intensified during the pandemic, is motivated by the opportunity to identify weaknesses and propose changes. Health systems analyses provide valuable feedback for policy makers, especially in developing countries, which struggle with obstacles such as limited resources, financial constraints and deficiencies in health infrastructure. As a developing country, Türkiye has been striving to ensure equal access to health services through its health transformation programme. In the last decade, developments such as the increase in Syrian migrants and economic contraction have negatively affected this effort. This situation motivates the need to analyse the current situation in the Turkish health system and provide suggestions for improvement. The literature on the Turkish health system mostly focuses on broad health system indicators such as health service accessibility, efficiency, quality and user satisfaction. This study focuses on assessing the accessibility of health infrastructure resources. In the study, health infrastructure indicators related to the Turkish health system are evaluated on a province basis for the period from 2012 to 2021. The evaluation is based on the descriptive statistics of the dataset and the province-based health index. The findings show changing trends and gaps in access to health services with the increase in population in the period 2012-2021. Some variables (e.g. population per hospital and population per bed) show low variances, while others (e.g. population per intensive care bed) show large differences. These differences may indicate unequal development and investment in health infrastructure. For policy makers, they emphasise the need to develop policies to address these inequalities and to distribute resources equitably. Analysing the health index values shows inequalities in access to health resources in different provinces of Türkiye as a score. In particular, while some provinces such as Isparta and Bolu stand out with consistently high index scores, lower index scores in other provinces such as Şanlıurfa, Mardin, Ağrı and Şırnak indicate that inequalities in access to health services are faced. This index identifies changes and gaps in the distribution of health resources and shows policy makers priority areas for intervention.

An analysis of the relative importance of healthcare services indicators in South Africa: Utilities Analysis Approach

Background: There is a wide gap in healthcare access between the poor and the rich in South Africa. The government has implemented several policies to address this gap; nonetheless the complaints about poor healthcare delivery exist. Aims: The objective of this study is to examine the relative importance of healthcare service indicators in Tshwane Municipality, South Africa. Methods: This research uses a utility approach to analyse the relative importance of healthcare service indicators in the context of the Tshwane Municipality in South Africa. The study applies conjoint analysis to better understand healthcare users' preferences for several factors such as service range, waiting time for medications and consultations, waiting time for elective operations, and location. Questionnaire was administered on 280 respondents, comprising the following: Black – 130, Whites – 70, Indians – 40, and Coloured – 40. The data was collected from both public and private healthcare users, and the results were compared using an independent t-test. Results: The study found that there were no statistically significant variations in the mean utilities of public and private healthcare users. The finding suggests that healthcare users' preferences, whether they utilize public or private services, are largely comparable and can be addressed by utilizing unified techniques. The result also demonstrates the most favoured levels for each metric, providing insights into patient preferences and their social impacts. The study further highlights various healthcare preferences of users. Conclusion: This finding emphasises that healthcare users have unique expectations, requiring personalised healthcare delivery. The findings have several recommendations for policymakers and healthcare practitioners to improve service delivery and patient satisfaction. Received: 01 May 2024 | Reviewed: 03 June 2024 | Revised: 12 July 2024 | Accepted: 21 July 2024.

Gaps in Access to Medically Necessary Dental Care for Patients Living With and Beyond Cancer: We Must Do Better.

Delivery of high-quality, evidence-based oral care for those living with and beyond cancer needed!

Rural veteran perception of healthcare access in South Carolina and Florida: a qualitative study

BackgroundAccess to mental and physical healthcare in rural areas is challenging for Veterans and their families but essential for good health. Even though recent research has revealed some of the challenges rural Veterans face accessing healthcare, a complete understanding of the gap in access is still unclear.MethodsThis qualitative study aimed to explore participants’ perceptions of healthcare access. Structured interviews were conducted with 124 Veterans and spouses of Veterans from rural qualifying counties in South Carolina and Florida.ResultsThe study’s results revealed five main dimensions of access: geographic proximity, transportation, communication, cultural competence, and resources. Distance to service needed can negatively impact access for Veterans and their families in general, especially for those whose health is declining or who cannot drive because of their age. Lack of transportation, problems with transportation services, and lack of public transportation can lead to delays in care. Additionally, the lack of communication with the Veterans Affairs (VA) Health System and with the healthcare team, as well as inefficient communication among the healthcare team, lack of coordination of care between the VA health system and community providers, and the lack of cultural competence of healthcare providers and contracted personnel made access to services even more challenging.ConclusionsImproving communication can help to develop a sense of trust between Veterans and the VA, and between Veterans and spouses with the healthcare team. It can also lead to increased patient satisfaction. Ensuring healthcare providers and contracted personnel are culturally competent to talk and treat Veterans can improve patient trust and adherence to treatment. Lastly, resource-related challenges included financial problems, lack of prompt access to appointments, lack of providers, limited access to local clinics and hospitals, limited local programs available, and reimbursement issues.

Exploring the complex interplay of green finance, business cycles, and energy development

Green finance has emerged as a contemporary mechanism to support investments in renewable energy, energy efficiency, and sustainable infrastructure projects. This study aims to provide empirical insights into the asymmetric influence of green finance and business cycle fluctuations on energy development in 60 developing countries from 2000 to 2021. Four aspects of energy development, including energy access, stability, efficiency, and production gap, are examined using panel quantile regression with additive fixed effects. The research findings demonstrate that green finance plays a significant role in fostering energy development, with varying effects across different quantiles of the distribution. Specifically, the results indicate that green finance supports energy access and stability, particularly during economic recession, low-income levels, and limited technological advancement. However, the impact of green finance on energy efficiency exhibits notable heterogeneity, contingent upon technological and periods of economic expansion. Achieving tangible improvements in energy efficiency necessitates a certain level of technological and economic development. Moreover, green finance shows a capacity to maintain an optimal level of energy production, particularly evident during economic expansion and for highly technologically developed countries. The impact of business cycle fluctuations varies across different quantile distributions of energy development indicators, predominantly exerting an inhibitory effect of economic recession. In light of these results, it is recommended that policies in developing countries be revised to enhance energy access, optimize energy production levels, and promote the cost-effectiveness of renewable energy in conjunction with green finance initiatives.

Building resilience of street-connected children during COVID-19: turning rights into practices through CINI method.

This article examines the methods and opportunities for SCC's meaningful participation that recognize their agency and are aligned with General Comment No. 21 (GC21) to the United Nations Convention on the Rights of the Child (UNCRC) on Children in Street Situations (UNCRC, 1989). This article explains the application of CINI's core practice models which explains the child centrality in development practices for "turning rights into practice for children" derived from the Sustainable Development Goals, principles of Human Rights, UNCRC, and General Comment No. 20 (2016). The Institutional knowledge was practiced through child-led action research with street- connected children which resulted in the development of agency among SCC, peer researchers, and child advocates for resilience building within their community during COVID-19. Child in Need Institute (CINI) has been working with SCC since 1989 and has derived a rich body of experience from the interventions. CINI applied participatory approaches to practice, research, decision-making, and policy development; thus, facilitating children in the process of systematically gathering information with their peers, identifying key issues and problems faced by SCC, and securing support from duty bearers that were required for the survival within their situations. Drawing on the approach undertaken and the tools used in the participatory research and advocacy, this article reflects upon the processes and strategies that worked out in facilitating SCC's ability to exercise agency and resilience through evidence generation and advocacy during COVID-19 and the associated lockdown and beyond. Through capacity building on research tools, leadership and communication skills, SCC can build concrete evidence of their vulnerabilities and the gaps that pose as barriers to their access to existing support mechanisms. This evidence helps them to prioritize the solutions that are required to bring changes in their lives and that of their peers, with which they can advocate at different platforms that promote dialogs and negotiations between children and duty-bearers. A participatory research project funded by Wellcome Trust focused on the vulnerabilities faced by street-connected young people and the access to services available to them. It revealed the lack of understanding regarding SCC and their invisibility in data and planning of support services, the gaps in access to healthcare services, the social determinants of health including safety, and their exclusion in platforms for dialogs with duty bearers. They took these issues to local government leaders, service providers, and national and international advocacy platforms; and suggested solutions to local and world leaders to bring changes in their situations. This resulted in a marked increase in the responsiveness of service providers toward SCC during the period of COVID-19, and the increased agency and negotiation skills of peer leaders to support their communities and demand solutions during the period of COVID-19 and associated lockdown.

An Oxygen Supply Is Not Enough: A Qualitative Analysis of a Pressure Swing Adsorption Oxygen Plant Program in Ethiopian Hospitals.

In response to critical gaps in medical oxygen access, 2 pressure swing adsorption (PSA) oxygen production centers were established using an ecosystem-strengthening strategy in Amhara, Ethiopia, in 2019. A qualitative study was conducted to assess enablers and bottlenecks to oxygen access at the hospital level after installation. A variety of hospital staff (clinicians, biomedical professionals, hospital administrators, and procurement teams) across 13 hospitals procuring oxygen from the plants participated in comprehensive, semistructured focus group discussions. A thematic framework analysis approach was used to identify key themes. A total of 101 individuals participated in 26 focus groups in 2021, 2 years after plants were installed. Primary themes were accessibility of supply, affordability, and hospital readiness. Respondents indicated a substantial increase in their hospital's ability to access lower-cost oxygen, with many attributing this to the locality of plants and reduced transportation barriers. However, other challenges persisted, and the emergence of COVID-19 1 year after plant installation and a civil conflict exacerbated supply shortages. Investments in equipment, supplies, and training optimized clinical utilization of oxygen and were highlighted as a need for ongoing investment. To achieve maximum impact, investments in large-scale oxygen systems must be accompanied by strategic plans to transport oxygen, reduce costs to hospitals, and provide support to clinical teams through equipment, supply procurement, and clinical training. These findings support comprehensive ecosystem approaches to strengthening oxygen access for sustainable impact.

Dissecting Water, Sanitation, and Hygiene (WaSH) to Assess Risk Factors for Cholera in Shashemene, Oromia Region, Ethiopia.

Cholera outbreaks have afflicted Ethiopia, with nearly 100 000 cases and 1030 deaths reported from 2015 to 2023, emphasizing the critical need to understand water, sanitation, and hygiene (WaSH) risk factors. We conducted a cross-sectional household (HH) survey among 870 HHs in Shashemene Town and Shashemene Woreda, alongside extracting retrospective cholera case data from the Ethiopian Public Health Institute database. Relationships between WaSH and sociodemographic/economic-levels of HHs were examined. WaSH status and cholera attack rates (ARs) were described at kebele-level using geospatial mapping, and their association was statistically analyzed. Access to basic drinking water, sanitation, and hygiene facilities was limited, with 67.5% (95% confidence interval, 64.4-70.6), 73.4% (70.3-76.3), and 30.3% (27.3-33.3) of HHs having access, respectively. Better WaSH practices were associated with urban residence (adjusted odds ratio, 1.7, [95% confidence interval, 1.1-2.7]), higher educational levels (2.7 [1.2-5.8]), and wealth (2.5 [1.6-4.0]). The association between cholera ARs and at least basic WaSH status was not statistically significant (multiple R2 = 0.13; P = .36), although localized effects were suggested for sanitation (Moran I = 0.22; P = .024). Addressing gaps in WaSH access and hygiene practices is crucial for reducing cholera risk. Further analyses with meaningful covariates and increased sample sizes are necessary to understand the association between cholera AR and specific WaSH components.

An update on factors affecting umbilical cord care among mothers: A review.

Umbilical cord care remains a critical aspect of newborn health, yet practices vary significantly across different cultures and healthcare settings. This paper aims to provide an updated synthesis of the factors influencing umbilical cord care among mothers. The umbilical cord is a vital link between the fetus and the placenta during pregnancy, but after birth, it requires proper care to prevent infections. Numerous factors influence a mother's approach to umbilical cord care, including cultural beliefs, socio-economic status, access to healthcare information, and traditional practices passed down through generations. Understanding these factors is crucial for healthcare providers to offer tailored guidance and support to mothers, ensuring the optimal care for newborns. This paper examines recent research and literature encompassing diverse cultural perspectives, socio-economic considerations, healthcare access, and educational interventions related to umbilical cord care. It also highlights the impact of technological advancements, such as telemedicine and digital health platforms, in disseminating crucial information to mothers, especially in remote or underserved areas. Moreover, the review delves into the role of healthcare professionals in promoting evidence-based practices and addressing misconceptions regarding umbilical cord care. It emphasizes the importance of culturally sensitive and context-specific interventions in enhancing maternal knowledge and practices related to neonatal care. In conclusion, this review presents an updated overview of the multifactorial influences on umbilical cord care among mothers. It calls for continued research and concerted efforts to bridge gaps in knowledge, cultural beliefs, and healthcare access, ultimately contributing to the promotion of optimal newborn health outcomes.

Accessibility and utilization of health-care services among rural–urban migrants in Ghana: A scoping review

Since the second half of the 20th century, internal migration patterns in Ghana have been dominated by movements from rural (or northern) to urban (or southern) areas. Numerous studies report wide socioeconomic gaps between the geographical north and south of Ghana, explaining the unidirectional movement in search of better opportunities. Differences in personal health profiles, values, and beliefs mean that internal migrants face a higher risk of ill health than urban natives. Compounding this issue is the barriers that impede their access to and utilization of health-care services. We synthesized evidence from existing literature to understand internal migrants&amp;rsquo; access to and utilization of healthcare in Ghana, as well as their coping strategies. This review followed Arksey and O&amp;rsquo;Malley&amp;rsquo;s guidelines for conducting scoping reviews. We searched PubMed, EconLit, CINAHL, PsychINFO, and Medline (Ovid) electronic databases for studies published from January 2012 to June 2022. In addition, a manual literature search was conducted on Google by examining the reference lists of selected articles to identify other relevant studies. The majority of the studies (n = 12 [75%]) focused on female migrants, while 4 (25%) included both male and female migrants. This review identified several factors affecting access to health-care services for internal migrants in Ghana. These factors included infrastructural, financial, and language barriers, as well as long patient waiting times. Significantly, these barriers resulted in increased self-medication and self-diagnosis among internal migrants, leading to overall poor health outcomes. Based on the study findings, we propose a multidimensional approach to bridging the health access gap for internal migrants. This approach involves improving health system factors such as health service delivery, health workforce, availability of essential medicines, and health finance reforms to provide quality health-care services at affordable or no cost, while considering the socioeconomic and cultural conditions of the internal migrants.

Cost–utility analysis of a palliative care program in Colombia

BackgroundThe economic assessment of health care models in palliative care promotes their global development. The purpose of the study is to assess the cost-effectiveness of a palliative care program (named Contigo) with that of conventional care from the perspective of a health benefit plan administrator company, Sanitas, in Colombia.MethodsThe incremental cost-utility ratio (ICUR) and the incremental net monetary benefit (INMB) were estimated using micro-costing in a retrospective, analytical cross-sectional study on the care of terminally ill patients enrolled in a palliative care program. A 6-month time horizon prior to death was used. The EQ-5D-3 L questionnaire (EQ-5D-3 L) and the McGill Quality of Life Questionnaire (MQOL) were used to measure the quality of life.ResultsThe study included 43 patients managed within the program and 16 patients who received conventional medical management. The program was less expensive than the conventional practice (difference of 1,924.35 US dollars (USD), P = 0.18). When compared to the last 15 days, there is a higher perception of quality of life, which yielded 0.25 in the EQ-5D-3 L (p < 0.01) and 1.55 in the MQOL (P < 0.01). The ICUR was negative and the INMB was positive.ConclusionBecause the Contigo program reduces costs while improving quality of life, it is considered to be net cost-saving and a model with value in health care. Greater availability of palliative care programs, such as Contigo, in Colombia can help reduce existing gaps in access to universal palliative care health coverage, resulting in more cost-effective care.

Los laboratorios virtuales y su inclusión en una institución educativa rural

This essay aims at discussing how virtual laboratories impact educational inclusion for high school and middle school chemistry students in a rural educational institution. It objectively examines virtual laboratories and educational inclusion, highlighting the benefits and drawbacks of these digital resources and the various perspectives on their relationship. Virtual laboratories, as pedagogical tools, are increasingly used in education, enabling students to conduct experiments in a safe, controlled environment without needing complex infrastructure, costly equipment, or hazardous materials. The essay also supports the idea that virtual laboratories are a cost-effective alternative, as infrastructure investment, reagents or similar costs, are they significantly reduced or zero. This leads to more efficient financial management in educational institutions, allowing for the reinvestment of resources into computer equipment that improves coverage and accessibility for students. As a result, virtual laboratories help bridge the gap in inclusion and access to information, enabling students to access educational experiences and resources from anywhere in the world.