Government Healthcare Services Research Articles

Study profile: the Genetics of Glaucoma Study

PurposeGlaucoma, a major cause of irreversible blindness, is a highly heritable human disease. Currently, the majority of the risk genes for glaucoma are unknown. We established the Genetics of Glaucoma...

Care-seeking practices for non-communicable chronic conditions in a low-income neighborhood in Southern India.

Given that access to healthcare is less challenging in urban India, evidence shows that affordable government healthcare services are underutilized by the vulnerable and disadvantaged groups. There are emerging studies on healthcare seeking behavior in the context of short-term morbidities and communicable diseases that attempted to understand this gap of underutilization of government healthcare services, but similar studies are rare in the context of non-communicable diseases (NCDs) and associated chronic conditions. Given the urban health system is ill- prepared and ill-equipped to deliver NCD services, it is important to understand how the vulnerable and disadvantaged groups seek healthcare for chronic conditions. This article investigates the care-seeking practices of these individuals living in a low-income neighborhood and care-seeking pathways for chronic conditions. The study is conducted at Kadugondanahalli-a low-income neighborhood with the presence of a recognized slum, in Bengaluru city. A total of twenty in-depth interviews are conducted with individuals diagnosed with non-communicable chronic conditions. Participants were selected through purposive and snowball sampling method. The data is collected between January 2020 to June 2021. The study participants practice a wide range of care-seeking practices based on the management of comorbidity and multimorbidity, recognizing the symptoms and severity, experiences of family members, belief, and purchase and consumption of medicines. These practices clearly highlighted not only the nuances of non-adherence to the long-term treatment and medications, but it also strongly influences the care-seeking behavior, which in turn make the care-seeking continuum very complex. The care-seeking continuum attempted each of the components (i.e. the screening, diagnosis, treatment, and control) of NCD care cascade but participants often failed to do screening on time, delayed diagnosis, and did not meet the treatment goals, leading to their conditions becoming further uncontrolled due to the care-seeking practices they practice. These practices delayed not only the diagnosis but also the completion of each component of the care cascade. This study emphasizes strengthening of the health system in addressing the individual and community level practices, that significantly affect the entire care-seeking continuum, in the sustained monitoring and adherence to the treatment of chronic conditions.

Scopes of utilization of public health specialist nurses in government health care service of Bangladesh

Scopes of utilization of public health specialist nurses in government health care service of Bangladesh

Role of accredited social health activists in treatment of persons with severe mental illness in the community.

Role of accredited social health activists in treatment of persons with severe mental illness in the community.

Health Status and Healthcare Services of Scheduled Tribes in Odisha: Challenges and the Way Forward

Health is an essential aspect of human life, and good health significantly contributes to the social development and economic progress of a nation. The health practices are shaped by culture, economic life, and geographical and ecological conditions, among others. The Scheduled Tribes (STs) are socially and educationally backward. The government healthcare services have not optimally reached the tribal communities, and, hence, they are forced to depend on their traditional health practices. This article presents and critically evaluates the health status of STs in Odisha. It outlines the performance of various health indicators, health status and the factors influencing tribal health. The analysis is based on secondary data, including the National Family Health Survey-4 and Rural Health Statistics, 2019. The relevant indicators reveal that the nutrition and health status among the STs in Odisha is poor and is much lower than the national average.

Postpartum Health Care Seeking Behaviour among the Rural Women in Bangladesh

Introduction: Pregnancy and childbirth is an important event in the life cycle of women and their health during this period is very much vital for the mother and children. Maternal mortality ratio (MMR) of a country is an important indicator of the overall health status of mother. Objectives: To assess the health care seeking behaviour of postnatal women in rural Bangladesh. Materials and Methods: This cross sectional study was conducted at Chaturia in Dhamrai upazilla of Dhaka district from January 2019 to March 2019 among purposively selected 196 rural women of reproductive age who had at least one living child. Data were collected by face-to-face interview using pretested questionnaire. Results: Among 196 respondents average monthly family income was 12561 Taka with SD of 10462 taka. Majority of them were housewives and about two-third (64.8%) were educated above secondary level. 70.9% respondents had their delivery of last child in a government health care center and 37.8% deliveries were conducted by nurses which was followed by government doctors (36.2%). Majority (62.2%) had their health checkup within 42 days, 59.2% of them had checkup for three or more times and the checkup were done by government doctors (60.2%). 47.1% of the respondents experienced high grade fever as postpartum complication. Statistically significant association (p<0.05) were revealed between age group of the respondents with health personnel conducted deliveries and also between educational level of the respondents with place of delivery of last child. Conclusion: Awareness, motivation and infrastructural development play a vital role in utilizing the government healthcare services by the postnatal women in rural Bangladesh. JAFMC Bangladesh. Vol 16, No 2 (December) 2020: 80-83

Birth Preparedness and Complication Readiness (BPACR) among brick kiln workers in Indore, India

Abstract Background Birth preparedness and complication readiness (BPACR), promotes utilization of skilled maternal and neonatal care. Preparing for childbirth reduces delays in seeking care. Brick-kiln workers constitute a vulnerable social group who contribute to city infrastructure by laboring at low wages. 37% of the sample were Scheduled Castes, 49% Scheduled Tribes. Methods 139 mothers of children < 2 years, residing temporarily in brick kilns of Indore were asked about preparedness for birth of youngest child. Birth preparedness was assessed by enquiring about saving money, arranging transport, identifying health facility for delivery, identified family member to accompany for labor/emergency. Findings 10% did >3 BPACR practices implying good level of preparedness; 50% did 1-2 BPACR practices; 40% did no birth preparedness. Access to maternity benefit scheme was twice as likely to result in reasonable birth preparedness as compared to no access. Those with primary to class XII were twice as likely to practice birth preparedness as compared to those with no formal education. >3 ANC was associated with 8 percentage points greater practice of reasonable BPACR as compared to < 2 or no ANC. Mothers with knowledge of one danger sign each of pregnancy and delivery were 3 times more likely to practice BPACR than those without this knowledge. FGDs revealed challenges in access to bank account, obtaining required documents to apply for and access state maternity benefit. Lack of family support led to low BPCAR and low institutional delivery. Conclusions Brick-kiln women face risk of low utilization of government healthcare services. The health systems should conduct outreach antenatal care sessions in brick-kilns on knowledge of key danger signs and BPACR during health education and ANC counselling can help promote BPACR and hospital delivery. Information on requisite steps to apply for maternity benefit schemes should be shared among brick-kiln workers. Key messages It is crucial to promote BPACR among urban vulnerable sections, through NUHM’s outreach sessions by ANMs/ASHAs in brick-kiln, construction workers and similar groups. Access to maternity benefit cash transfer scheme should be enhanced particularly among excluded temporary urban groups such as brick-kiln workers as it is a motivation to avail hospital care.

Public transit accessibility approach to understand the equity for public healthcare services: A case study of Greater Mumbai

Urban public health is one of the most critical yet neglected aspects of urban planning in developing countries such as India. Inequity in access to government healthcare facilities affects the overall urban population and can substantially negatively impact the vulnerable population, who mostly rely on government healthcare services. In this paper, the accessibility measure for healthcare services by public transport is developed using travel time and the number of transit stops (accounting for transit connectivity) for Greater Mumbai. We also identified socially vulnerable wards (administrative units) using a Social Vulnerability Index (SVI), developed based on 16 indicators using Principal Component Analysis (PCA). Developed regression models showed that the proposed accessibility measure explains the coverage and usage of healthcare services better than the traditional accessibility measure, which is based on only aggregate level travel time impedances. South Mumbai has relatively better accessibility for public hospitals and dispensaries, whereas, lower level of accessibility is observed in the eastern part for public healthcare services. Assessment for the spatial inequity based on the Gini index, bivariate Moran's I, and mean access value reveals a higher degree of spatial inequity for accessing government hospitals for the slum population. The study developed a decision framework to suggest effective policy measures, which can be prioritised based on SVI to reduce the disparity in the spatial distribution of accessibility to government healthcare systems for vulnerable groups. Our findings can aid transportation and urban planners, health researchers, and policymakers to improve accessibility in under-served areas and give special attention to the needs of the vulnerable population.

Views on Unassisted Childbirth among Mothers at a Teaching Hospital in Kuala Lumpur, Malaysia

A cross-sectional study was conducted among mothers visiting antenatal clinic in UKMMC from 1st to 19th August 2016 to acquire opinions on unassisted childbirth and the determinant factors among mothers at a teaching hospital. Structured questionnaires were used in assessing their opinions on unassisted childbirth. A total of 259 respondents were recruited, 229 of them who met the inclusion criteria were included for analysis. Majority (87.3%) was Malay and 98.7% of respondents were more than 25 years old. The prevalence for mothers who agreed with unassisted childbirth was 6.6%. Bivariate analysis showed Malay (p=0.013) and non-working mothers (p=0.000) are the significant factors. There was no significant association between opinions on unassisted childbirth and quality of government healthcare services. Multivariate analysis showed middle income and non-working mothers were the significant factors contributing to opinions on unassisted childbirth. The outcome showed minority of mothers agreed with unassisted childbirth, middle income group and non-working mothers agreed on unassisted childbirth. Dissatisfaction to the quality of care at government healthcare services was not found to be the reason for unassisted childbirth. However, there could be other factors contributing to opinions on unassisted childbirth delivery which were not studied. Community-based study should be conducted to determine the other factors.

Utilization of government healthcare services by adult leprosy patients in the Western Province, Sri Lanka.

The leprosy services utilization by the patients at the clinic and field level should be high to achieve the target of eliminating leprosy as a public health problem in Sri Lanka. Furthermore, assessing patient and health system delay of a diagnosis and patient knowledge on disease are of equal importance to reveal the accurate picture. A descriptive cross-sectional study was conducted to assess the utilization of government healthcare services by 672 adult leprosy patients in Western Province (WP). Paucibacillary patients diagnosed at least six months and above, and Multibacillary patients diagnosed at least 12 months and above were selected by consecutive sampling method. An interviewer-administered questionnaire (IAQ) was used for data collection. Clinic utilization by leprosy patients was 87.8%. The mean patient-related delay (time taken from the onset of symptoms to the encounter of a doctor/health facility for the first time) was 16.8 months and health care system delay (time taken from the date of clinic registration to start of treatment) was 21.2 days. The overall delay was 17.5 months. Services provided by the Medical Officer of Health (MOH) office for families affected with leprosy was known by 53.8% (n = 298) of patients. Majority of family contacts were examined at the hospitals (n = 299, 44%), 30.8% (n = 207) by the Public Health Inspectors (PHI) and 7% (n = 46) at the MOH offices. PHIs had visited 56.7% (n = 401) of the patient's houses and 54% (n = 363) had received health education by PHI. Mean knowledge score was 50.7 (SD = 17.9). More than half (57.9%, n = 389) of the study sample had a good or very good knowledge level. Utilization of clinic services was satisfactory. However, a considerable patient-related delay was found. Half of the patients were aware of available field services and a majority of contact screening was conducted at hospitals. Patient knowledge on leprosy was satisfactory.

Primary healthcare services in the rural Eastern Cape, South Africa: Evaluating a service-support project.

BackgroundIn 2012, 38% of the South African population resided in the rural areas of the country. The professional healthcare services are concentrated in the urban areas, resulting in an imbalance between urban and rural healthcare services.AimThe aim of this study was to evaluate the use of a non-governmental organisation (NGO)-supported mobile healthcare service in a remote area.SettingEastern Cape Province in South Africa.MethodsThe walking distance between the community and the nearest fixed government healthcare service was evaluated and compared with the recommendations of World Health Organization (WHO). Services provided to people visiting the mobile community service were recorded, and descriptive data were analysed and compared with the anonymised patient records of the nearest fixed service clinic.ResultsOf the 30 outreach points served by the NGO, 24 points were at a distance more than the WHO-designated walking distance and 11 points were more than twice the WHO-designated distance from the perspective of fixed clinic. The average headcount per annum of the outreach NGO mobile clinics exceeded those of the fixed Department of Health (DoH) clinics by an average of 250 patients per clinic session. The increase in services was also noteworthy, with a mean differential of 1774 services per annum for the same day above that of the DoH clinics.ConclusionMobile services could make a difference to the utilisation of essential healthcare facilities. The provision of augmented NGO-led mobile clinical outreach services and joint government–NGO partnerships holds possibilities for improving healthcare for those living in remote rural areas.

Demographics as Variable in Assessing the Awareness and Utilization of Health Care Services of Emirati Women in the Western Region

Emirati women in the Western Region have limited access to specific health care. Thus, this study assessed the awareness and utilization of health care services of Emirati women of the seven municipalities in the Region identified through stratified random sampling. This quantitative descriptive-comparative and correlational research used a researcher-made questionnaire based on the guidelines of the Department of Health. Statistical computation using the mean revealed the women’s lack of knowledge and information about government health care services and their rare availing of these services. The use of ANOVA showed significant differences in their awareness and utilization according to demographics. Pearson Product Moment Correlation showed a significant relationship between awareness and utilization of health care services. Significant challenges encountered are the distance to the health center, the long waiting time for the doctor, and religion. The study recommends to strengthen advocacy programs and provide appropriate health facilities to women.

The costs of seeking healthcare: Illness, treatment seeking and out of pocket expenditures among the urban poor in Delhi, India.

The poor often experience illness and the treatment costs are high and even catastrophic for the poor. This paper reports the extent of illness, treatment-seeking behaviour and out of pocket healthcare expenditures and the determinants of treatment-seeking behaviour and healthcare expenditures among the urban poor living in Delhi. A total of 2,998 households participated in the study. Socio-demographic details, illness experiences (episodic illness in the past 3months, hospitalisation in the past 1year and any chronic illness), treatment seeking and healthcare expenditures were collected for all household members through a pretested, interviewer-administered questionnaire. Logistic regressions were carried out for factors associated with treatment-seeking choices. Multiple linear regressions were carried for factors associated with out of pocket expenditures (OOPE). Of the total 15,218 household members (of the 2,998 households), 4,052 (26.6%) experienced episodic illness (mainly fever, respiratory illnesses, food- and waterborne diseases and eye infections) in the past 3months, 230 (1.5%) were hospitalised and 976 (6.4%) have chronic illness (mainly hypertension, diabetes, arthritis and respiratory problems). Of the 2,998 households, 2,225 (74.2%) households reported at least one event of illness. Unqualified practitioners were the main source of care for episodic illnesses. Perceived seriousness of the illness, having Employees State Insurance Scheme (ESIS) benefit, higher educational status of the head of the household, higher monthly household incomes, belonging other backward castes and settled-migrant status led to seeking formal care. Dengue was the main reason for hospitalisation. Government including ESIS hospitals were mainly utilised for hospitalisation. Healthcare expenditures were higher for private healthcare. Possession of mandatory health insurance was protective against OOPEs. OOPEs were more for the men/boys and for the young. Improving access to government healthcare services is important. Extending the ESIS to the unorganised workers including urban poor migrants should be considered so as to bring them under mandatory social protection.

A Secure G-Cloud-Based Framework for Government Healthcare Services

Within the literature, we have witnessed in the healthcare sector, the growing demand for and adoption of software development in the cloud environment to cope with and fulfill current and future demands in healthcare services. In this paper, we propose a flexible, secure, cost-effective, and privacy-preserved cloud-based framework for the healthcare environment. We propose a secure and efficient framework for the government EHR system, in which fine-grained access control can be afforded based on multi-authority ciphertext-policy attribute-based encryption (CP-ABE), together with a hierarchical structure, to enforce access control policies. The proposed framework will allow decision-makers in Saudi Arabia to develop the healthcare sector and to benefit from the existing e-government cloud computing platform “Yasser,” which is responsible for delivering shared services through a highly efficient, reliable, and safe environment. This framework aims to provide health services and facilities from the government to citizens (G2C). Furthermore, multifactor applicant authentication has been identified and proofed in cooperation with two trusted authorities. The security analysis and comparisons with the related frameworks have been conducted.

Impediments to Optimal Health-care Utilization of a Particularly Vulnerable Tribal Group in Wayanad: A Qualitative Study.

Introduction:The pathways and mechanisms through which constraints that impede optimal utilization of the government health-care service provisions translate into health inequities among Particularly Vulnerable Tribal Groups seem to be an area that warrants research.Objective:The objective is to explore and understand the mechanisms/pathways through which various factors result in health care inequity among the Kattunayakan tribe in Wayanad.Materials and Methods:Designed as a qualitative case study, using observations and interviews with mothers, community members, and frontline health-care personnel, the study was conducted in a Kattunayakan hamlet in Wayanad. The data, in the form of digital audio recordings and field notes, were transcribed, coded, and analyzed using a thematic approach.Results and Discussion:Axes of inquiry like access to health-care institutions, acceptability of the services provided, hurdles faced by the tribes, the health-care personnel, and how the system responded to these issues were explored. Disregard for the identity and culture of the tribes, geographical barriers for utilization and providing health services, proactive efforts from government systems, collaborations with private and professional bodies are important factors that possibly influence health inequities among tribes.Conclusion:Acknowledgment of the sociocultural identity of the tribes, gaining their trust, proactive efforts from the government machinery, innovative context-specific programs, strategic partnerships and a departure from the “blame the victim” philosophy are key in the effort to provide services that meet the health-care needs of the tribes.

Health seeking behaviour among post menopausal women in rural and urban field practice areas of Gandhi Medical College, Hyderabad: a cross-sectional study

Background: The phase of menopause is a physiological event which occurs as a result of progression of reproductive ageing. Women from developing countries view variations due to menopause as natural process and there is no need for medical care. The objective of the study was to assess the health seeking behaviour among the post menopausal women.Methods: A cross-sectional study was conducted in the rural and urban field practice areas of department of Community Medicine of Gandhi Medical College, Hyderabad. About 300 urban and 300 rural women were interviewed using a semi-structured and pretested questionnaire from August 2015 to September 2017.Results: Among the rural women, 100 (25.4%) women did not seek health care and among those who sought health care, majority (34.3%) preferred government healthcare services followed by 23% who consulted private facility. Of the urban women, 14.7% did not seek health care, 42% of the women approached private practitioner followed by 23% who sought health care in government hospital. Majority of the women (42.2%) did not seek health care as they thought they will be normal with time.Conclusions: More than one third of the women are not aware of menopause and related problems. Among those who did not seek health care, higher proportion felt they will be Ok with time followed by financial constraints, fear/shy, family problems and lack of transport.

IKure Techsoft: Providing Technology Enabled Affordable Health Care in Rural India

iKure Techsoft was established in 2010 with the main objective to provide affordable and high quality primary health care to the rural population in India and to build a sustainable for-profit business model. To that end, iKure’s cloud based, and patent pending, Wireless Health Incident Monitoring System (WHIMS) technology along with their hub-and-spoke operating model are central, but also essential to exploit and explore further if iKure is to scale-up. iKure provides primary health care services through three hub clinics and 28 rural health centres (RHCs). Each hub clinic employs between one and up to six medical teams (each consisting of 1 doctor, 1 nurse, 1 paramedic and 2 health workers stationed at the hub) & 1 mobile medical team (1 doctor, 1 paramedic, 2 health workers) for catering to the RHCs). Each medical team manages six RHCs. Paramount in iKure’s health care delivery model is their self-developed software called WHIMS, which is a cloud-based award-winning application that runs on low internet bandwidths. WHIMS allow for (a) centralized monitoring of key metrics such as doctor’s attendance, treatment prescribed, patient record management, pharmacy stock management, and (b) supports effective communication, integration and contact that connects RHCs with hub clinics, but also city-based multi-specialty hospitals with whom iKure has formal tie-ups. iKure, moreover, also works extensively with Non-Governmental Organizations (NGOs). Collaboration with local NGOs in the target areas helps to build trust with the rural villagers and their local knowledge and access helps to assess service demand. NGOs also provide the necessary local logistical support and basic infrastructure in the rural areas where iKure works. Moreover, collaboration, for example, with corporate organizations are central as they contribute with part of their corporate social responsibility (CSR) funds to support iKure initiatives. At present, iKure is planning to add diagnostic services to its six hub clinics as well as expand its presence in other parts of West Bengal and other states across India. Expanding rural health care services even with the technology support of WHIMS is challenging because, for example, health is a very local issue (due to, among other things, local customs and languages) and it requires investing significant amount of time and resources to build relationship with the rural people as well as collaborators such as NGOs and corporates. The accompanying case describes iKure’s journey so far in terms of understanding: (a) the state of health care and government health care services provided in rural India, (b) the establishment and evolution of the iKure business and health care model, (c) iKure’s operations and health care delivery model including the WHIMS technology solution and hub-and-spoke set-up of operations, (d) the collaborative model which relies on NGOs and private corporates, and (e) finally iKure’s challenges related to scaling-up.

Birth preparedness and determinants of birth place among migrants living in slums and slum-like pockets in Delhi, India

ObjectiveThe objective of this paper is to report birth preparedness and place of birth and its determinants among recent- and settled- migrant households living in slums of Delhi. MethodsIn a cross-sectional survey, 458 migrant mothers with a child aged below one year of age were identified. Socio-demographic details, data on the place of childbirth, antenatal care (ANC) and birth preparedness in terms of planning for home birth or hospital birth, transport, saving money, knowledge of danger signs were collected through interviewer-administered pretested questionnaire. Logistic regression was carried out for the determinants of hospital birth. ResultsThe present study migrants are characterised by younger ages, low educational attainment, low incomes and represented by socioeconomically disadvantaged communities. They mainly relied on government healthcare services for maternal care. ANC seeking was not satisfactory with 16% of women with no ANC; 46% receiving 1–3 visits; and only 23% of women reported health worker visited them at home. 59% of the births took place at hospitals. Having ANC visits (Adjusted Odds Ratio (AOR) for having 4 or more ANC visits = 5.252), planning for hospital birth (AOR = 6.114), plan for transport (AOR = 1.989), mass media exposure (listening to radio; AOR = 2.871) and knowledge of danger signs (AOR = 3.872) resulted in significant chances of hospital birth. ConclusionMigrant women are at the risk of utilizing the services to a less extent. The health systems need to take measures to mitigate the disadvantage due to migration through specific strategies to make them inclusive and outreach to the poor migrants.

Reassessing the gender differences in type and place of health care utilisation in India: does the gender gap no longer exist?

Two of the crucial components of health care service utilisation are the type of health care services received (government, private, others) and the place visited (same village, another village, another district/town, a metro city, abroad, etc.). The association between health care facilities and gender is important for understanding the disparities between males and females. Thus, the primary objective of this study was to reassess the gender differences in the type and place of health care utilisation. Data from the second round of the India Human Development Survey (2011–2012) were used for this study. Analysis was done using both bi- and multivariate techniques (multinomial logistic regression). Results indicate an improvement in the female health care-seeking behaviour. We found that females have a higher tendency to visit private health care centres, whereas a higher percentage of males used government health care services for the treatment of both long- and short-term morbidities. Males and females reported visiting health care centres within the village, in another village, in another district/town and in a metro area/abroad for treatment approximately to the same extent. The analysis of the male and female treatment-seeking behaviour revealed a clear picture of proliferating gender neutrality. The increase in the health care-seeking behaviour of women can be considered an upshot of improved female education and increased awareness among males regarding female empowerment. Government interventions in different sectors have also improved the plight of women directly or indirectly.

A scoping review protocol on social participation of indigenous elders, intergenerational solidarity and their influence on individual and community wellness

IntroductionIndigenous elders have traditionally played an important role in maintaining social cohesion within their communities. Today, part of this role has been taken over by government social and healthcare services,...