Health Services In Urban Areas Research Articles

Unraveling the Factors Influencing Healthcare Accessibility: An In-depth Investigation in Jhenaidah Sadar Upazila

Healthcare plays a significant role in Bangladesh. The key to wealth is health. In the absence of healthcare development, we would not be able to live a quality lifestyle. In order for a nation to develop economically and socially, its health must be in good condition. It is reported that health services in Bangladesh are well funded by the government, but some issues affect the sector. A considerable proportion of Bangladesh's population lacks or has little access to healthcare services. There are several dimensions to the problem of lack of health service participation. This study evaluates, through collecting information from primary data, public health facilities' scarceness and identifies factors that act as barriers to the functioning effectively of public health facilities. The authors conducted qualitative research in order to gain an in-depth understanding of the underlying insights of various components that affect Bangladesh's healthcare sector. A purposive sampling style is followed to specify the respondents. The findings scrutinize the healthcare system in the selected areas of Bangladesh. It has explored what factors affect access to health services in urban areas of Bangladesh. It has also revealed patients’ views towards healthcare services. The findings from the qualitative data have unveiled that there are many key dimensions, in terms of various dimensions, that indicate why people face hurdles when accessing health services. Finally, the paper concludes with a variety of recommendations.

Urban health in India: from smaller steps to a big leap

The focus on urban health in India was majorly lagging in the initial years post-independence except in some specific areas like family planning during the 1st and 2nd Five Year Plans (FYPs). The subsequent FYPs too for the next ten to fifteen years did not witness any shift in focus to the diverse health-related problems in urban areas. The National Rural Health Mission in 2005 had a primary focus on rural health, with some initiatives taken up to expand health services in urban areas. However, the major milestone in urban health was the launch of the National Urban Health Mission (NUHM) in 2013, wherein urban health in India got centre stage. The COVID-19 pandemic led to an accelerated response in strengthening the health systems across the country including health infrastructure in urban areas. Overall, it can be said that urban health in the country is currently undergoing major transitions. Despite there being several issues, the reforms for assured comprehensive primary health care services seem promising in improving the status of health in urban India. Convergence with key stakeholders and other sectors beyond health would be the key to bridging the gap in addressing social determinants of health, social protection for migrants and floating population and focusing on environmental protection. Such actions would leverage enhanced health access of urban poor to quality and equitable healthcare services. The paper focuses on government policies that began prioritising urban health, the limitations of present health systems, and the roadmap to construct a much-needed future foundation for improved health outcomes in urban India.

Primary Psychiatric Diagnoses, Commercialized Tobacco Use, and Homelessness: Comparisons Between Urban American Indian/ Alaska Native and Non-American Indian/Alaska Native Adult Clinical Samples.

Although over 70% of American Indians and Alaska Natives (AI/ANs) reside in urban areas, our knowledge of urban AI/AN adults receiving mental health treatment is limited. This study compares primary psychiatric diagnoses, commercialized tobacco use, and homelessness between AI/AN and non-AI/AN adults receiving services in an urban public mental health agency serving primarily AI/AN people in southern California. Depressive disorders were the most common psychiatric diagnoses for both groups. However, AI/AN adult clients demonstrated significantly less anxiety disorders and significantly more homelessness. Schizophrenia spectrum and other psychotic disorders, bipolar and related disorders, and commercialized tobacco use were higher among AI/AN adults compared to non-AI/AN adults. Results from this study offer data needed to further understand important public health issues that exist among AI/AN adults receiving mental health services in urban areas. We provide suggestions to enhance integrated and culturally appropriate treatment approaches and homelessness initiatives for this under-resourced, yet resilient population.

Studying the Performance, Achievements and Challenges of Providing Community-Oriented Mental Health Services: A Preliminary Case Study

Background. Primary health care system provides appropriate prevention and primary mental care services for the rural population, but not in urban areas. Therefore, the Community Mental Health Center (CMHC) was developed to provide mental health services in urban areas. The present study aimed to outline the performance, achievements and challenges of CMHC in one of the main cities in north west of Iran. Methods. This was a case study with in-depth interview approach. The outcomes, implications, and challenges of CMHC in Tabriz city of Iran were evaluated from 2015 to 2019 using three methods: 1) in-depth interviews with two executive managers, 2) focus group discussion with managers and mental healthcare providers, and 3) collection of mental health care indicators which was collected from patient health records. After the final evaluations, the challenges and appropriate recommendations were presented for improving mental health services in urban areas. Results. A total of 17 specialists and general medical doctors collaborated in conducting the study. During the study, 1053 initial visits and/or screenings, and 2313 patients with psychological disorders were identified and recorded. Moreover, a total of 988 mental training sessions were held for patients and their families. Five main themes, including the necessity for establishment and objectives, implementation process, achievements, challenges, and recommendations, with many sub-themes were identified during in-depth interviews and focus group discussions. Conclusion. It seems that CMHC is an appropriate strategy and model for providing basic mental health services, especially in metropolitan cities. Longitudinal studies with a randomized controlled trial design as well as cost-effectiveness evaluation studies are required to confirm CMHC in the Iranian context.

Indigenous initiative for the start-up of health services in urban areas: The Holistic Strategy Project

Background: The report of the Public Inquiry Commission on relations between Indigenous Peoples and certain public services in Québec (2019) reported problems in accessing health and social services, specifically in urban areas. In order to better serve their members, the Centre d’amitié autochtone de Trois-Rivières (CAATR) launched the Holistic Health Strategy Project. The objectives were: 1) to assess the needs of CAATR members and of the partners in health and social services, and 2) to create a directory of resources intended for the Indigenous people in the region. Methods: An assessment of health and services needs was completed through consultation with members of the community. A literature review was carried out to draw a portrait of the health and social care services and models intended for Indigenous people. Results: A total of 25 participants took part in the consultation. Better access to services (e.g., transport and daycare) and a need for liaison with non-native institutions (e.g., interpreters in hospitals and liaison officers with schools) are expressed. A directory of resources intended for Aboriginals has been created, bringing together more than 20 services and organizations. Conclusion: The results of the Holistic Health Strategy Project highlight the health needs and health particularities of Indigenous people living in urban areas. Measures adapted to the realities of Aboriginal people in urban areas must support and facilitate their access to services.

Enabling culturally safe sexual health services in western Sydney: a protocol to improve STI treatment outcomes for Aboriginal young people

BackgroundAboriginal people face challenges on several fronts when it comes to the health and wellbeing of their community, compared to the rest of the Australian population. This is no different in urban areas such as Australia’s largest urban Aboriginal community located in Blacktown, NSW, where sexually transmitted infections (STIs) remain an issue of concern. Across Australia, rates of infectious syphilis, human immunodeficiency virus (HIV), and hepatitis C infection have increased by 400, 260, and 15% respectively while gonorrhoea decreased 12% in the 5-year period from 2013 to 2017. This study explores how to address the barriers that prevent young Aboriginal people under 30 years of age from accessing STI treatment through Government Sexual Health Services.MethodsThis qualitative study will use purposeful sampling to recruit 20 male and 20 female health consumers, 10 Aboriginal elders and 10 sexual health clinicians. This recruitment will be undertaken with the assistance of the local Government Health Services and local Aboriginal organisations. One-on-one semi-structured interviews will be undertaken by someone of the same gender in order to address cultural preferences. Data will be entered into NVivo and thematically analysed.DiscussionThis study will seek to add to the literature that explores why young Aboriginal people do not access sexual health services. This study seeks to understand the experience of clinicians, Aboriginal elders and Aboriginal young people to provide practical policy and clinical redesign evidence that can be used to improve the experience and cultural safety of sexual health services in urban areas of Australia. The results of the qualitative research will be disseminated with the assistance of participating local Aboriginal organisations, and the findings will be published through peer-reviewed scientific journals and conference presentations.Trial registrationThe study is approved by the Western Sydney Local Health District Human Research Ethics Committee (HREC/16/WMEAD/449) and the New South Wales Aboriginal Health and Medical Research Council’s Human Research Ethics Committee (1220/16).

Reducing Maternal Mortality: A Qualitative Study of Health Workers’ Expectation in Urban Area, Indonesia

BACKGROUND: Maternal mortality is a sentinel event used globally to monitor maternal health and the overall quality of reproductive health care. Globally, maternal mortality is mostly due to direct causes; apparently, it is not limited by the setting or geographic region. However, Indonesia has failed to achieve the Millenium Development Goals (MDGs) target for maternal mortality.
 AIM: This study aims to explore health workers' and stakeholders' expectations in maternal health services to reduce maternal mortality in urban areas.
 METHODS: It is qualitative research through naturalistic, conducted in one of the regencies in Indonesia, the urban area with the highest Maternal Mortality Rate (MMR) in one province by 2019. Data were obtained in the form of information from Focus Group Discussions (FGDs). FGDs were carried out with stakeholders at the Health Service level (n=3), first-level health facilities or public health centres (n=3), and advanced health facilities or hospitals (n=7). Data analysis in this study employed software (Nvivo Release 1.0) to utilise transcripts in coding and categorising.
 RESULTS: The expectations that emerged from health workers' perspectives in the field were an integrated system of collaboration between health facilities, affordability of Hospital with Comprehensive Emergency Obstetric Care (CEmOC) in action for maternal-neonatal referral urgency, and the skilled health workers as a golden opportunity.
 CONCLUSION: Health workers’ expectations can improve the quality of maternal health services in urban areas, thereby reducing the MMR with a system of collaboration between health facilities, the affordability of maternal-neonatal emergency referral facilities, and the availability of Obstetricians who standby.

Expanding the use of community health workers in urban settings: a potential strategy for progress towards universal health coverage.

Community health worker (CHW) programmes have been used for decades to improve access to health services in rural settings in low- and middle-income countries. With more than half of the world's population currently living in urban areas and this population expected to grow, equitable access to health services in urban areas is critically important. To understand the extent to which CHW programmes have been successfully deployed in low-income urban settings, we conducted a review of the literature between 2000 and 2018 to identify studies evaluating and describing CHW programmes implemented fully or partially in urban or peri-urban settings. We identified 32 peer-reviewed articles that met our inclusion criteria. Benefits have been documented in several urban settings in low- and middle-income countries including those to address TB/HIV, child health, maternal health and non-communicable diseases through a variety of study designs.

Reducing Inequity in Urban Health: Have the Intra-urban Differentials in Reproductive Health Service Utilization and Child Nutritional Outcome Narrowed in Bangladesh?

Bangladesh is undergoing a rapid urbanization process. About one-third of the population of major cities in the country live in slums, which are areas that exhibit pronounced concentrations of factors that negatively affect health and nutrition. People living in slums face greater challenge to improve their health than other parts of the country, which fuels the growing intra-urban health inequities. Two rounds of the Bangladesh Urban Health Survey (UHS), conducted in 2013 and 2006, were designed to examine the reproductive health status and service utilization between slum and non-slum residents. We applied an adaptation of the difference-in-differences (DID) model to pooled data from the 2006 and 2013 UHS rounds to examine changes over time in intra-urban differences between slums and non-slums in key health outcomes and service utilization and to identify the factors associated with the reduction in intra-urban gaps. In terms of change in intra-urban differentials during 2006–2013, DID regression analysis estimated that the gap between slums and non-slums for skilled birth attendant (SBA) during delivery significantly decreased. DID regression analysis also estimated that the gap between slums and non-slums for use of modern contraceptives among currently married women also narrowed significantly, and the gap reversed in favor of slums. However, the DID estimates indicate a small but not statistically significant reduction in the gap between slums and non-slums for child nutritional status. Results from extended DID regression model indicate that availability of community health workers in urban areas appears to have played a significant role in reducing the gap in SBA. The urban population in Bangladesh is expected to grow rapidly in the coming decades. Wide disparities between urban slums and non-slums can potentially push country performance off track during the post-2015 era, unless the specific health needs of the expanding slum communities are addressed. To our knowledge, this is the first systematic explanation and quantification of the role of various factors for improving intra-urban health equity in Bangladesh using nationally representative data. The findings provide a strong rationale for continuing and expanding community-based reproductive health services in urban areas by the NGOs with a focus on slum populations.

Gender and Age Differences in Patient Satisfaction with Dental Care in the Urban and Rural Areas of Indonesia: Pilot Pathfinder Survey

Objective: To know the difference of patient satisfaction to dental service based on gender and age in urban and rural area of Gowa regency of South Sulawesi, Indonesia. Material and Methods: This study used pilot pathfinder survey design, conducted in Gowa regency in April 2018. The sample consisted of 420 participants. Data were collected using a satisfaction III questionnaire that has been designed in accordance with a survey of fifty-one questions. Questionnaires are divided into seven subscales: General Satisfaction, Technical Quality, Interpersonal Aspect, Communication, Financial Aspect, Time Spent with Doctors, Access / Availability / Convenience. The level of satisfaction was analyzed using t independent test. The level of significance was set at 5%. Results: In dental and oral health services in urban areas there was a significant difference of satisfaction level between males and females group >35 years and in rural area there was difference of satisfaction level significant between mals and females based on communication aspect in age group ≤35 years and there is no significant difference of satisfaction level between urban and rural area. Conclusion: There is difference of satisfaction level between males and females based on technical and communication quality aspect and there is no difference of level of satisfaction between urban and rural area.

The approaches to measuring the potential spatial access to urban health services revisited: distance types and aggregation-error issues

BackgroundThe potential spatial access to urban health services is an important issue in health geography, spatial epidemiology and public health. Computing geographical accessibility measures for residential areas (e.g. census tracts) depends on a type of distance, a method of aggregation, and a measure of accessibility. The aim of this paper is to compare discrepancies in results for the geographical accessibility of health services computed using six distance types (Euclidean and Manhattan distances; shortest network time on foot, by bicycle, by public transit, and by car), four aggregation methods, and fourteen accessibility measures.MethodsTo explore variations in results according to the six types of distance and the aggregation methods, correlation analyses are performed. To measure how the assessment of potential spatial access varies according to three parameters (type of distance, aggregation method, and accessibility measure), sensitivity analysis (SA) and uncertainty analysis (UA) are conducted.ResultsFirst, independently of the type of distance used except for shortest network time by public transit, the results are globally similar (correlation >0.90). However, important local variations in correlation between Cartesian and the four shortest network time distances are observed, notably in suburban areas where Cartesian distances are less precise. Second, the choice of the aggregation method is also important: compared with the most accurate aggregation method, accessibility measures computed from census tract centroids, though not inaccurate, yield important measurement errors for 10% of census tracts. Third, the SA results show that the evaluation of potential geographic access may vary a great deal depending on the accessibility measure and, to a lesser degree, the type of distance and aggregation method. Fourth, the UA results clearly indicate areas of strong uncertainty in suburban areas, whereas central neighbourhoods show lower levels of uncertainty.ConclusionIn order to accurately assess potential geographic access to health services in urban areas, it is particularly important to choose a precise type of distance and aggregation method. Then, depending on the research objectives, the choices of the type of network distance (according to the mode of transportation) and of a number of accessibility measures should be carefully considered and adequately justified.

Expansion of directly observed treatment, short-course in urban and public-private mix areas of Bangladesh

Expansion of directly observed treatment, short-course in urban and public-private mix areas of Bangladesh Mohiuddin Hussain Khan1,2, ABM Tauhidul Islam31Department of Drug Management and Policy, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa City, Ishikawa, Japan; 2World Health Organization, Dhaka, Bangladesh; 3World Health Organization, Geneva, SwitzerlandAbstract: Success with tuberculosis (TB) control was relatively poor in urban centers and some of the difficult to reach areas (eg, workplaces and prisons) in Bangladesh prior to 2004. This may be due to the complexities that exist within urban health care systems and the unique health care-seeking behaviors of urban citizens. A variety of health care institutions and providers are providing health services in urban areas. To increase the case detection of TB suspects, a number of initiatives were undertaken by the National Tuberculosis Control Program. The total geographic area was divided among different nongovernmental organizations to implement TB care services. Medical academic institutions and hospitals, industrial workplaces, and prisons were involved to provide DOTS (directly observed treatment, short-course, as an internationally recommended strategy for TB control) services. As a result, an increased number of TB cases were identified and reported in the urban and public-private mix areas. The TB case detection rate in the six city corporation areas increased from 60% in 2005 to 74% in June 2007, with an 87% sputum conversion rate in 2006 and an 84.5% treatment success rate in 2005. However, decreased treatment success rates were observed in hospital settings and in prisons, which might be due to ineffective referrals provided upon discharge. It is crucial to engage all care providers to increase DOTS coverage and to control TB in urban and special settings.Keywords: public health, tuberculosis, developing country, program, expansion, DOTS, public-private mix

Childhood anxiety in rural and urban areas: Presentation, impact and help seeking

The current study investigated relationships between anxiety symptoms and residential location on problem recognition, service use and resultant impact. Clinically significant differences between rural and urban residents were not found on mental health symptoms, problem recognition or history of service use. Parent and family interference was found to be strongly linked to a child's anxiety level in both regions, with a child's negative experiences and direct interference on the child's life being attributed a smaller role. The impact of anxiety in rural areas was found to be higher than that experienced by similarly anxious children from urban areas. Finally patterns of service use were found to vary with a greater reliance on medical and school services in rural areas, and specialist and allied health services in urban areas. The findings together provide support for the development of specialised services for rural communities, and have implications for targeted education of parents to improve the number of children receiving appropriate help.

Health planning in India 1951–84: the role of the Planning Commission

An attempt is made to answer 2 sets of questions: how much is spent by Indian central and state governments on sectors and how does this relate to plan and nonplan expenditures; and how far does the Indian case support the argument that health sector expenditure in developing countries is skewed too far in favor of curative health services in urban areas. The term health refers to the Indian budgetary categories of medical and public health; health-related includes the plan categories of health family planning (or family welfare) water supply and sanitation and where possible nutrition. In India the most obvious feature of public sector health expenditures is that little in absolute terms is spent directly on providing health services to the population. How little continues to be unclear partly because of the complications caused by the different agencies concerned with health-related issues. The main areas which tend to be omitted from discussions of health expenditures in India are social insurance and nutrition. All government expenditures in India are divided into plan and nonplan categories. The plan covers most new developmental expenditure; the nonplan category covers routine activities. In general for health topics plan expenditures have included all those on preventive campaigns family planning and some water supply and sanitation. In other parts of the health budget only new developments have been paid for from the plan budget with recurrent costs becoming part of the nonplan budget at the end of the relevant plan. In general there have been 3 financial categories of plan expenditures: those paid for totally by central government and disbursed by its own agencies; those paid for in whole or in part by the center but disbursed by state governments; and those funded and disbursed by the state governments. Family planning always has been a completely centrally funded area. The Planning Commission both in its own right and as a channel for foreign pressures has ensured that the Indian plans have been fairly consistent in their emphasis on rural preventive services but the Planning Commission can only restrain expenditures by state governments (rather than being able to insist on spending) and is only concerned with plan expenditures. The actual patterns of total health expenditures may be very different. The differences between outlays and actual plan expenditures are considered along with total health expenditures in some states. In sum the balance between major categories of health expenditure has shifted dramatically towards family planning and the shift is most marked in plan expenditures.