Important Determinant Of Access Research Articles

Women’s autonomy and maternal health decision making in Kenya: implications for service delivery reform - a qualitative study

BackgroundMaternal and neonatal outcomes in, Kakamega County is characterized by a maternal mortality rate of 316 per 100,000 live births and a neonatal mortality rate of 19 per 1,000 live births. In 2018, approximately 70,000 births occurred in the county, with 35% at home, 28% in primary care facilities, and 37% in hospitals. A maternal and child health service delivery redesign (SDR) that aims to reorganize maternal and newborn health services is being implemented in Kakamega County in Kenya to improve the progress of these indicators. Research has shown that women’s ability to make decisions (voice, agency, and autonomy) is critical for gender equality, empowerment and an important determinant of access and utilization. As part of the Kakamega SDR process evaluation, this study sought to understand women’s processes of decision-making in seeking maternal health care and how these affect women’s ability to access and use antenatal, delivery, and post-natal services.MethodsWe adapted the International Centre for Research on Women (ICRW) conceptual framework for reproductive empowerment to focus on the interrelated concepts of “female autonomy”, and “women’s agency” with the latter incorporating ‘voice’, ‘choice’ and ‘power’. Our adaptation did not consider the influence of sexual relationships and leadership on SRH decision-making. We conducted key informant interviews, in-depth interviews, small group interviews and focus group discussions with pregnant women attending Antenatal clinics, women who had delivered, women attending post-natal clinics, and men in Kakamega County. A thematic analysis approach was used to analyze the data in NVivo 12.ResultsThe results revealed notable findings across three dimensions of agency. Women with previous birthing experiences, high self-esteem, and support from their social networks exhibited greater agency. Additionally, positive previous birthing experiences were associated with increased confidence in making reproductive health choices. Women who had control over financial resources and experienced respectful communication with their partners exhibited higher levels of agency within their households. Distance relational agency demonstrated the impact of health system factors and socio-cultural norms on women’s agency and autonomy. Finally, women who faced barriers such as long waiting times or limited staff availability experienced reduced agency in seeking healthcare.ConclusionsIndividual agency, immediate relational agency, and distance relational agency all play crucial roles in shaping women’s decision-making power and control over their utilization of maternal health services. This study offers valuable insights that can guide the ongoing implementation of an innovative service delivery redesign model, emphasizing the critical need for developing context-specific strategies to promote women’s voices for sustained use.

What Is the Evidence Base Linking Gender with Access to Forests and Use of Forest Resources for Food Security in Low- and Middle-Income Countries? A Systematic Evidence Map

In nearly all parts of the world, an important part of people’s livelihood is derived from natural resources. Gender is considered one of the most important determinants of access and control over forests. It is thought that women and men within households and communities have different opportunities and different roles and responsibilities in relation to forest use. It is probable that when women have equal access to forests, better food security outcomes can be achieved for individuals and households that are dependent on forests for their livelihoods. A systematic evidence map of the evidence base linking gender with access to forests and use of forest resources for food security was undertaken. Ten bibliographic databases and 22 websites of international development and conservation organisations were searched using keywords suggested by stakeholders. Other articles were found by emailing authors and organisations to send potentially relevant publications. 19,500 articles were retrieved from bibliographic databases and 1281 from other sources. After iterative screening, 77 studies were included: 41 focussed on Africa, 22 on Asia, 12 on Latin America, 2 were global. Most indicators of food security measure access to food, measured by total consumption, expenditure, or income. Studies showed strong gender specialisation: commercial access and utilisation of forests and forest products dominated by men, whereas access for subsistence and household consumption is almost exclusively the task of women. Despite the large number of studies reviewed, limitations of the evidence base, including methodological heterogeneity, a dominance of case studies as the study design, and unequal geographical representation in study locations, make it difficult to generalise about the overall importance of gender and its effect on access to and use of forests for food security in developing countries. The critical gaps in the evidence base include geographical representation in primary research and a greater breadth of study designs to assess gender implications of access to forest resources globally.

Provider and Administrator Experiences With Providing HIV Treatment and Prevention Services in Rural Areas

Using Andersen's behavioral model of health services use, this study analyzes data from 62 semistructured interviews of providers and administrators at health clinics and social service agencies in rural Florida. Andersen's model addresses predisposing, enabling, and need factors that influence health services use. ATLASti was used to code all interviews and to extract HIV-related themes. The aim of this study was to: (1) add a new dimension to the literature on HIV care services in rural areas, (2) reveal factors that impact ability to provide care to PLWH in rural areas, and (3) suggest ways in which providers and administrators may address any unmet health care needs of PLWH. Respondents perceived systems factors to be more important determinants of access to care for individuals living with HIV and supported ongoing trainings that would increase staff understanding of the needs of people living with HIV.

Credit Invisibles and the Unscored

Having a record and a score can be an important determinant of access. Yet, surprisingly little is known about people who lack records or scores. This paper provides the first documented analysis of the characteristics of consumers without records, called credit invisibles, and of consumers whose records are treated as unscorable by a widely used credit-scoring model. Our estimates suggest that 26 million adults, representing about 11 percent of the adult population, lack records. An additional 8.3 percent, or 19.6 million adults have records that are unscored. The incidence of having a record is not evenly distributed. Young, elderly, minority, and lower-income consumers are more likely to be invisible or have an unscored record. Additionally, our analysis finds that observable performance is not widely available for such consumers, which may hinder the ability of alternative data to expand access for these consumers.

Abstract 338: High Quality Medical Care: A Key Component in Access to Vascular Care for Patients with Lower Extremity PAD

Objectives: Prior work has demonstrated that patients at risk for amputation often have limited access to vascular care. We hypothesized that patients at risk for amputation may also have poor access to medical care related to their peripheral arterial disease (PAD). Therefore, we studied the intensity of medical care provided to patients at risk for amputation, and its relationship to access to vascular care. Methods: We identified a cohort of 52,505 Medicare patients at risk for amputation (pre-existing diabetes, PAD, and foot ulceration) who required hospital admission for leg or foot cellulitis. Using the 307 hospital referral regions defined in the Dartmouth Atlas, we determined the proportion of patients that received appropriate, high quality medical care within 1 year (before or after) hospital admission. High-quality medical care was defined as evidence of (1) hemoglobin A1C testing (2) podiatric care, and (3) non-invasive vascular testing. Then, using regression analysis at the regional level, we assessed relationships between the use of high quality of medical care and access to diagnostic or therapeutic lower extremity vascular procedures. Results: Across the United States, only 36% of diabetic patients with PAD and tissue loss received all three components of high quality medical care; 76% received 2 of 3 components. A non-invasive vascular study was absent in 41%. Provision of high-quality medical care varied across regions, from 4% of patients in Mason City, Iowa to 58% of patients in Sun City, Arizona. Regions that provided high quality medical care were significantly more likely to provide vascular care (R=0.30, p<0.001). Across quintiles of medical care quality, those regions most likely to provide high quality medical care were 24% more likely to provide invasive vascular care and revascularization (p<0.001, Figure). Conclusions: Fewer than 4 out of 10 Medicare diabetics with PAD and tissue loss receive high-quality, appropriate medical care. Quality improvement efforts at limiting amputation need to incorporate multidisciplinary strategies and involve primary care providers, as high quality medical care is an important determinant of access to vascular care and limb preservation.

Access to credit and informality among micro and small enterprises in Ethiopia

This paper examines the determinants of Micro and Small and Enterprises (MSEs) access to credit in Ethiopia using detailed firm‐level data collected in 2003. Its basic purpose is to identify the various attributes of a firm that determine its access to credit with an emphasis on the role of firm formality. We find that informal firms are more credit constrained compared to formal firms. A firm’s location, membership of a business association and maintaining an accounting record are found to be important determinants of access to credit. Further, we find firms whose owners have vocational training are more credit constrained than those who are not, as are firms that are exclusively male owned. There is no systematic relation between access to credit and a firm’s age, size and the sector in which it operates. The paper concludes with possible policy interventions designed to improve access to credit for MSEs in Ethiopia.

Financing the response to AIDS: some fiscal and macroeconomic considerations

This article examines the international response to AIDS from a fiscal perspective: first the financing of the international response to AIDS, especially the role of external financing, and second, a more comprehensive perspective on the costs of the national response to AIDS relevant for fiscal policy. The second half of the article focuses on the effectiveness of the response to AIDS. We find that there is little basis for concerns about macroeconomic constraints to scaling up, in light of the moderate scale of AIDS-related aid flows relative to overall aid. Regarding sectoral constraints, the picture is more differentiated. Many countries with high prevalence rates have also achieved high rates of access to treatment, but most of these are middle-income countries. Our econometric analysis credits external aid as a key factor that has enabled higher-prevalence countries to cope with the additional demands for health services. At the same time, gross domestic product per capita and health sector capacities are important determinants of access to treatment.

Who Treats whom? An Application of the Pathways to Care Model in Australia

The present paper applies Goldberg and Huxley's Pathways to Care (PTC) model to the Australian health-care system to ask: who is treated in each sector and what does this tell us about the performance of the health-care system? It examines the factors associated with reaching primary care, outpatient and inpatient sectors, as well as private and public mental health services. Data from the Australian National Survey of Mental Health and Wellbeing were used to determine the proportion of the population treated in each sector. Sociodemographic and clinical characteristics were examined and logistic regression was used to determine which factors were associated with use of different sectors of care. Of the total population, 80.5% reached primary care, 8.2% primary care for mental health problems, 6.5% outpatient care and 0.4% reached the mental health inpatient sector. Clinical severity increased across these sectors and was an important determinant of access to care. Those consulting private practitioners were clinically similar to those consulting in the public sector. Sociodemographic characteristics were important determinants of access to primary, specialist and private mental health care. Being aged over 55 years or living in a rural area was associated with lower access to several sectors. Although at a broad level the health-care system is performing as expected, limited access among some groups is cause for concern. Applying the PTC model to a population sample offered useful insights into the performance of the Australian health-care system.

From coverage to care.

An important determinant of access is whether people have a usual source of care. Health insurance coverage is one factor that makes people more likely to have a usual provider, but coverage alone does not guarantee access. This synthesis examines the relationship between health insurance and having a regular care provider. Results indicate people with health insurance are more likely to have a usual source of care; the newly insured, as well as people with unstable coverage are less likely to have a regular source of care; and about two-thirds of those without a usual source of care say the main reason they have no such source is because they rarely get sick. Among those who have a usual source of care, most see an office-based doctor as their primary provider. The uninsured and publicly-insured are more likely to use an institution and to face access barriers.

Wegen naar macht: de politieke participatie en toegang van het maatschappelijk middenveld op lokaal niveau

This article is concerned with the description and explanation of political activities of local non-profit organisations on the basis of an empirical study in the city of Zwolle, the Netherlands. Attention is devoted to (1) the political participation of these organisations (2) the access of these organisations to the political system (3) the relation between participation and access. Two factors turn out to have a significant positive effect on the participation of organisations: centrality in the local organisational network and being involved in executing local policies. Furthermore, results show the local political system to be reasonably accessible: there is a strong correlation between political participation and access; in addition participation is the most important determinant of access.

Supervisor accessibility and subordinate role clarity

The relationship between supervisor accessibility and role clarity has been established. Previous organizational analyses have underscored the importance of structural determinants of accessibility. It has long been assumed that these formal organizational designations were among the most important determinants of access to supervisors. The structural orientation excluded the contributions of shared normative and dyadic expectations to the accessibility of supervisors. This study examined the significance of each of these components in the role assimilation process. The Supervisor Accessibility Measure and formal work group size were used to estimate supervisor accessibility. Two hundred and forty‐six civil service personnel at a midwestern university completed these scales along with the Rizzo, House, if Lirtzman (1970) measure of role ambiguity. The results suggest that structural aspects of the work environment contribute little to the ease of communication between superior and subordinate, while norma...