Inequalities In Service Provision Research Articles

How the content of digital complaints shapes bureaucratic responsiveness in Mumbai

AbstractWhen do unelected officials respond to citizen complaints, and what are the implications for service delivery? In the formal complaint system for Mumbai's water sector, bureaucrats addressed 44% of the roughly 20,000 complaints lodged from 2016 to 2018. In line with literature on distributive politics, responsiveness to marginalized citizens is lower. Yet in interviews, officials emphasize that programmatic goals and capacity constraints lead to prioritization by what the complaint is about. In fact, once controlling for complaint content, the relationship between complainant identity and responsiveness disappears. Initial patterns of differential responsiveness by complainant identity arise from the fact that citizens from marginalized groups experience lower levels of service provision, which leads them to make complaints that are more difficult to address. The paper sheds light on the role of bureaucracy in e‐governance and service delivery, showing administrative priorities in responding to complaints may perpetuate inequalities in service provision.

Culturally sensitive neonatal palliative care: a critical review.

Although there are known disparities in neonatal and perinatal deaths across cultural groups, less is known about how cultural diversity impacts neonatal palliative care. This article critically reviews available literature and sets out key questions that need to be addressed to enhance neonatal palliative care provision for culturally diverse families. We begin by critically reviewing the challenges to recording, categorizing and understanding data which need to be addressed to enable a true reflection of the health disparities in neonatal mortality. We then consider whose voices frame the current neonatal palliative care agenda, and, importantly, whose perspectives are missing; what this means in terms of limiting current understanding and how the inclusion of diverse perspectives can potentially help address current inequities in service provision. Utilizing these insights, we make recommendations towards setting a research agenda, including key areas for future enquiry and methodological and practice-based considerations.

“A lot of work needs to be done”—Service provider perspectives of mental health services available to Croatia‐ and Bosnia‐born migrants

AbstractResearch suggests that migrants have higher rates of mental health disorders but are less likely to access mental health services, which highlights both their vulnerability to mental illness and inequity in service provision. Despite being large and established culturally similar migrant cohorts in Australia, Croatians and Bosnians are invisible in mental health research. This qualitative study collected practice‐based evidence from eight mental health service providers who have had direct professional contact with these communities, in order to understand how they engage with services, barriers to uptake and provide suggestions for service improvements. Thematic analysis was used to identify themes across interviews, which were then compared against Yang and Hwang's Migrant Mental Health Service Utilisation Model. The study identified unique factors specific to Croatia‐ and Bosnia‐born migrants that impact how they engage with services, including mandated/prescribed services, religious resources, knowledge resources, referral pathways and procedures, and service provider competencies. This study will promote a better understanding of the limitations of the current mental health service offerings for Croatia‐ and Bosnia‐born migrants, making it significant to practitioners, mental health organizations, policymakers and the general public.

Shoulder replacement surgery’s rising demand, inequality of provision, and variation in outcomes: cohort study using Hospital Episode Statistics for England

BackgroundThe aim of this study was to forecast future patient demand for shoulder replacement surgery in England and investigate any geographic and socioeconomic inequalities in service provision and patient outcomes.MethodsFor this cohort study, all elective shoulder replacements carried out by NHS hospitals and NHS-funded care in England from 1999 to 2020 were identified using Hospital Episode Statistics data. Eligible patients were aged 18 years and older. Shoulder replacements for malignancy or acute trauma were excluded. Population estimates and projections were obtained from the Office for National Statistics. Standardised incidence rates and the risks of serious adverse events (SAEs) and revision surgery were calculated and stratified by geographical region, socioeconomic deprivation, sex, and age band. Hospital costs for each admission were calculated using Healthcare Resource Group codes and NHS Reference Costs based on the National Reimbursement System. Projected rates and hospital costs were predicted until the year 2050 for two scenarios of future growth.ResultsA total of 77,613 elective primary and 5847 revision shoulder replacements were available for analysis. Between 1999 and 2020, the standardised incidence of primary shoulder replacements in England quadrupled from 2.6 to 10.4 per 100,000 population, increasing predominantly in patients aged over 65 years. As many as 1 in 6 patients needed to travel to a different region for their surgery indicating inequality of service provision. A temporal increase in SAEs was observed: the 30-day risk increased from 1.3 to 4.8% and the 90-day risk increased from 2.4 to 6.0%. Patients from the more deprived socioeconomic groups appeared to have a higher risk of SAEs and revision surgery. Shoulder replacements are forecast to increase by up to 234% by 2050 in England, reaching 20,912 procedures per year with an associated annual cost to hospitals of £235 million.ConclusionsThis study reports a rising incidence of shoulder replacements, regional disparities in service provision, and an overall increasing risk of SAEs, especially in more deprived socioeconomic groups. These findings highlight the need for better healthcare planning to match local population demand, while more research is needed to understand and prevent the increase observed in SAEs.

Promoting equity in health emergencies through health systems strengthening: lessons learned from disability inclusion in the COVID-19 pandemic

Discriminatory health systems and inequalities in service provision inevitably create barriers for certain populations in a health emergency. Persons with disabilities have been disproportionately affected by the COVID-19 pandemic. They commonly experience three increased risks - of contracting the disease, of severe disease or death, and of new or worsening health conditions. These added risks occur due to a range of barriers in the health sector, including physical barriers that prevent access to health facilities and specific interventions; informational barriers that prevent access to health information and/or reduce health literacy; and attitudinal barriers which give rise to stigma and exclusion, all of which add to discrimination and inequality. Furthermore, national health emergency preparedness and planning may fail to consider the needs and priorities of persons with disabilities, in all their diversity, thus leaving them behind in responses. This commentary discusses the importance of inclusive health systems strengthening as a prerequisite for accessible and comprehensive health emergency preparedness and response plans that reach everyone. Lessons learned relating to disability inclusion in the COVID-19 pandemic can inform health systems strengthening in recovery efforts, addressing underlying barriers to access and inclusion, and in turn improving preparedness for future health emergencies.

Socioeconomic and racial/ethnic inequalities in depression prevalence and the treatment gap in Brazil: A decomposition analysis

Depression is a major global health burden and there are stark socioeconomic inequalities in both the prevalence of depression and access to treatment for depression. In Brazil, racial/ethnic inequalities are of particular concern, but the factors contributing to these inequalities remain mostly unknown. This paper firstly explores determinants of depression and the treatment gap (i.e., untreated afflicted individuals) in Brazil and identifies if socio-economic and health system factors explain changes over time. Secondly, it analyses income and racial/ethnic inequalities in depression and the treatment gap and identifies factors explaining inequalities through decomposition methods. Data from two waves (2013 and 2019) of a representative household-based survey are used. In 2019, 10.8% of adults were depressed, but over 70% of depressed adults did not receive care. Black or brown/mixed Brazilians were more likely to have untreated depression, and region of residence was the most important determinant of these racial/ethnic inequalities. Notably, 44.6% of the difference in the treatment gap between white individuals and black and brown/mixed individuals was not explained by differences in observables, which could potentially be due to discrimination or difficulties in accessing treatment due to other non-observable characteristics. Employment, age, exposure to violence and physical activity are the main contributing factors to income inequalities in depression. These results suggest that policies aimed at improving the levels of exposure of lower-income individuals to risk factors may positively impact mental health and mental health inequalities, while addressing inequalities in service provision and resourcing for mental health and tackling barriers to access stemming from discrimination are essential to bridge the treatment gap equitably.

Cause and risk factors of early neonatal death in Ethiopia.

BackgroundGlobally, three fourth of neonatal deaths occur during the early neonatal period, this makes it a critical time to reduce the burden of neonatal death. The survival status of a newborn is determined by the individual (neonatal and maternal), and facility-level factors. Several studies were conducted in Ethiopia to assess early neonatal death; however, most of the studies had limited participants and did not well address the two main determinant factors covered in this study. In response to this gap, this study attempted to examine factors related to early neonatal death based on perinatal death surveillance data in consideration of all the possible determinants of early neonatal death.MethodsThe national perinatal death surveillance data were used for this study. A total of 3814 reviewed perinatal deaths were included in the study. Bayesian multilevel parametric survival analysis was employed to identify factors affecting the survival of newborns during the early neonatal period. Adjusted time ratio (ATR) with 95% Bayesian credible intervals (CrI) was reported and log-likelihood was used for model comparison. Statistical significance was declared based on the non-inclusion of 1.0 in the 95% CrI.ResultMore than half (52.4%) of early neonatal deaths occurred within the first two days of birth. Per the final model, as gestational age increases by a week the risk of dying during the early neonatal period is reduced by 6% [ATR = 0.94,95%CrI:(0.93–0.96)]. There was an increased risk of death during the early neonatal period among neonates deceased due to birth injury as compared to neonates who died due to infection [ATR = 2.05,95%CrI:(1.30–3.32)]; however, perinates who died due to complication of an intrapartum event had a lower risk of death than perinates who died due to infection [ATR = 0.87,95%CrI:(0.83–0.90)]. As the score of delay one and delay three increases by one unit, the newborn’s likelihood of surviving during the early neonatal period is reduced by 4% [ATR = 1.04,95%CrI:(1.01–1.07)] and 21% [ATR = 1.21,95%CrI:(1.15–1.27)] respectively. Neonates born from mothers living in a rural area had a higher risk of dying during the early neonatal period than their counterparts living in an urban area [ATR = 3.53,95%CrI:(3.34–3.69)]. As compared to neonates treated in a primary health facility, being treated in secondary [ATR = 1.14,95%CrI:(1.02–1.27)] and tertiary level of care [ATR = 1.15,95%CrI:(1.04–1.25)] results in a higher risk of death during the early neonatal period.ConclusionThe survival of a newborn during the early neonatal period is determined by both individual (gestational age, cause of death, and delay one) and facility (residence, type of health facility and delay three) level factors. Thus, to have a positive early neonatal outcome, a tailored intervention is needed for the three major causes of death (i.e Infection, birth injury, and complications of the intrapartum period). Furthermore, promoting maternal health, improving the health-seeking behaviour of mothers, strengthening facility readiness, and narrowing down inequalities in service provision are recommended to improve the newborn’s outcomes during the early neonatal period.

Synthesis of the Evidence on What Works for Whom in Telemental Health: Rapid Realist Review.

BackgroundTelemental health (delivering mental health care via video calls, telephone calls, or SMS text messages) is becoming increasingly widespread. Telemental health appears to be useful and effective in providing care to some service users in some settings, especially during an emergency restricting face-to-face contact, such as the COVID-19 pandemic. However, important limitations have been reported, and telemental health implementation risks the reinforcement of pre-existing inequalities in service provision. If it is to be widely incorporated into routine care, a clear understanding is needed of when and for whom it is an acceptable and effective approach and when face-to-face care is needed.ObjectiveThis rapid realist review aims to develop a theory about which telemental health approaches work (or do not work), for whom, in which contexts, and through what mechanisms.MethodsRapid realist reviewing involves synthesizing relevant evidence and stakeholder expertise to allow timely development of context-mechanism-outcome (CMO) configurations in areas where evidence is urgently needed to inform policy and practice. The CMO configurations encapsulate theories about what works for whom and by what mechanisms. Sources included eligible papers from 2 previous systematic reviews conducted by our team on telemental health; an updated search using the strategy from these reviews; a call for relevant evidence, including “gray literature,” to the public and key experts; and website searches of relevant voluntary and statutory organizations. CMO configurations formulated from these sources were iteratively refined, including through discussions with an expert reference group, including researchers with relevant lived experience and frontline clinicians, and consultation with experts focused on three priority groups: children and young people, users of inpatient and crisis care services, and digitally excluded groups.ResultsA total of 108 scientific and gray literature sources were included. From our initial CMO configurations, we derived 30 overarching CMO configurations within four domains: connecting effectively; flexibility and personalization; safety, privacy, and confidentiality; and therapeutic quality and relationship. Reports and stakeholder input emphasized the importance of personal choice, privacy and safety, and therapeutic relationships in telemental health care. The review also identified particular service users likely to be disadvantaged by telemental health implementation and a need to ensure that face-to-face care of equivalent timeliness remains available. Mechanisms underlying the successful and unsuccessful application of telemental health are discussed.ConclusionsService user choice, privacy and safety, the ability to connect effectively, and fostering strong therapeutic relationships need to be prioritized in delivering telemental health care. Guidelines and strategies coproduced with service users and frontline staff are needed to optimize telemental health implementation in real-world settings.Trial RegistrationInternational Prospective Register of Systematic Reviews (PROSPERO); CRD42021260910; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021260910

Trust in the publicly financed care system and willingness to pay for long-term care: A discrete choice experiment in Denmark

Aging populations put pressure on the provision and financing of long-term care (LTC) services in many countries. The projected increase in LTC expenditures may in particular constitute a threat to the future sustainability of public budgets in welfare states, where LTC is financed through taxes. To accommodate the increasing number of 80+ year-olds in society, policy-makers and service administrators need a better understanding of care preferences among future older adults: What types of services do older citizens prefer most, and which factors shape their LTC preferences? A discrete choice experiment (DCE) was administered to a representative sample of the Danish population aged 54–64 from May to July 2019 (n = 1154), investigating which factors shape individuals' preferences and willingness-to-pay (WTP) for their future LTC. Our results reveal that respondents are willing to make additional out-of-pocket payments to supplement the care provided for free by the municipality. The WTP was highest for services such as receiving help from a regular care team ($129 per month) and an extra shower a week ($116 per month). Moreover, we find heterogeneous care preferences, with three user characteristics associated with higher WTP for services: higher education, high wealth, and a low trust in the publicly financed care system. Our results raise concerns that inequalities between relatively more- and less-resourceful older adults may increase in Scandinavian-type welfare states in the future. Such increasing inequality in service provision may undermine citizens’ trust in and support of the publicly financed care system.

Decentralization, historical state capacity and public goods provision in Post-Soviet Russia

• Studies public service delivery during Russian decentralization after the mid-1990s. • Regions with a legacy of historical state formation perform better. • Fieldwork suggests state legacies create more cohesive and accountable local elites. • Democratic decentralization can increase spatial inequalities in disparate polities. • Failed decentralization risks being reversed in favor of bureaucratic centralism. Democratic decentralization has been widely adopted across the developing world with the goal of improving local accountability and the delivery of public services. However, outcomes have varied widely depending on the degree of local-level elite capture, cohesion, and governing capacity. This article draws on data from one of the most radical recent cases of fiscal and administrative decentralization: post-Soviet Russia from the mid-1990s to the early 2000s. Drawing upon detailed demographic, survey, and time-series public goods data from each of 83 districts, this article documents growing inequality in service provision over time and shows via a series of spatial regressions that a strong predictor of success in maintaining public goods delivery was the degree of historically accumulated state capacity. This effect is independent of the degree of local ethnic fractionalization, economic development, or civic association. A detailed examination of two case studies at similar levels of ethnic diversity and baseline development - Tatarstan and Buryatia – suggests that legacies of historical state formation established indigenous elites and bureaucratic capacity, resulting in stronger elite-citizen ties and accountability to local actors and concerns. The wide variation of post-decentralization trajectories in Russia, and the eventual push to recentralize control. suggests an important concern for policymakers promoting devolved governance in polities with divergent subnational legacies of historical state development. Where decentralization occurs in contexts that are not uniformly favorable to its success, both the decentralization and democracy-building aspects of devolution reforms may come under threat from bureaucratic centralism.

Does COVID-19 cause pre-eclampsia?

Does COVID-19 cause pre-eclampsia?

Early childhood teachers' and managers' lived experiences of the COVID-19 pandemic in South Africa

The declaration of COVID-19 as a global pandemic by the World Health Organisation in March 2020 brought many changes to the early childhood sector internationally. The South African response is best understood in the context of an under-developed sector with pre-existing vulnerabilities. In this article, we present a contextual understanding of the lived experiences of early childhood development (ECD) teachers and managers during the lockdown and the opening phases of a risk-adjusted approach. Our use of a phenomenological lens together with systems theory provides a reality check through a focus on lived experiences. Data were produced through an online survey with 28 ECD teachers and managers. We conducted semi-structured interviews with a subset of 8 of these participants. Findings show that disruptions of COVID-19 led to entrenching inequities in service provision and early learning opportunities. These intersecting dimensions have implications for building effective ECD systems.

The impact of COVID-19 in chronic kidney disease stage 5 patients on haemodialysis in Romania

BackgroundCKD 5 is a life threatening condition irrespective of cause. Most patients reach RRT. Predominant therapy is HD. Pandemic preparedness is an important pro-active public health function.Objectives1) to describe the incidence of COVID19 and IFR among CKD HD patients; 2) to evaluate the vaccination coverage among HD patients (Jan-Mar 2021); 3) to update a spreadsheet CKD5 HD 12-scenario treatment model by considering two new scenarios based on IFR: before and after vaccination.MethodsFirst two objectives use secondary data: JHSU and ECDC (secondary sources of COVID19 data) for Apr 2020-Mar 2021. The 3 NPM periods are: Apr-May 2020 (state of emergency), Jun-Dec 2020 (state of alert; vaccination -), Jan-Mar 2021 (state of alert; vaccination +). Data are taken from the Romanian Renal Registry and population data from Eurostat (available July 2021). IFR was estimated with a modified Kaplan-Meier method (Ghani,2005). A calibrated and validated CKD5 treatment model has previously been defined (10.1093/eurpub/cku161.026). Scenarios are re-run with one parameter adjusted by IFR levels. Analyses used Excel, SPSS.Resultsn = 14300 adult HD patients in March 2020; highest incidence (risk) was recorded in Apr-May 2020: 4.5% (CI95% from 4.1 to 4.8) and 2.5% (CI95% from 2.2 to 2.7). Cumulative incidence was 6.9% vs 18.5 pmp in the general population (period 1). In the general pop COVID19 incidence was highest at 443 pmp in Nov 2020 (period 2). The IFR requires full data validation; CFR was 7.7% (CI95% from 5.97 to 9.46; period 1). It is estimated that by Mar 2021 the IFR has decreased by 50%. Vaccination coverage in HD patients reached 94% (Apr 2021). Preliminary results from the updated model are presented. The model upholds its validity as the IFR allows for a better fine tuning of one parameter (mortality).Conclusionstreatment need and inequality in service provision can be addressed with a spreadsheet model by including pandemic preparedness measures.Key messages Haemodialysis patients had a very high COVID-19 incidence and CFR during the first two months of the COVID-19 pandemic when compared with the incidence in the general population.Pandemic preparedness must include protection measures for patients with chronic diseases. Renal patients are particularly vulnerable given their co-morbidity.

The Consequences of the Austerity Policies for Public Services in the UK

This article examines the changing landscape of public service provision in the UK during austerity. Austerity is presented through the notions of retrenchment, decentralisation and shifts in governance. The analysis shows that retrenchment and decentralisation eroded the capacity of public institutions to protect the provision of vital public services. This is revealed through the reduced provision of non-statutory services and the reinforcement of inequalities in service provision. Shifts in governance have led to mixed outcomes in the quality of services. This article also addresses how austerity influenced many of the problems observed in service provision during the COVID-19 pandemic. Vital public services in the UK faced the pandemic with a diminished resource base, heightened inequalities and significant fragmentation in service provision.

Geospatial Distribution of Family Planning Services in Kira Municipality, Wakiso District, Uganda.

Introduction: Access to family planning (FP) services remains a challenge, particularly in informal urban settlements. The unmet need for FP in these settings is high, with a correspondingly high prevalence of unintended pregnancies that may lead to unsafe abortions. However, there is a paucity of quality data on the distribution of FP services in such settings in Uganda. This paper described the geospatial distribution of FP services in Kira Municipality, Wakiso District, Uganda.Methods: This was a cross-sectional study in which we determined the availability and distribution of FP services in Kira Municipality. Community mapping and analysis were conducted using ArcGIS (version 10.1) and ArcGIS Online. Stata version 13.1 was used for data analysis. Chi-square test was used to compare the contraceptive provision and availability among facilities from informal and formal settlements.Results: Of the 176 healthcare facilities surveyed, only 42% (n = 74) offered contraceptives in informal settlements. The majority of the facilities were privately owned small clinics (95%). At least 80% of the facilities provided three or more modern contraceptive methods, with no difference (p = 0.107) between facilities in informal and formal settlements. Only 30.7% (p = 0.001) of the facilities provided at least one long-acting contraceptive. Similarly, 20 and 12% (p = 0.001) of the facilities had implants and intrauterine devices (IUDs) on the day of the survey. Almost 25% of the facilities did not offer contraceptive services (counseling and commodities) to unmarried adolescents.Conclusions: Most facilities were small privately-owned clinics, offering at least three modern contraceptive methods. The unavailability of long-acting reversible methods in the informal settings may affect the quality of FP services due to limited choice. The inequity in service provision that disfavors the unmarried adolescent may increase unwanted/unintended pregnancies. We recommend that local governments and partners work toward filling the existing commodities gap and addressing the discrimination against unmarried adolescents in such settings.

Factors influencing the migration intention of health professionals in low and middle income countries: Critical review with a theoretical model

Objective
 Migration of healthcare workers could result in shortage of human resources and rising inequalities in service provision in resource poor countries. The aim of this review was to determine the factors influencing the migration decisions of medical and dental graduates migrating from low- and middle-income countries as well as introducing a practical model for health professional’s migration.
 Methods
 Google Scholar and PubMed were searched together with relevant journals for English studies from January 2005 to January 2020. The original studies which evaluated the motivational factors of dental and medical graduates migrating from low or middle income countries were included. The migration model was developed by investigating the factors and frameworks of selected studies.
 Results
 Twenty-five articles were met the inclusion criteria. Push and pull theory was the most popular way to describe the driving factors of migration. These factors were classified into three macro-, meso- and micro-level with eight key domains. Poor income, unfavorable socio-economic situation, political instability, lack of professional and educational opportunities together with family and personal concerns found as strong common reasons perpetuating migration.
 Conclusion
 Despite the fact that health workers migrate for different reasons, they follow a same route for decision to stay or leave their home countries. Un-fulfillment of expectations in mother land in addition to media reconstructed reality of life in foreign land can develop a positive attitude for better quality of life improvement after migration. Once individuals could overpass their national identity and barriers of migration, the final decision toward migration would be more feasible.

Transforming a global order in New Zealand to reduce health inequities in service provision

Abstract St John has been providing service in New Zealand for nearly 140 years since its arrival. It has now close to 4000 staff and nearly 20000 Members and over 8500 volunteers. In New Zealand the major work of St John is its Ambulance service providing front line first responders to crash, medical emergency and other life-threatening situations. St John New Zealand also provides a number of 'Community Health' initiatives focused on strengthening communities and prevention. In recent years St John has recognised that they have not engaged well with Indigenous communities and that their organisation in New Zealand must become skilled and relevant in addressing the needs of the Indigenous people of New Zealand, as they suffer the greater burden of disease and illness than any other population in the country. St John NZ Community and Health Services are embarking on a process of transformation through re-orienting its culture and practice by adopting Public Health approaches and an equity lens over all its programmes. They also have committed to understanding and using Indigenous knowledge to support this re-orientation to most effectively engage and implement programmes that will reduce Indigenous health inequities. This presentation will describe the process by which they will be implementing their strategy for change and highlight best practice for working with Indigenous communities. Key messages Indigenous Knowledge is key to addressing Indigenous Health inequities. Mainstream Public Health can learn from Indigenous Public Health approaches.

Home Modification Service Delivery in Australia

In Australia, a patchwork of services provide home modifications, each with varying approaches and service guidelines. This context is rapidly changing with consumer directed care models impacting the aged care and disability sectors. A study investigating satisfaction with service delivery for 31 clients of major home modification services is presented to illustrate home modification practice in Australia. The findings indicate overall satisfaction with home modification services, but also revealed areas for improvement and inequalities in service provision. This included the need for more choice in design, materials and products and the impact of housing tenure, where renters reported lower satisfaction.

Does quality of care in hip fracture vary by day of admission?

SummaryThis study investigates if the day of the week a person is admitted with a hip fracture influences the quality of care they receive. We found those admitted Thursday and Friday were likely to obtain poorer postoperative care, indicating a need to optimize services ensuring equality for all.PurposeWe sought to investigate how the day of admission affects the quality of care provided to hip fracture patients according to national standards (The Scottish Standards of Care for Hip Fracture Patients [SSCHFP]).MethodsRetrospective analysis of national cohort data. Data were collected by the Scottish Hip Fracture Audit (SHFA) local audit co-ordinators (LACs) at participating Scottish hospitals on behalf of NHS Scotland and the Scottish Government. Adherence to the SSCHFP included assessment of both individual and cumulative standard attainment as a marker for quality of patient care.ResultsFrom January 2014 to April 2018, 15,351 admissions for hip fracture were recorded. Compared with Monday admission (reference day), patients admitted on a Thursday or Friday had a significantly lower likelihood of achieving the postoperative standards of prompt mobilization (OR 1.77; p < 0.001 & OR 1.48; p < 0.001, respectively); prompt physiotherapy assessment (OR 8.61; p < 0.001 & OR 3.47; p < 0.001, respectively); and prompt comprehensive geriatric assessment (OR 1.88; p < 0.001 & OR 1.41; p < 0.001, respectively). Patients admitted on a Friday or Saturday were less likely to receive the preoperative standards of no delay prior to theatre (OR 1.24; p = 0.001 & OR 1.23; p = 0.002, respectively) and avoidance of repeat fasting (OR 1.22; p = 0.009 & OR 1.22; p = 0.01, respectively).ConclusionPatients admitted on Thursday or Friday were significantly more likely to not receive postoperative care standards than patients admitted on the reference day (Monday). This appears to be related to inequalities in service provision for Saturday and Sunday compared with the rest of the week.

Factors influencing the migration intention of dental and medical graduates in developing countries

Abstract Background Migration of skilled health workers could result in shortage of human resources and rising inequalities in service provision in source countries. To date, most of relevant papers are focused on rate and reasons of migration while the need for conducting studies on modelling of factors is more vividly felt. The aim of this review was to determine the factors influencing the migration decisions of medical and dental graduates migrating from developing countries and to introduce a practical conceptual framework for health worker migration. Methods Electronic databases PubMed, Google Scholar and relevant Journals were systematically searched for English language publications from January 2009 to April 2019. The inclusion criteria were: 1) article stated factors affecting migration decisions of medical doctors and/or dentists, 2) the source country in the study was a developing country, 3) participants’ primary qualification country was in a developing country,4) the study used primary data both qualitative or quantitative. Results The search identified 814 articles from which we included 23 full-text studies after applying eligibility checklist. Push and pull theory was the most popular model to describe the migration driving factors. Poor socio-economic situation, political instability, lack of professional and educational opportunities together with family concerns found as strong common push factors that perpetuate migration. The most influencing pull factors were desire for better quality of life, career and training opportunities and financial gain. Conclusions Despite the fact that health workers migrate for different reasons, they follow a same route for decision to stay or leave their own countries. Un-fulfillment of expectations in mother land in addition to media reconstructed reality of life in foreign land can develop a positive attitude for migration Which should be considered before weighing up the push and pull factors of both sides. Key messages A better understanding of the migration motives of health professionals will help health authorities to improve their workforce recruitment and retention strategies and health service planning. Our simple yet comprehensive framework can mainly identify the development of migration desire through combining different models and concepts of migration, behavioral change, values, needs and so on.