Inequitable Service Research Articles

AI-Driven Governance: Transforming Public and Addressing Legacy Issues in Post-Colonial Africa

This paper examines the transformational potentials that artificial intelligence (AI) may hold to reshape our public policies and methods of administration in the unique post-colonial context of Africa. We thus seek to unearth how AI technologies can be employed at a continental scale in the remedy of legacy issues arising from colonialism including; governance inefficiency, literacy gaps, and inequitable service delivery across the continent. From critically analyzing the application of AI in various public sectors, our research seeks to unveil opportunities for AI in inclusive decision-making processes to improve transparency as well as tailoring public service delivery to the diversified needs of African populations. The paper describes the way forward in the adoption of AI solutions that involve issues on a variety of considerations, infrastructure requirements, financial obstacles, and capacity development, among others. Highlighting the potential of AI in governance, this research underscores the place of local innovation stakeholder engagement, and international collaboration in assuring that AI plays out as a development lever for both sustainable development and empowerment in post-colonial Africa.

Barriers and enablers to accessing perinatal health services for rural Australian women: A qualitative exploration of rural health care providers perspectives.

To identify perceived barriers and enablers for rural women in accessing perinatal care within their own community from the perspective of perinatal health care providers. A qualitative descriptive study design utilising reflexive thematic analysis, using the socioecological framework to organise and articulate findings. Victoria, Australia. Semi-structured interviews were conducted with nine perinatal health care providers who provide care to pregnant women or new mothers in rural communities. Participants were recruited across Victoria in 2023. Providers reported multi-level barriers and enablers that exist for rural women in accessing perinatal care within their communities. Barriers included women's personal circumstances, challenging professional relationships, inequitable service provision, ineffective collaboration between services and clinicians and government funding models and policies. Enablers included strength and resilience of rural women, social capital within rural communities, flexible care delivery and innovative practice, rural culture and continuity of care models. Rural perinatal health care providers perceived that rural women face multiple barriers that are created or sustained by complex interpersonal, organisational, community and policy factors that are intrinsic to rural health care delivery. Several addressable factors were identified that create unnecessary barriers for rural women in engaging with perinatal care. These included education regarding health systems, rights and expectations, equitable distribution of perinatal services, improved interprofessional relationships and collaborative approaches to care and equity-based funding models for perinatal services regardless of geographical location.

Who Does the Public Blame for Inequities in Public Service Provision? Examining the Effect of Contracting and Cost Information in a Survey Experiment

Research assessing blame attribution in third-party governance views public service performance as a function of efficiency and effectiveness but overlooks equity. We address this gap in the literature by asking two questions: (1) Does contracting out lessen the blame assigned to the government for inequitable service provision? and (2) Is the public less critical of inequitable service provision when told it results in greater efficiency? To answer these questions, a survey experiment was conducted using a representative sample of United States residents (n = 1034). The results show that, while the government still bears responsibility for inequitable service provision, contracting out diminishes some of the responsibility placed on the government, shifting it toward the contractor instead. In addition, citizens’ blame attribution patterns do not change when told inequitable service provision results from efforts to improve efficiency, which suggests that the public does not excuse inequitable service provision even when told it saves money. The findings of this study contribute to the understanding of blame dynamics in third-party governance and bring implications to democratic accountability.

Partnering Early to Provide for Infants At Risk of Cerebral Palsy (PĒPI ARC): protocol for a feasibility study of a regional hub for early detection of cerebral palsy in Aotearoa New Zealand.

Cerebral palsy (CP) can now be diagnosed in infants with identified CP risk factors as early as three months of age; however, many barriers prevent equitable access to early detection pathways. The "Partnering Early to Provide for Infants At Risk of Cerebral Palsy" feasibility study (PĒPI ARC) seeks to trial a new approach to decrease inequitable health service in Aotearoa New Zealand for high-risk infants and their families. PĒPI ARC incorporates face-to-face clinics, an in-person and virtual Hub, and the use of telehealth to enable flexible access to CP assessments and support for health professionals in early CP detection. A non-randomised feasibility study was conducted from a tertiary Neonatal Intensive Care Unit (NICU) in Wellington and included seven regional referral centres, servicing nearly 30% of the total population in New Zealand (NZ). The families of infants with a high risk of neurodevelopmental impairment and health professionals interacting with the Hub were invited to participate. Mixed methods were used to evaluate the (i) equitable implementation of an early detection pathway, (ii) acceptability, (iii) demand among families and health professionals, (iv) efficacy in relation to reducing the age of receipt of CP diagnosis, and (v) the experiences around communication and information sharing. The NZ Health and Disability Ethics Committee approved this study (HDEC: 2022 FULL 13434). The findings will be disseminated in peer-reviewed journals, in conference presentations, and via professional networks. Australian New Zealand Clinical Trials Registry: ACTRN12623000600640.

Antenatal ultrasound needs-analysis survey of Australian rural/remote healthcare clinicians: recommendations for improved service quality and access

BackgroundUltrasound is the primary diagnostic tool in pregnancy, capable of identifying high-risk pregnancies and life-threatening conditions, allowing for appropriate management to prevent maternal and fetal morbidity and mortality. Women and babies from rural and remote Australia and low-resource areas worldwide experience poorer health outcomes and barriers to accessing antenatal care and imaging services. Healthcare clinicians working in these regions face significant challenges practising with limited resources and accessing training opportunities.ObjectiveTo perform an exploratory needs-analysis survey investigating the availability, accessibility and use of antenatal ultrasound in rural Australia, exploring rural clinicians’ interest in and access to ultrasound training opportunities.MethodsThe survey tool for this cross-sectional study was designed and distributed as an anonymous online questionnaire targeting healthcare clinicians (doctors, nurses, midwives, clinic managers, Aboriginal healthcare workers) providing antenatal care in rural regions. Descriptive analysis was applied to quantitative data and thematic analysis was used to explore qualitative components.ResultsA total of 114 valid survey responses were analysed. Overall, 39% (43/111) reported ultrasound was not used when providing antenatal care to patients at their clinic, stating ‘Lack of ultrasound equipment (73%,29/40) and inaccessibility of training opportunities (47%,19/40) as the main reasons. For those with ultrasound (61%,68/111), estimating due date (89%,57/64) was the main use, and limited training/skills to operate the equipment (59%,38/64) and inaccessibility/distance of training opportunities (45%,29/64) were the most commonly reported barriers. Clinicians described a lack of childcare options (73%,74/102), long distances to reach ultrasound services (64%,65/102), appointment (59%,60/102) and transport availability/times (46%,47/102) as the main obstacles to patient access. Increased attendance, compliance with care directives, parental bonding and improved lifestyle choices were described by respondents as positive outcomes of antenatal ultrasound use.ConclusionsFuture efforts to combat inequitable service access must adopt a coordinated approach to meet the needs of pregnant women in low-resource settings. Providing portable ultrasound equipment, training in antenatal Point-of-Care ultrasound (PoCUS) with ongoing support/mentoring and accreditation of health professionals could strengthen rural workforce capacity. This, along with addressing the complex economic, environmental and socio-cultural barriers faced by patients, could improve service access and pregnancy outcomes in rural and remote communities.

Evolution of Government-funded health insurance for universal health coverage in India.

India has run multiple Government-Funded Health Insurance schemes (GFHIS) over the past decades to ensure affordable healthcare. We assessed GFHIS evolution with a special focus on two national schemes - Rashtriya Swasthya Bima Yojana (RSBY) and Pradhan Mantri Jan Arogya Yojana (PMJAY). RSBY suffered from a static financial coverage cap, low enrollment, inequitable service supply, utilization, etc. PMJAY expanded coverage and mitigated some of RSBY's drawbacks. Investigating equity in PMJAY's supply and utilization across geography, sex, age, social groups, and healthcare sectors depicts several systemic skews. Kerala and Himachal Pradesh with low poverty and disease burden use more services. Males are more likely to seek care under PMJAY than females. Mid-age population (19-50 years) is a common group availing services. Scheduled Caste and Scheduled Tribe people have low service utilization. Most hospitals providing services are private. Such inequities can lead the most vulnerable populations further into deprivation due to healthcare inaccessibility.

Catching up with AI: Pushing toward a cohesive governance framework

AbstractArtificial Intelligence (AI) contributes to public administration by augmenting public services, including managing big data and information technology. AI is currently utilized in e‐government services that contribute value to American citizens, including providing a personalized customer experience, such as linking individualized data and processing individual assistance requests. Furthermore, AI can take over redundant routine tasks such as digital information provisioning and delivering services. However, in the United States, there is no overarching policy that governs AI. Inconsistent public policy contributes to public distrust of AI, concerns about privacy intrusion, and fears of inequitable service delivery. This review article discusses the rapid emergence of government applications of AI and provides a systematic review of proposed AI governance models. It then outlines their common components for the purpose of building a coherent, yet adaptable, AI Governance Framework and proposes a research agenda for policy and administration researchers.Related ArticlesGlen, Carol M. 2014. “Internet Governance: Territorializing Cyberspace?” Politics & Policy 42(5): 635–57. https://doi.org/10.1111/polp.12093.Glen, Carol M. 2021. “Norm Entrepreneurship in Global Cybersecurity.” Politics & Policy 49(5): 1121–45. https://doi.org/10.1111/polp.12430.Zeng, Jinghan, Tim Stevens, and Yaru Chen. 2017. “China's Solution to Global Cyber Governance: Unpacking the Domestic Discourse of ‘Internet Sovereignty.’” Politics & Policy 45(3): 432–64. https://doi.org/10.1111/polp.12202.

' Like I said about culture. You don't talk about mental health' : An interpretative phenomenological analysis of the experience of first-episode psychosis in South Asian individuals.

There is strong evidence of inequalities in mental healthcare access, experiences and outcomes for service users belonging to Black and Asian Minority Ethnic groups experiencing psychosis. Clinicians and academics have speculated that cultural variation in conceptualisations of psychosis, alongside inequitable service provision may explain disparities. There is, however, a dearth of literature exploring this in a South Asian population, despite this ethnic group being the second largest in the United Kingdom. The present study aimed to explore how people from this minority group have experienced and made sense of first-episode psychosis (FEP). A qualitative approach was used to explore the lived experience and sense-making of South Asian individuals experiencing FEP and accessing early intervention services. Eight people were interviewed using a semi-structured format. The data were analysed using Interpretative Phenomenological Analysis. Three superordinate themes were identified in the group analysis: (1) Disconnection from self and others (2) Doubt and dispute (3) Power and shame. Distinctive ethnic, cultural and systemic influences were strongly evident in how people conceptualized their experiences, how they managed their sense-making and where they sought support. Experiences were discussed in the context of power and shame, and this research proposes that socio-cultural context and racialised discourses have an impact on self-concept, the experiences of help-seeking (formal and informal), and fundamentally how services help individuals from marginalized communities.

Improving Professional Spiritual Care to Persons With Limited English Proficiency: The Cross-Language Chaplaincy Introduction Guidebook.

Hospitalized individuals in the United States with limited English proficiency (LEP) may experience complications when receiving hospital care. Grounded in the ethical principles of chaplaincy and motivated by the desire to address inequitable health service provision, we developed the Cross-Language Chaplaincy Introduction Guidebook. The Guidebook introduces chaplaincy in 20 different languages with the goal of improving chaplain accessibility. We report on the rigorous development of the Guidebook and how to integrate the resource clinically.

Social Disparities in the Duration of Power and Piped Water Outages in Texas After Winter Storm Uri.

We assessed sociodemographic disparities in basic service disruptions caused by Winter Storm Uri in Texas. We collected data through a bilingual telephone survey conducted in July 2021 (n = 753). Being Black, having children, and renting one's residence were associated with longer power outage durations; being Black was also associated with longer water outages. Our findings highlight the need to plan for and ameliorate inequitable service outages and their attendant health risks in climate change-related extreme weather events such as Uri. (Am J Public Health. 2023;113(1):30-34. https://doi.org/10.2105/AJPH.2022.307110).

‘Homelessness is a queer experience.’: utopianism and mutual aid as survival strategies for homeless trans people

Trans people are at considerably elevated risk of homelessness, yet services poorly meet their needs. I explore how community support, anchored in queer praxis and concrete utopian thinking enables trans people to survive homelessness. Drawing upon interviews with 35 trans people who have recently experienced homelessness in Wales, I explore how queer practices of mutual aid, contextualized by utopian possibility, engender community support for trans people experiencing homelessness. I argue that trans and queer communities provide extensive, often exhausting, practical, material and emotional support which counters well-established queer exclusion within statutory services. I show that community support is critical to the survival of homeless trans people within a complex and unwelcoming system, and that informal crisis alternatives are enabled by idealism, hope and pragmatism. These findings are important in visibilising how shared precarity produces practices of care, in offering strategies to address inequitable service failures, and in demonstrating the relevance of queer theoretical approaches to housing justice.

Leave no one behind: A case of ecosystem service supply equity in Singapore.

Urban populations benefit greatly from the ecosystem services provided by urban green and blue spaces. While the equity of provision of and access to urban green and blue spaces has been widely explored, research on equity of ecosystem service provision is relatively scant. Using household level data, our study aims to assess the supply equityof five regulatory ecosystem services in Singapore. We employed linear mixed-effects models and Hot Spot Analysis to analyze theirdistributional equity across individual households of various demographic characteristics (horizontal inequality), and calculated Gini coefficient for the distribution of PM10 removal service among households categorised into demographic subgroups (vertical inequality). Our results show littleevidence of inequitable ecosystem service provision among Singapore's diverse socio-demographic groups. This can be attributed to the early integration of environmental management strategies and meticulous socio-economic desegregation effortsinto urban development plans, which maximised provision and maintenance of urban green spaces to all residents.

Inclusive WASH and sustainable tourism in Labuan Bajo, Indonesia: needs and opportunities

Abstract Rapid tourism growth can place unprecedented strain on water resources and reduce access for local communities. This study explored the state of Inclusive water, sanitation and hygiene (WASH) in the tourism sector and local communities of Labuan Bajo, one of Indonesia's ‘super-premium’ tourism destinations. The formative research applied an Inclusive WASH-at-Work framework; data were collected using a case study methodology through semi-structured interviews (n = 20) and focus groups (n = 6) with government, tourism and community stakeholders. The findings identified growing tensions over inequitable water service levels and WASH access. Significantly, reported negative impacts were disproportionately experienced by women and girls, elderly and disabled members of the community, who suffer most from inadequate WASH facilities in hotels, public settings and their homes. Governance of and capacity constraints around WASH management highlighted the value of Inclusive WASH solutions to overcome the challenges Labuan Bajo faces as a rapidly developing tourism destination. Critically, solutions must be locally-driven, build local capacity and open pathways to collaboration between the community and decision-makers in the national government, provincial government and private tourism sector. Enhanced stakeholder collaboration and increased private sector contributions are needed to ensure a more equitable distribution of tourism benefits to underpin WASH and destination sustainability.

Potential indirect impacts of the COVID‐19 pandemic on children: a narrative review using a community child health lens

▪In this narrative review, we summarise the vast and burgeoning research on the potential and established indirect impacts on children of the COVID-19 pandemic. We used a community child health lens to organise our findings and to consider how Australia might best respond to the needs of children (aged 0-12 years). ▪We synthesised the literature on previous pandemics, epidemics and natural disasters, and the current COVID-19 pandemic. We found clear evidence of adverse impacts of the COVID-19 pandemic on children that either repeated or extended the findings from previous pandemics. ▪We identified 11 impact areas, under three broad categories: child-level factors (poorer mental health, poorer child health and development, poorer academic achievement); family-level factors that affect children (poorer parent mental health, reduced family income and job losses, increased household stress, increased abuse and neglect, poorer maternal and newborn health); and service-level factors that affect children (school closures, reduced access to health care, increased use of technology for learning, connection and health care). ▪There is increasing global concern about the likely disproportionate impact of the current pandemic on children experiencing adversity, widening existing disparities in child health and developmental outcomes. ▪We suggest five potential strategy areas that could begin to address these inequities: addressing financial instability through parent financial supplements; expanding the role of schools to address learning gaps and wellbeing; rethinking health care delivery to address reduced access; focusing on prevention and early intervention for mental health; and using digital solutions to address inequitable service delivery.

InterRAI Pediatric Home Care (PEDS-HC) Assessment Tool: Evaluating Ontario Healthcare Workers' Experience.

High quality pediatric homecare requires comprehensive assessment of the needs, supports, and health care challenges of children with special healthcare needs and their families. There is no standardized homecare assessment system to evaluate children’s clinical needs in the home (support services, equipment, etc.) in Ontario, Canada, which contributes to inequitable homecare service allocation. In 2017, the interRAI Pediatric Home Care assessment tool (PEDS-HC) was implemented on a pilot basis in several regions of Ontario. This qualitative descriptive study explores the experiences of homecare coordinators using the PEDS-HC, seeking to understand the utility and feasibility of this tool through focus group discussion. Four major themes were identified including: the benefits of the tool; areas for modification; challenges to use; and Clinical Assessment Protocols to develop. These themes can guide modifications to the tool to improve utility and improve pediatric home care services. The PEDS-HC is an effective tool to assess children needing homecare in a standardized and comprehensive manner. Use of the tool can improve the quality of homecare services by ensuring equity in service provision and facilitate early identification of clinical issues to prevent unexpected health deteriorations.

Pakistan’s Health-Care System: A Case of Elite Capture

Pakistan currently ranks 154 out of 189 countries on the UNDP’s Human Development Index. In this paper, we use a ‘political settlements analysis’ to understand how the distribution of political, economic and social power explains this ranking and the inequity in Pakistan’s health system. We investigate elite power struggles over the last seven decades to explain how ad hoc policy-making, instability, patronage politics and rent-seeking have led to a maldistribution of resources, lack of oversight, and inequitable access and service provision for a burgeoning population. We argue that these factors have had two consequences: the privatisation of health care, and the opening up of a considerable sphere of influence to the donor community to direct state policy. Despite promising ongoing reform efforts, we conclude that Pakistan’s health system will remain hamstrung by the constraints of a political settlement in which elites with short-term horizons bargain for influence rather than developing an inclusive, consensus-based approach to improving governance outcomes for citizens.

Development of an occupational-therapy-led paediatric burn telehealth review clinic.

Burns are a common injury in children. Rural and remote children with burn injuries are disadvantaged if their burns require hospitalisation and specialist rehabilitation. Most specialist burn rehabilitation is provided in regional or metropolitan cities by a multidisciplinary team. Therefore, rural and remote burn patients are required to travel to access these services. This project aimed to develop an Occupational Therapy (OT)-Led Paediatric Burn Telehealth Review Clinic (OTPB Clinic) at Townsville University Hospital (TUH) to provide ongoing rehabilitation to rural and remote children after burn injury closer to home. Local audits identified inequitable service delivery to children from rural and remote areas after burn injury. A project officer was appointed to develop the OTPB Clinic, including comprehensive guidelines to support sustainability. An expanded scope role was undertaken by the treating OT, and allied health assistants were engaged to promote efficient service delivery. The OTPB Clinic commenced in 2017 and was evaluated using patient satisfaction surveys and number of clinical encounters pre- and post-implementation. During the implementation period, 28 rural or remote paediatric burn patients were reviewed. Review frequency increased from 20-week to 8-week intervals. Travel time was reduced by approximately 12 hours per appointment. Families identified numerous benefits of the clinic including continuity of care and reduced time away from work. Less than 4% of patients required re-engagement with paediatric surgeons for surgical intervention. The model has the potential to be transferred to other tertiary referral burns services.

Ethnic, socio-economic and geographic inequities in maternal health service coverage in Australia.

Disparities in health service use exist in many sectors of Australia's health system, particularly affecting the most vulnerable people in the population, who are typically those with the greatest healthcare needs. Understanding patterns of health service coverage is critical for acknowledging the underlying, systemic drivers including racialised practices that inhibit the uptake of health services for certain population groups. This study aims to determine whether there are disparities in health service utilisation between socioeconomic, geographic and ethnic groups of mothers who experience hypertension, diabetes and mental health conditions. This study utilised a linked administrative healthcare dataset containing data of all mothers who gave birth in Queensland, Australia, between 2012 and 2015 (n=186,789), plus their resultant babies (n=189,909). The study compared health service utilisation for mothers with maternal health conditions between population groups. The results of this study showed a broad trend of inequitable health service utilisation, with mothers who experienced the greatest healthcare needs-First Nations, rural and remote and socio-economically disadvantaged mothers-being less likely to access health services and in some cases when care was accessed, fewer services being utilised during the perinatal period. Access to health care during the perinatal period is a reflection of Australia's general health system strengths and weaknesses, in particular a failure of the government to translate national and state policy intent into acceptable and accessible care in rural and remote areas, for First Nations women and for mothers experiencing socio-economic disadvantage.

The provision of additional services in primary care: a cross-sectional study of incentivised additional services, social deprivation, and ethnic group.

BackgroundPrimary care in England is contracted to provide essential services. Many practices also provide additional services, termed ‘directed enhanced services’ (DES), for extra income. The optional nature of DES may result in inequitable service delivery.AimTo determine the range of DES activity and equity of service provision.Design & settingA cross-sectional analysis of data from general practices in England took place from 2018–2019.MethodDES were defined in terms of activity level and measured as total DES funding per registered patient. Linear regression modelling was used to explore the relationship between DES activity, practice, and population characteristics.ResultsData were available for 6873 practices providing up to 10 DES in the initial sample. Due to negative funding amounts and a list size of ≤750 registered patients, 24 practices were excluded. Of the final sample (n = 6849), highest DES provision was for influenza and pneumococcal immunisation (99.9%), pertussis immunisation (97.9%), rotavirus and shingles immunisation (99.9%), meningitis immunisation (99.7%), and childhood immunisation (99.6%); lowest provision was for extended hours access (72.4%), violent patient services (2.0%), and out-of-area urgent care (1.3%). Mean DES funding was £6.25 per patient. In deprived areas, DES funding was £0.35 lower (95% confidence interval [CI] = £0.60 to £0.10) per patient (most versus least deprived quintiles); ethnic group-related differences were not significant. DES funding was higher in practices with more GPs or practice nurses per patient. In deprived communities, there was less immunisation activity (including influenza, pneumococcal, meningitis, childhood, and rotavirus and shingles immunisation) and provision of extended hours access; however, learning disability checks provision was greater in these communities.ConclusionDES provision is lower in deprived areas (notably for immunisations and some aspects of access) but higher in better staffed practices. Voluntary quality schemes may contribute to widening health inequalities.

Health needs of indigenous Mayan older adults in Mexico and health services available.

Current data indicate that inequitable health service access is one of the major problems faced by indigenous people in Mexico and around the world. The aim of this study was to analyse the perceived health needs of indigenous older adults in a Mayan region of Mexico and the health services provided to address these needs. It used a qualitative design which explored health needs, perceptions of well-being, experiences with public health services and obstacles in accessing services through semi-structured interviews with 20 older adults, nine traditional healers and seven public healthcare providers from Mayan municipalities in southeastern Mexico during 2013-2014. We identified that cultural differences related to the language, values, beliefs and worldview of indigenous populations are ignored or incorporated only minimally by health services. The provision of services does not correspond to the health needs of indigenous Mayan older adults, and wide gaps still undermine their human rights and health status; despite the establishment of favourable regulations, healthcare services are organised for the non-indigenous population. The conditions of social vulnerability affecting indigenous older adults require that healthcare institutions incorporate an intercultural approach in order to improve the quality of care according to the necessities of the population.