Formal Services Research Articles

Connecting through public transport: accessibility to health and education in major African cities

ABSTRACT Transport matters for health and education outcomes, by ensuring physical access to crucial facilities. Using spatial modelling techniques and routable public transport service data, this study assesses the effectiveness of mostly semi fixed-route public transport systems in connecting people to advanced healthcare and education facilities in African cities. Uncovering significant pockets of ‘accessibility poverty’ – travel times above an acceptable level – it underscores the inequality in access within the cities, disproportionately affecting poor populations. Proximity of public transport to homes matters but has limited impact, due to how the routes, operated mainly by informal service providers, are allocated across the urban space and the low technical performance. The low ‘value added’ of public transport compared to walking helps explain the prevalence of foot travel. Tailored policy interventions – improving the public transport systems and, equally importantly, ensuring more equitable spatial distribution of advanced healthcare facilities – emerge as crucial strategies for addressing accessibility poverty.

Effect of Education Level, Personal Income, and Accessibility of Banking Services on Personal Financial Management among Working Women in West Java

This quantitative study examines the influence of education level, personal income, and accessibility of banking services on personal financial management practices among working women in West Java, Indonesia. Data were collected from a sample of 180 working women using structured questionnaires and analyzed using Structural Equation Modeling with Partial Least Squares (SEM-PLS) 3. The findings reveal significant positive relationships between education level, personal income, accessibility of banking services, and personal financial management practices. Moreover, banking services accessibility partially mediates the relationships between education level and personal financial management and between personal income and personal financial management. These results underscore the importance of financial literacy, economic empowerment, and access to formal financial services in fostering financial well-being among working women in West Java. The study contributes to a deeper understanding of the socio-economic factors influencing personal financial management and informs evidence-based interventions to promote financial inclusion and gender equity in the region.

Vulnerable Group Theory of Financial Inclusion

Abstract In this article, I propose the vulnerable group theory of financial inclusion. The theory begins with the premise that vulnerable people are often left behind in society, they suffer the most from economic hardship and crises, and they are at risk of being excluded from the formal financial sector. The theory therefore proposes that financial inclusion efforts should be targeted at all vulnerable people and groups in society. Bringing vulnerable people into the formal financial sector will give them access to available formal financial services, which they can use to earn income and acquire assets that they can use to take themselves out of the vulnerability bracket. The study also identifies the vulnerable groups in need of financial inclusion and proposes a vulnerability grid. Several avenues to expand the theory are suggested.

Barriers Experienced by Community-Dwelling Older Adults Navigating Formal Care: Evidence From an Australian Population-Based National Survey.

This study aims to identify the relationship between psychosocial factors and unmet needs among community-dwelling older adults who have received or who expect to receive formal home-based aged care services. A subsample of the national Survey of Disability, Ageing and Carers was used to examine the prevalence of having any unmet needs among older adults navigating care. We also examined associations between older adults' psychosocial factors and their unmet needs using logistic regression. Regression analyses highlighted that perceived social isolation (OR = 1.62, 95% CI: 1.30-2.01), high/very high psychological distress (OR = 2.11, 95% CI: 1.52-2.93), and occasional assistance from informal support (OR = 1.92, 95% CI: 1.22-3.05) were associated with increased odds of having unmet needs, after adjusting for other covariates. Our study suggests that older adults facing psychosocial difficulties or lacking informal support are more likely to encounter barriers in accessing formal care. Future policy should address the psychosocial needs and support networks of older adults.

Informal–Formal Healthcare Services Delivery Nexus in Nigeria’s Urban Slums: A Reconnaissance Study

Urban slums are human habitats with poor habitation qualities that are vulnerable to infectious diseases and public health crises. Low coverage from formal healthcare services providers created opportunity for informal providers to thrive in urban slums. This study examined the nature of relationship between informal and formal healthcare services providers in urban slums and explored opportunities for strengthening collaborations between them. Reconnaissance research method, a qualitative research approach for exploring under-researched terrains, guided the interview of 104 slum healthcare stakeholders across eight purposively selected slums in Enugu and Onitsha cities, in southeastern-Nigeria. Findings show that informal healthcare service providers are dominant in urban slums, and many of them cooperate and compete with formal providers. Supervision of informal providers in slums is inadequate, and the formal providers report that the informal providers find acceptance, despite their lack of adequate training and professionalism. Authorities governing health systems in slums are encouraged to establish a mechanism to profile informal providers, delineate the scope of services, and bridge the gap through the creation of referral channels. Subsequent studies may explore what character any mechanism created to institutionalize the collaboration toward improving healthcare services delivery should take and what challenges could undermine it.

“Thanks to my activists Friends”: a qualitative study of perspectives of young adults and professionals on the factors related to seeking support among victims of sexual violence in Spain

BackgroundSexual violence (SV) is a public health problem with high prevalence among the young population. The use of formal resources for SV care (e.g. institutional services) is low in this age group. This study applies a framework of health assets to identify the factors that positively influence the search for support for SV among young people, the functions of that support and the level of proximity as articulated by both young people and professionals.MethodsA qualitative study was conducted through 38 semi-structured interviews with young people and professionals from SV resource centers and/or care services for the young population in Spain. A thematic theoretical analysis was conducted, embedded in inductive insights emerging from the data, following a particular adaptation of the constant comparative method, under the grounded theory approach. This analysis was carried out by coding the interview transcripts with the support of Atlas.ti.ResultsYoung women identified assets, categorized as feminist, that they believe they are essential in the search for formal support services for SV. However, unlike young men, they considered the police and judicial system to be barriers and not assets. There were also differences between the young people and professionals in identifying assets. Young people also considered their partner and traditional media as health assets, in contrast to professionals who did not identify these as such valuable resources in the help-seeking process. Informal assets, such as family, friends and the internet are considered close resources. In contrast, specialized care services for gender-based violence/SV and the judicial and police systems were perceived as more distant resources among the young interviewees.ConclusionsThis study shows similarities and discrepancies among young women and men and SV response professionals in identifying assets for seeking SV support among youth. The study shows an inverse relationship between perceptions of proximity and the level of formality of the asset. This study also contributes to map the relationships and information exchanges between assets. It is advisable to inform professionals about the assets that professionals do not acknowledge, and about actions that allow young people to access formal resources.

Gender Disparities and Social Responsibilities as a Barrier to the Adoption of E-Commerce for Women Entrepreneurs of India in the MSME Sector

Gender-based obstacles that prevent women from beginning and expanding their enterprises include unequal distribution of family and domestic duties, restricted mobility, discriminatory property, marriage, and inheritance laws and/or cultural traditions. When it comes to accessing resources such as commercial credit from formal financial service providers, more lucrative markets rather than traditional local markets, technology and information to launch and expand their businesses, national incentives in small enterprise development through gender-blind private sector development, fiscal policies and legislation, and training and education for small enterprise development, women entrepreneurs are less privileged than men due to these factors combined with social exclusion based on gender. In the informal sector, women entrepreneurs running micro and small companies significantly improve the financial security of their families and communities. They have little chance of creating successful firms as long as they are not covered by SME development laws and initiatives. In order to address these issues, this research paper takes a development and rights-based strategy that strives to meet the real-world needs of female entrepreneurs, eliminate the political, legal, and sociocultural obstacles to their success, and promote an atmosphere that is supportive of both gender equality and business growth.

The meaningful participation of children in matters that affect them: Child participation in the context of child protection across five European countries

This paper compares children’s participation in child protection (CP) legislative and policy frameworks and how this is then reflected in practice among five European countries namely Bulgaria, Ireland, Malta, Norway and Serbia. Literature suggests that whereas many countries have adapted their legislative and policy frameworks, there exists a gap between these frameworks and what happens in practice (Wilson et al., 2020; Jensen et al., 2020). This paper will address this gap by considering the contextual forces that facilitate the participation of children in formal CP services, where listening to their voices and involving them in decision-making processes is important. The authors draw on the Eurofamnet national reports (Abela and Dudova, 2021) to provide an overview of the history of child protection, and other important indicators such as poverty. A case study approach is adopted. The comparative analysis of the five countries suggests that whereas all five countries have adapted their legislation to achieve child participation and CP policies are increasingly becoming child-centered, there exists a gap between the legislative and policy frameworks and what is on offer in practice. The participation and protection of children is interdependent on a child protection service with the necessary infrastructure in terms of legislation and policy but also necessitates contextually framed resources, knowledge and awareness about the benefits of such a policy for the wellbeing of children and their families. The exchange of good practices, knowledge and experiences in terms of child participation between countries with more developed CP systems and those with a shorter history of CP practices could create long-term collaborations and innovation in the area for those countries who most need it. The influential role of international institutions is also an important driving force, especially for those countries who may not have a welfare regime context that is supportive of entering into a conversation with children when they most need protection and support.

Efficient self-organization of informal public transport networks

The Global South, encompassing more than 80% of the world population, heavily relies on informal paratransit services with ad-hoc routes. Yet, it remains unclear how efficiently such informal public transport services organize and operate. Here, we analyze and compare the structural efficiency of more than 7000 formal and informal bus service routes in 36 cities across 22 countries globally. Intriguingly, informal transport self-organizes in ways at or above efficiency levels of centralized services. They exhibit fewer detours, more uniform paths, and comparable interconnectivities, all while remaining profitable without the major subsidies common in the Global North. These insights challenge the global perception of informal transport as an inferior alternative to centrally organized services. More generally, analyzing large-scale microscopic transport data and condensing them into informative macroscopic observables may qualitatively improve system understanding and reveal specific options to create more accessible, efficient, and sustainable public transport solutions.

A Postcolonial Feminist Perspective on Traditional Birth Attendants and Management of Pregnancy Complications Among Indigenous Women in Rural Nigeria

The work of Traditional Birth Attendants (TBAs) in the Global South continues to be pivotal to the operations of rural healthcare services, especially as formal healthcare services often malfunction in rural communities, as in rural Nigeria, where TBAs preponderantly conduct deliveries among Indigenous women. This study examines TBAs’ management of delivery complications in rural Nigeria among Indigenous women using a sample of TBAs and TBAs’ service users. The study adopts a qualitative methodology involving focus groups of TBAs’ service users and interviews of TBAs to determine TBAs’ effectiveness in managing obstetric complications, considering their differentiation in terms of service competence. The study apprehends the phenomenon through a postcolonial feminist theoretical lens. The results show that TBAs have differential capabilities in the management of cases and their perception and interpretation of problems determined whether physical or metaphysical strategies were employed in their work. While some TBAs competently managed the presented cases, others invited either TBA colleagues or traditional resource persons to assist in such dire moments. Even though the TBAs—victims of patriarchy and colonial subjugation—continue to be marginalized and subjugated by male-dominated colonial and neocolonial power structures, they have significantly transformed their values to create a model for rural social work that provides social and emotional support to Indigenous women in rural spaces. The study therefore identifies a social policy and social work imperative for ideas sharing between different forms of Westernized healthcare practitioners and TBAs to engender the best health outcomes for rural Indigenous women.

Factors associated with utilisation of staff clinic services by nurses at Parirenyatwa Group of Hospitals, Zimbabwe. A cross-sectional study

Introduction: Nurses, as gatekeepers of health, are expected to seek formal healthcare services, reflecting the advice they give patients. However, squalid working conditions, long hours, and heavy workloads expose them to occupational health hazards, limiting their ability to care for themselves. Properly implemented employee clinic services can help nurses address health problems, promote well-being, and reintegrate them into the workforce. Objective: This study sought to determine factors associated with the utilization of staff clinic services by nurses at Parirenyatwa Group of Hospitals. Materials and Methods: The study used an analytical cross-sectional design conducted in May 2023. A consecutive sampling method selected 50 participants. Data were collected via a structured questionnaire and presented as numbers and percentages. The questionnaire was divided into sections as follows: Participant demographic information (Age, gender, marital status, religion etc.); uptake of staff clinic services (Screening, treatment, awareness services etc), and factors associated with uptake of staff clinic services among nurses. Chi-square test or Fisher’s exact test to evaluate significant differences for unpaired data. Statistical analysis was performed using STATA 16. Results: Among the 50 participants, 66% were female. The study results show that the uptake of staff clinic services was low, with only 54% of the participants visiting the clinic on rare occasions. The most common barriers to utilizing the staff clinic were lack of time to go for screening (16%), fear of stigma (14%), and uncertainty about confidentiality (14%). Most participants utilized the acute illness treatment service (62%). Age was a significant factor associated with the utilization of the staff clinic (p = 0.021), with younger nurses using the clinic more often. Perceived benefits were also significantly associated with utilization (p < 0.05). Discussion: The utilization of staff clinic services by nurses remains suboptimal despite high knowledge and awareness of these services. Utilization was mainly associated with age, perceived benefits of accessing the staff clinic services, and reasons for not utilizing some of the services. There is need to strengthen promotional activities for the utilization of staff clinic health services as this has been proven to increase productivity and health outcomes of clinical staff.

Comprehensive molecular pathology review service to reduce barriers to precision oncology in rural eastern North Carolina.

11129 Background: ECU Health system serves a rural 29-county region where cancer mortality rates exceed those of the state’s remaining 71 counties combined. Insufficient tissue and lack of local infrastructure contribute to suboptimal precision oncology care. We aimed to enhance the clinical utility of send-out molecular tests for patients with solid cancers through a quality improvement (QI) initiative. Methods: We used the EPIDEM model of QI to explore, promote, and implement a molecular review service, which includes intervening on send-out molecular orders that would otherwise have been insufficient for the requested molecular pathology test. The interventions include combining blocks, sending alternative specimens, and/or modifying testing strategy. We documented cases in a molecular send-out database and electronic health records, evaluated the service's impact, and modified it to include an orderable molecular consultation. Results: In 2023, We reviewed 699 send-out comprehensive genomic tests on solid tumors (173 cytology, 192 resections, 332 biopsies), including 582 (83.3%) advanced cancers. In total, there were 576 sufficient reports. Actions taken on 185 orders (26.5% of reviewed cases) led to 156 reported results. Of these, 70 showed clinically significant findings, and 31 patients received targeted therapy because of those interventions. In March 2023, we initiated a formal consultation service with in-depth review. From 3/3/2023-1/29/2024, we performed 50 pre-test (e.g., specimen to use, testing strategy, tumor origin testing) and 60 post-test (e.g., result interpretation, treatment based on molecular data) consultations; 10 patients received both pre and post-test support. The molecular pathologist tended to initiate post-test, while clinicians preferentially initiated pre-test consultations (p<.01). Clinician-initiated consultations were more frequent in community practices (p <.01). Conclusions: Even without the resources for in-house testing, our molecular review service provides essential pre- and post-analytic support by successfully rescuing cases that would have otherwise been insufficient molecular tests and by providing comprehensive consultative support. The positive impact and reception among community oncologists suggest that our strategy holds potential to alleviate barriers to precision oncology in underserved areas. [Table: see text]

FINANCIAL INCLUSION AND INCOME INEQUALITY IN NIGERIA

Studies show that the low level of economic development in countries occasioned by high income inequality levels may be addressed by financial inclusion policies via providing increased access and availability of formal financial services to the financially excluded segment of the economy. This paper investigates the extent to which this is applicable in Nigeria using the Auto regressive distributed lag estimation technique on time series data for the period 1985 to 2019. The results, consistent with the special agent theory of financial inclusion, show that financial inclusion significantly reduce the income inequality gap in Nigeria. Furthermore, the results also suggest that education and economic growth lowers the gap while population widens the gap. Based on this, the study recommends that policy makers in Nigeria put in more efforts to achieve the set target rate of financial inclusion as well put in place population reducing polices to further reduce the gap while promoting policies that will actualise the potentials of the other indices.

"It's a Postcode Lottery": How Do People Affected by Dementia in Wales Experience Their Diagnosis and Post-Diagnostic Support, and How May These Be Improved?

National dementia strategies are government policies that guide the provision of appropriate support for people living with dementia. These strategies, developed through extensive stakeholder engagement, should be tailored to the cultural and demographic needs of a country. Using a mixed methods survey design, this study explored the aims of the Dementia Action Plan (2018-2022) for Wales (UK) around assessment, diagnosis, and post-diagnostic support, and assessed whether these are being realized. Further, it sought to gain insight from people living with dementia and their carers around how the experience may be improved for others in the future, as the development of the next iteration of the Action Plan is anticipated. Respondents included 71 people, affected by typical and rarer types of dementia, living in both rural and urban areas. Findings suggest both positive and negative experiences, reflecting a 'postcode lottery' of service provision. Attainable recommendations for improvement were made by respondents, which would ultimately likely be cost-effective and reduce strain on formal services. The findings reported in this paper concur with those reported by people living with dementia in other countries, indicating their relevance for policymakers beyond Wales.

Use of Long-Term Care Services by Older Persons with Limited English Proficiency

ABSTRACT Older migrants face special difficulties in the access and use of long-term care services and supports (LTSS). Our study was designed to examine how older persons with limited English proficiency (LEP) in two groups of migrants (Spanish or Chinese speaking) interact with the LTSS system. Focus groups were used to elicit information from members of these groups. We discovered Chinese elders were likely to believe that the LTSS services could, if managed properly, meet their needs, while the Spanish speakers were more skeptical. These differences were associated with the presence of trusted intermediaries among the Chinese elders who could represent their interests, while most Spanish speakers did not report having such intermediaries. In this way, trust, or lack of it, was uncovered as the key element defining older adults’ interactions with the formal health and social service systems. Findings will be used to develop a modeling method that will allow us to analyze results in a manner that can be extended to use with other migrant groups.

Proches aidants en psychiatrie : quelle (in)adéquation entre besoins et offres de soutien ?

Informal caregivers play a vital role in supporting people with severe mental illness. However, this role can leave informal caregivers with significant unmet needs. The aim of this qualitative study is to identify the extent to which the support offered to informal caregivers in adult psychiatry in French-speaking Switzerland meets their needs. Individual semi-structured interviews and focus groups were conducted with informal caregivers, mental health professionals, and service providers. The data were analyzed by theme. The need for assistance and the need for information are two themes identified as prevalent among informal caregivers. Despite a consensus on the need for more support and information, informal caregivers, service providers, and health professionals do not assign the same importance to specific aspects of these themes. Suggestions for improving practices at the institutional, socio-political, and civil-society levels are put forward. Given the diversity of viewpoints on the priority needs of informal caregivers, there is a risk of offering support that only partially corresponds to the difficulties encountered by informal caregivers. Matching support and needs remains a major challenge. Agreeing on a consensual definition of support and information needs and proposing tailored approaches could make it possible to develop support services that meet the actual needs of informal caregivers.

The Impact Of Fintech Innovations On Traditional Financial Institutions, Financial Inclusions, and Payment Systems – A Review Of Case Studies

Fintech (monetary innovation) advancements have been reshaping the monetary scene, altering the manner in which individuals access monetary administrations, go through with exchanges, and deal with their funds. It has fundamentally disturbed the customary monetary scene, it are conveyed and experienced to change the way monetary administrations. Fintech startups have pushed traditional financial institutions to change and improve their services in order to remain competitive with agile, customer-focused solutions. Fintech has revolutionized payment systems simultaneously by introducing digital payment methods and making cross-border transactions easier, reducing cash-based systems' reliance. Most importantly, fintech has increased financial inclusion by enabling individuals and small businesses to participate more actively in the formal economy by providing formal financial services to previously underserved populations via mobile platforms. While the extraordinary effect of fintech is apparent, policymakers and partners should address administrative intricacies and network protection dangers to guarantee supportable and comprehensive monetary environments. This article looks at the extraordinary effect of fintech on customary monetary foundations, installment frameworks, and monetary incorporation. By breaking down different literary works and contextual analyses, the specialist attempts to investigate how fintech has disturbed conventional practices, further developed productivity, and cultivated more noteworthy monetary incorporation around the world. IndexTerms - Fintech, computerized installments, monetary environment, network safety, monetary consideration, artificial intelligence, man-made consciousness, information security, risk.

“In my Own Land, I Am Treated like a Foreigner”: Mining-Induced Challenges and Psychological Distress Among Farmers in Ghanaian Mining Communities

This study explored mining-induced challenges, experiences of psychological distress, and coping strategies among farmers in mining communities in Ghana. Using a qualitative research approach, in-depth interviews were conducted with 30 crop farmers in two mining communities in the Ellembelle District in the Western Region of Ghana. Thematic analysis of the data suggests that psychological distress is a common experience among farmers in mining communities. Farmers’ experiences of psychological distress emanate from various mining-induced challenges, including deprivation of vital resources, constraints on farming activities, economic hardship, and adjustment difficulties associated with displacement and resettlement. Faced with limited formal support services, farmers in mining communities employ religious faith, avoidance, and adaptation as mechanisms for coping with the adverse impacts of mining. The findings of this study suggest the need to address issues related to psychological well-being before and after the onset of mining activities in communities.

Support for Family Caregivers: Implications of Work Strain and Its Intersections With Formal and Informal Help.

This study seeks to assess whether and to what extent caregiver work strain is ameliorated by the presence of additional family caregivers and formal service use. Building on the stress process model and stress-appraisal moderation, we examine how formal and informal support varies in associations with caregiver distress for men and women. This study utilizes data provided by the National Study of Caregiving, which is linked with care-recipient information from the National Health and Aging Trends Study. Using panel methods for the pooled waves, we estimated caregiver outcomes of emotional well-being on the intersection of experiences of work strain and (a) the number of additional caregivers and (b) utilization of 6 different types of formal support. Additional informal caregivers for each respective care recipient are associated with lower levels of distress, although utilization of formal services (paid help and Medicaid funding) is positively associated with caregiver distress. Informal support can offset the impact of work strain, but interactions are only evident for women caregivers. The findings suggest that informal support, exemplified by the number of additional caregivers, corresponds with reduced emotional distress among employed caregivers and can mitigate the negative impacts of work strain. However, positive associations between formal support and male and female caregiver distress suggest that the context of formal services may offer limited or untimely support. This study is expected to broaden our understanding of informal caregiving in later life and provide practical implications on how to sustain informal care.

War-Related Life Course Stress and Late-Life Subjective Age in Northern Vietnam.

The role of early life stressors in subjective aging is weakly understood, especially in low- to middle-income countries. This paper investigated how early life stressors encountered in armed conflict influence subjective age among Vietnamese older adults who experienced war over decades of their early life. We analyzed survey data from the 2018 Vietnam Health and Aging Study involving 2,447 Vietnamese older adults who encountered diverse war-related stressors in early adulthood. The analytical sample (N = 2,341) included 50.9% women and 49.1% men, with an average age of 69.8. 41.1% are military veterans. We conducted survey-adjusted multinomial logistic regression analyses with mediation to predict the probability of feeling younger or older than one's chronological age. We examined how childhood adversity (i.e., childhood hunger and low parental SES) and wartime stressors (i.e., war-related violence, malevolent environment, and military service) influenced late-life subjective age, both directly and as mediated by late-life mental, functional, and physical health. We found significant associations between early adulthood war-related stressors and subjective age. Formal military service significantly lessened the relative risk of feeling subjectively old, and more plentiful wartime violence exposures significantly increased the risk of feeling younger than one's chronological age. Violence exposure's effects were both direct and indirect through functional and mental health. Conversely, greater exposure to wartime malevolent conditions (e.g., shortages of clean water and evacuations) and multiple episodes of severe hunger in childhood increased the risk of feeling older, effects both direct and mediated by late-life functional and mental health. Results suggest wartime stressors, especially war's malevolent environments and severe childhood hunger, experienced in many conflict-affected populations globally, have the potential to subjectively "age" survivors. Yet, not all war exposures are equal, and some may yield psychological and socioeconomic resources that support healthy aging.