Use Of Public Health Facilities Research Articles

Health services satisfaction and medical exclusion among migrant youths in Gauteng Province of South Africa: A cross-sectional analysis of the GCRO survey (2017-2018).

Medical xenophobia of migrant (either in-migrants or immigrants) youths is an ongoing problem in contemporary South African society. Medical mistreatment by healthcare workers and social phobia from migrant youths have been attributed to major obstacles to healthcare utilization as well as health services satisfaction. This study aimed to determine the prevalence and factors contributing to health services satisfaction and medical exclusion among migrant youths in Gauteng province in South Africa. The Round 5 Gauteng City-Region Observatory (GCRO) Quality of Life (QoL) survey was conducted in 2017‒2018, a nationally representative survey piloted every two years in South Africa, was utilized in this study. A 2-year cohort study of 24,889 respondents aged 18 to 29 and a baseline data consisted of 4,872 respondents, comprising non-migrants, in-migrants and immigrants, from where 2,162 in-migrants and immigrants were utilized as the sample size. The data was analysed using descriptive statistics, Chi-Square analysis and logistic regression. A total of 2,162 migrants, comprising 35.4% in-migrants and 9.0% of immigrants, from the 4,872 respondents, were included in the analysis. The prevalence of medical exclusion of in-migrant and immigrant youths were 5.5% and 4.2%, and the majority of them reported the use of public health facilities (in-migrants ‒ 84.3% vs. immigrants ‒ 87.1%). At the bivariate level, demographic (age, sex, and population group), economic (employed and any income) and health-related (no medical aid and household member with mental health) factors were significantly associated with medical exclusion (ρ≤0.05). The adjusted odds ratio showed that only female gender (AOR: 1.07, 95% CI: 0.678, 1.705), no medical aid cover (AOR: 1.23, 95% CI: 0.450, 3.362), and neither (AOR: 1.59, 95% CI: 0.606, 4.174) or dissatisfied (AOR: 4.29, 95% CI: 2.528, 7.270) were independent predictors of medical exclusion. Having no medical aid cover, being a female and dissatisfied, or neither satisfied nor dissatisfied with health services significantly increased the odds of medical exclusion among migrant youths. To increase healthcare utilization and ensuring adequate medical care of migrant youths, opting for medical aid insurance without increasing costs should be guaranteed. Therefore, there should be no consequences for lack of residence status or correct documentation papers when accessing healthcare services among migrant youths in South Africa.

Health Seeking Behaviour and Healthcare Utilization in a Rural Cohort of North India.

Background: The healthcare infrastructure of a country determines the health-seeking behaviour of the population. In developing countries such as India, there is a great disparity in the distribution of healthcare institutions across urban and rural areas with disadvantages for people living in rural areas. Objectives: Our objectives were to study the health-seeking behavior and factors associated with the use of formal healthcare among the Gorakhpur Health and Demographic Surveillance System (GHDSS) cohort of North India. Methods: The study was conducted in 28 villages from two rural blocks in the Gorakhpur district of eastern Uttar Pradesh, North India. Structured questionnaires were used to collect the data with regard to demographics, health-seeking behaviour and healthcare utilization. An adjusted odds ratio with 95% confidence interval was used to report the factors associated with the utilization of healthcare. Results: Out of 120,306 individuals surveyed, 19,240 (16%) individuals reported having any health problem in the last 15 days. Of them, 90% sought healthcare for their health needs. The formal healthcare utilization was 79%. The use of public health facilities was very low (37%) with most of the people seeking treatment from private healthcare (63%). Females, people with a higher level of education (graduate and above), and those belonging to rich and middle tercile were more likely to use formal healthcare services. Among different ailments, respiratory problems, gastrointestinal problems, and musculoskeletal problems were associated with decreased use of formal healthcare. Conclusion: About four in five individuals surveyed who had health problems sought treatments from formal healthcare with three in five preferring private institutions to public healthcare facilities due to a perceived higher level of treatment quality and nearby availability. There is an urgent need to re-establish community trust among public healthcare facilities with a focus on delivering on-site health care and enhancing the quality of services offered by public healthcare institutions.

An extensive review of patient health-care service satisfaction in Bangladesh

Patient satisfaction is a useful measure for providing quality indicators in health-care services. Concern over the quality of health-care services in Bangladesh has resulted in a loss of faith in health-care providers, low use of public health facilities, and increased outflows of patients from Bangladesh to hospitals abroad. The main barriers to accessing health services are inadequate services and poor quality of existing facilities, shortage of medicine supplies, busyness of doctors due to high patient load, long travel distance to facilities, and long waiting times once facilities were reached, very short consultation time, lack of empathy of the health professionals, their generally callous and casual attitude, aggressive pursuit of monetary gains, poor levels of competence and occasionally, disregard for the suffering that patients endure without being able to voice their concerns. All of these service failures are frequently reported in the print media. Such failures can play a powerful role in shaping patients’ negative attitudes and dissatisfaction with health-care service providers and health-care itself.

Patient satisfaction with healthcare services: Bangladesh perspective

<p>Patient satisfaction is a useful measure for providing a quality benchmark for healthcare services. Concern about the quality of healthcare services in Bangladesh has led to a loss of confidence in healthcare providers, low use of public health facilities and increased outflows of patients from Bangladesh to hospitals abroad. The key obstacles to access to health services are insufficient infrastructure and poor quality of existing facilities, lack of medical equipment, scarcity of doctors due to high patient load, long distance to the facilities and long waiting times until facilities have been reached, very short appointment hours, lack of empathy of health professionals, their generally callous and casual attitude, aggressive pursuit of monetary gains, poor levels of competence and, occasionally, disregard for the suffering that patients endure without being able to voice their concerns-all of these service failures are reported frequently in the print media. Such failures can play a powerful role in shaping patients’ negative attitudes and dissatisfaction with healthcare service providers and healthcare itself.</p>

Changes in catastrophic health expenditure in post-conflict Sierra Leone: an Oaxaca-blinder decomposition analysis

BackgroundAt the end of the eleven-year conflict in Sierra Leone, a wide range of policies were implemented to address both demand- and supply-side constraints within the healthcare system, which had collapsed during the conflict. This study examines the extent to which households’ exposure to financial risks associated with seeking healthcare evolved in post-conflict Sierra Leone.MethodThis study uses the 2003 and 2011 cross-sections of the Sierra Leone Integrated Household Survey to examine changes in catastrophic health expenditure between 2003 and 2011. An Oaxaca-Blinder decomposition approach is used to quantify the extent to which changes in catastrophic health expenditure are attributable to changes in the distribution of determinants (distributional effect) and to changes in the impact of these determinants on the probability of incurring catastrophic health expenditure (coefficient effect).ResultsThe incidence of catastrophic health expenditure decreased significantly by 18% from approximately 50% in 2003 t0 32% in 2011. The decomposition analysis shows that this decrease represents net effects attributable to the distributional and coefficient effects of three determinants of catastrophic health expenditure – ill-health, the region in which households reside and the type of health facility used. A decrease in the incidence of ill-health and changes in the regional location of households contributed to a decrease in catastrophic health expenditure. The distributional effect of health facility types observed as an increase in the use of public health facilities, and a decrease in the use of services in facilities owned by non-governmental organizations (NGOs) also contributed to a decrease in the incidence of catastrophic health expenditure. However, the coefficient effect of public health facilities and NGO-owned facilities suggests that substantial exposure to financial risk remained for households utilizing both types of health facilities in 2011.ConclusionThe findings support the need to continue expanding current demand-side policies in Sierra Leone to reduce the financial risk of exposure to ill health.

Factors influencing women's utilization of public health care services during childbirth in Malawi Public health facility utilization.

Maternal mortality remains a public health challenge claiming many lives at the time of giving birth lives. However, there have been scanty studies investigating factors influencing women's use of public health facilities during childbirth. The aim of the study was to explore the factors associated with women choice of public health facility during childbirth. The study used 2010 Malawi Demographic Health Survey dataset and a binary logistics regression analysis to estimate the determinants influencing women's use of public health facilities at the time they give birth. Of 23020 women respondents, 8454(36.7%) chose to give birth in public health facilities. Multivariate analysis reported that frequency of antenatal care (ANC), birth order, women's education, wealth status and quality of care were the major predictors increasing women's choice to use public health facilities at childbirth. There is need to use multimedia approach to engage women on significance of utilizing public health facilities during childbirth and promote quality of care in facilities if their health outcome is to improve in Malawi.

An assessment of the effect of user fee policy reform on facility-based deliveries in rural Zambia.

BackgroundImproving maternal health outcomes by reducing barriers to accessing maternal health services is a key goal for most developing countries. This paper analyses the effect of user fee removal, which was announced for rural areas of Zambia in April 2006, on the use of public health facilities for childbirth.MethodsData from the 2007 Zambia Demographic and Health Survey, including birth histories for the five years preceding the survey, is linked to administrative data and geo-referenced health facility census data. We exploit a difference-in-differences design, due to a differential change in user fees at the district level; fees were removed in 54 rural districts, but not in the 18 remaining urban districts. We use multilevel modelling to estimate the effect of this policy change, based on 4018 births from May 2002 to September 2007, covering a period before and after the policy announcement in April 2006.ResultsThe difference-in-difference estimates point to statistically insignificant changes in the proportion of women giving birth at home and in public facilities, but significant changes are found for deliveries in private (faith-based) facilities. Thus, the abolition of delivery fees is found to have some effect on where Zambian mothers choose to have their children born.ConclusionThe removal of user fees has not overcome barriers to the utilisation of delivery services at public facilities. User fee removal may also yield unintended consequences deterring the utilisation of delivery services. Therefore, abolishing user fees, alone, may not be sufficient to affect changes in utilisation; instead, other efforts, such as improving service quality, may have a greater impact.

Positive deviance as a novel tool in malaria control and elimination: methodology, qualitative assessment and future potential

BackgroundPositive deviance (PD) is an asset-based, community-driven approach to behaviour change that has successfully been applied to address many health and social problems. It is yet to have been assessed for malaria control but may represent a promising tool for malaria elimination given its suitability in targeting small and remote population groups, apparent sustainability and ability to instil a high amount of community mobilisation. Here, the PD methodology as applied to malaria is explained, with focus upon and qualitative assessment of a proof of concept study in Cambodia.MethodsThree villages in Battambang, northwestern Cambodia were selected for the intervention, with an estimated population of 5036 including both residents and migrant workers. In August 2010, field teams conducted a 1 week PD process to sensitise and mobilise the community, establish normative behaviours in relation to malaria control and prevention, identify positive deviant behaviours from within the community, and identify PD volunteers. Until March 2011, PD volunteers were supported by field teams via monthly meetings to conduct activities in their respective communities to increase practice of PD behaviours. In February 2012, 1 year following the end of external support, evaluative interviews were conducted with community members to qualitatively assess community acceptance and interpretation of the PD intervention, perceived behaviour changes, and perceived positive outcomes.ResultsQualitative data from focus group discussions and in-depth interviews showed that the PD approach was well-accepted into the communities and created a strong sense of community empowerment. Positive behaviour change was linked to the PD intervention, including greater usage of nets by forest goers, and use of public health facilities for malaria diagnosis and treatment. One year following the end of external assistance, PD volunteers were still conducting activities in their respective communities.ConclusionsPD offers a promising tool in malaria control and elimination settings. Work is ongoing to quantitatively measure impact of PD on behaviours and malaria transmission and once gathered, national malaria control programmes should be encouraged to look at including PD as part of their national strategies. Feasibility of scale-up, cost-effectiveness, and applicability to other settings and diseases is also currently being explored.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-016-1129-5) contains supplementary material, which is available to authorized users.

Trends in Maternal Care Utilization in Urban India

The present study attempts to observe the recent changes in the Indian health care utilization pattern based on secondary data from three National Sample Survey Organisation (NSSO) rounds. The study focuses on urban households across different classes of towns emphasizing the most recent births to married women within a recall of period 365 days. Three dimensions of maternal care services have been discussed in this study, namely, prenatal care services, delivery services and postnatal care services. It is found that the utilization of prenatal, postnatal and delivery services are positively correlated with the economic status of households as measured by the per capita monthly consumption expenditure (MPCE). It is also noted that the household educational and employment index are correlated with the level of prenatal and postnatal care utilization and the dimension of correlation is positive and statistically significant. But in case of delivery services the degree of correlation has changed from being highly positive to negative, specifically in case of household employment index. This study also attempts to understand the changes in utilization of maternal health care services with respect to public health infrastructure. It is found that the use of public health facilities has significantly reduced over time. The correlation between household economic status and the use of public facilities for the prenatal, postnatal and delivery care present a strong negative and the degree of correlation becomes stronger over time. A similar dimension of association is found in the case of household educational index. It may be the improvement in utilizing public health infrastructure among households from the formal sector. The discrepancy in access to health facilities among different classes of cities can be cited as one of the reasons for lower utilization of maternal health care services. Such discrepancies are relatively lower in case of small towns especially in the case of delivery and prenatal care services.

Trends and Differentials in Health Care Utilization Pattern in India

The results from this study indicate that a vast majority of people (almost 80 per cent) in India use the private sector for outpatient care curative services, albeit a slight decline is noted between 1995–96 and 2004. The utilization of private sector for outpatient services has become more inequitable across expenditure quintiles, favouring the rich at the national level during the period 1995–96 to 2004. There are also large inter-state variations in the choice between private and public provision for poor and non-poor people at the state level. The results indicate that Himachal Pradesh is the only state where the public outpatient services are well targeted and fairly accessible to the poor people (84 per cent) than other states. The multivariate analysis suggests that the gap in access to private provider for outpatient care between poor and non-poor, highly educated and uneducated and scheduled tribes (STs) and other social groups have broadened over the study period. Unlike outpatient care, the results show a trend of declining use of public health facilities for inpatient care. A sizeable proportion of the poor were forced to visit private provider due to non-availability of public facilities: this suggests the need for the public health care system to be responsive to the needs of the poor by ensuring availability of quality services in the public facilities.

Determinants of cervical cancer screening in a poor area: results of a population‐based survey in Rivas, Nicaragua

To obtain baseline information for designing a community-based intervention programme aimed at increasing the cervical cancer screening coverage of women most at risk. A population-based survey, using proportional stratified two-stage cluster sampling in Rivas, one of the 16 Departments of Nicaragua. The individuals selected were interviewed at home by one of 26 interviewers, using a structured questionnaire. The questionnaire was designed to elicit (1) knowledge, attitudes and practices concerning sexual and reproductive health and behaviour, (2) risk factors for cervical cancer and (3) the use of health and cervical cancer screening services. A total of 612 men and 634 women participated in the survey. Of the women who had been sexually active at least 3 years, only 41.1% had undergone screening within that period and were considered adequately screened. Correlates of inadequate screening status included low educational level, exclusive use of public health facilities and lack of knowledge about prevention and symptoms of cervical cancer. Negligence, absence of medical problems, fear, lack of knowledge and economic reasons were the main reasons given for not being screened. Reluctance to be screened in the future was related to lack of knowledge of the disease, inadequate screening status, older age and low educational level. The current screening programme is not effective in reaching the majority of the population. Complementary activities such as education and information, as well as a more pro-active approach to invite women for screening are necessary.

Bicultural Stress: An Aboriginal Community Perspective

A survey was designed to assess and to compare the levels of stress being experienced by Aboriginal and Torres Strait Islander and non-Aboriginal respondents. The survey covered a range of areas including demographics, access to transport, drug and alcohol use, use of public services, identification of stressful events in the past 12 months and a self evaluation of stress symptoms. The groups were matched by age, sex and income. The results showed differences between the stressful events and stress symptoms reported by the two groups, with the Aboriginal and Torres Strait Islander group reporting considerably higher levels. There were significant differences in access to transport and use of public health facilities. The barriers to the use of public health services were identified. A major finding was that 69% of the Aboriginal and Torres Strait Islander sample experienced more than one loss through death compared to 5% of the non-Aboriginal sample in the previous 12 months. It was concluded that the Aboriginal and Torres Strait Islander sample experienced more stressful events, had more stress related symptoms and used public mental health services less than the non-Aboriginal sample. The barriers to use of services were a lack of cultural sensitivity and the discomfort experienced by the Aboriginal and Torres Strait Islander sample when accessing services. A partnership with the Aboriginal and Torres Strait Islander community is required to develop a public health service that is acceptable and useful to the Aboriginal and Torres Strait Islander sample.