Use of emergency room facilities in a rural area: A spatial analysis

This paper is a spatial analysis of travel patterns to emergency room facilities. Spatial patterns of travel to emergency room (ER) facilities are analysed in this paper to determine the extent to which the residents of a rural region use the ER facilities of nearby small towns, and to explore variables affecting their choice of facility and their travel pattern. This study involves the hospitals of a small town in western New York near the Pennsylvania line which receive sufficient number of ER patients from two Pennsylvania countries besides their local and other New York State patients.     

Distance and the utilization of health facilities in rural Nigeria

The distance patients must travel in order to obtain treatment has long been recognized as a primary determinant of the utilization of health care facilities. The distance factor is especially significant in rural Third World settings where the density of Western-type health facilities is often low, where the majority of patients are likely to make the journey for treatment as pedestrians and where there are viable and usually more accessible alternate sources of medicine. This study examines the impact of distance on the utilization of health care facilities in the Hadejia area of Kano State, Nigeria. Per capita utilization was found to decline exponentially with distance. The rate of distance decay in utilization levels varies according to the type of facility, socio-demographic variables and illness. Hausa perceptions about sickness and about specific illnesses are reflected in the varying incidence of health facility utilization in the treatment of particular illnesses and distance decay gradients of varying steepness. Although the per capita consumption of health care decreases exponentially for concentric distance bands, individual villages show great disparities in utilization rates which are only partly attributable to distance.     

Effects of PEPFAR on beneficiaries' determinants of health: perspectives from a beneficiary community in Gaza province, Mozambique

While the national prevalence of HIV in Mozambique is estimated at 14%, Gaza has the highest provincial prevalence at 27%, almost double the national estimate. PEPFAR's mandate is to combat HIV/AIDS by providing treatment for 4 million people, prevent 12 million new infections, and care for 12 million people including 5 million orphans and vulnerable children (OVC). In Gaza, PEPFAR funds non-governmental organizations (NGOs) which provide community level activities. However, no assessment had been done of beneficiary's perception of PEPFAR initiatives. This article shares results of a study carried out to identify the perceived effects of PEPFAR interventions on the determinants of health among beneficiaries. Qualitative methods were used to explore which PEPFAR initiatives beneficiaries believed influenced their determinants of health. The findings exposed beneficiaries' determinants of health, and which PEPFAR initiatives affected those determinants, particularly those focused on nutrition, environmental influences, and educational support services.     

Water use and health in Mueda, Mozambique

A comparison of domestic water use in 2 villages in Mueda, Mozambique, indicated that a reduction in the length of the water collection journey from 5 h to 10 min was associated with an increase in average water consumption from 4.1 to 11.1 litres per person per day. Bathing and washing clothes accounted for 70% of the increased total. Bathing of children was a regular nightly event in the village with a water supply but almost unknown in the other. Water used for food preparation also increased, suggesting that scarcity of water may also influence diet. A major benefit of water supply is the saving of women's time and effort from water collection. In Mueda, it was an average of 1 3/4 h per day. More than half the time saved was spent on other household tasks, particularly grinding cereals, and on other productive work. Women spent much of the remainder with their children. A trachoma survey, organized as a training exercise for medical students, found a 19% prevalence of trachoma in the village with a water supply, while the prevalence was twice this figure in another village with no supply.     

广西农村地区孕产妇住院分娩状况及影响因素研究

目的 了解1998-2003年广西农村地区孕产妇住院分娩服务的状况,并探讨影响住院分娩服务利用的因素.方法 以安德森卫生服务利用行为模型为分析框架,资料来源于第三次国家卫生服务调查的广西数据库.以其中1998-2003年有活产史的广西农村地区妇女为研究对象,描述住院分娩服务的状况,进行单因素分析并拟合多因素logistic回归模型,考察农村妇女住院分娩的影响因素.结果 在全部407名有活产史的妇女中,39.80%的妇女是住院分娩;1998-2003年的住院分娩率呈逐年升高(P＜0.0001),在乡镇卫生院分娩的产妇呈逐年上升趋势,在家分娩的产妇比例则逐年减少(P＜0.0001).经综合考虑单因素分析和多因素logistic回归分析结果,孕产妇的分娩史、教育状况、家庭的饮水类型、以最快方式去最近医院的时间、产前检查情况,以及是否被动员住院分娩等因素是影响广西农村地区孕产妇住院分娩服务利用的重要因素,其OR值分别为:经产妇1.749、以最快方式去最近医院的时间少于10 min者1.995、家庭饮用自来水者3.011、高中及以上文化程度者5.435、接受5次及以上产前检查者29.149与被动员过住院分娩者37.822.结论 社会经济发展水平、孕期保健状况、分娩史等是影响广西农村妇女选择住院分娩,接受专业人员助产服务的主要因素.     

Quality assessment of health facilities in rural Papua New Guinea

A cost study of rural health facilities in Papua New Guineaconducted in 1988 included assessment of the potential qualityof each unit. A checklist of simple criteria was developed,measuring the level of care and the capability of the centreto perform certain health service tasks. This was used to providean overall picture of how well rural health services in thecountry were running, and whether centres were reaching thelevel of performance expected of them. The results suggested that managerial weaknesses at provincialand local levels were contributing to poor functioning at someof the centres, with wide regional variation in the amount ofmedical supervisory visits. Although mission services appearedto be functioning better than government services, they werealso better staffed and cost more to run. Despite a long-standingrational drugs policy in the country, incorrect prescribingpractices were detected at some health facilities. Checklists of this kind are useful to obtain a rapid overviewof health service provision within a country or a district,and could be useful in training supervisors of rural healthfacilities.     

Primary health services in Ecuador: Comparative costs, quality, and equity of care in ministry of health and rural social security facilities

This study of costs, quality and financial equity of primary health services in Ecuador, based on 1985 data, examines three assumptions, common in international health, concerning Ministry of Health (MOH) and Social Security (SS) programs. The assumptions are that MOH services are less costly than SS services, that they are of lower quality than SS services, and that MOH programs are more equitable in terms of the distribution of funds available for PHC among different population groups. Full costs of a range of primary health services were estimated by standard accounting techniques for 15 typical health care establishments, 8 operated by the MOH and 7 by the rural SS program (RSSP), serving rural and peri-urban populations in the two major geographical regions of Ecuador. Consistent with the conventional premise, MOH average costs were much lower than RSSP costs for several important types of services, especially those provided by physicians. Little difference was found for dental care. The lower MOH physician service costs appeared to be attributable primarily to lower personnel compensation (only partially offset by lesser productivity) and to greater economies of scope. Several measures of the quality of care were applied, with varying results. Based on staff differences and patterns of expenditures on resource inputs, notably drugs, RSSP quality appeared higher, as assumed. However, contrary to expectation, a questionnaire assessment of staff knowledge and procedures favored the MOH for quality. Program equity was judged in terms of per capita budgeted expenditures (additional measures, such as the likelihood of receiving necessary care, would have required household survey data beyond the scope of this program-based study). The results support the assumption of greater MOH financial equity, as its program reveals less variation in budgeted expenditures between different population groups covered. Additional evidence of equity, using other indicators, would be helpful in future research. The paper's findings have policy implications not only for Ecuador's health sector but also for policy-makers in other countries at similar levels of socioeconomic development. These implications are spelled out in order to guide officials wrestling with issues of efficiency, quality, and equity as they search for the best use of scarce resources to promote health.     

Social,political, commercial,and corporate determinants of rural health equity in Canada: an integrated framework

People in rural and remote areas often experience greater vulnerability and higher health-related risks as a result of complex issues that include limited access to affordable health services and programs. During disruptive events, rural populations face unique barriers and challenges due to their remoteness and limited access to resources, including digital technologies. While social determinants of health have been highlighted as a tool to understand how health is impacted by various social factors, it is crucial to create a holistic framework to fully understand rural health equity. In this commentary, we propose an integrated framework that connects the social determinants of health (SDOH), the political determinants of health (PDOH), the commercial determinants of health (ComDOH), and the corporate determinants of health (CorpDOH) to address health inequity in rural and remote communities in Canada. The goal of this commentary is to situate these four determinants of health as key to inform policy-makers and practitioners for future development of rural health equity policies and programs in Canada.     

Contextual and individual determinants of health among Aussiedler and native Germans

Aussiedler, also referred to as ethnic German immigrants from countries of the former Soviet Union and other parts of Eastern Europe, constitute one of the largest immigrant groups in Germany. Little is known about their health relative to the health of native Germans. Using the German Microcensus 2005, which includes information about the health of 10,022 Aussiedler and 322,813 native Germans aged 20+ we find that in both groups high regional centrality depresses health, as does living in a region with low GDP. The proportion of foreigners does not have any consistent effect. The two groups differ with respect to educational gradients in health: there is none for Aussiedler, while there is a steep gradient for native Germans. Aussiedler who have lived in Germany for less than 15 years are healthier than native Germans which supports the healthy migrant hypothesis. Their deteriorating health status by duration of stay suggests that migration, deprivation and discrimination may have negative effects on the health of Aussiedler.     

Racial and spatial relations as fundamental determinants of health in Detroit

African Americans in the United States have a higher than average risk of morbidity and mortality, despite declining mortality rates for many causes of death for the general population. This article examines race-based residential segregation as a fundamental cause of racial disparities, shaping differences in exposure to, and experiences of, diseases and risk factors. The spatial distribution of racial groups, specifically the residential segregation of African Americans in aging urban areas, contributes to disparities in health by influencing access to economic, social, and physical resources essential to health. Using the Detroit metropolitan area as a case study, this article looks at the influences of the distribution of African American and white residents on access to these resources and discusses the implications for urban policies to reduce racial disparities in health status.     

Assessing spatial accessibility to mental health facilities in an urban environment

Canadian provincial health systems are obligated to ensure access to health services for all citizens, based primarily on the principles of "universality" and "accessibility" which is enshrined in the Canada Health Act. Nevertheless, less than 40% of Canadian with mental health problems uses mental health services. Efforts to understand underutilization of mental health services have focused on individual and neighborhood characteristics. The aim of this study was to examine whether we could identify areas with mental health facilities shortage in the southwest of Montreal which may possibly explain disparities in access to mental health facilities. We applied the two-step floating catchment area method for our analyses. The results of our analysis show that mental health services are not equally distributed in the southwest of Montreal and in consequence, accessibility scores vary greatly from one DA to another.     

How institutional change and individual researchers helped advance clinical guidelines in American health care

Clinical guidelines are important tools for managing health care quality. Research on the origins of guidelines primarily focuses on the institutional causes of their emergence and growth. Individual medical researchers, however, have played important roles. This paper develops knowledge of the role of individual medical researchers in advancing guidelines, and of how researchers' efforts were enabled or constrained by broader institutional changes. Drawing on an analytical case study focused on the role of Kerr White, John Wennberg, and Robert Brook, it shows that guidelines were a product of the interplay between institutional change in the medical field and actions by individual researchers, acting as institutional entrepreneurs. Increased government involvement in the health care field triggered the involvement of a range of new actors in health care. These new organizations created a context that allowed individual researchers to advance guidelines by creating job opportunities, providing research funding, and creating opportunities for researchers to engage with the policy process. Individual researchers availed of this context to both advance their ideas, and to draw new actors into the field.