Youth experiences in accessing sexual healthcare services in Vietnam

Poor sexual and reproductive health outcomes among youth are reflective of the many barriers members of this group face in accessing health services. This study provides an in-depth account of the unique challenges that young people face in accessing sexual healthcare services in Vietnam. We surveyed 130 men and women aged 18–24 years at two major reproductive health sites in Ho Chi Minh City. We identified and explored seven domains: health insurance status, modern contraception use, HIV/STI testing, cervical cancer screening, unintended pregnancy, reproductive coercion and the patient-provider relationship. Attitudes towards the national health insurance system suggest that it does not facilitate access to healthcare. Despite widespread and affordable services, fears, fallacies and fixed social mores created formidable barriers for unmarried youth to access sexual and reproductive health services in Vietnam.     

Changing geographic access to and locational efficiency of health services in two Indian districts between 1981 and 1996

In developing countries, including India, the role of the private sector in the provision of basic healthcare services is gradually expanding, since the public sector provides limited services and covers only limited areas. Using location-allocation models (LAM), this paper (1) examines the changing geographic access to and locational efficiency of basic public healthcare vis-à-vis private healthcare services in two districts located in northwestern part of India, and (2) interrogates the factors that govern their geographic accessibility and locational-efficiency. Although this research confirms regional inequalities in geographic accessibility and locational efficiency of both public and private healthcare services in the selected districts, the locational efficiency of private health services is significantly lower than that of public health services. This paper further demonstrates the use of LAM for new site identification (keeping the existing healthcare sites intact) that will, in the future, improve locational efficiency of these services. This paper not only recommends improved geographic access to both public and private health services and their enhanced complementary role, but also stresses the need to evaluate geographic access from the service-users' perspective and the use of more realistic data on demand and supply in future research. The findings of this paper can be extended to areas with similar geographic settings, and socio-economic and demographic conditions.     

“Yo No Sabía...”—Immigrant Women’s Use of National Health Systems for Reproductive and Abortion Care

Half of pregnancies worldwide are unintended; half of these end in abortion. Immigrant women encounter more obstacles to reproductive healthcare than non-immigrant women, and access to national healthcare is a particularly important factor in abortion access. Spain’s government recently liberalized abortion laws, including abortion services in the national health system available to immigrants. Evidence suggests that immigrant women in Spain experience difficulties navigating the health system—the impact of the changed abortion laws on immigrant’s women’s access to care is not yet clear. Through a literature review and analysis, this paper examines the experiences of immigrant women with national health systems, and their use of such systems for reproductive and abortion care, in order to explore what could be expected in Spain as the national health system expands to include abortion care, and to illuminate immigrant women’s experiences with using national health systems for reproductive healthcare more broadly.     

Unequable spatial accessibility to hospitals in developing megacities: New evidence from Beijing

The increasing inequality in spatial accessibility to hospitals in developing countries has been attracting attention from researchers and politicians. The situation seems to be worse in growing megacities where more than 10 million people live and rapid urban sprawl has caused serious problems with the supply of health and public transport services. The recent global COVID-19 pandemic calls for particular attention to be afforded to the matter of equal access to basic medical facilities and services for people across different neighborhoods. Although some studies have already been undertaken into the subject of health-focused inequality in the cities of developing countries, the spatial inequity in hospital accessibility has rarely been discussed to date. In this paper, I aim to provide new evidence by considering Beijing as a case study. With the results of my analysis, I show that low-income neighborhoods have experienced lower levels of accessibility not only to high-tier hospitals (secondary and tertiary hospitals) but also to primary healthcare services (primary hospital and neighborhood clinics). The rate at which high-income neighborhoods access secondary and tertiary hospitals is approximately 4 times and 1.5 times as high as that of low-income neighborhoods. Low-income face nearly twice the travel time of those from high-income neighborhoods to reach the nearest primary hospital or neighborhood clinics. Suburban neighborhoods have less access to medical services than neighborhoods that are located in the central urban areas. It seems that the rapid urban sprawl has been worsening spatial inequality in the context of access to medical services in the growing megacity of Beijing. Equal access to healthcare services should be prioritized in future policy discussions, especially in relation to the urban growth management of megacities in developing countries in order to ensure that fair and inclusive urbanization processes are undertaken. Equal access to healthcare services would also be widely beneficial in the context of managing the COVID-19 pandemic.     

An intercept study of persons attending traditional birth homes in rural southeastern Nigeria

Analysing data from interviews with traditional birth assistants and their clients in rural Nigeria, this paper examines the characteristics and conditions of persons using the services of traditional birth homes. The clients of traditional birth homes mainly comprise women with little or no formal education and in low or no‐income occupations. These persons present at traditional birth homes for child delivery, abortion, family planning, STIs, infertility and a host of other reproductive health‐related conditions. Economic and cultural factors are primary considerations in the uptake of services. Findings highlight the critical role of poverty and culture in mediating access to good quality reproductive healthcare, the burden of unmet needs for good quality neonatal healthcare and reproductive health services among local women, and the critical health role of traditional birth homes in rural Nigeria. Local peoples' access to good quality health services could be improved by integrating traditional birth homes into mainstream healthcare delivery, and making available formal health facilities responsive to the socio‐economic and cultural needs of local peoples and communities.     

Perceived,anticipated and experienced stigma: exploring manifestations and implications for young people’s sexual and reproductive health and access to care in North-Western Tanzania

Abstract

Young people – particularly girls and young women in sub-Saharan Africa – face significant challenges accessing sexual and reproductive health information and services. These challenges are shaped in part by sociocultural factors, including stigma. This paper presents findings from a qualitative study that explored the micro-level social process of stigma surrounding young people’s sexual and reproductive health in two communities in Tanzania. Respondents described an environment of pervasive stigma surrounding the sexual and reproductive health of unmarried young people. Stigma manifested itself in multiple forms, ranging from verbal harassment and social isolation to physical punishment by families, community members, peers and healthcare providers. Respondents perceived that stigma was a barrier to young people accessing sexual and reproductive health services and identified excessive questioning, scolding and requirements to bring sexual partners or parents to receive services at health facilities as obstacles to accessing care. The pervasiveness and complexities of stigma surrounding young people’s sexual and reproductive health in the two study communities and its potential consequences for health suggest both a need for care in using the term stigma as well as further studies on the feasibility of incorporating stigma-reduction strategies into young people’s sexual and reproductive health programmes.     

Health access and status of adolescents and young adults using youth employment and training programs in an urban environment.

PURPOSE: To describe the health status and access to healthcare of adolescents and young adults disconnected from traditional education and work settings. The health status of these disconnected youth is largely unknown, although it is suspected to be quite poor. Most information about the health of youth in the United States relies on school-based samples. METHOD: In-person interviews with 1037 adolescents and young adults (aged 16-24 years) enrolled in an employment and training program in Baltimore were used to measure access to health services and health status in four domains: violent behavior, mental health, substance use, and reproductive health. Differences in healthcare access and health status by age and gender were examined. In addition, youth in the employment and training sample are compared with Baltimore youth in school and of comparable ages, as measured by the Youth Risk Behavior Surveillance System. RESULTS: Nearly 50% of young adults in the employment and training program were found to lack health insurance, and about 20% reported a time when they needed medical care but did not receive it. Youth in the program exhibited notable health status concerns, often exceeding the risk prevalence of students in school. In particular, adolescents and young adults disconnected from traditional employment and work settings were more likely to be in physical fights, to smoke cigarettes, and to use marijuana than their in-school counterparts. In-school youth were more likely to have considered harming themselves and to have made a suicide plan in the last year. CONCLUSIONS: Given high levels of health risk among youth disconnected from traditional education and work settings, adolescent health providers must increasingly pay attention to integrating health promotion and disease prevention strategies into youth employment and training programs, where sizable numbers of these youth can be reached.     

Using Geographic Information Systems to investigate variations in accessibility to ‘extended hours’ primary healthcare provision

There are ongoing policy concerns surrounding the difficulty in obtaining timely appointments to primary healthcare services and the potential impact on, for example, attendance at accident and emergency services and potential health outcomes. Using the case study of potential access to primary healthcare services in Wales, Geographic Information System (GIS)‐based tools that permit a consideration of population‐to‐provider ratios over space are used to examine variations in geographical accessibility to general practitioner (GP) surgeries offering appointment times outside of ‘core’ operating hours. Correlation analysis is used to explore the association of accessibility scores with potential demand for such services using UK Population Census data. Unlike the situation in England, there is a tendency for accessibility to those surgeries offering ‘extended’ hours of appointment times to be better for more deprived census areas in Wales. However, accessibility to surgeries offering appointments in the evening was associated with lower levels of working age population classed as ‘economically active’; that is, those who could be targeted beneficiaries of policies geared towards ‘extended’ appointment hours provision. Such models have the potential to identify spatial mismatches of different facets of primary healthcare, such as ‘extended’ hours provision available at GP surgeries, and are worthy of further investigation, especially in relation to policies targeted at particular demographic groups.     

Achieving the Cairo Conference (ICPD) goal for youth in Bangladesh

Sexual and reproductive health education is not yet formally introduced in Bangladesh without which the International Conference on Population and Development (ICPD) in Cairo's goal to ensure young people's right to access to such information and services will remain unfulfilled. The Population Council provided technical assistance to a governmental department to pilot youth reproductive health education. Study findings from the pre- and posttests of 379 matched respondents revealed significant changes in knowledge, attitudes, and life-skills. Knowledge about long-term contraceptives and skills on negotiating safe sex improved significantly by 63% and 26%, respectively. Youths who do not consider menstruation as a disease nearly doubled, and misunderstandings about the mother's role in sex determination of a child were significantly dispelled. Decisions not to accompany friends in visiting sex workers and to use condoms, ignoring friends' disapproval, were increased over 18%. Over 98% of students reported that teachers discussed condoms, while only 12% alleged unfriendly behavior. Findings motivated the department to scale up the reproductive health curriculum.     

Reproductive Health Services for Adolescents With Hearing Impairment in Indonesia: Expectations and Reality

ObjectivesReproductive health education is essential for adolescents with hearing impairment. Since they communicate using specialized language (i.e., sign language), specialized reproductive health services in sign language is a necessity. This study aimed to describe the needs, availability, and expectations of reproductive health services among adolescents with hearing impairment. MethodsThis study used a qualitative approach. It was carried out at a school for children with special needs in the city of Denpasar, Bali, Indonesia. Data were collected by in-depth interviews. The informants were 6 adolescents with hearing impairment aged 16-17 years and 4 other key informants, including school staff and health officers. The data were then analyzed using the thematic method. ResultsWe found that the informants had insufficient knowledge regarding reproductive health. There was no specific subject in the curriculum regarding this issue. Teachers did not specifically provide reproductive health information. The health service unit in the school had not been utilized well for this purpose. Furthermore, no reproductive health services were provided due to the limited number of healthcare workers who could use sign language. ConclusionsThe awareness and intentions of adolescents with hearing impairment regarding access to reproductive health services remain low. Health service units at schools should be optimized to enable schools to provide reproductive health information and services for these adolescents.     

Horizontal inequity in healthcare access under the universal coverage in Japan; 1986-2007

Universal coverage of healthcare aims at securing access to appropriate healthcare for all at an affordable cost. Since 1961, Japan's national health insurance has provided an equal package of benefits including outpatient, inpatient, dental, and pharmaceutical services. Reduced copayment and other welfare programs are available to the elderly. However, social health insurance may not be a panacea to achieve healthcare for all, especially when facing household impoverishment due to economic stagnation. Using time-series cross-sectional data of a nationally representative survey of Japan, we assessed the degree of inequity in healthcare access in terms of the "equal treatment for equal needs" concept, to identify the impact of changing economic conditions on people's healthcare access. Concentration indices of actual healthcare use (C(M)) and standardized health status as a marker of healthcare needs (C(N)) were obtained. We decomposed C(M) to identify factors contributing to inequalities in healthcare use. Results showed that horizontal inequities in healthcare access in favor of the rich gradually increased over the period with a widening health gap among the poor. The inequality in favor of the rich was specifically observed among people aged 20-64 years, whereas high horizontal equity was achieved among those aged >65 years. Decomposition of C(M) also demonstrated that income and health status were major contributors to widening inequality, which implies that changes in household economic conditions and copayment policy during the study period were responsible for the diminished horizontal equity. Our results suggest that the achievement of horizontal equity through universal coverage should be regarded as an ongoing project that requires continuous redesign of contribution and benefit in the nation's healthcare system.     

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.     

潍坊市普及基本医疗卫生制度实验研究目标分析

潍坊市于2008年开展了基本医疗卫生制度实验研究,文章从普及基本医疗卫生制度目标体系制订的目的和意义的角度出发,结合潍坊市卫生经济发展情况,通过文献检索和专家咨询的方法,从可得性和可及性两个方面确定了"小病社区低收费、大病住院有保险和公共卫生政府管"的目标体系,为下一步基本医疗卫生制度的建立奠定基础。     

Influences on healthcare-seeking during final illnesses of infants in under-resourced South African settings

To examine how health caregivers in under-resourced South African settings select from among the healthcare alternatives available to them during the final illness of their infants. Qualitative interviews were conducted with 39 caregivers of deceased infants in a rural community and an urban township. Nineteen local health providers and community leaders were also interviewed to ascertain opinions about local healthcare and other factors impacting healthcare-seeking choices. The framework analysis method guided qualitative analysis of data. Limited autonomy of caregivers in decision-making, lack of awareness of infant danger-signs, and identification of an externalizing cause of illness were important influences on healthcare-seeking during illnesses of infants in these settings. Health system factors relating to the performance of health workers and the accessibility and availability of services also influenced healthcare-seeking decisions. Although South African public-health services are free, the findings showed that poor families faced other financial constraints that impacted their access to healthcare. Often there was not one factor but a combination of factors occurring either concurrently or sequentially that determined whether, when, and from where outside healthcare was sought during final illnesses of infants. In addition to reducing health system barriers to healthcare, initiatives to improve timely and appropriate healthcare-seeking for sick infants must take into consideration ways to mitigate contextual problems, such as limited autonomy of caregivers in decision-making, and reconcile local explanatory models of childhood illnesses that may not encourage healthcare-seeking at allopathic services.     

Efficacy of integrated school based de-worming and prompt malaria treatment on helminths -Plasmodium falciparum co-infections: A 33 months follow up study

Background

Serbia has proclaimed access to healthcare as a human right. In a context wherein the Roma population are disadvantaged, the aim of this study was to assess whether the Roma population are able to effectively access primary care services, and if not, what barriers prevent them from doing so. The history of the Roma in Serbia is described in detail so as to provide a context for their current vulnerable position.

Methods

Disaggregated data were analyzed from three population groups in Serbia; the general population, the Roma population, and the poorest quintile of the general population not including the Roma. The effective coverage framework, which incorporates availability, affordability, accessibility, acceptability, and effectiveness of health services, was used to structure the secondary data analysis. Acute respiratory infection (ARI) in children less than five years of age was used as an example as this is the leading cause of death in children under 5 years old in Serbia.

Results

Roma children were significantly more likely to experience an ARI than either the general population or the poorest quintile of the general population, not including the Roma. All three population groups were equally likely to not receive the correct treatment regime of antibiotics. An analysis of the factors that affect quality of access to health services reveal that personal documentation is a statistically significant problem; availability of health services is not an issue that disproportionately affects the Roma; however the geographical accessibility and affordability are substantive issues that disproportionately affect the Roma population. Affordability of services affected the Roma and the poorest quintile and affordability of medications significantly affected all three population groups. With regards to acceptability, mothers from all three population groups are equally likely to recognize the importance of seeking treatment.

Conclusions

The Roma should be assisted in applying for personal documentation, the geographical accessibility of clinics needs to be addressed, and the costs of healthcare visits and medications should be reviewed. Areas for improvement specific to ARI are the costs of antibiotics and the diagnostic accuracy of providers. A range of policy recommendations are outlined.     

Patterns of health services utilization by recent immigrants

This study was undertaken to analyze how the way young, recently immigrated, families utilize health services evolves over time. Twenty families participated in the study. They all included at least one child of preschool age, had immigrated less than 8 years previously, and had used primary healthcare services since their arrival. A triphasic pattern of utilization was observed, consisting of contact with one or more health services, selection of specific services from those available, and consolidation of choices. Families relied upon a variety of information sources in each of these phases. The primary attributes upon which the families based their evaluation, selection, and adoption of health services were geographical and temporal accessibility, interpersonal and technical quality of services, and language spoken by health professionals and staff. Perception of health services' attributes is influenced by the families' sociocultural referents and preemigration experience. Results indicate that utilization of primary healthcare services progressively changes over time, evolving from the ad hoc use of walk-in services to the adoption of regular sources of care.     

Addressing contraceptive needs exacerbated by COVID-19: A call for increasing choice and access to self-managed methods

The COVID-19 pandemic has exposed the vulnerability of global contraception provision, exacerbating the barriers to access reproductive health services, leading to suspension of clinical services and disruption of supply chains. Critical to combatting this crisis is the expansion of healthcare to include self-care approaches to de-medicalize contraception and increase an individual's agency in determining what method they use, when they use it, and where they obtain it. Expanding the mix of self-administered contraceptives is essential for ensuring choice, access, and availability. We highlight advances in the self-care movement and actions needed to strengthen self-management approaches to maximize our chances of preventing a reproductive health crisis.     

Lay evaluation of services for childhood asthma

Users' views on health services are increasingly valued, but insufficient attention has been given to evaluations of childhood services. Asthma, the most common chronic childhood disease, is an significant condition around which to explore views of childhood services, especially since most care is provided in the community rather than in hospital. The aim of the present study was to investigate the views of children, young people and their parents on primary care services for childhood asthma, to explain how they should be characterised as evaluators of health services, and to identify the dimensions of care which they see as important. The authors conducted semi-structured interviews with 20 families recruited from responders to a respiratory symptoms questionnaire and from two general practices. Data were analysed using the constant comparative method. Children and young people identified outcomes of care, quality of care, communication and the professional-patient relationship, and organisation and access to healthcare as the key dimensions of their experiences of health services. They were active and critical, judging the performance and delivery of health services against standards which drew on lay knowledge and experience. Parents also emphasised outcomes, quality, organisation and access to healthcare as important, and drew attention to the complex and challenging nature of the professional-parent relationship. Parents had several roles, seeing themselves as carers and advocates as well as users of health services. They also drew on lay standards to evaluate care. Children and young people are willing and able to give active and critical views on health services. Parents' views should also be sought in their own right.